Tapia syndrome is known as a rare complication of airway manipulation, which can occur after any type of surgery under endotracheal general anesthesia. This syndrome is characterized by neurologic deficits involving the hypoglossal (XII) and recurrent laryngeal branch of the vagal nerve (X) that result in the tongue muscle's unilateral paralysis associated with the vocal cord's unilateral palsy. This article describes the first case of Tapia syndrome, which occurred after repair of a fractured zygomatic complex. In this article, we discuss the diagnosis, possible causes, clinical manifestations, treatment methods, and preventive strategies as described in 10 case reports in the literature that have been attributed to manipulation of the airway.

Objectives:L-Carnitine is a crucial component of activated fatty acid transport. The aim of this study was to evaluate the effect of L-carnitine on patients with a history of mild heart failure and diastolic dysfunction. Methods: Twenty-nine patients with a history of NYHA functional class II symptoms and ejection fraction >45% with documented grade 1 diastolic dysfunction on echocardiogram were randomized in blinded fashion to receive 1,500 mg of L-carnitine daily for 3 months in comparison to a no treatment group (31 patients). Baseline echocardiographic and follow-up measurements of diastolic parameters were assessed after 3 months. Results: Important parameters of diastolic function improved in the L-carnitine group only: left atrial size (3.6 ± 0.4 cm before treatment vs. 3.4 ± 0.5 cm after treatment, p = 0.01); isovolemic relaxation time (127 ± 26 ms before vs. 113 ± 24 ms after treatment, p = 0.007); septal mitral E′ velocity (0.064 ± 0.01 m/s before vs. 0.074 ± 0.01 m/s after treatment, p = 0.01), and lateral mitral E velocity (0.082 ± 0.01 m/s before vs. 0.091 ± 0.02 m/s after treatment, p = 0.006). Dyspnea also significantly improved in L-carnitine-treated patients. Conclusion: In patients with a history of diastolic heart failure, important indices of diastolic function and symptoms appear to improve with L-carnitine treatment.

(ECHOCARDIOGRAPHY 2010;27:210‐214)

Shishegar, Mahmood; Hosseini, Seyed Hossein Dastgheib; Varedi, Peyman; Varedi, Payam; Mahmoodi, Simin; Ashraf, Mohammad Javad; Faramarzi, Abolhassan Author Information

Primary hydatid cyst of the parotid gland is extremely rare, even in the endemic areas. A 23-year-old woman presented with slowly progressive swelling in the right periauricular region. Computed tomography (CT) scan of the head and neck revealed a round, well-demarcated water-density mass in the right parotid gland. At the operation, the cystic mass replacing most of the superficial part of right parotid gland was demonstrated. Superficial parotidectomy was carried out. Histopathological examination confirmed the diagnosis of hydatid disease. CT scan is a valuable imaging method for diagnosis of parotid cystic lesions; however, other acquired and congenital cystic lesions of parotid gland may have similar appearance and should be differentiated. Where the incidence of the disease is high, hydatid cyst of parotid gland should be considered in the differential diagnosis of lesions causing swelling of the parotid area.

SIR, The prevalence of the urinary infections in patients with autosomal dominant polycystic kidney disease (ADPKD) is abnormally high. Pyocyst in patients with ADPKD is a very serious and potentially fetal infection. Diagnosis and treatment of this rare complication is hampered by the problems in the delicate identification of the infected cysts and poor penetration of the systemically used antibiotics into the infected cysts. Limited entry of commonly used antibiotics into the cysts makes these cysts refractory to treatment. Even in the cases of lipophilic compounds, such as ciprofloxacin and new quinolones, trimethoprimsulphamethoxazole, and chloramphenicole which can accumulate in the renal cysts, therapeutic levels cannot be achieved satisfactorily.1-3 The English literature is scares about the role of intracystic injection and irrigation of the infected cysts by using the appropriate antibiotics. To our knowledge, no evidence-based data about the efficacy of this method in the treatment of intractable pyocyst in ADPKD has been reported so far. Recently, we presented a case of ADPKD with refractory pyocyst which was successfully treated with repeated irrigation and drainage of the infected cysts with normal saline solution. We also used povidone iodine in only one of the steps of irrigation.4 We believe that ultrasonography-guided intracystic injection of the appropriate antibiotics into the cysts containing echogenic debris and thick septae and irrigation of them in the patients with ADPKD—in whom the high index of suspicion of having pyocysts will be present—may have beneficial effects in the treatment of the refractory pyocysts. It is a logical and simple proposal, because by means of direct intracystic injection of these agents, better penetration of the antibiotics into the cystic fluid will be achieved; however, exact determination of the role of irrigation of the infected cysts with the ideal antibiotics such as quinolones requires replication in the future investigations.

