Congenital colonic varices in the adult. Report of a case

PURPOSE: This study was conducted to report a rare cause of colonic bleeding. METHODS: Case report. CONCLUSION: Surgical resection of congenital colonic varices is associated with a low incidence of morbidity and mortality, and a favorable long-term prognosis can be expected when there is no evidence of hepatocellular disease (portal hypertension).     

Sinus node dysfunction after complete correction of tetralogy of Fallot. Report of a case

Atrioventricular conduction defects after complete correction of tetralogy of Fallot are well known and their prevalence is decreasing with improved operative techniques. On the other hand, sinus node dysfunction has not been described after this type of surgery. The authors report the case of a 24 year old patient operated at the age of 2 for a favourable form of tetralogy of Fallot. In the long-term, this patient had a minimal anatomical sequel (mild pulmonary insufficiency) and first degree AVB with complete right bundle branch block with sinus bradycardia on the surface ECG. A recent aggravation of the patient's functional status led to rhythmological investigation which showed chronotropic atrial incompetence with nodal atrioventricular delay. The patient was implanted with a permanent DDD cardiac pacemaker programmed in the DDDR mode with a good outcome. Atrial chronotropic incompetence is one of the modes of expression of sinus node dysfunction. This has not been previously described in this context. This form of sinus node dysfunction should be systematically excluded after surgical cure of tetralogy of Fallot by exercise stress testing and 24 hour Holter ECG. Symptomatic patients are greatly improved by permanent cardiac pacing with hysteresis.     

Congenital complete atrioventricular block

A new system, the Toxorhynchites-fluorescent antibody (TFA) test in which the larvae of Toxorhynchites splendens mosquitoes were used for the detection of bluetongue virus (BTV) from Culicoides midges, was developed. Twenty-seven pools of Culicoides midges were collected from bluetongue-prone areas of Tamil Nadu by use of the light-trap and suction-trap methods. A suspension of each pool was injected intrathoracically into T. splendens IV instar larvae and inoculated onto Vero cell monolayers. An indirect fluorescent antibody technique and an immunoperoxidase test were used to detect BTV antigen in smears of crushed midges, crushed larval head smears after incubation for 7 d at 28 degrees and cell monolayers showing cytopathic effects 48 h post inoculation. The suspensions were also injected intravenously into embryonated chicken eggs, and the characteristic BTV-induced lesion(s), viz. cherry-red appearance of embryos, were observed after 48 h. Virus was confirmed by a qualitative neutralization test conducted simultaneously in embryonated chicken eggs. A total of seven out of 27 samples (26%) were positive for the presence of BTV antigen in all the diagnostic systems used. Since BTV propagates readily in experimentally infected T. splendens larvae and the BTV antigen can be detected by the fluorescent antibody technique with a sensitivity comparable to that for virus propagated in tissue culture and embryonated eggs, the TFA system can be adopted as a new method for the isolation of BTV from vectors. The advantages of the TFA system are discussed.     

Congenital tuberculosis. A report of a probable case

Extensive miliary pulmonary tuberculosis in a 17-day-old infant born to a mother with pulmonary tuberculosis is described. It was assumed that the patient probably had congental tuberculosis. We report our findings to draw attention to a rare disease where a high index of suspicion, timely diagnosis and adequate management are essential if treatment is to be successful.     

Renal endometriosis. Report of a case

In the light of a personal case and a review of the literature, the authors recall the specific features of renal endometriosis. This rare lesion, with a favourable prognosis, is difficult to diagnose and is rarely diagnosed preoperatively. Medical treatment by LHRH agonists is discussed and has been used exceptionally.     

Retroperitoneal ganglioneuroma. Report of a case

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.     

Tropical pulmonary eosinophilia. Report of a case

Tropical pulmonary eosinophilia (TPE) is an unusual manifestation of filarial infection, most commonly found in South-East Asia and caused by immunologic hyperresponsiveness to Wuchereria bancrofti and Brugia malayi. This report concerns a case of TPE in a 25-year-old Indian male who had been living in Italy for two years and was admitted to hospital with chest pain. Diethylcarbamazine therapy proved effective in rapidly eliminating symptoms and pulmonary abnormalities, as well as normalizing of laboratory findings.     

