A case of adenocarcinoma arising in the vesical diverticulum

A 70-year-old woman presented at our hospital with the chief complaint of gross hematuria and pain on urination. Cystoscopy revealed a broad-based tumor covered with mucus on the right wall of the bladder and therefore a transurethral resection was performed. At surgery the tumor was found to arise from the diverticulum and could not be resected because of the risk of perforation. A histopathological examination disclosed adenocarcinoma including a small region of signet ring cell carcinoma. The tumor was thus diagnosed to be adenocarcinoma originating from the vesical diverticulum and total cystectomy and urinary diversion (ileal conduit) were scheduled. At operation, the carcinoma was found to have infiltrated into the cecum. The operation procedure was therefore changed to partial cystectomy and excision of the cecum in consideration of both the patient's quality of life and her overall prognosis. Although a tumor originating from the vesical diverticulum and adenocarcinoma are both considered to be factors indicating a poor prognosis, no signs of recurrence or metastasis have been detected in this patient at 26 months after the operation.     

A rare case of a perforated diverticulum of the cecum

A rare case of peritonitis by cecal perforated diverticulum which was diagnosed after surgery by histology is reported. Preoperative diagnosis is often ignored and, in rare cases, is not always clear at laparotomy. Clinical aspects, diagnostic procedures, histological picture and surgical treatment are described. In the literature diverticula are classified as "solitary" and "multiple", "congenital" and "acquired", "true" and "false" and finally "usual type" and "hidden variant". The treatment of cecal acute diverticulitis is, in the majority of patients, surgery. Simple resection of the diverticulum and suture of the breach in double layer is the elective operation of non-complicated diverticulum or with an inflamed projection from the cecal wall ("usual type"). Segmental resection of colon or "right hemicolectomy" is recommended when a precise diagnosis is not possible and in complicated diverticula ("hidden variant"). On the basis of personal experience it is underlined that diagnosis is rarely made preoperatively since the clinical picture suggests an acute appendicitis. If there are some doubts for appendicitis, a incidental tumor or possible perforated diverticulum of the cecum should be considered and urgent surgery is mandatory.     

A case of a urachal fistula

The authors report a case of urachal fistula diagnosed after repeated omphalitis, this disease was associated with coronal hypospadias. Diagnosis was done thanks to a fistulography; subsequently, during the operation, to evidence the fistula, this was injected with methylene blue, this expedient showed that the fistula was longer than that disclosed from fistulography. To carry out a complete extirpation of the fistula the authors were bound to make a cystotomy. The course after operation was good and the patient discharged after a few days. After 5 years the patient is in perfect health. This case allowed some anatomic, clinical and semeiotic considerations.     

A case of anastomotic aneurysm-enteric fistula

Reimplantation failure of avulsed anterior teeth in an adolescent patient requires removal of the attempted-reimplanted teeth and consideration of several restorative options. These options may include a removable partial denture, as well as a transitional bridge or permanent fixed prosthesis. In all cases, the potential effects of the adolescent's expected amount and directions of maxillary and mandibular growth must be considered. A case is presented examining how maxillary growth may affect the restorative treatment options for avulsed anterior teeth replacement for an adolescent boy. Unfortunately, the patient and family were unable to complete treatment due to financial considerations. Consequently, the case presented here is submitted as a treatment planning exercise.     

Unilateral compartment syndrome after prolonged gynecologic surgery in the dorsal lithotomy position. A case report

We describe the onset of the compartment syndrome after gynecologic surgery in the dorsal lithotomy position for neovaginal reconstruction with a fasciocutaneous flap.     

