The relationship between bladder functions, pelvic floor muscle strength, fall, and fatigue in multiple sclerosis

BACKGROUND

The aim of this study was to determine the relationship between the severity of bladder functions, fatigue, quality of life (QoL), fall, and pelvic floor muscle strength in patients with Multiple Sclerosis (PwMS).

METHODS

Patients were divided into two groups according to their Expanded Disability Status Scale (EDSS) bladder scores as Group 1 (EDSS bladder score 0-1, mildly affected group, n = 25) and Group 2 (EDSS bladder score 2-3-4, moderate and severely affected group, n = 21). Pelvic floor muscle (PFM) strength (EMG-Biofeedback device), fear of fall (Fall Efficacy Scale (FES-1)), fatigue (Fatigue Severity Scale (FSS)), QoL (Urogenital Distress Inventory-short form (UDI-6), and Incontinence Impact Questionnaire-short form (IIQ-7)) were evaluated.

RESULTS

46 female patients diagnosed with MS were included in this study. No significant differences in baseline characteristics were seen between the groups except age. EDSS bladder score were 1 (0-1) and 3 (2-4), EMG-Biofeedback score were 79,5 ± 8,11 and 41,7 ± 5,48, FSS score were 38,7 ± 2,80 and 54±2,20, FES-I score were 16,9 ± 2,15 and 40,2 ± 7,39, UDI-6 score were 4,24±0,47 and 8,42±0,64, IIQ-7 score were 3,64±0,86 and 18,2 ± 1,42 in Group 1 and Group 2. As a result of statistical analysis, significant differences were found in less fatigue and fall, higher PFM strength and better QoL with mildly affected PwMS (p<0,05).

CONCLUSION

There was a significant difference in terms of bladder function level in PFM strength, fall, fatigue and QoL between the mildly affected group and the moderate and severely affected group.

The effect of sarcopenia and serum myokines on prognosis and survival in cirrhotic patients: a multicenter cross-sectional study

OBJECTIVE

Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease.

METHODS

In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis.

RESULTS

A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( P < 0.001).

CONCLUSION

Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.

Investigation of cytokine levels in calves with sepsis

This study aimed to detect changes in clinical parameters, biochemical and serum cytokine levels in calves with sepsis. In the study, 34 calves diagnosed with sepsis according to clinical and laboratory results and 7 calves deemed to be healthy according to clinical and laboratory results were used. The blood sample was taken from vena jugularis for determination of hematological, biochemical, and cytokine levels. Significant changes were observed in the clinical parameters of calves with sepsis. Serum concentrations of IL-1β, IL-6, IL-10, TNF-α, and INF-γ were significantly increased (p < 0.05) in calves with sepsis compared to the control group. Also, a significant increase (p < 0.05) in serum BUN, creatinine, CK, and CK-MB levels and a significant decrease in TP level (p < 0.05) were determined in calves with sepsis compared to the control group.In conclusion, it was concluded that varying degrees of tissue/organ damage developed in calves with sepsis and cytokines played an important role in the development of inflammatory damage during sepsis.

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13 years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p = .753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.

Chronological echocardiographic evaluation of left ventricular systolic and diastolic function in term and premature neonatal calves

Echocardiographic studies in human neonatology has demonstrated that prematurity can lead to cardiovascular dysfunction and especially compromises the left ventricular (LV) systolic and diastolic functions. As echocardiographic studies have not been performed on cardiovascular dysfunction in premature calves, we echocardiographically evaluated and compared the LV systolic and diastolic function in full-term and premature calves. We followed the hemodynamical changes of LV during first 3 days of life. Twenty premature calves and 10 healthy term calves were enrolled in the study. 2D, M-mode and Doppler echocardiographic examinations were performed at days 1, 2 and 3 after birth to evaluate LV systolic and diastolic functions. Our findings demonstrated that not only was there LV diastolic dysfunction (55% premature calves, 10% term calf at day 1; 65% premature calves, 10% term calf at day 2 and, 75% premature calves, 20% term calf at day 3), but also LV systolic dysfunction (55% premature calves, 60% term calf at day 1; 55% premature calves, 50% term calf at day 2, and 45% premature calves, 40% term calf at day 3) deteriorated in both term and premature calves. In conclusion, the present study, which was the first comparative echocardiographic assessment of LV systolic and diastolic functions in term and premature newborn calves, showed that both systolic and diastolic dysfunctions might occur in term and premature calves.

Investigating the relationships between quality of life, fatigue and leisure time physical activity in prostate cancer patients

OBJECTIVES

The aim of this study was to investigate the relationship between the parameters of fatigue, quality of life and leisure time physical activity in prostate cancer (PCa) patients. This is the first study in the literature to report interaction between these parameters from the perspective of physiotherapy and rehabilitation.

MATERIALS AND METHODS

Fifty-eight out-patients were enrolled in this study. In an oncologic rehabilitation unit, Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire (FACIT-F), Functional Assessment of Cancer Therapy-Prostate Questionnaire (FACT-P) and Godin Leisure Time Exercise Questionnaire (GLTEQ) were utilized to evaluate fatigue, quality of life and physical activity, respectively. Frequencies and the relationships between the results of the parameters were analyzed.

RESULTS

The average age of patients was 67.68 ± 7.54 years. Mean scores of FACIT-F [42.94 ± 8.25] and FACT-P [118.81 ± 13.39] were determined. The median score of GLTEQ was 14 (0-70). There were positive correlations between FACIT-F and FACT-P (r= 0.633, p< 0.001); GLTEQ and FACT-P (r= 0.275, p< 0.05) and; FACIT-F and GLTEQ (r= 0.297, p< 0.05).

