Laparoscopic repair of chronic traumatic diaphragmatic hernia: case report and review of the literature

This study compared the efficacy and tolerability of nisoldipine coat core (CC) 10-40 mg o.d. and hydrochlorothiazide (HCTZ) 25-50 mg o.d. Patients with mild-to-moderate essential hypertension received either nisoldipine CC 10 mg o.d. or HCTZ 25 mg o.d. Treatment was titrated at two-weekly intervals as necessary. The primary efficacy endpoint was a defined reduction in diastolic blood pressure (DBP). Response rates were similar for both the nisoldipine CC- and HCTZ-treated groups (74% and 70%, respectively). Secondary efficacy endpoints were reductions in both diastolic and systolic blood pressures (SBP). At treatment endpoint, the change from baseline in SBP was 16.2 mmHg for the nisoldipine CC group and 14.9 mmHg for the HCTZ group. Both drugs were well tolerated, and adverse events were generally minor and typical of these antihypertensive agents. Drug-related adverse events were greater in the nisoldipine CC- than the HCTZ-treated patients (50% and 37%, respectively). Nisoldipine CC was shown to demonstrate antihypertensive efficacy similar to HCTZ in the treatment of mild-to-moderate hypertension.     

A case of traumatic pericardiophrenic rupture

Two phenethylguanidine derivatives, 7,8-dihydrotubastrine (1) and 4-deoxy-7,8-dihydrotubastrine (2), along with the sterol xestobergsterol A (3), were isolated from the marine sponge Petrosia cf. contignata. The structures of the new natural products 1 and 2 were based on spectroscopic data and comparison to the literature properties for semisynthetic 1. This is the first example from this compound class with a saturated acyclic C2 unit.     

Misleading symptoms after a minor blunt chest trauma. Thoracoscopic treatment of diaphragmatic rupture

We present a case of missed diaphragmatic rupture which was treated thoracoscopically. Rupture of the diaphragm is a serious complication of blunt trauma. The diaphragmatic injury can easily be overlooked. This report illustrates the diagnostic dilemma in a patient where the injury was missed at the time of initial presentation. The role of thoracoscopy both for diagnosis and therapy is discussed.     

Application of heparin-coated PCPS for traumatic cardiac rupture: report of a case

OBJECTIVES: This study examined whether primary care physicians provide education and counselling on head injury prevention as part of their routine health care discussions with patients. METHODS: A preventive health care practices survey was distributed to 678 physicians in the Central Virginia area. Data regarding respondents' age, gender, medical specialty, patient population and counselling practices were obtained. RESULTS: Fifty-one per cent of those surveyed responded. Ninety-five per cent of physicians reported providing health care counselling 'in most cases' or 'commonly'. Less than half (46%) of physicians discussed head injury prevention with their patients. In contrast, almost all respondents (97%) discussed smoking. Physician age, specialty, and patient population did not affect head injury counselling practices. CONCLUSIONS: Prevention strategies for head injury are discussed much less frequently than other health risks such as heart disease and cancer in the primary care setting. Strategies for educating primary care physicians on head injury should be considered in order to increase their efforts toward prevention.     

Combined repair of a traumatic rupture of the aorta and anterior stabilization of a thoracic spine fracture: a case report

The combination of traumatic aortic rupture and spine fracture is rare. We describe the treatment of both injuries in a one-stage procedure with good results in a 47-year-old woman.     

Closed rupture of the anterior tibial tendon. A case report

Closed subcutaneous rupture of the anterior tibial tendon is a relatively uncommon injury that requires a thorough clinical examination to diagnose correctly. The authors report a case of this disorder and provide a review of the relevant literature. A method of surgical repair not previously described in the literature is also presented.     

A case of traumatic diaphragmatic hernia repaired 40 years after the injury

A 65-year-old male complaining dyspnea on exertion and epigastric discomfort was diagnosed to have left traumatic diaphragmatic hernia elsewhere and referred to Keio university Hospital for treatment. He had thoracicio-abdominal trauma which was conservatively treated, 40 years ago. Because he was symptomatic and the possibility of future strangulation could not be denied, surgical repair of the hernia was performed. The defect in the diaphragm was too large to be directly sutured and it was repaired with GORE-TEX patch. The gastric fundus partially prolapsed in the paraesophageal region, but the diaphragm was repaired quite satisfactorily otherwise. Pulmonary function and dyspnea on exertion improved.     

