Superior mesenteric artery syndrome presenting with acute massive gastric dilatation

A 14-year-old girl presenting with acute massive gastric dilatation secondary to duodenal obstruction by the superior mesenteric artery is described. The diagnosis was facilitated by contrast-enhanced abdominal computerized tomography. She was successfully treated by gastrostomy and subsequent duodenal derotation. This unique presentation of the superior mesenteric artery syndrome is discussed.     

The significance of gastric helicobacteriosis in the genesis hemorrhage from duodenal peptic ulcer

Based on a comprehensive analysis of findings from examination and surgical treatment of 196 patients with bleeding pyloroduodenal ulcers, it was found out that patients with concurrent helicobacteriosis of the stomach are prone to more unfavourable course of their illness, which fact is evidenced by a greater loss of blood and higher risk for bleeding recurrences. A classification is proposed by the authors, taking advantage of the data from endoscopic, microscopic and immunoenzymatic techniques, with the purpose of providing an assessment of degree of severity of helicobacteriosis of the stomach.     

Epidemiology of toxic shock syndrome toxin-1 production in Staphylococcus aureus strains isolated in Denmark between 1959 and 1990

A total of 436 Staphylococcus aureus bacteremia strains isolated between 1959 and 1990 were tested for the production of toxic shock syndrome toxin-1 (TSST-1) by a semiquantitative reversed passive latex agglutination test. TSST-1 production was found in 147/260 (57%) of phage group I strains, excluding the "80" complex, and in 17/176 (10%) of non-group I strains. Strains of the 52, 52A, 80, 81 complex ("80" complex), constituting a subgroup of group I, did not have the same high frequency of TSST-1 production as the rest of group I strains (4% versus 57%). The "80" complex has almost disappeared in Denmark. TSST-1 production was found with the same high frequency among group I strains from the beginning (1959) and throughout the observation period. The TSST-1 production was associated with the phages 29 and/or 52, which in turn lysed 95% of group I strains. The TSST-1 production was quantitatively greater in the phage group I strains than in the non-group I strains. TSST-1 production of the bacteremia strains was not correlated to the clinical parameters: mortality, age, gender, bacterial focus, underlying diseases, or whether the infection was hospital or community acquired.     

Somatic mosaicism in a patient with neurofibromatosis type 1

Using loss of heterozygosity analysis, a method designed to detect moderate to large gene deletions, we have identified a new-mutation neurofibromatosis type 1 (NF1) patient who is somatically mosaic for a large maternally derived deletion in the NF1 gene region. The deletion extends at least from exon 4 near the 5' end of the gene to intron 39 near the 3' end. The gene-coding region is, therefore, mostly or entirely deleted, encompassing a loss of > or = 100 kb. We hypothesize that the deletion occurred at a relatively early developmental timepoint, since signs of NF1 in this patient are not confined to a specific body region, as seen in "segmental" NF, and since both mesodermally and ectodermally derived cells are affected. This report provides the first molecular evidence of somatic mosaicism in NF1 and, taken together with a recent report of germ-line mosaicism in NF1, adds credence to the concept that mosaicism plays an important role in phenotypic and genetic aspects of NF1 and may even be a relatively common phenomenon.     

Successful innominate thromboembolectomy of a paradoxic embolus

A 54 year-old man had symptoms of acute right hemispheric cerebral ischemia. He was initially considered for participation in a trial of early thrombolysis in stroke, but an innominate artery embolus was found with no apparent arterial source. The embolus was removed by means of a combined brachial and carotid bifurcation approach to protect the cerebral vasculature from embolic fragmentation during extraction. Further investigation revealed deep venous thrombosis, evidence of pulmonary emboli, and a patent foramen ovale, supporting a diagnosis of paradoxic embolus. Additional treatment included anticoagulation and placement of an inferior vena caval filter. The unusual condition of paradoxic embolus is reviewed, and the management of this patient is discussed.     

Differential diagnosis of the transplant rejection and herpesvirus-related infections in kidney transplant recipients

An algorythm of differential diagnosis conduction of the transplant rejection reaction and the diseases caused by herpes viruses in recipients after the kidney transplantation was elaborated, basing on the analysis of results of the clinical, laboratory, immunological and serological examination methods.     

The value of palpation as basis for decision on lymph node excision

The purpose of the study was to evaluate palpation of the regional lymph nodes in control examinations of patients with malignant disease. A retrospective review of the medical records of 188 cases in which the patients had had an extirpation of the regional lymph nodes was performed. We have compared the preoperative findings through palpation with the histological diagnosis. The patients were grouped according to the region in which the lymph node removal had been done. The specificity of palpation when the histological diagnosis was malignant was (with 95% confidence limits), in the axilla 0.65 (0.54-0.75), in the inguinal region 0.86 (0.75-0.94) on the neck 0.83 (0.52-0.98) and in the suprahyoid region 0.58 (0.28-0.85). In conclusion, palpation of regional lymph nodes is not a sufficient control examination in the estimation of the course of malignant disease. Supplementary examination methods are recommended.     

Choledocholithiasis after cholecystectomy

Concrements were found in the ducts of 172 patients subjected to secondary surgical interventions on bile ducts. The detailed analysis of the data failed to answer the question whether the stones could be formed immediately in the ducts without such conditions as a mechanical obstacle for the outflow of bile, the presence of foreign bodies and a big stump of the cystic duct. Such a formation of stones can take place in very few cases. The authors have shown that control cholangiography and especially choledochoscopy can reduce the danger to leave the stones in the ducts, but does not eliminate the danger completely. Nevertheless they think that now it is possible to lessen the indications for biliodigestive anastomoses in choledocholithiasis since the retained stones can be revealed within the first days after surgery and, as a rule, removed with instruments or by other methods using the drainage left in the ducts.