CONCLUSION

Increased fatigue and decreased leisure time physical activity level may affect quality of life negatively. Moreover, it was observed that decreasing leisure time physical activity level affects fatigue negatively. Accordingly, physiotherapists with PCa patients may focus on developing physical activity levels in various ways to address the multidimensional problems of fatigue and quality of life.

Effect of combinations of intravenous small-volume hypertonic sodium chloride, acetate Ringer, sodium bicarbonate, and lactate Ringer solutions along with oral fluid on the treatment of calf diarrhea

The aim of this study was to compare effect of combinations of intravenous isotonic sodium bicarbonate (NaHCO3), acetate Ringer, lactate Ringer and small-volume hypertonic sodium chloride (NaCI) solutions along with oral electrolyte solutions (OES) on the treatment of neonatal calf diarrhea with moderate dehydration and metabolic acidosis. Thirty-two calves with diarrhea were used in the study. Calves were randomly assigned to receive acetate Ringer solution (n=8), lactate Ringer solution (n=8), isotonic NaHCO3 (n=8) and 7.2% saline solutions (n=8), and two liters of OES were administrated to all calves orally at the end of intravenous administration. Blood samples for blood gas and biochemical analyses were collected at 0 hours and at 0.5, 1, 2, 4, 6 and 24 hours intervals. All the calves had mild to moderate metabolic acidosis on admission. Increased plasma volume and sodium concentration, but decreased serum total protein were observed within 0.5 hours following administration of hypertonic 7.2% NaCI + OES, compared to other 3 groups. In conclusion, administration of intravenous hypertonic 7.2% NaCI solution in small volume along with OES provided fast and effective improvement of dehydration and acid-base abnormalities within short time in treatment of calf diarrhea with moderate dehydration and metabolic acidosis.

Clinical importance of lipid profile in neonatal calves with sepsis

In this study, it was aimed to determine of diagnostic importance blood lipid levels in neonatal calves with sepsis. The study was carried out on a total of 70 calves, 60 with sepsis and 10 healthy calves. The calves with sepsis were included in the study, according to clinical and hematological findings.  After routine clinical examinations of all the calves, blood samples were taken from the V. jugularis for hematological, lipid profile and biochemical analyzes. There were significantly (P < 0.05) decreased in body temperature, increased in respiration rate and capillary refill time in the calves with sepsis, compared to control group calves. The levels of blood urea nitrogen, creatinine concentrations of calves with sepsis were significantly higher (P < 0.05), however, levels of total cholesterol, HDL, LDL and albumin concentrations were significantly lower (P < 0.05) than control group. In addition, blood triglyceride and VLDL concentrations of calves with sepsis were higher than control group, however there was no statistical difference.In conclusion, serum total cholesterol, HDL and LDL in neonatal calves with sepsis could be used in evaluation of the sepsis.

The Slaughtening Causes with Dental and Gingival Lesions in Dairy Cows within Postmortem Period

Background: A regular and balanced feeding is essential for the animals in order to maintain their normal physiological function and be productive at the desired level. Digestion activities start with chewing in the mouth and the healthy dental arch is needed to perform a complete chewing function. Abnormal dental development and other dental pathologies impair digestive functions by negatively affecting chewing functions. The aim of the present study was to classified dental anomalies, dental degenerations, dental and gingival lesions seen in dairy cows and was aimed to reveal these lesions and depending on these disorders the reasons for slaughtering in dairy cows.Materials, Methods & Results: The material of this study consists of 600 dairy cows, being slaughtered for a year, and 170 dairy cows, detected dental anomalies, dental degenerations and dental-gingival lesions in the postmortem examination. Detailed macroscopic and radiological examinations of mandibles and maxillae of the dairy cows with dental and gingival lesions in postmortem examination were performed. The detailed information of the cases, such as: age, race, breeding, living region and slaughtering causes, etc. of dairy cows, suffering from dental lesions was recorded from slaughterhouse data access. In this study, 87 cases (51.18%) of the determined dental lesions were defined as dental degeneration, 34 cases (20%) as caries, 30 cases (17.64%) as dental abnormalities in the formation and dental arch and 19 cases (11.18%) as periodontal inflammation.Discussion: In dairy cow breeding, there is a close relationship between production costs and business profitability and animal disease and fertility problems. Although the existence of negative effects of dental lesions directly on the digestive functions is known in dairy cattle breeding; there was no study about the state of dental diseases in dairy cow. In this respect, this research is quite important both for revealing the proportion of dental diseases seen in dairy cow and for drawing attention to the relationship between these diseases and the reasons for slaughtering of dairy cow. In this study, various dental anomalies, dental degenerations, dental and gingival lesions (28.33%) were detected in 170 dairy cows; The decreased milk production in 38 cases (22.35%), infertility in 65 cases (38.24%), gastrointestinal system diseases such as abomasal dislocation, constipation and indigestion in 38 cases (22.35%), foot diseases in 19 cases (11.18%) and economic reasons in 10 cases (5.88%) were determined as slaughtering reasons of the cases. The results of this research indicate that dental and gingival lesions may be regarded as preliminary results in the development of digestive system diseases, and then the various detailed clinical studies are needed to determine whether there is a relationship between digestive system diseases and dental diseases. As a result; this study first classified the dental lesions determined after slaughter in cattle and revealed the relationship between the reasons for slaughtering of dairy cows of the determined dental lesions. The results obtained in this study showed that dental anomalies, caries and periodontal inflammation effect significantly on the dairy cow fertility.

