Syphilis causing hearing loss.

An HIV-positive man with hepatitis B co-infection, naïve to highly active antiretroviral therapy, with a CD4 of 594 copies/mL and HIV-1 viral load of 140,070 copies, presented with right-sided facial weakness and hearing loss. He had been treated for secondary syphilis three months earlier when his rapid plasma reagin (RPR) result was 1:16, this had fallen to neat. At presentation, his RPR had risen to 1:16 again. A magnetic resonance imaging scan showed enhancement of the internal auditory canal and right cochlea. His cerebrospinal fluid examination was normal. He was treated with acyclovir and prednisolone before the syphilis serology was known. He was then treated for syphilis with doxycycline. He made an excellent recovery.

Meningioma metastatic to thyroid gland.

OBJECTIVE: To describe the first reported case of meningioma metastasizing to and completely infiltrating the thyroid gland. METHODS: We present a detailed case report, including radiographic, histologic, and immunostaining findings, in a patient with an atypical meningioma who had a progressively enlarging thyroid mass that proved to be a metastatic meningioma. RESULTS: A 49-year-old man had a meningioma in the parieto-occipital region that had spread locally to the scalp and bone by the time of surgical resection. Local recurrence during the following year prompted repeated surgical resection, tumor embolization, radiotherapy, and chemotherapy. Despite aggressive therapy, the tumor progressed. A thyroid mass was first noted 2 years after the meningioma was diagnosed. Enlargement of the mass caused airway obstruction, necessitating an emergency thyroidectomy. Histologic examination of the thyroidectomy specimen showed that the thyroid gland had been extensively replaced by metastatic meningioma. CONCLUSION: To our knowledge, this is the first reported case of metastatic meningioma extensively infiltrating the thyroid gland. This case report expands the spectrum of tumors that metastasize to the thyroid gland.

HbA1c predicts length of stay in patients admitted for coronary artery bypass surgery.

Diabetes mellitus is associated with coronary artery disease, and diabetic patients are frequently referred for coronary bypass graft surgery. It is well known that HbA1c, which reflects long-term glycemic control, is related to diabetic morbidity and mortality. It is not known whether HbA1c is related to postoperative length of stay among patients who undergo coronary artery bypass surgery. The authors evaluated 135 patients who underwent bypass surgery at the Westchester Medical Center (Valhalla, NY). HbA1c was measured in all patients preoperatively; a value of 7% or greater was used as a threshold for uncontrolled hyperglycemia. A postoperative length of stay of 6 days or more was used as the cutoff for an extended length of stay. Linear regression was used to assess the relationship between HbA1c, adjusted for age, and length of stay in days. Logistic regression, with length of stay a binary variable <6, > or =6 days, was used to assess the accuracy of HbA1c <7%, > or =7%, adjusted for age, in predicting length of stay. An HbA1c of 7% or greater was found to be a strong predictor of a length of stay of 6 days or longer. These data suggest that HbA1c can be used as a surrogate marker for cardiac and noncardiac morbidity that prolongs hospitalization after coronary artery bypass surgery.