Gallbladder diverticulum: a case report and review of the literature

BACKGROUND: The clinical significance of the 14 and 6 positive spikes (PS) electroencephalographic (EEG) phenomenon is not well established. This study was performed to provide further data regarding the clinical correlates of the PS, particularly attention-deficit/hyperactivity and somatic symptoms. METHODS: Diagnostic information gathered through structured interviews was compared among four groups of psychiatric inpatients aged 4-17 years who underwent an EEG examination over a 2-year period. Groups consisted of patients with: 1) 14 and 6 PS (n = 25); 2) epileptic discharges (n = 29); 3) slow-wave abnormalities (n = 23); and 4) a normal EEG group age and sex matched to the 14 and 6 PS group (n = 25). RESULTS: Attention-deficit hyperactivity disorder (ADHD) symptoms were significantly more frequent in the PS group (chi 2 = 2.96, p < .05) compared to the other three groups combined. Although somatic symptoms were not increased in the 14 and 6 PS group, anxiety symptoms tended to occur more in this group (chi 2 = 3.50, p < .06). CONCLUSIONS: The PS profile appears associated with ADHD symptoms. Possible treatment implications of this finding (e.g., use of anticonvulsants in ADHD patients with PS) need to be explored.     

A rare case of a preauricular fistula

A female patient with a preotic fistula caused by a defect in the development of the first branchial arch is described. Repeated surgeries for lateral fistula of the neck brought no success. The pathogenesis of the defect and difficulties in its diagnosis are discussed; the authors claim that fistulography with contrast agents may be effective. Histologic verification is needed in all the cases.     

A retroperitoneal abscess with cutaneous fistula developed after stercoral fistula operation: a case report

Sparing treatment of chronic purulent sinusitis in children is an urgent problem of rhinology. Usage of preparations of donor (parental, of the same group) autoleukomass and blood plasm which possess all the components of humoral and cellular immunity proved highly effective against chronic purulent sinusitis in children. The drawback of this method is the necessity of regular lavage of the sinuses after insertion of the leukomass and heparinized plasm. The use of donor serum (parental, of the same group) also produced a good effect in purulent sinusitis. The serum advantage over the leukomass or plasm is that it can be left in the sinuses until the next procedure.     

Nephrolithiasis due to primary hyperparathyroidism and enteric hyperoxaluria: a case report

Enteric hyperoxaluria and primary hyperparathyroidism have been associated with the development of nephrolithiasis. We report a case involving a patient who had hyperparathyroidism due to a parathyroid adenoma and enteric hyperoxaluria resulting from a small bowel bypass and who had severe stone-related complications. This combination of stone-generating factors has heretofore not been reported. The pathophysiology of these entities is discussed.     

Giant colonic diverticulum: presentation of one case and review of the literature

Since the first case described in 1946, fewer than 100 cases of giant colonic diverticula have been reported in the literature. We discuss the clinical, radiologic, and pathologic findings in a case of giant colonic diverticulum and review the etiology and differential diagnosis.     

Iatrogenic perforation of perivaterian duodenal diverticulum: report of a case

The author reports a case of iatrogenic perforation of a duodenal diverticulum, an extremely rare occurrence, during percutaneous radiologic extraction of a retained common-bile-duct-stone. Perforation was related to the perivaterian location of the duodenal diverticulum. Because an inflammatory reactions was present, tube duodenostomy was chosen over excision, closure and drainage to prevent the complication of lateral duodenal fistula and sepsis. Whenever iatrogenic duodenal perforation is suspected, prompt radiologic documentation and early surgical consultation should be sought.     

A specific deficit of dorsal stream function in Williams' syndrome

Williams' syndrome (WS) is a rare, genetically based disorder of cognitive development. Affected individuals show a severe deficit of spatial cognition but a relative sparing of language and face recognition. To examine the possible neural basis of the spatial deficit, we tested a group of WS children, aged 4-14 years, on two measures specific to dorsal cortical stream function: global motion coherence thresholds, in comparison with an analogous form-coherence test, and visuo-manual accuracy in posting a card through a slot, compared with matching the slot orientation. Deficits in these tasks provide the first evidence of specific involvement in WS of the dorsal stream, the cortical system believed to encode information about spatial relationships and the visual control of action.     

Aortoventricular fistula secondary to blunt trauma: a case report and review of the literature

An aorto-right ventricular fistula secondary to nonpenetrating trauma is described. Review of the literature is reported. Ascending aortic injuries present as either traumatic pseudoaneurysms or, less commonly, as aortocardiac fistulas. Blunt cardiac injury is a frequent concomitant injury and contributes to the high mortality of this lesion. Prompt surgical intervention is required for survival.     