Groundwater Quality beneath an Asian Megacity on a Delta: Kolkata's (Calcutta's) Disappearing Arsenic and Present Manganese

Kolkata, the capital city of West Bengal, exploits groundwater for public water-supply. The groundwater has been reported to be widely polluted by arsenic (As). Analysis for As in 280 groundwaters from across Kolkata, failed to detect As concentrations >10 μg/L from natural processes. Arsenic concentrations between 10 and 79 μg/L found in 14 of the 280 groundwaters are remnant from a pollution-plume emanating from a single factory site where Paris Green, an arsenical pesticide, was manufactured between 1965 and 1985. In 45% of groundwaters sampled, concentrations of Mn exceed 0.4 mg/L, a putative health guideline value for drinking water. Sporadic minor hazards are posed by Pb > 10 μg/L introduced into groundwater from well-fittings, from 4% of groundwaters with F concentrations between 0.75 and 1 mg/L, and the 14% of groundwaters containing more than 500 mg/L Na, concentrations that might contribute to excessive daily intake of Na. Compounding hazards from As, F, Mn, Na, and Pb, shows that 64% of public wells and 40% of municipal wells supply groundwater of suspect quality. Groundwaters comply with WHO Guideline Values for drinking water in terms of Cr, Cu, Co, NO₂, NO₃, Sb, Se, and U. Aesthetic guideline values for Fe, Mn, SO₄, and Cl are exceeded for many groundwaters.

Variable Presentations of Sinonasal Polypoid Masses: A Tertiary Institution Experience

Background Lesions of the sinonasal area are varied, but they mostly present as polypoid masses which require meticulous work-up to reach at the most probable diagnosis. Objective Analysis of polypoid sinonasal masses in terms of etiology, clinical presentations, brief demographic profile, clinico-histologic correlate where possible, and follow-up results. Method In this descriptive, longitudinal study, 198 patients with polypoid sinonasal masses attending the otolaryngology clinic of a tertiary teaching institute were selected using proper selection criteria and analyzed through a pre-set proforma and algorithm for a diagnostic work-up (that included histopathology where necessary). Result Common presentations were nasal obstruction (~89%), discharge (~70%) and hyposmia (~22%). Though nearly 87% was clinically benign and 8% indeterminate, therapeutic and diagnostic interventions (including histopathology) showed 91% truly benign, of which polyposis formed the bulk. Sensitivity of clinical detection was 75% for benign lesions and 62% for malignancies. Diagnosis depended on histopathology in 52.52% cases, including the clinically malignant, the "grey zone", and more than 40% of the clinically benign lesions. There was male predilection (2.16 for benign lesions and 1.57 for malignant), rural preponderance, and above 60% of the patients were within 50-70 years. There was ~26% recurrence in the follow-up period of a minimum of one year, predominantly in polyposis (29.55%) and malignancies (~39%). Conclusion Presentations of polypoid sinonasal masses are variable, etiology of which is mostly benign. Proper clinico-histologic correlate is necessary for correct diagnosis. A low threshold of suspicion is required because of this variability, necessitating follow-up for further evaluation.

An evaluation of fecal incontinence in women with urinary incontinence

OBJECTIVE

To investigate the occurrence of and risk factors for fecal and/or gas incontinence in female patients having urinary incontinence.

PATIENTS AND METHODS

741 consecutive adult female patients presenting with urinary incontinence alone (group 1, n = 700) or urinary incontinence with fecal and/or gas incontinence (group 2, n = 41) were enrolled into the study. As potential risk factors for fecal and/or gas incontinence in this population, the following variables were investigated: age, body mass index, type of urinary incontinence, childbirth history, menopausal symptoms, history of pelvic surgery, neurological disease, diabetes mellitus, tobacco use, constipation, cystocele, rectocele. Quality of life was assessed with the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7).

RESULTS

Of the women having urinary incontinence, 5.5% also had fecal and/or gas incontinence. Associated risk factors were history of difficult delivery, postmenopausal symptoms, history of pelvic surgery and constipation. Fecal and/or gas incontinence was also associated with a lower quality of life in terms of both questionnaires.

CONCLUSIONS

Women have urinary incontinence may have also fecal and/ or gas incontinence. Particularly if they have chronic constipation, postmenopausal symptoms or history of difficult delivery or pelvic surgery they must be evaluated for this additional symptom. So we can treat these patients appropriately and increase their quality of life.

Serum ST2 in inflammatory bowel disease: a potential biomarker for disease activity

ST2, a specific ligand of interleukin 33, was described as a biomarker protein of inflammatory processes and overexpression of ST2 in ulcerative colitis (UC) was shown previously. We aimed to investigate the potential relationship of serum ST2 levels with the clinical, endoscopic and histopathological activity scores in UC and Crohn's disease (CD). Serum ST2 levels were determined in 143 patients with inflammatory bowel disease (IBD) (83 UC and 60 CD), in 50 healthy controls (HC), and in 32 patients with irritable bowel syndrome (IBS). Serum ST2 levels were elevated in IBD (56.8 (41.9-87.2) pg/mL) compared to HC and IBS (30.7 (20.2-54.3), p<0.001 and 39.9 (25.9-68.7) pg/mL, p=0.002, respectively). No significant difference was found between UC (54.2 (41.3-93.0) pg/mL) and CD (63.8 (42.7-88.4) pg/mL) and between IBS and HC. Serum ST2 levels were significantly increased in active UC compared to inactive UC (72.5 (44.1-99.5) vs 40.0 (34.7-51.6) pg/mL, p<0.001) and in active CD in comparison with inactive CD (63.8 (42.7-88.4) vs 48.4 (29.6-56.9) pg/mL, p=0.036). Patients with CD showing fistulizing behavior had significantly higher ST2 levels compared to patients with inflammatory and stricturing CD (p<0.001). Clinical activity scores of patients with UC and CD were correlated with serum ST2 levels (r=0.692, p<0.001 and r=0.242, p=0.043, respectively). Serum ST2 levels showed stepwise increases with the increasing histopathological scores of patients with UC and CD (p<0.001 for both). The present study highlights significant associations between ST2 and IBD presence and activity and demonstrates elevated serum ST2 levels in patients with active CD as a novel finding.

