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High-resolution temporal bone computer tomography (HRTBCT) is the most common initial radiological modality used for the assessment of necrotizing otitis externa (NOE). (1) To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE. All NOE patients were hospitalized between 1990 and 2018. All patients underwent HRTBCT at admission. Three groups (fungus-NOE, PA-NOE and sterile-NOE) comprising of ten patients each were randomly selected. HRTBCT was reevaluated by a senior radiologist. Thirteen radiological subsites were selected for reevaluation. All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04). TMJ involvement may be more common in fungal disease, suggesting a different spreading pathway, as opposed to PA-NOE. Accordingly, TMJ involvement on HRTBCT may justify antifungal treatment in sterile culture-NOE.

A 68-year-old man underwent 18F-prostate-specific membrane antigen (PSMA) PET/CT for staging of a newly diagnosed prostate adenocarcinoma. Unexpectedly, PET/CT revealed high focal 18F-PSMA brain uptake, which initially was suspected for a brain metastasis. Corresponding CT and MRI scans revealed characteristic imaging features of an intracranial dermoid cyst at this site. This is an exceptional location for a dermoid cyst, which had been followed up conservatively with no substantial changes. This case shows that dermoid cyst should be added to the reported list of benign neoplasms that shows "false-positive" PSMA uptake during evaluation of patients with prostate carcinoma, representing a potential interpretative pitfall.

The exstrophy-epispadias complex (EEC) ranges from distal epispadias to cloacal exstrophy, with serious repercussions on the quality of life of patients. However, reconstructive surgery offers the opportunity to reach adulthood and consider motherhood.The objective of this work is to assess the uro-gynecological characteristics and the risks that pregnant women have with EEC. MATERIALS AND METHOD: Retrospective study of 50 patients diagnosed with EEC and treated in a reference center for this pathology, born between 1968 and 2000. Their medical records were reviewed and all demographic, pathological and gynecological data were collected. RESULTS: 37 patients have the inclusion criteria and of these 8 achieved 17 pregnancies (90% spontaneous and 10% through IVF). 10 were successful (50% at term) and 7 were abortions, 87.5% of which were in the first trimester. Urinary tract infection (UTI) was the most frequent complication (41.6%) and the most severe was intestinal occlusion. None of the patients presented renal function impairment during the gestation or dilation of the pathological upper urinary tract (UUT). 62.5% of the patients presented genital prolapses after pregnancies, 80% of which were grade III and IV. 87.5% were dry in the follow-up after their pregnancies. CONCLUSION: Pregnancy in the EEC patients is high risk and it is crucial that the follow-up is carried out by a specialized and integrated multidisciplinary team to minimize complications.El complejo extrofia-epispadias (CEE) abarca desde las epispadias distales hasta la extrofia de cloaca, con serias repercusiones en la calidad de vida de los pacientes; sin embargo, la cirugía reconstructiva ofrece la oportunidad de llegar a la edad adulta y plantearse la maternidad. El objetivo de este trabajo es valorar las características uro-ginecológicas y los riesgos que presentan las gestantes con CEE. MATERIALES Y MÉTODO: Estudio retrospectivo de 50 pacientes diagnosticadas de CEE y tratadas en un centro de referencia para esta patología, nacidas entre 1968 y 2000. Se revisaron sus historias clínicas y se recogieron todos los datos demográficos, patológicos y ginecológicos.37 pacientes cumplían los criterios de inclusión y de estas 8 lograron 17 embarazos (90% espontáneos y 10% mediante FIV). 10 fueron exitosos (50% a término) y 7 fueron abortos, 87,5% de los cuales fueron en el primer trimestre. La infección urinaria (ITU) fue la complicación más frecuente (41,6%) y la más severa fue la oclusión intestinal. Ninguna de las pacientes presentó deterioro de la función renal durante la gestación o dilatación del tracto urinario superior (TUS) patológica. 62,5% de las pacientes presentaron prolapsos genitales posteriores a los embarazos, 80% de los cuales fueron grado III y IV. 87,5% se encontraban secas en el seguimiento posterior a sus embarazos. CONCLUSIÓN: El embarazo en el CEE es de alto riesgo y es crucial que el seguimiento sea llevado a cabo por un equipo multidisciplinar especializado e integrado para minimizar las complicaciones.