Recurrent bronchogenic cyst with rupture into the pericardium. A case report

A case of tamponnade due to intrapericardial rupture of a recurrent bronchogenic cyst, presenting as pericarditis, is described. This case is unique because it demonstrates the possibility of rupture of a bronchogenic cyst into the pericardium and by the unusual mode of presentation. It also shows that bronchogenic cysts may recur many years after incomplete ablation. Bronchogenic cysts are benign dysembrioplasic formations characterised by their respiratory epithelial lining. The usual presentation in the adult is by haemorrhage or infection, but our case shows that recurrent pericarditis without an obvious cause may be due to bronchogenic cyst, which should be systematically excluded. The diagnosis suspected after medical imaging (chest X-ray, scanner, magnetic resonance imaging) is confirmed by histology. Total surgical ablation is the treatment of choice and may be curative.     

Insidious rupture of the Achilles tendon after ciprofloxacin-induced tendopathy. A case report

A 64-year-old male patient had two episodes of transient ischemic attack and a cerebral infarction. Cerebral angiography showed 50% stenosis at the junction of left internal carotid artery and 90% stenosis at left mid-cerebral artery (MCA). Coronary angiography showed two vessel disease with arteriosclerotic change and underwent coronary artery bypass grafting. To prevent intraoperative cerebral infarction, we used brain protect solution just before starting ECC, set perfusion flow around 3 l/min/m2, monitored the flow of left MCA using Transcranial Doppler (TCD) and the saturation of left internal jugular vein (SjO2) continuously. PaCO2 was controlled around 45 mmHg. TCD showed good pulsatile flow, and SjO2 was kept over 60%. The patient recovered consciousness 2 hours after operation in the intensive care unit without paresthesia. We thought the number of open-heart cases with cerebrovascular disease increased, and pulsatile low of ECC by intraaortic balloon pumping and the monitoring of SjO2 are useful for the cases.     

HELLP syndrome: undiagnosed in a case of impending rupture of uterus. A case report

Eleven patients with chronic renal failure who were being treated with haemodialysis three times a week were monitored for a total of 34 haemodialysis sessions. Erythrocyte 2,3-biphosphoglycerate (2,3-BPG) concentration was analysed immediately before initiation of bicarbonate haemodialysis and 1 h afterwards. The 2,3-BPG concentration was expressed relative to the haemoglobin tetramer (Hb4) concentration as the 2,3-BPG/Hb4 ratio and compared with blood gas analyses and biochemical variables important for characterizing uraemia. During the first hour of haemodialysis the 2,3-BPG/Hb4 ratio decreased (p < 0.002), but the magnitude of the decrease did not significantly correlate with the 2,3-BPG/Hb4 ratio measured before haemodialysis (p=0.104). The decrease is most likely to be caused by the haemodialysis procedure itself. Mechanical stress on the erythrocytes is believed to cause the 2,3-BPG to escape; it is then removed by haemodialysis. Physiologically, an increase in 2,3-BPG would be expected to counteract the hypoxia which is frequently observed during haemodialysis. However, the present results show the opposite, a decrease in 2,3-BPG. No significant correlation was shown between the haemoglobin concentration and the 2,3-BPG/Hb4 ratio before dialysis (p=0.414). The pH showed a significant positive correlation with the 2,3-BPG/Hb4 ratio before dialysis, whereas the arterial pO2 and the 2,3-BPG/Hb4 ratio before dialysis were insignificantly negatively correlated. The concentrations of calcium, phosphate, creatinine, urea and albumin did not correlate significantly with the change in 2,3-BPG/Hb4-ratio after 1 h. The 2,3-BPG/Hb4 ratio (p=0.03) sampled just before dialysis correlated significantly and positively with the total weekly dosage of erythropoietin given to the patients.     