Etiopathogenesis, Prevention, and Treatment of Thromboembolism in Inflammatory Bowel Disease

The close relationship between inflammation and thrombosis affects the progression and severity of inflammatory bowel disease (IBD). The prevalence of venous thromboembolism (VTE) varies between 1% and 7% among patients with IBD. The VTE risk in patients with IBD is at least 3 times higher than that in the normal general population. The absolute risk is very high during hospitalization, active disease, and surgery. The IBD-related VTE occurs at younger ages and recurs more frequently. The development of thrombosis in IBD is due to the interaction of many hereditary and acquired risk factors. Each patient diagnosed with IBD should be evaluated for a personal and family history of thrombosis and for prothrombotic drug use. Although procoagulant factors are increased during the natural course of inflammation, natural anticoagulants and fibrinolytic activity are decreased. Although IBD is accepted as a prothrombotic condition, there is no treatment that can remove this risk from daily practice. Patient training is required to control important factors, such as long-term immobilization and smoking. Oral contraceptives and hormone replacement therapy should be avoided. Inducing permanent disease remission must be the key approach for the prevention of thrombosis. Low-molecular-weight heparin (LMWH) is the basis of prophylactic treatment, which reduces the thrombosis risk by 50%. Prophylaxis with LMWH should be administered to all patients with IBD hospitalized due to disease attack or surgery. Long-term or even life-long anticoagulation therapy should be planned if there is insufficient disease control, recurrent VTE attacks, positive thrombophilia tests, or thrombosis in vital veins.

Hepatic granulomas in Turkey: a 6-year clinicopathological study of 35 cases

BACKGROUND/AIMS

Granulomas are focal aggregates of modified macrophages that are surrounded by a rim of lymphocytes and fibroblasts. The present study aimed to evaluate the prevalence and etiology of hepatic granulomas (HGs) in the Department of Gastroenterology with a wider population.

MATERIALS AND METHODS

We performed a retrospective study on 2662 liver biopsy specimens analyzed between 2005 and 2011 at Gazi University Department of Gastroenterology to determine the presence of HGs.

RESULTS

There were 16 cases with primary biliary cirrhosis, of whom 14 without any other causative etiology. There were 6 cases of sarcoidosis, 2 cases of Fasciola hepatica infection, 2 cases of hepatitis C, and 2 cases of hepatitis B. One case had both tuberculosis and rheumatoid arthritis and one case had both tuberculosis and brucellosis. There was also one case each of leishmaniasis and Hodgkin's lymphoma. The diagnosis of autoimmune hepatitis was found in two cases. One case had immune cholangiopathy.

CONCLUSION

The leading causative etiology of HGs was primary biliary cirrhosis, followed by sarcoidosis. As a study performed in a center that accepts patient profiles throughout Turkey, tuberculosis took a minor part in HG etiology. A drug-affected or toxic case of HG was not observed.

Computerized diagnosis of respiratory disorders. SVM based classification of VAR model parameters of respiratory sounds

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced METHODS for Studying Cardiovascular and Respiratory Systems".

OBJECTIVES

This work proposes an algorithm for diagnostic classification of multi-channel respiratory sounds.

METHODS

14-channel respiratory sounds are modeled assuming a 250-point second order vector autoregressive (VAR) process, and the estimated model parameters are used to feed a support vector machine (SVM) classifier. Both a three-class classifier (healthy, bronchiectasis and interstitial pulmonary disease) and a binary classifier (healthy versus pathological) are considered.

RESULTS

In the binary scheme, the sensitivity and specificity for both classes are 85% ± 8.2%. In the three-class classification scheme, the healthy recall (95% ± 5%) and the interstitial pulmonary disease recall and precision (100% ± 0% both) are rather high. However, bronchiectasis recall is very low (30% ± 15.3%), resulting in poor healthy and bronchiectasis precision rates (76% ± 8.7% and 75% ± 25%, respectively). The main reason behind these poor rates is that the bronchiectasis is confused with the healthy case.

CONCLUSIONS

The proposed method is promising, nevertheless, it should be improved such that other mathematical models, additional features, and/or other classifiers are to be experimented in future studies.

Biodegradable stents for caustic esophageal strictures: a new therapeutic approach

The treatment of caustic esophageal strictures is a challenging topic. Although traditional therapies have limited efficacy, most of these patients eventually require surgery. Biodegradable (BD) stents are newly designed stents for benign conditions. This is a retrospective case series of seven patients with caustic esophageal stricture. BD esophageal stents were inserted for palliation of dysphagia. The position of the stent was checked at 1, 4, 8, 12 16, 20, and 24 weeks and at the end of follow-up period. The follow-up period was 60 ± 23 (36-102) weeks. Complete dissolution of the stent occurred at 16 ± 4 (12-20) weeks. Three patients had partial/complete relief of dysphagia. The remaining four patients experienced tissue hyperplasia at the edges of the stent and required serial dilations. At the end of follow-up, all patients had partial or complete relief of dysphagia. Although BD stents have some efficiency, tissue hyperplasia is the main limiting factor. Further randomized trials are needed to determine efficiency of BD stents for caustic damage.

Open safety pin in the nasal cavity

Foreign bodies in the nasal cavity are common-day occurrences in Otolaryngologic practice. But an open safety pin in nose with it' s sharp end directed towards roof is a rare incidence, and available literature is silent about this presentation; it is probably, the first of it' s kind being reported. Two cases of safety pins inside the nasal cavity, one open and the other closed, have been presented here with a brief review of literature.

Tuberculosis in a renal allograft recipient presenting with intussusception

Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11(th) postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

Benign biliary papillomatosis in a patient with a choledochal cyst presenting as haemobilia: a case report

Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.