OBJECTIVE To report on the characteristics of pregnancy in female patients with EEC (exstrophy-epispadias complex), determining in particular whether they are at higher risk of spontaneous abortion or complications. MATERIALS AND METHOD Fifty patients diagnosed with EEC and treated in a reference center for this pathology were reviewed. Those with an incomplete medical history were excluded, leaving a total of 37 women with a median follow-up of 26 years (1-48 years). The outcome measurements were successful pregnancies, miscarriages, urological, gynecological and obstetric complications, impaired renal function, newborn characteristics, and postpartum urogynecological complications. Descriptive statistics was used. RESULTS Eight patients achieved 17 pregnancies (88.2% spontaneous). Of these pregnancies, 10 (58.8%) were successful, while 7 (41.2%) terminated in miscarriages. Urinary tract infection (UTI) was the most frequent complication (41.6%) and intestinal occlusion was the most severe. A total of 62.5% of the patients presented genital prolapses after pregnancies. A total of 85.7% of patients were dry during the follow-up after their pregnancies. No newborn presented EEC or any other type of malformation. Our study has the limitation of being a retrospective review of a very heterogeneous and small group of patients. CONCLUSION EEC patients can achieve spontaneous pregnancies but have an increased risk of miscarriage. For this reason, monitoring and control by a specialized and integrated multidisciplinary team is required to minimize complications. (C) 2021 Elsevier Inc.

Context The rare hypoparathyroidism—retardation—dysmorphism (HRD) syndrome (OMIM #241410) is caused by the mutated tubulin chaperone E (TBCE) gene. This gene encodes a critical protein in the microtubule assembly pathway. Objective To evaluate the endocrine profile of patients with HRD. Methods The study used a retrospective analysis of a large cohort of patients in a single university medical center. Sixty-three patients were diagnosed with HRD during 1990 to 2019; 58 of them had an endocrine evaluation. Main outcome measures We investigated somatic growth parameters, the prevalence of hypoglycemia, growth hormone deficiency, hypothyroidism, hypogonadism, and cortisol deficiency. Results All patients were born small for gestational age, and severe growth retardation was found in all patients with mean height standard deviation score (SDS) of –8.8 (range: –5.1 to –15.1) and weight SDS –18 (range: –5.1 to –61.2). Serum insulin-like growth factor-1 concentrations were very low among the 21 studied patients: –2.32 SDS (range: –0.6 to –2.7). Four out of 14 (28%) investigated patients had growth hormone deficiency, and 55% of patients were hospitalized due to symptomatic hypoglycemia. Adrenal glucocorticoid insufficiency was diagnosed in 22% of those tested. Hypothyroidism was found in 36% of patients. Both hypogonadotrophic and hypergonadotrophic hypogonadism were observed. The main magnetic resonance imaging findings were small anterior pituitary gland, small hippocampus, brain atrophy, thin corpus callosum, Chiari type I malformation, and septo-optic dysplasia. Conclusion Multiple endocrine abnormalities are common in patients with HRD syndrome. Periodic screening of thyroid and adrenal functions is recommended.

We aimed to correlate amplitude-integrated EEG (aEEG) in neonatal hypoxic ischemic encephalopathy (HIE) with early magnetic resonance imaging (MRI). In this retrospective study, 32 neonates over 35 weeks' gestation with moderate/severe HIE who were treated with hypothermia were included. Early MRI scans and daily aEEG background were categorized to mild/normal, moderate, and severely abnormal. Time to sleep cycling was noted on aEEG. Mantel-Haenszel test for trends was used to explore associations between aEEG and MRI and outcome. LOESS regression was used for exploring the association of cycling with MRI scores. MRI was normal/mildly abnormal in 20 (63%) infants; in 9 (28%), moderately abnormal; and in 3 (9%), severely abnormal. Twenty-seven (84%) infants s urvived. MRI severity score was significantly associated with aEEG background score on the third and fourth days of life (p 0.01). An increase in the MRI severity score was noted if sleep cycling appeared after the fifth day of life.Conclusions: Depressed aEEG at the third and fourth days of life and appearance of cycling beyond the fifth day of life are associated with cerebral MRI abnormalities and may be associated with increased risk of abnormal outcome. What is known: • Since therapeutic hypothermia has been shown to change long-term outcome, amplitude-integrated EEG in infants with hypoxic ischemic neonatal encephalopathy soon after birth have a limited predictive power for long-term outcome in treated infants. • Brain MRI after therapeutic hypothermia in the above infants has a significant predictive value for long-term outcome What is new: • Background amplitude-integrated EEG activity depression at the age of 3 and 4 days and delay of appearance of cycling activity are associated with worse MRI scores and may be predictive of worse long-term outcome.

Dural sinuses vary in size and shape in many pathological conditions with abnormal intracranial pressure. Size and shape normograms of dural brain sinuses are not available. The creation of such normograms may enable computer-assisted comparison to pathologic exams and facilitate diagnoses. The purpose of this study was to quantitatively evaluate normal magnetic resonance venography (MRV) studies in order to create normograms of dural sinuses using a computerized algorithm for vessel cross-sectional analysis. This was a retrospective analysis of MRV studies of 30 healthy persons. Data were analyzed using a specially developed Matlab algorithm for vessel cross-sectional analysis. The cross-sectional area and shape measurements were evaluated to create normograms. Mean cross-sectional size was 53.27 ± 13.31 for the right transverse sinus (TS), 46.87 + 12.57 for the left TS (p = 0.089) and 36.65 + 12.38 for the superior sagittal sinus. Normograms were created. The distribution of cross-sectional areas along the vessels showed distinct patterns and a parallel course for the median, 25th, 50th and 75th percentiles. In conclusion, using a novel computerized method for vessel cross-sectional analysis we were able to quantitatively characterize dural sinuses of healthy persons and create normograms.