Synchronicity of nociceptive and non-nociceptive adjacent neurons in the spinal dorsal horn of the rat: stimulus-induced plasticity

Current knowledge of spinal processing of sensory information is largely based on single-cell recordings; however, temporal correlation of multiple cell discharges may play an important role in sensory encoding, and single electrode recordings of several neurons may provide insights into the functions of a neuronal network. The technique was applied to the lumbar spinal dorsal horn of pentobarbital-anaesthetized rats during background activity, steady-state noxious heat stimulation (48 degrees C, 100 s), cold block spinalization or radiant heat-induced inflammation of the skin, and the recordings were evaluated by means of auto-correlation, autospectral and cross-correlation analysis. Background patterns obtained by these three methods were extremely stable in time. Autocorrelation with short lag peaks was observed in 72.2% of neurons (n = 223). Background correlated discharges were found in 83.6% of the neuron pairs (n = 134). Cross-correlation with a central peak, suggestive of common input to the recorded cells, was the most common pattern observed in almost all laminae and was associated with high incidence (91.8%) of overlapping receptive fields and with neurons with initial peak autocorrelation pattern. Cross-correlations with central trough were associated with increase autocorrelation patterns. Bilateral peaks in cross-correlation, suggestive of reverberating circuitry, were observed only for pairs of neurons located in laminae IV and V and were associated with rhythmic discharges in one or in both simultaneously-recorded neurons. Lagged peaks or troughs were observed in 4.6% and 2.2% of neuronal pairs, respectively. Long-lasting skin heating induced qualitative changes (pattern changes) in the cross-correlation of 21.6% of the neuron pairs and quantitative changes in 85.7% of them. During skin inflammation qualitative changes in the cross-correlation pattern were observed in 30.8% of the neuron pairs, and quantitative changes (strength and/or synchronization time) in about 57.7% of them. Spinalization induced quantitative changes in cross-correlation in the vast majority of neuron pairs. The results of the present study suggest that discharges of neighbouring spinal dorsal horn neurons are strongly synchronized probably by propriospinal and primary afferent sources. The existence of functional reverberating circuitry was also evidenced. Finally, the functional synchronicity in the spinal dorsal horn presents stimulus-induced plasticity which consists mainly of changes on the strength and/or time of the synchronization and rarely of activation of new connectivities.     

Hemoptysis due to aortopulmonary fistula: a case report of successful surgical treatment

A 76-year-old man was admitted for recurrent hemoptysis of 3 weeks' duration. Chest X-ray revealed lung emphysema, but no findings of thoracic aortic aneurysm. The patient's physician attributed to bronchoectasia, and he underwent angiography for the purpose of embolization of bronchial arteries. Angiography showed a small saccular thoracic descending aortic aneurysm and an aortopulmonary fistula. So aneurysmectomy and patch angioplasty was done under partial cardiopulmonary bypass. Lobectomy or wedge pulmonary resection was not necessary. His postoperative course was uneventful. In case of the patients with hemoptysis, the possibility of aortopulmonary fistula should be considered, and computed tomography or aortography should be done to rule out other pulmonary diseases.     

Subclavian arterio-esophageal fistula secondary to fish bone impaction: report of a case

A 48-year-old Indian man swallowed a fish bone and presented 1 week later with dysphagia, following a single episode of fresh hematemesis. A barium swallow demonstrated a horizontal mucosal tear at the level of the aortic arch, and computed tomography (CT) showed mediastinal emphysema and a bleeding point medial to the left subclavian artery which appeared to be contained by a surrounding hematoma. Subsequently, he developed sudden massive hematemesis and collapsed. Despite emergency surgery, the patient died. At the postmortem examination, a 1.2-cm fistula tract was found connecting the esophagus to the left subclavian artery. This case report emphasizes that a diagnosis of arterio-esophageal fistula should be considered if a patient presents with fresh hematemesis and a recent history of foreign body ingestion.     

A case of syndrome X

Type 2 diabetes is increasing in prevalence and is predominantly managed in general practice. This series contains case histories which deal with some of the metabolic problems that may be encountered in the management of these patients and indicates some of the many issues, other than glycaemic control, that need to be considered.