Serum amyloid A and haptoglobin concentrations and liver fat percentage in lactating dairy cows with abomasal displacement

BACKGROUND

There has been increased interest in measuring the serum concentration of acute phase reactants such as serum amyloid A [SAA] and haptoglobin [haptoglobin] in periparturient cattle in order to provide a method for detecting the presence of inflammation or bacterial infection.

OBJECTIVES

To determine whether [SAA] and [haptoglobin] are increased in cows with displaced abomasum as compared with healthy dairy cows.

ANIMALS

Fifty-four adult dairy cows in early lactation that had left displaced abomasum (LDA, n = 34), right displaced abomasum or abomasal volvulus (RDA/AV, n = 11), or were healthy on physical examination (control, n = 9).

MATERIALS AND METHODS

Inflammatory diseases or bacterial infections such as mastitis, metritis, or pneumonia were not clinically apparent in any animal. Jugular venous blood was obtained from all cows and analyzed. Liver samples were obtained by biopsy in cattle with abomasal displacement.

RESULTS

[SAA] and [haptoglobin] concentrations were increased in cows with LDA or RDA/AV as compared with healthy controls. Cows with displaced abomasum had mild to moderate hepatic lipidosis, based on liver fat percentages of 9.3 +/- 5.3% (mean +/- SD, LDA) and 10.8 +/- 7.7% (RDA/AV). [SAA] and [haptoglobin] were most strongly associated with liver fat percentage, r(s) = +0.55 (P < .0001) and r(s) = +0.42 (P = .0041), respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

An increase in [SAA] or [haptoglobin] in postparturient dairy cows with LDA or RDA/AV is not specific for inflammation or bacterial infection. An increase in [SAA] or [haptoglobin] may indicate the presence of hepatic lipidosis in cattle with abomasal displacement.

Renal tissue damage after experimental pyelonephritis: role of antioxidants and selective cyclooxygenase-2 inhibitors

OBJECTIVES

To investigate the involvement of oxidative stress in the pathogenesis of acute pyelonephritis, and to evaluate the impact of meloxicam and/or L-carnitine in addition to conventional antibiotic treatment.

METHODS

A total of 48 Wistar rats were divided into 4 groups according to their treatment, which was started 1 day after inoculation of all rats with Escherichia coli (ATCC 25 922, 10(10) cfu/mL). Group 1 received only antibiotic treatment with ceftriaxone (50 mg/kg, IM). Groups 2 and 3 received L-carnitine (500 mg/kg, IM) and meloxicam (3 mg/kg, IM) in addition to conventional treatment, respectively. Group 4 received combination therapy (L-carnitine and meloxicam) in addition to the first group. Rats were killed 3 and 7 days after E. coli inoculation and underwent nephrectomy. Histologic determination of tubular atrophy, acute and chronic inflammation, interstitial fibrosis and biochemical determination of superoxide dismutase and catalase activity, total thiol content, total antioxidant capacity, and malondialdehyde and protein hydroperoxide levels were measured.

RESULTS

Interstitial fibrosis (P = .06), chronic inflammation (P = .536), and tubular atrophy (P = 0.094) decreased in group 4 compared with the other groups, but there was a statistically significant decrease only in acute inflammation (P = .015). In addition, if the day of nephrectomy is considered, there was again a significant decrease in acute inflammation on day 7 compared with day 3 in groups 2, 3, and 4 (P = .002). Catalase significantly increased in group 2 (P = .029), group 3 (P = .02), and group 4 (P = .014), and decreased in group 1 (P = .012) in day 7.

CONCLUSIONS

L-carnitine and meloxicam alleviated oxidative stress, probably by decreasing lipid peroxidation and enforcing antioxidant defense system. Acute renal inflammatory injury can be prevented much more effectively by combination therapy rather than by conventional therapy alone.

Heparan sulfate gene polymorphism in calcium oxalate nephrolithiasis

Calcium oxalate (CaOx) nephrolithiasis has a complex pathogenic mechanism. Besides environmental factors, genetic factors also have influence on stone formation. This study represents the effects of heparan sulfate (HSPG2) gene polymorphism for determining the risk of urolithiasis. We investigated 143 CaOx stone formers with 158 healthy individuals for the BamHI restriction site polymorphism located in intron 6 of the HSPG gene using the polymerase chain reaction, restriction fragments length polymorphism method. After digestion with BamHI, the polymorphism was assumed to cause three genotypes according to the banding types as GG (242 bp), GT (242, 144, and 98 bp) and TT (144 and 98 bp). According to the genotype frequencies between the groups, TT genotype showed significantly increased risk for urolithiasis than TG and GG genotypes. We concluded that HSPG2 gene polymorphism might be one of the genetic factors affecting the CaOx stone formation.

The studies on the aetiology of diarrhoea in neonatal calves and determination of virulence gene markers of Escherichia coli strains by multiplex PCR

The purpose of this study was to determine aetiological agents of diarrhoea in neonatal calves and to investigate virulence gene markers of Escherichia coli strains isolated from calves by multiplex polymerase chain reaction (PCR). Eighty‐two diarrhoeic calves and 18 healthy calves were used as subjects. Faeces were taken from the rectums of all the calves and were subjected to bacterial culture. Antigen enzyme‐linked immunosorbent assay (ELISA) was performed to detect rotavirus, coronavirus and E. coli K99 in faeces of all the calves. A multiplex PCR was used to characterize E. coli strains in all the calves. Escherichia coli was isolated from 37 faeces samples, Enterococcus ssp. was isolated from 22 faeces samples and Salmonella was isolated from one faeces sample in diarrhoeic calves. Furthermore, only E. coli was isolated from all 18 faeces samples of healthy calves. Of the 37 E. coli isolated from diarrhoeic calves, K99 (18.9%), F41 (18.9%), heat‐stable enterotoxin a (STa) (18.9%), Shiga toxin 1 (Stx1; 13.5%) and Shiga toxin 2 (Stx2; 5.4%) and intimin (8.1%) genes were identified by multiplex PCR. Of the 18 E. coli isolated from healthy calves, K99 (16.6%) and intimin (55.5%) genes were identified by PCR. A total of 15 rotavirus, 11 coronavirus and 11 E. coli K99 were detected in diarrhoeic calves by the antigen ELISA. As a result, this study shows that rotavirus, coronavirus, E. coli and Enterococcus ssp. were determined to play a role in the aetiology of diarrhoea in the neonatal calves. K99, F41, STa, Stx1 and Stx2 were found as the most common virulence gene markers of E. coli strains isolated from calves with diarrhoea. Multiplex PCR may be useful for characterization of E. coli isolated from calves.

