Primary adenocarcinoma of the appendix

Two cases of carcinoma of the appendix presenting as appendicular masses are discussed. Carcinoma of the appendix is rare and hence a pre-operative diagnosis is seldom made. Awareness of the condition would naturally arouse suspicion of its presence, especially in elderly patients who present with cute appendicitis or an appendix mass. It is known to have occurred in an appendix stump several years after the initial appendicectomy, and also in a 17-year-old patient. The need for histological examination of all appendicetomy specimens is stressed. The operation of choice is right hemicolectomy, either as a primary or as a secondary procedure. This is associated with better survival rates than when the condition is treated by appendicectomy alone.     

Cytogenetic analysis of several pseudomyxoma peritonei lesions originating from a mucinous cystadenoma of the appendix

BACKGROUND: Reports of endovascular stent infection have recently been described. The purpose of this study was to determine if intravascular metallic stents in a swine model could become infected following a bacterial challenge given remote from the time of stent placement. METHODS: Balloon expandable metallic stents (Palmaz) were implanted in the iliac arteries of 14 swine. An angioplasty, without stent placement, was also performed in the contralateral iliac artery. An intravenous bacterial challenge with Staphylococcus aureus was given 4 weeks after stent placement. Euthanasia was performed 72 hours after the bacterial challenge. At the time of euthanasia, the iliac artery/stent complex and the contralateral angioplastied iliac artery were harvested and sent for microbiologic and pathologic analysis. RESULTS: Seven of the 14 stent/artery complexes were culture positive for S aureus whereas only one of the 14 angioplastied arteries was positive for S aureus (P = 0.03). On histologic examination, 6 of the 14 stent/artery complexes had evidence of acute inflammatory changes in the arterial wall. This compares with only 1 of 14 angioplastied arteries having evidence of inflammatory infiltrate in the arterial wall (P = 0.07). All 6 of the stent/artery complexes with inflammatory infiltrate were culture positive. CONCLUSION: In the swine model, intravascular metallic stents have the potential to become infected when a bacterial challenge is given 4 weeks after stent placement. Further studies evaluating the incidence of stent infections in humans are needed.     

Prostatic adenocarcinoma showing features of endometrioid and mucinous carcinomas: a case report

A 77-year-old male was admitted for the examination of post renal acute renal failure. Blood examination revealed renal dysfunction and elevation of carcinoembryonic antigen (CEA). Computed tomography and retrograde pyelography showed bilateral hydronephrosis due to ureteral stenosis. He died of renal failure and autopsy was done. Histologic findings showed moderately differentiated adenocarcinoma of the prostate associated with endometrioid and mucinous carcinoma, and metastases of retroperitoneal lymph nodes and multiple bones. Immunohistochemically, endometrioid carcinoma was positive for prostatic acid phosphate (PAP) and prostatic specific antigen (PSA), and negative for CEA. Mucinous carcinoma was negative for PAP and PSA, and positive for CEA. Including our case, 29 cases of endometrioid and 32 of mucinous carcinoma of the prostate reported in the Japanese literature are reviewed.     

Cytotoxic agents active against mucinous adenocarcinoma of the ovary

OBJECTIVE: To determine the stability of immunoglobulin E levels in obstetric sera. METHODS: AlaSTAT(R) and AlaTOP(R) (Diagnostic Products) were used to assay total and specific IgE levels in obstetric sera collected in Memphis, TN and Portland, OR. The samples were collected from the Collaborative Perinatal Project (CPP) between 1959 and 1965 and stored at -20 degrees C. The assay results were compared with IgE levels found in sera collected at the same locations for the Calcium for Pre-eclampsia Prevention Study (CPEP) and stored since 1992 at -70 degrees C. The samples were also assayed for cockroach (CR) and mouse urine specific IgE using the AlaSTAT(R) assay (Diagnostic Products). RESULTS: Total IgE and specific IgE to CR and mouse urine were detectable in older and recent samples. The median total IgE for the recent and older Portland samples was 26 IU/ml and 65 IU/ml, respectively. The median total IgE was identical (40 IU/ml) in the recent and older Memphis samples. CONCLUSION: Long-term storage does not diminish the ability to measure serum IgE. Levels of IgE in sera stored 32-37 years were equal to or greater than levels in sera stored for 5 years. reserved.     

