Minimally symptomatic posterior reversible encephalopathy in Guillain-Barré syndrome.

Posterior reversible encephalopathy syndrome (PRES) is a rare occurrence in patients with Guillain-Barré syndrome (GBS). Two patients with neuroradiological evidence of PRES without central nervous system (CNS) symptoms were recently reported. We present the case of a GBS patient with minimal CNS symptoms and magnetic resonance imaging findings consistent with PRES. PRES in GBS might be an underestimated condition. It should be suspected in GBS patients in the presence of even mild CNS symptoms. A timely PRES diagnosis along with early correction of autonomic system dysfunction in GBS patients is recommended to prevent possible dangerous CNS complications.

Reversible cerebral vasoconstriction syndrome possibly induced by etoricoxib.

Etoricoxib is a newer cyclooxygenase (COX)-2 inhibitor anti-inflammatory drug with a favorable safety profile. However, several randomized trials have provided evidence of an increased risk for acute myocardial infarction associated with the use of COX-2 inhibitors. Fewer data are available concerning the risk for ischemic stroke associated with COX-2 inhibitors. Although sporadic classes of drug-induced reversible cerebral vasoconstriction syndrome (RCVS) have been reported, this was not the case for etoricoxib. We report a patient who developed thunderclap headache, reversible cerebral arterial vasoconstriction, high blood pressure, and ischemic stroke (ie, RCVS) with recent exposure to etoricoxib. Although the association is hypothetical, the authors suggest consideration of RCVS in hypertensive patients presenting with headache, focal deficits, and evidence of cerebral ischemia during COX-2 inhibitors use.

Perspective on the role of transrectal and transvaginal sonography of tumors of the rectum and anal canal.

OBJECTIVE: Intestinal sonography is characterized by excellent resolution of the multiple layers of the intestinal wall and sensitive depiction of the degree of invasion of rectal tumors. Traditional transrectal sonography has been enhanced by the addition of transvaginal scanning for women and by advances in transducer technology. Our purpose is to describe the current status of sonography in the evaluation of rectal and anal tumors and in the staging of rectal cancer. CONCLUSION: Endorectal and transanal sonography are fast, minimally invasive techniques that can be performed with portable equipment and yield rapidly interpreted images. They are considered the reference standard for the preoperative staging of rectal and anal cancers and have relatively high accuracy in categorization of tumors and nodes in TNM staging.

Sonography of benign conditions of the anal canal: an update.

OBJECTIVE: The objective of this article is to describe our experience with sonography for the study of benign conditions of the anal canal and perianal soft tissues. CONCLUSION: Assessment of the anal sphincters in patients with fecal incontinence and documentation of perianal inflammatory masses and tracts in those with perianal inflammatory disease are the major indications for imaging the anal canal. We augment traditional transanal sonography with transperineal scanning in both sexes and transvaginal scanning in women to better show the anal canal in its quiet state to allow an accurate assessment of the integrity of the anal sphincters and of evidence of acute or chronic inflammatory involvement.

Urethral polyp in a 1-month-old child.

Urethral polyps are a rare finding in children, particularly in the very young. They are suspected by the presence of various clinical signs such as obstruction, voiding dysfunction and haematuria. There is an association with other urinary tract congenital anomalies. They are usually benign fibro-epithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy. We report a 1-month-old boy with an antenatally diagnosed left ectopic pelvic kidney, postnatal urinary tract infection and no clinical signs of obstruction. Voiding cystourethrography to exclude vesico-ureteric reflux showed a trabeculated bladder and a mobile filling defect in the posterior urethra. Owing to its large size, cystotomy was necessary to remove the polyp successfully.