The effect of regular long term training on antioxidant enzymatic activities

AIM

It has been reported that exercise induces oxidative stress and causes adaptations in antioxidant defenses. The purpose of the present study was to investigate the effects of regular long term training on antioxidant enzymatic activities consisting of superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) in a group of basketball players engaged in a physical training program.

METHODS

SOD, GPX and GST activities were measured as an indicator of antioxidant defenses in long term trained basketball players and compared with non-sporting age matched controls. Independent samples t test was used to compare the data between the two groups.

RESULTS

SOD, GPX and GST levels were significantly higher in basketball players than sedentary controls (P < 0.05, P < 0.05 and P < 0.01, respectively).

CONCLUSION

Data suggest that regular long term training can induce antioxidant response to the oxidative stress. These results support the possibility that the beneficial effect of physical exercise on oxidative stress might be associated with increased antioxidant defenses.

False positive 18F-FDG PET scan in adrenal oncocytoma

18F-FDG whole-body positron emulsion tomography (18F-FDG PET) has become an established imaging modality for a variety of cancers. Today, 18F-FDG PET is utilized to differentiate benign from malignant non-functioning adrenal masses. In this report, a 25-year-old woman presented with a 2-month history of left flank pain. Abdominal CT revealed a left 6.5 x 4.5 cm adrenal mass with regular margins and focal calcification. To make a differential diagnosis, 18F-FDG PET was performed. Preoperative laboratory studies showed that the mass was non-functioning. A left adrenalectomy was performed through a left subcostal incision. The final pathologic evaluation revealed adrenal oncocytoma. We present the disassociation between preoperative 18F-FDG PET and pathologic findings of a benign adrenocortical oncocytoma.

Foreign body in ENT--general practitioner's duty

Foreign body in ENT region is an age-old problem. Introduction of foreign body in ear, nose and throat is specially seen in children. There are many types of foreign body seen in the ear, nose and throat. They can aspirate into larynx, trachea and bronchus. How to manage the removal of foreign body in ear, nose and throat had been discussed in a nutshell. General practitioners should be skilled enough to remove foreign body with their limited resources and they should know when to send the cases to an ENT specialist or to a hospital.

Changes in abdominal dimensions during late gestation and early lactation in Holstein-Friesian heifers and cows and their relationship to left displaced abomasum

The changes in abdominal dimensions and contour during late gestation and early lactation were investigated in 44 Holstein-Friesian cattle, 20 normal heifers and 17 normal cows, and seven cows that had a left displaced abomasum (LDA) surgically corrected by a right flank omentopexy in a previous lactation. Abdominal measurements were made eight times during the six months spanning the last trimester of pregnancy and the first three months of lactation, they included the circumference of the thorax and abdomen, the depth and width of the abdomen, the vertical distance between the ventral abdomen and the descending duodenum, the height at the withers, and the length of the trunk. There were significant changes in these dimensions during the last trimester of pregnancy, immediately after parturition and during the first three months of lactation. The depth of the abdomen and the vertical distance between the ventral abdomen and the descending duodenum were greater in the cows with a previous history of LDA than in those without.

Using lung sounds in classification of pulmonary diseases according to respiratory subphases

Auscultation-based diagnosis of pulmonary disorders relies heavily on the presence of adventitious sounds and on the altered transmission characteristics of the chest wall. The phase information of the respiratory cycle within which adventitious sounds occur is very helpful in diagnosing different diseases. In this study, respiratory sound data belonging to four pulmonary diseases, both restrictive and obstructive, along with healthy respiratory data are used in various classification experiments. The sound data are separated into six subphases, namely, early, mid, late inspiration and expiration and classification experiments using a neural classifier are carried out for each subphase. The AR parameters acquired from segmented sound signals, prediction error and the ratio of expiration to inspiration durations are used to construct the feature set to the neural classifier. Classification experiments are carried out between healthy and pathological sound segments, between restrictive and obstructive sound segments and between two different disease sound segments. The results indicate that the classifier performance demonstrates subphase dependence for different diseases. These results may shed light in eliminating redundant feature spaces in building an expert system using lung sounds for pulmonary diagnosis.

The impact of radiological anatomy in clearance of lower caliceal stones after shock wave lithotripsy

The goal of this study was to determine the factors affecting stone clearance after extracorporeal shock wave lithotripsy (ESWL) for lower caliceal stones. Lower pole stone clearance was investigated in 128 (80 males, 48 females) patients treated with ESWL during 1998-2003 in our clinic. Renal anatomy was determined on standard intravenous urogram. The lower infundibulopelvic angle (LIPA) was measured as the angle between the vertical pelvis axis and the vertical axis of lower infundibulum (Sampaio's method). The mean age of the patients was 42.8 +/- 12.4 (19-77) years. The mean stone diameter and burden were found to be 1.28 +/- 0.58 (0.5-3.5) cm and 1.2 +/- 1 (0-7) cm(2) respectively. The stone-free rate was 62.5% and ESWL was unsuccessful in 16 (12.5%) patients. Thirty-two (25%) patients had residual fragments < or =4 mm retained in lower calices after lithotripsy. The stone clearance was found to be unrelated to stone burden and diameter (P = 0.17 and P = 0.14, respectively). However, there was a significant difference between mean lower pole infundibulum length (P = 0.001), infundibulum width (P = 0.001) and LIPA (P = 0.0001) between stone-free patients and patients with residual fragments. Multivariate logistic regression analysis accepting stone-free as the favourable result also confirmed that LIPA, lower pole infundibulum length and width were factors that significantly affected the outcome. Lower pole anatomy has a significant influence on clearance of fragments after ESWL.