Intestinal obstruction as late presentation of traumatic diaphragmatic hernia: report of a case and review of the literature

Until recently, tumours involving the pelvis were usually treated by hemipelvectomy, otherwise called "hindquarter amputation". A more recent approach of treating these tumours is the 'conservative hemipelvectomy', which consists of removing the tumour and sparing the lower extremity. A patient with Ewing's sarcoma of the pelvis underwent such a procedure. The femoral head was fixed temporarily to the remaining parts of the acetabulum and the iliac wing by a Steinman pin. The Steinman pin was removed 6 weeks after the operation and the patient was then put into traction for another 6 weeks. Weight-bearing was gradually allowed after 3 to 6 months. The patient remodelled a neoacetabulum, which gave sufficient stability to the hip joint. Walking without external help was possible. The patient presented with a 2 cm limb-shortening. No local recurrence was observed during a follow-up of 30 months. This experience with internal hemipelvectomy shows an encouraging result in terms of tumour control and gait function.     

Endoscopic bladder repair during total modified laparoscopic hysterectomy. A case report

A case of abdominal mycobacterial infection mimicking acute appendicitis in a human immunodeficiency virus (HIV) infected patient is reported. The case illustrates the unusual aetiology of an acute abdomen in this population and the report reviews the aetiology of surgical abdominal pain in HIV infection and discusses the management of abdominal mycobacterial infections.     

Gunshot uterine rupture: a case report

PURPOSE: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotation. METHODS: From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's procedure for malrotation. All patients had symptoms of intermittent upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study. None of the patients had acute volvulus or compromised bowel. The procedure was performed using 3 trocars of 3.5 mm diameter. Ports were placed in the infraumbilical ring, and the right and left mid to lower quadrants. A standard Ladd's procedure with appendectomy was performed in all cases. RESULTS: All procedures were completed successfully through the laparoscope. Operative times averaged 58 minutes (35 to 120 minutes). One patient with Pierre-Robin underwent a laparoscopic Nissen fundoplication and gastrostomy tube placement at the same time requiring 120 minutes. Feedings were started on postoperative day (POD) 1 in 10 cases and POD 2 in two cases. Hospital stay ranged from 2 to 4 days (average, 2.2) in the patients with isolated malrotation. The patient with Pierre-Robin had a prolonged hospitalization because of chronic respiratory problems not associated with surgery. There were no complications. All patients had resolution of their symptoms. CONCLUSIONS: Laparoscopic Ladd's procedure is a safe and effective technique. It can be performed in neonates in times equivalent to standard open techniques, and it appears to allow for earlier feeds and decreased hospital stays.     

The surgical treatment of traumatic rupture of the aortic valve: report of a case after blunt chest trauma

An elderly patient with traumatic aortic valvular insufficiency was treated surgically with valve replacement, the preferred method of treatment, since prognosis is poor without timely surgical therapy. Further emphasis should be given to early diagnosis of this lesion.     

Thoracoscopic resection of mediastinal parathyroid adenoma with cyst and hyperparathyroidism--a case report

A 51-year-old woman was admitted because of general fatigue assumed to be due to climacteric disturbance. Laboratory examinations suggested a diagnosis of hyperparathyroidism based on high serum levels of Ca, intact PTH, and high-sensitivity PTH. No abnormalities were found in the cervix. Chest X-ray films and CT scans showed a mass measuring 4 cm in the right postero-upper mediastinum. The tumor was positive on a parathyroid scintigram, and was diagnosed as a mediastinal parathyroid adenoma with hyperparathyroidism. Operative findings showed a tumor surrounded by the superior vena cava, vagus nerve, azygos vein, and brachiocephalic artery. Careful resection of the hypervascular tumor from surrounding tissues was performed using a thoracoscopic technique alone. The postoperative course was uneventful. Serum values of Ca, intact PTH, and high-sensitivity PTH decreased to within normal ranges. after surgery. Pathohistological study confirmed the diagnosis of parathyroid adenoma including a cyst caused by degeneration of the tumor.     

Flexor digitorum superficialis rupture: a case report

A rupture of the musculotendinous junction of the flexor digitorum superficialis to the index finger in a baseball pitcher is described. No underlying abnormality could be detected. Because of loss of strength and dexterity, repair of the rupture was accomplished with an improved result.