The authors report an interesting case of right retroesophageal aortic arch (REAA) with pulmonary embolism that presented like the dissection of the aortic aneurysm but eventually diagnosed by means of spiral CT Right REAA should be considered as a rare cause of mediastinal widening in the patients in whom significant difference between the blood pressure and pulse intensity of both extremities is evident to prevent the erroneous diagnosis and treatment.

INTRODUCTION:The objective of this study was to evaluate the value of serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in the diagnosis of prostate cancer.MATERIALS AND METHODS:A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results.RESULTS:One hundred and twenty-one patients (36.7%) had prostate cancer. In this group, the mean PSA was 31.60 +/- 30.85 ng/mL (range, 1.9 ng/mL to 166.0 ng/mL) and the mean PSAD was 0.83 +/- 1.01 (range, 0.04 ng/mL/cm3 to 6.38 ng/mL/cm3). In those without prostate cancer the mean PSA and PSAD levels were 13.80 +/- 18.72 ng/mL (range, 0.4 ng/mL to 130.0 ng/mL; P < .001) and 0.24 +/- 0.32 (range of 0.01 ng/mL/cm3 to 2.29 ng/mL/cm3; P < .001). The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 (P < .001). For the PSA range of 3.5 ng/mL to 41 ng/mL (gray zone) the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD (P < .001).CONCLUSION:The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy.

BACKGROUND:Cyst infections is not common in the patients with autosomal dominant polycystic kidney disease (ADPKD) however it may pose major problems to the clinicians because the diagnosis is hampered by lack of reliable imaging techniques for identification of the infected cysts and treatment may be difficult due to poor penetration of antibiotics into the cysts.CASE PRESENTATION:We present a case of ADPKD and intractable pyocysts that did not respond to standard antibiotic therapy but successfully treated by using ultrasound-guided cyst puncture, and repeated irrigation and drainage.CONCLUSION:Where the experienced interventional radiologists are available, this method can rescue these patients from nephrectomy.

Computed tomography (CT)-guided percutaneous transthoracic biopsy of the lung is a well-established diagnostic technique, but it can pose complications to the patients. Air embolism is one of the rarest but potentially fetal complications of this procedure. The authors report a fetal case of systemic and massive air embolism to the coronary and cerebral arteries after the performance of lung biopsy. Careful reviewing of the obtained CT images during the proceduremay avoid a missing systemic air embolism and can immediately provide an adequate therapy also in asymptomatic patients. This extremely rare complication is an inevitable event and may happen in spite of appropriate experience and meticulous care.

We report and discuss a case of primary hydatidosis of the pelvic cavity in a woman who presented with severe weight loss and abdominal pain. This unusual presentation was initially considered as a tumor process until surgical exploration and microscopic studies confirmed the diagnosis. The gynecologists should be aware of possibility of primary hydatid cyst of the pelvic cavity and should be considered in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.

Hepatic venous outflow obstruction is a rare but serious complication after liver transplantation. We report ultrasound-guided percutaneous transhepatic stent placement in a 9-month-old infant with a left lateral split liver transplantation with near-complete hepatic vein obstruction.

Diphallia or duplication of the penis is an extremely rare but well-documented anomaly. According to the presence of one or two corpora cavernosa in each of the penises, diphallia is classified into two major groups of bifid phallus or true diphallia, respectively. We report a 5-year-old boy with duplication of the penis. Significant separation of the penises and their morphology made them appear as true complete phalluses, but MRI established the definitive diagnosis of bifid phallus by demonstrating the presence of one corpus cavernosum in each penis. MRI is a valuable method for achieving the accurate diagnosis of these anomalies and associated malformations. It also provides the appropriate knowledge regarding anatomical detail and assists the surgeon in decision making and preoperative planning for the optimal surgical approach.