Assessment of urinary symptoms in children with dysfunctional elimination syndrome

OBJECTIVE

This study was organized to form a symptom scale for diagnosis and assessment of urinary and bowel symptoms in children with dysfunctional elimination syndrome (DES).

METHODS

The study group included 81 children presented to our clinic with symptoms of DES like enuresis, abnormal voiding, urinary tract infection and urgency, between January 2003 and February 2004. Age matched 102 children with no history of urological complaints were randomly recruited from a public school as control group. Children with isolated, mono-symptomatic nocturnal enuresis were not taken to the study. All children and parents were requested to fill a 35-item questionnaire related to symptoms of DES. After statistical analysis, questions from the initial form that had a P-value <0.05 and an area under curve (AUC) value >0.6 were selected to form a final scale.

RESULTS

The mean ages for study and control groups were 8.7 +/- 2.5 and 8.3 +/- 2.2 years, respectively (P = 0.236). The final scale was composed of 15 questions. The cut-off score for the presence of DES was determined as 7.5 (sensitivity 85.2%, specificity 93.1%, AUC value = 0.943) for the total population. When only the male population were concerned the cut-off score was 4.5 (sensitivity 93.8%, specificity 78%, AUC value = 0.913) while the cut-off score for the female population was 7.5 (sensitivity 87.7%, specificity 94.2%, AUC value = 0.953).

CONCLUSION

Providing objective assessment of symptom severity, formation of a validated scoring system for children with DES might be a good tool for diagnosis, confirmation of treatment results and follow up. It might also be useful for screening purposes.

Evaluation of Sexual Function in Women with Overactive Bladder Syndrome

INTRODUCTION

Of late, little data is available concerning factors affecting female sexual function. In the present study, we evaluated the effects of overactive bladder (OAB) syndrome symptoms on female sexual function.

MATERIALS AND METHODS

40 patients with OAB symptoms and 40 age-matched women as a control group were evaluated using the Female Sexual Function Index (FSFI) for sexual function. According to the presence of urge incontinence, women with OAB were also divided into wet and dry groups. After completion of the forms, groups were compared.

RESULTS

Although scores of all domains of FSFI (desire, arousal, lubrication, orgasm, satisfaction, pain and total) in the OAB group were found to be lower than in the control group, only 'desire' was found to be significantly different (p = 0.035). The FSFI scores of the OAB-dry and OAB-wet group were similar to each other.

CONCLUSION

The results indicate that there is a trend toward lower sexual function scores in women with OAB compared to controls.

A multi-channel device for respiratory sound data acquisition and transient detection

In this study, a multi-channel analog data acquisition and processing device with the additional feature of detecting adventitious sounds has been designed and implemented. The overall system consists of fourteen microphones attached on the backside, an airflow measuring unit, a fifteen-channel amplifier and filter unit connected to a personal computer (PC) via a data acquisition (DAQ) card, and an interface and adventitious sound detection program prepared using LabVIEW (6.0, National Instruments) and MATLAB (7.0.1, MathWorks). The system records the fourteen-channel respiratory sound data at the posterior chest wall and in addition measures the air flow to synchronize the pulmonary signal on the respiration cycle. Respiratory data are amplified and band-pass filtered, whereas flow signal is only low-pass filtered since it is a low-frequency signal with sufficiently high amplitude. All data are sent to a PC to be digitized by DAQ card, then to be processed and stored. An algorithm based on wavelet decomposition is developed which detects the adventitious pulmonary sounds, mainly the crackles and wheezes. This system is intended to be used for mapping the pulmonary sounds and detecting and locating the adventitious pulmonary sounds.

Adaptive modeling of sound transmission in the respiratory system

In this study, adaptive filtering techniques have been used in an attempt to model the respiratory system. The respiratory system has been considered as a dynamic system for which input-output relationship is to be defined. Simultaneous measurement of the respiratory sounds over the trachea and posterior chest were made, with the signal from the trachea forming the input to a finite impulse response filter and the signal from the posterior chest forming the desired response of the filter. The chest cavity was stimulated with speech sounds. Least-mean square algorithm was used to update filter coefficients. The learning curves of the filter are presented in the paper. It can be concluded that adaptive filtering is a promising way to characterize transmission characteristics of the respiratory system and further improvement may be obtained if anatomical information is integrated in the modeling process.

The impact of urinary incontinence on female sexual function

Although urinary incontinence is not a life-threatening disorder, it has been shown to have detrimental effects on quality of life in terms of psychological, social, and sexual problems. In this study, investigators explored the effects of different types of urinary incontinence on female sexual function with a reliable and validated questionnaire, the Female Sexual Function Index (FSFI). One hundred fifty-three women with complaints of incontinence were enrolled in the study. An age-matched group of 89 women who had no incontinence or lower urinary tract disorders were enrolled as a control group; all completed the FSFI. Incontinence was classified as urge, stress, and mixed type. Pelvic organ prolapse (POP), if present, was also recorded. FSFI scores were compared between the incontinent and control groups. A multivariate linear regression analysis model was used to explore the effects of patient characteristics on total FSFI domain score. All domain scores of FSFI except lubrication and pain were statistically significant in the incontinence group (for total domain score, P=.005). For FSFI, in terms of types of incontinence, the difference was significant when the group with mixed urinary incontinence was compared with the control group. In multivariate linear regression analysis, age, presence of POP, and mode of delivery were predictors of female sexual function. Mixed urinary incontinence, when compared with other types, had a significant impact on sexual function. When POP was also present, no negative effects were noted in incontinent women.

