Sub-pleural lipoma: apropos of a case]

The pyomyositis is still being a rare disease in our environment. A review of this illness is made as a result of a new case, which shows some peculiarities that differ it from others published previously: the patient showed a basic medullary carcynoma of thyroid with cerebral metastasis and the responsible germ was a Streptococcus pneumoniae. The immunodepressor factors which are presented at most patients who suffer a pyomyositis, the clinic picture so suggestive and the image methods we dispose nowadays, should serve to suspect its diagnostic in an earlier way, proceeding to its bacteriological confirmation before illness evolves to stages as advanced as in the shown case.     

Thyroid paraganglioma: report of a case

A case of thyroid gland paraganglioma is reported in a 48-year-old woman with cold thyroid nodule. Review of the literature reveals only 4 cases of intrathyroidal paraganglioma but none of them have complete immunohistochemical study. The main differential diagnosis in this localization, namely medullary carcinoma and trabecular hyalinizing adenoma, are discussed.     

Sneddon''s syndrome: apropos a case

The case of a 76 year old patient diagnosed of severe dysphagia by familiar oculopharyngeal muscular dystrophy is presented. Central venous catheterization (right internal jugular) was required for parenteral nutrition. A few minutes after catheterization, the patient developed respiratory arrest and coma and later cerebral vascular accident with left flaccid hemiplegia, with the ischemic lesion being focalized in the right parietooccipital region as well as in the left of the posterior fossa were observed. Aneurismatic dissection of the bilateral vertebral artery during lateralization of the head may be a cause of the lesions presented by the patient associated to arterial spasm or not. In central venous catheterization the possible complications derived from the position of the neck may carry must be taken into account.     

Muscular sarcoidosis: apropos of a case

We report the case of a 75-year old woman presenting sarcoid myopathy with pseudohypertrophy and skin involvement. Muscular biopsy confirmed the diagnosis of sarcoidosis. Symptomatic muscle involvement in sarcoidosis is rare. Three forms are described: myopathic, myositic and nodular. The relevance of imaging techniques is reviewed. Treatment is based on corticotherapy which is less efficient in myopathic form and in this case we had to use methotrexate with success.     

Necrotizing fasciitis: apropos of a case

Necrotizing fasciitis is an infection which involves soft tissues up to the fascia, with wide areas of necrosis, and is mainly caused by group A beta-hemolytic Streptococcus. The Authors report a case recently observed and after an accurate review of the Literature, taking into account the most recent pathogenetic knowledges, confirm the necessity of an early diagnosis based on clinical criteria but above all on histological biopsy. The treatment is mainly surgical, and allows, together with the medical treatment, to subdue the rapid progression of the infection which notwithstanding maintains an high mortality rate.     

Familial lymphohistiocytic hemophagocytosis: apropos of a case

In the second of a three-part series, the author draws further on the Sainsbury Centre for Mental Health's Acute Care In-Patient study for a critical look at life as a patient on an acute psychiatric ward.     

Multifocal bone tuberculosis: apropos of a case

OBJECTIVE: To review recent experience of gastroschisis at the Royal Children's Hospital, Melbourne. METHODOLOGY: Retrospective review of admissions over a 13 year period, June 1980-June 1993 inclusive, including an analysis of those factors influencing mortality, morbidity and complications. RESULTS: There were 49 infants, of whom two died (4%), both having an associated bowel atresia. Mode of delivery, age at operative repair, birthweight centile and silo repair had no significant effect on the duration of total parenteral nutrition (TPN) or hospital stay. The presence of short gut and/or gut resection and localized bowel narrowing or bowel atresia resulted in a significant increase in the duration of TPN and hospital stay. The presence of a central venous line was a highly significant risk factor for the development of systemic sepsis. CONCLUSION: Currently gastroschisis has a good outlook with a low mortality. Infants with short gut/resection and bowel atresia have a long duration of TPN and hospitalization, with significant morbidity and complications.     

Aspiration: a potential complication to vagus nerve stimulation

PURPOSE: Vagus nerve stimulation (VNS) is reported to reduce the frequency of seizures in children and adults without causing serious side effects. However, clinical observation of swallowing difficulties in 2 children treated with VNS made further investigation necessary. METHODS: Seven patients aged 4-18 years and treated with VNS for 6-14 months were investigated with videoradiography during barium swallow. The children performed 5-30 barium swallow investigations with the VNS device turned off, running as programmed, or set at continuous stimulations. The degree of aspiration was scored from 0 to 3. RESULTS: In 5 of 7 children, of whom reported transient swallowing difficulties, no change in the degree of aspiration was noted. The 2 children with swallowing difficulties, however. showed increased aspiration score when the stimulator was set at continuous stimulations. In 1 the score also appeared to increase with the VNS running as programmed (p > 0.05). Both children had severe mental and motor disabilities. CONCLUSIONS: Before and during VNS treatment patients should be evaluated with regard to swallowing problems. There needs to be an easy way to turn the device on and off to avoid aspirations, a hazardous and potentially life-threatening complication of VNS.     