Acute plasma-cell leukemia. Report of a case

A case of fatal, diffused plasmacytoma is presented. The picture also included leukaemia and is felt to be an example of plasma-cell leukaemia, as opposed to plasmacytoma in the light of the anatomical and clinical features of the onset and course: high and very pronounced plasma-cell leukocytosis, diffuse proliferation of the plasma cell series in the bone marrow, spleen and lymph nodes, infiltration of plasma cells in the parenchymal organs, extremely rapid progress with serious anaemia, haemorrhage, general organic involvement, high fever, and infection.     

Giant cell myocarditis. Report of a case

The authors report a case of giant cell myocarditis leading to rapidly progressive cardiac failure despite immuno-suppressor treatment in a 20 year old woman. The cardiac failure was successfully managed by implantation of a left ventricular assist device and then cardiac transplantation. The problems encountered underline the importance of accurate diagnosis by endomyocardial biopsy before undertaking treatment and the difficulties in the choice of appropriate method of assistance in this indication. Giant cell myocarditis is a rare cause of cardiac failure and should be considered in the differential diagnosis in view of its clinical features and risk of progression. The literature and the therapeutic implications are discussed.     

Intra-orbital dacryops. Report of a case]

Cirrhotic liver is predisposed to bacterial infections. Different species of bacteria including Escherichia coli, Enterobacter and Bacteroides fragilis were found to colonize thioacetamide-induced cirrhotic rat liver. Zinc treatment of the cirrhotic rats significantly corrected the histological and histochemical changes in the liver. However, this reversal with zinc treatment was not accompanied by any change in the bacterial colonies in the liver. The study shows that cirrhosis predisposes liver to bacterial colonization and the process is not reversible despite the partial reversal of the cirrhotic changes.     

Thoracic epidural angiolipoma. Report of a case

Angiolipomas of the spine are rare (40 cases in the literature). When they are intraspinal, these masses are epidural in more than 90% of the cases. Angiolipomas are benign tumors containing vascular and mature adipose elements. The clinical symptomatology is non specific, but computed tomography and mostly MRI provide a precise diagnosis. With one additional case and a review of the literature, we define the main characteristics of these tumors.     

Rendu-Osler-Weber disease. Report of a clinical case

Rendu-Osler-Weber disease is an hereditary disorder characterized by cutaneo-mucous telangiectasis and vascular abnormalities in several organs. Bleeding, especially epistaxis, represents the most important clinical feature. Pulmonary arteriovenous fistulae can cause hypoxaemia, haemoptysis, polycythaemia and clubbing. Diagnosis is based on family and personal history, teleangiectasis, laboratory (haemochrome, fibrinogen, PT, PTT) and instrumental findings (endoscopy and/or roentgen). Therapy depends on symptoms. Embolization of pulmonary arteriovenous fistulae and laser treatment of intestinal vascular abnormalities have been successful. Danazol treatment yielded controversial results. We report the case of a patient admitted for arterial hypertension and recurrent epistaxis. Rendu-Osler-Weber disease diagnosis was made based on positivity at family and personal history, clinical examination, laboratory and instrumental findings. In conclusion we underline the pivotal role of anamnesis and clinical examination in the differential diagnosis of hereditary bleeding disorders and emphasize the importance of early diagnosis for the correct therapeutic approach.     

Essential iris atrophy. Report of a case

The clinicopathologic findings in an eye from a 40-year-old man with essential iris atrophy are reported. Noteworthy is the proliferation of corneal endothelium and a laying down of a new Descemet (cuticular) membrane over the trabecular meshwork and in areas of anterior peripheral synechiae formation over the pseudoangle. The histologic characteristics favor a vascular cause for the condition, but the evidence is circumstantial.