Ductectatic mucinous cystadenocarcinoma of the pancreas: a rare variant

A rare case of the ductectatic variant of mucinous pancreatic cystadenocarcinoma in a 64 year-old man, presenting with painless obstructive jaundice, is reported. CT scan revealed a multicystic lesion of the pancreatic head, which caused biliary obstruction. Endoscopic retrograde pancreatography (ERP) revealed the characteristic grapelike cluster pattern of pancreatic ductectatic neoplasms. Pancreaticoduodenectomy was then successfully performed. Pancreatic ductectatic mucinous cystadenocarcinoma is a rare entity, presenting, usually, with obstructive pancreatitis, and is histologically indistinguishable from the classic malignant mucinous cystic neoplasm. ERP is the diagnostic method of choice and should be performed in any case of susceptible pancreatic lesions.     

Atresia of the appendix

A 4-day-old black male underwent laparotomy for intestinal obstruction. At surgery, multiple jejunal atresias (type IV) of the jejunum were detected. As an incidental finding, atresia of the appendix was also present. The jejunal atresia was repaired, and resection of the tip of the cecal pole and atretic appendix was performed. Gross and histological examination confirmed the presence of a type IV atresia of the jejunum and a cordlike (type II) atresia of the appendix with inflammatory changes in the tip of the appendix. The boy made an uneventful recovery. Examination of all organ systems did not show any associated findings, and the family history was unremarkable. To our best knowledge, this case represents the first case of atresia of the appendix described in the literature.     

Thymic carcinoid with mucinous stroma: a case report

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group.     

Latex allergy: a life-threatening complication

Bone mineralization of healthy preterm infants fed human milk were compared with that of similar fed preterm formula. Bone mineralization was studied by dual energy X-ray absorptiometry in 43 preterm infants divided into two groups; 21 preterm infants were fed with maternal breast milk and 22 preterm infants with a preterm formula containing 70 mg calcium and 35 mg phosphorus per decilitre. CONCLUSION: Preterm infants fed breast milk had lower bone mineral density than the preterm formula-fed group. Fortifying preterm human milk with calcium and phosphorus will improve bone mineralization in preterm infants.     

Hepatoid adenocarcinoma of the stomach: a case report

A patient with primary gastric carcinoma showing a high level of serum a-fetoprotein (AFP) (368 ng/ml) is described. Subtotal gastrectomy was performed, and a month after surgery the level of serum AFP fell rapidly to within normal limits. Histologically, two types of cells coexisted in the tumor: medullary-type cells resembling trabecular-type hepatocellular carcinoma, and moderately differentiated adenocarcinoma cells. The cells of the former type were arranged mostly in a trabecular pattern with bile granules, but also showed a scirrhous pattern in a restricted area. Immunohistochemistry demonstrated that both types of tumor cells stained positively for AFP. This tumor, which should be classified as a hepatoid adenocarcinoma of the stomach, is of interest because of its rarity, bile secretion (indicating marked differentiation toward a hepatocyte form), and two cellular arrangements-trabecular and scirrhous.     

Ulcerative colitis with skip lesions at the mouth of the appendix: a clinical study

OBJECTIVE: We examined the clinical characteristics of ulcerative colitis patients who demonstrated endoscopically discontinuous lesions at the mouth of the appendix. METHODS: Of patients with initial or recurrent active ulcerative colitis who underwent total colonoscopy during the past 3 yr at Osaka City General Hospital, we selected those who had skip lesions in the mouth of the appendix before treatment, and examined their gender, age, disease type, sites of lesions, inflammatory reaction, severity of disease, effects of treatment, and posttreatment course. RESULTS: Discontinuous lesions at the mouth of the appendix were found in 10 patients, who had the following common clinical features: the major lesion was usually present in the lower part of the large bowel including the rectum, many of the patients had suffered an initial attack only, all patients had mild disease, and many of the patients responded quite satisfactorily to treatment with salicylazosulfapyridine. CONCLUSION: Numerous patients with ulcerative colitis with discontinuous lesions at the mouth of the appendix were observed and their clinical characteristics were examined. Determination of the clinical significance of skip lesions in the appendix will contribute to elucidation of the pathogenesis of ulcerative colitis.     