Venous hemangioma of the mediastinum: apropos of a case

A case of mediastinal venous hemangioma is reported. It's a benign tumor rarely found in the mediastinum. In the last six years, we only know three cases reported and none of them in our country. Clinical manifestations were cough and pleuritic pain. The diagnosis was suggested by radiologic examination and was confirmed by histologic study after thoracotomy. The mass was totally removed surgically and the evolution of the patient was favorable.     

Carcinoma of Bellini's ducts: apropos of a case

OBJECTIVE: To report an additional case of collecting duct carcinoma of the kidney, known as carcinoma of Bellini. METHODS/RESULTS: A 65-year-old male patient was admitted for left renal pain. An ultrasound scan showed a solid right renal mass. The patient underwent extended radical nephrectomy. Pathological analysis of the surgical specimen disclosed carcinoma of Bellini. The patient is asymptomatic 18 months postoperatively. CONCLUSIONS: Carcinoma of Bellini is an uncommon tumor type arising from the collecting duct cells and accounts for 0.5%-2% of all renal tumors.     

Blind-ending branch of bifid ureter: apropos of a case

The Authors report on a case of blind-ending ureter. A young woman (29 years old) underwent surgery because of recurrent urinary tract infections and left loin pain. The operation consisted in a radical resection of the blind branch together with Coen's operation for the coexistence of vesicoureteral reflux. Authors' goal was to review the international Literature on this rare pathology pointing out their opinion on the existing terminology which is still far from being clear and definite.     

Dental enamel hypoplasia apropos of a case

The developmental anomalies of dental hard tissues are relatively common in children. These anomalies can involve separately the enamel and they are due to many factors acting during odontogenesis. The paper deals with the main ethological factors and describes a case of idiopathic hypercalcemia. It is normally accompanied by aortic stenosis, mental retardation and a characteristic elfin face. This is called Williams syndrome. In this case we only found enamel hypoplasia on the cusps of the first molars.     

Colchicine poisoning apropos of a pediatric case

The activity of trapidil, an antiaggregating agent with PDGF antagonist properties, was investigated in order to verify its possible modulating effect in the endothelial and platelet activation. PDGF, t-PA, PAI-1 and ET-1 plasma levels were measured before and after a 2 month treatment period with trapidil 200 mg tablets bid or placebo in 30 patients affected by POA in Fontaine stage II. PDGF and PAI-1 significantly (p < 0.05) increased in the placebo group, and PDGF also in the comparison between treatments (p < 0.05). Aggregation data demonstrate an absence of Ca++ antagonist action of trapidil. The results of this study suggest that trapidil can interfere with the combined vascular and platelet response in atherogenesis.     

Endobronchial lipoma: apropos of a case with dual localization

Endobronchial lipoma is an uncommon benign tumor. It is composed of fat tissue and is visible on CT scanner. We report an unusual case of a patient who developed two endobronchial lipomas. The first lipoma was removed 10 years earlier. We emphasize the contribution of computed tomography in the diagnosis of endobronchial lipoma. Cases of multiple lipomas are very scarce in the literature.     

Secreting retroperitoneal paraganglioma. Apropos of a case

A case of secreting, asymptomatic retroperitoneal paraganglioma is presented. Paragangliomas are rare neuroendocrine tumors and the malignant behaviour, higher than pheochromocytomas, is based on metastases or local recurrence. The treatment is complete surgical excision. Radiotherapy and chemotherapy may be used for palliation of symptoms.     

Paratesticular sarcoma: apropos of a case with a 19-year evolution

In young children with renal artery stenosis the applicability of percutaneous transluminal angioplasty is limited by the small vessel size. We report our experience in a 15-month-old girl with severe hypertension, who underwent successful balloon dilatation of a tight renal artery stenosis caused by fibromuscular dysplasia. The procedure was performed using the guided co-axial balloon catheter technique with a 6 F right coronary Judkins catheter, a 0.014" guidewire and a 2 mm coronary artery balloon dilatation catheter. Antihypertensive medication was discontinued 6 weeks after the procedure. During a follow up period of 11 months, Doppler sonography revealed no evidence of recurrent renal artery stenosis. CONCLUSION: Percutaneous transluminal angioplasty of renal artery stenosis can be performed safely in young children using equipment originally designed for treatment of coronary artery stenosis in adults.     

Thoughts apropos of a case of adenomyoepithelioma of the breast

We have observed one case of adenomyoepithelioma of the breast in a 65-years-old woman. Mammography was suspicious of malignancy. Morphological features were characteristic of this tumor. The origin of tumor cells was defined by immunohistochemical study using keratin and actin. The follow-up is not sufficient to predict the prognosis of our case.     

Objective tinnitus and velar myoclonus: apropos of a case of a child

The syndrome in which velar myoclonus is associated with objective tinnitus is rare, and in the adult corresponds most commonly with a lesion in the dentato-rubro-olivary tract. In the child, no lesion can usually be found. The disorders of function resulting from this syndrome are very disabling. Many forms of treatment have been proposed, and the results have been found to be disappointing. The authors report the case of a child in which muscle relaxants were used to very good effect, and emphasize the fact that the natural history of the condition in childhood is one of spontaneous remission, so that aggressive treatment is not appropriate.