Assessment of total thrombus load in symptomatic patients with venous thromboembolism

Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1,552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.

The evaluation of coagulation profiles in calves with suspected septic shock

The purpose of the study reported here was to evaluate the haemostatic function in calves with suspected septic shock and to reflect the occurrence of disseminated intravascular coagulation (DIC). Twenty-six calves suspected of having septic shock (experimental group) and 10 clinically healthy calves (control group) were used. On admission, the experimental group of calves had been ill for an average of 2 days. Therapy was applied to the experimental group of calves. The packed cell volume (PCV), haemoglobin (Hb), white blood cell (WBC), red blood cell (RBC) and platelet (PLT) counts were determined. Blood smears for toxic neutrophil and schistocyte intensity were evaluated. For the coagulation profile, plasma activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen and fibrin/fibrinogen degradation products (FDPs) values were determined. Toxic neutrophils in blood smears were observed in 12 calves of the experimental group. APTT was prolonged in the experimental group compared with the control group (p < 0.05). Fibrinogen concentration was found to be higher in the experimental group than in the control group (p < 0.001). Total leukocyte counts were higher in the experimental group compared with the control group (p < 0.01). Platelet counts in the experimental group were lower than the control group (p < 0.001). However, when the individual values of coagulation profiles of each calf were evaluated, 8 calves had at least three abnormal coagulation profiles (APTT >72 s, PT >34.5 s, TT >33.7 s, FDPs >5 microg/ml, PLT < or = 150 x 10(3)/mm(3)) and abnormal erythrocyte morphology (schistocytes > or = 1). The most common abnormal tests in the coagulation profile were APTT and PT (7 cases), FDPs (6 cases), thrombocytopenia (4 cases), and schistocytes in blood smears (8 cases) in these 8 calves. The results of this study indicate that DIC might be a significant risk factor for mortality in calves with suspected septic shock.

Prolapse of a simple ureterocele presenting as a vulval mass in a woman

A 48-year-old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single-system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.

Serum P-selectin, soluble vascular cell adhesion molecule-I (s-VCAM-I) and soluble intercellular adhesion molecule-I (s-ICAM-I) levels in bladder carcinoma patients with different stages

Adhesion molecules are thought to have a role in the host defense against carcinogenesis. In this study, we measured serum platelet-(P-) selectin, soluble vascular cell adhesion molecule-I (s-VCAM-I), and soluble intercellular adhesion molecule-I (s-ICAM-I) levels in 51 sequential bladder cancer patients at our urology clinic and 8 controls. Serum levels of P-selectin, s-VCAM-I and s-ICAM-I were significantly higher in all patients than controls. Serum P-selectin and s-ICAM-I levels did not differ based on tumor (T) stage and tumor grade, whereas serum levels of s-VCAM-I were significantly higher in patients with muscle invasive tumors than those with superficial tumors. Further, s-VCAM-I levels correlated with T stage. In conclusion, significantly increased P-selectin, s-VCAM-I, and s-ICAM-I levels were observed in patients with bladder cancer, and s-VCAM-I levels correlated with T stage. Thus, we suggest that the analysis of serum s-VCAM-I levels may provide a prognostic test for T stage and bladder cancer progression during and/or following therapy.

The level of serum ionised calcium, aspartate aminotransferase, insulin, glucose, betahydroxybutyrate concentrations and blood gas parameters in cows with left displacement of abomasum

The purpose of this study was to determine concentrations of serum glucose, aspartate aminotransferase (AST), insulin, beta-hydroxybutyrate (BOH) and ionised calcium (Ica) in dairy cows with left displaced abomasum (LDA) and to compare these parameters before and after surgical correction of LDA. Eighteen Swiss-Holstein dairy cows with LDA were used in this study. Clinically healthy post parturient cows (n: 10) from a local dairy farm were used as control group. Blood samples were collected from the jugular vein from all the cows. Surgery was performed in cows with LDA. Blood samples from cows with LDA were collected 24 hours after surgery. The abomasum was repositioned followed by an omentopexy. Six of the 18 cows with LDA had clinical ketosis as detected with urine dipstick. The mean concentrations of insulin, BOH, glucose and AST in cows with LDA at admission time were increased compared with the healthy cows. But the mean concentration of ICa at admission time was slightly decreased compared with healthy cows. The mean BOH concentration was decreased 24 hours following surgery compared with values on admission time. However, the mean serum AST levels were increased both at admission time and 24 hours after surgery compared with healthy cows. The levels of blood gas parameters in cows with LDA were not significantly different in comparison with healthy cows, although hyperbasemia in six of 18 cows with LDA was determined. In conclusion, the results of this study indicated that serum insulin, glucose, AST and BOH levels were increased in dairy cows with LDA. Serum BOH and ICa levels were decreased 24 hours after surgery compared with values on admission time. All cows with LDA used in this study had subclinical/clinical ketosis. We could say that ketosis might be a risk factor for the displacement of the abomasum.

Renal brucelloma: A rare infection of the kidney

We report a case of renal abscess caused by brucellosis (renal brucelloma) which was treated by surgery. Renal parenchymal involvement of systemic brucellosis is a very rare condition and relapses after medical treatment, such as solid organ abscess including kidney, should be especially considered. In chronic cases, laboratory findings including polymerase chain-reaction examination is needed for definitive diagnosis.