Carcinoid tumors of the appendix

OBJECTIVE: A retrospective study of 41 patients with histologically confirmed diagnosis of appendix carcinoid tumors was undertaken by reviewing the surgical records at Massachusetts General Hospital. METHODS: There were 8 male and 33 female patients (mean age 32 years). Twenty-two patients (54%) presented with signs and symptoms suggestive of acute appendicitis. In 19 patients (46%) the lesions were discovered incidentally. The tumors were located in 32 patients at the tip, in 6 patients in the middle third, and in 3 patients at the base of the appendix. The tumor was less than 1 cm in diameter in 32 patients, between 1 and 2 cm in 7 patients, and was bigger than 2 cm in 2 patients. In 29 patients, the depth of tumor penetration was confined to the submucosa or to the muscle layers of the appendix, and in 8 patients the serosa was involved. In 4 patients, evidence of tumor extension into the meso-appendicular fat was present, including one patient with a tumor bigger than 2 cm and local lymph-node metastases. Forty patients underwent appendectomy alone. One patient with a tumor size bigger than 2 cm in diameter with positive lymph nodes in the mesoappendix underwent secondary right hemicolectomy. Complete follow-up was achieved in 35 patients, and all patients remained free of tumor recurrence. CONCLUSIONS: The authors conclude that appendiceal carcinoids are rare and most often are asymptomatic. Tumors of less than 1 cm are adequately managed by appendectomy alone. The appropriate treatment for tumors of 1 to 2 cm continues to be controversial. Right hemicolectomy is recommended for all tumors larger than 2 cm, whereas preference for an aggressive approach should be given in young patients.     

Adenocarcinoma of the cecal appendix

The authors report one rare case of primary adenocarcinoma of the vermiform appendix. The patient, an 83 year old female, presented with a non-pathognomonic symptomatology; diagnosis was made postoperatively. Surgery consisted of appendicectomy. The patient, due to her poor general condition, died three days after surgery for cardiocirculatory complications. In the light of the very rare case published in the literature, some diagnostic, anatomic-clinical, therapeutic and prognostic aspects of this rare tumor are discussed.     

Retrograde ureteral intussusception: a rare complication

A 45-year-old man with a history of cyclophosphamide exposure underwent repeated ureteroscopy for positive urine cytology findings after resection of a Grade 2 papillary transitional-cell carcinoma of the bladder. Despite careful technique, an intussusception developed in the left ureter, which was repaired by resection and construction of a Boari flap. To our knowledge, this is the first report of retrograde ureteral intussusception caused by ureteroscopy.     

Shunt obstruction: a preventable complication?

Mechanical shunt complications account for more than half of all shunt failures. This study compares the incidence and etiology of mechanical shunt failure in a recent series of 343 pediatric patients with a flow-regulating shunt, Cordis Orbis-Sigma valve (OSV; Cordis, Miami, Fla., USA) to a previous series of 1,719 pediatric patients with standard differential pressure (DP) valves. The 1- and 5-year shunt failure probabilities were 20.1 and 23.6%, respectively, for the OSV valve and 31.1 and 49%, respectively, for the standard DP valves. The incidence of slit ventricles was 8.2% for the OSV and 33.2% for the conventional DP valve. Proximal obstruction remained the commonest cause of failure in both groups. Valve obstruction was higher (18.3 vs. 9.7%) with the OSV, although the obstructions tended to occur mostly in the early postoperative period possibly for debris introduced at the time of insertion. This review of the mechanical complications reported in this and other series suggests that despite the complexity of the interactions between variables associated with the patient, the surgeon and the shunt, mechanical complications are to a significant degree preventable. Verification will require prospective randomized clinical trials.     

Internal ophthalmoplegia: a rare complication of varicella

INTRODUCTION: Internal ophthalmoplegia complicating Chickenpox is rare. Fifteen cases have been reported so far. CLINICAL CASE: We reported a new case of this neurological complication in a 3 1/2 year old girl that 6 days after the onset of the typical rash, the right pupil was dilated and fixed to light and accommodation. Pupillary dilatation and accommodative paralysis persist after five years, but spectacle correction has restored the visual acuity.