The swelling capacity and release rate of two homologous drugs, theophylline and aminophylline, from acrylic acid/n-alkyl methacrylate hydrogels have been studied. The maximum equilibrium swelling increases as the molar fraction of acrylic acid or the chain length of the methacrylate in the hydrogels increases. Water diffusion to the hydrogels is non-Fickian. Both drugs are released from the fully swollen hydrogels according to Fick's law. However, the drug release from xerogels deviates from Fick's law, especially for aminophylline. As expected because of its larger size, aminophylline diffuses more slowly than theophylline under similar experimental conditions. © 2004 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 42: 2756–2765, 2004

Swelling kinetics and drug release (theophylline and aminophylline) from acrylic acid/n-alkyl methacrylate hydrogels are presented. Swelling rate of xerogels decreases as the alkyl chain length in the hydrogels increases because of the increasing hydrophobicity; however, the equilibrium swelling increases with increasing chain length. Drug release from swollen hydrogels is Fickian. Theophylline release is fairly independent of alkyl chain length whereas aminophylline release is highly dependent of alkyl chain length which suggest steric effects and stronger affinity of the latter with the hydrogels. Drug release from xerogels is also different for theophylline and aminophylline. The release of theophylline from xerogels is diffusion controlled and so, it has only a small dependence on the viscoelastic relaxation of the polymeric matrix. By contrast, release of aminophylline from xerogels is non-Fickian.

Hydrogels are hydrophilic polymers that swell to an equilibrium volume in the presence of water but preserve their shape. The dynamic swelling behavior of poly(acrylic acid-co-acrylamide) copolymers, at 37°C, was investigated. It was observed that the liberation mechanism was non-Fickian. Diffusion coefficients according to Ficḱs law as a function of concentration of N,N′-methylenebisacrylamide and results on the effects of crosslink density on the release of theophylline are reported.

The aim of this study is to identify surgical, patient- and stone-related factors predictive of clinical success and complications after percutaneous nephrolithotomy (PCNL).We prospectively studied 100 consecutive PCNL procedures. Univariate and multiple regression models were used in order to identify which variables could act as independent predictors of PCNL outcomes. Success was defined as complete absence of fragments in a non-contrast CT. The Clavien-modified grading system was used to classify the complications.Univariate analysis showed that patients rendered stone-free had a significantly lower stone burden, shorter operating times, single stones and non-struvite composed calculi. Patient age, nephrostomy tract dilation with high pressure balloon and a stone composition different to struvite behaved as significant protective factors for complications. Logistic regression models revealed that the main independent prognostic factor for success was stone surface (OR = 0.997 per mm2, p = 0.000), followed by multiple stones (OR = 0.203, p = 0.050). On the other hand, struvite composition (OR = 5.911, p = 0.028) was an independent predictor for the development of complications, whilst age (OR = 0.936, p = 0.012) and high pressure balloon dilation (OR = 0.041, p = 0.007) were rendered independent protective variables.Stone burden and multiple calculi in the kidney affect the immediate stone-free rate, whilst Amplatz dilation, struvite stones and young patients lead to a higher incidence of postoperative complications. This information can be very useful for patient counseling, regarding percutaneous kidney stone management.

Se presenta una técnica para la obtención de hidrogeles de acrilamida, empleando comonómeros monoésteres del ácido itacónico. A estos hidrogeles se les determina su cinética de hinchamiento a pH neutro y 20 °C.

Objective An epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia. Materials and methods A fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess. Results Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5 days from his admission to the hospital after an improvement was noticed in his epiglottis. Conclusion Treatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present.

Acute urinary retention (AUR) is unusual in children. We report for the first time a case of recurrent urinary retention due to massive hematocolpos resulting from an imperforate hymen in a 14-year-old girl. In case of AUR in adolescent girls, clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically, but follow-up is still necessary to ensure that there is no recurrence.

Hydrogels of mono-n-alkyl itaconate/N-acrylamide have been synthesised. The swelling process at three different pH values (acid, neutral and basic) has been studied. The experimental data indicate that our hydrogels follow second-order swelling kinetics. According to this, the kinetic constant, K∞, and the swelling capacity at equilibrium, W∞, have been calculated. The influence of the solvent pH and the molar mass of the mono-n-alkyl itaconate monomeric unit has been analysed. It seems that the general balance between the hydrogen bonding and the hydrophobic interactions regulates the swelling process of these hydrogels.