Outcome of nonspecific right iliac fossa pain syndromes

One-third of all cases of abdominal pain and a quarter of cases of right iliac fossa pain urgently admitted to hospital leave hospital with no precise diagnosis. Based on a series of 400 patients hospitalised for right iliac fossa pain, comprising 107 cases with no identified aetiology, this prospective study was designed to assess the medium-term outcome of these patients, with or without surgical exploration. 67 cases were reviewed at five years. No major diagnosis was missed. Over this 5-year period, 30 patients (45%) experienced another episode of abdominal pain. Among the third of patients (21 cases, 31%) reviewed for another episode of right iliac fossa pain, 7 were readmitted to hospital, with 5 operations, for histologically confirmed acute appendicitis in 3 cases (5% of the series). The patient and his attending physician must be informed of the nonspecific diagnosis established during the first hospitalisation. There is no significant evidence to suggest a psychological component in the recurrent nature of the pain. Cancer must be formally excluded in patients over the age of 50. When surgical exploration is performed, nowadays by laparoscopy, appendicectomy is recommended. This procedure does not decrease the risk of recurrent pain, but confirms the real absence of histopathological abnormality and decreases the number of subsequent hospitalisations.     

Spontaneous rupture of right iliac arterial aneurysm into ureter

Severe hypoxia unresponsive to maximum ventilatory support occurs both in idiopathic respiratory distress syndrome and meconium aspiration. We recently encountered a 980 g female infant with respiratory distress syndrome and 3 300 g female infant with meconium aspiration and persistant fetal circulation whose clinical course necessitated the use of tolazoline and dopamine to reduce pulmonary and to stabilize systemic pressures. The infant with respiratory distress syndrome responded with a PaO2 increase of 2.7 kPa while the infant with persistant fetal circulation and meconium aspiration showed a 51.6 kPa rise. Combined pharmacologic therapy may have a role in improving oxygenation status in severely hypoxemic infants receiving maximum support.     

Persistence of right umbilical vein--a rare vascular abnormality of the umbilical cord

We report on a persistent V. umbilicalis dextra as an extrem rare anomaly of the vessels of the umbilical cord and its embryological base. The compression of this umbilical cord was responsible for the emergence of abnormal QRS-complexes in the fetal electrocardiogram according to typus 2 by Larks. To detect these anomalies of vessels should be investigated on princip every umbilical cord.     

Mass in the infratemporal fossa

The effects of glutamate (Glu) and ATP on interleukin-6 (IL-6) production from cultured neonatal rat astrocyte were studied. Glu (100-200 mumol.L-1) strongly increased, IL-6 production at 16 h in a dose-dependent manner and ATP (50-100 mumol.L-1) induced a inhibition effect. The results suggest that Glu stimulted IL-6 release may be one of mechanisms of astrocyte "neuroprotective" function in ischmia/reperfusion.     

A case of the active intestinal tuberculosis detected during the examination of the right pleural effusion

A 76-year-old female was admitted to our hospital because of fever and the right pleural effusion. On the analysis of pleural effusion, the total cell count was 6720/microliter with 95% lymphocytes, and ADA was 38.1 U/l. The culture of pleural effusion was negative, and the smear and PCR for Mycobacterium were also negative. For examinations, we performed eterography that showed cicatricial strictures of intestine. X-ray examination of the colonated colonoscopy showed ulcers (circular type), shortening of the colon, Bauhin's value insufficiency and diverticulum-like deformity. Then, she was diagnosed as intestinal tuberculosis. The smear and PCR of biopsy specimens from the lesion were positive, and antituberculotic therapy was effective. Finally, the culture of pleural effusion for Mycobacterium tuberculosis was positive after 8 weeks. We thought intestinal examination may be useful for the diagnosis of tuberculosis, when lymphocyte-rich exudative pleural effusion of unknown etiology is seen.     

Sonography of patellar abnormalities in children

OBJECTIVE: We describe our experience using sonography to evaluate the patella and patellofemoral joint in three children with congenital abnormalities of the extensor mechanism of the lower extremity. CONCLUSION: Sonography can be used to evaluate the extensor mechanism and unossified patella in young children. Advantages of sonography over MR imaging are no need for sedation, speed of examination and ability to compare with the contralateral knee, low cost, and the sonographer's ability to dynamically evaluate the extensor mechanism.     

Sonography in early pregnancy failure

Early pregnancy can be best divided into embryonic and fetal periods (dividing line 70 days after last menstrual period), which more naturally reflect developmental changes, morphologic appearance, loss rates, and concerns about teratogens. Newer endovaginal probes and a better understanding of anatomic landmarks and expected growth rates can improve clinical management and patient counseling.     

Sonography of the kidneys and urinary tract in infancy

Sonography is the imaging method of choice in all diseases of the kidneys and urinary tract in infancy. The most important indications are all malformation syndromes, especially malformations of the urinary tract, urinary tract infections, space occupying lesions of the kidney, renal insufficiency, hematuria, arterial hypertension, abdominal pain and inherited kidney diseases.     

Sonography of the knee in normal and abused infants

Histometric evaluations as a function of time were performed with zirconium implants during the healing period in 10 Wistar rats. The implants (7 mm x 1 mm x 0.1 mm) were placed in the right tibia of the animals. Five rats were killed after 14 days and the remainder were sacrificed 30 days after implantation. The tibiae were resected, radiographed, and embedded in poly(methyl methacrylate). Three cross-sections were obtained transverse to the major axis of each tibia. Osseointegrated tissue thickness, percentage of direct bone-to-implant contact, and osseointegrated tissue volume were evaluated for each specimen. Bone formation was observed on the surface of the implanted strip that was in contact with tibia marrow. This method is proposed for the evaluation of the first stage of healing of bone in contact with different implant materials subjected to various surface treatment.     

Mental disorders in meningiomas of the olfactory fossa

In 19 patients with meningiomas of the olfactory fossa the author established a certain development of the psychopathological symptomatology. First of all asthenia ensues, eventually a complacent mood with an underestimation of the severity of the disease and an emotional crudeness is seen. These disorders are gradually substituted by euphoric dementia with a tendency towards foolish jokes, anosognosia of the disease, severe intellectual disorders and a desintegration of the "personality nuclei" with desinhibited drives. The intellectual disorders are expressed not in formal disturbances (logic operations), but in insufficient goal-directness and uncritical thinking.     

Epidural hematomas in the posterior cranial fossa

A review of 89 cases of posterior fossa epidural hematoma (PFEDH) is presented. The mortality rate was 17.9%. In 44 cases (49.4%) there were associated intracranial hematomas. In 30 cases the hematoma was localized within the boundary of the foramen magnum and the transverse and sigmoid sinuses ("pure" PFEDH). In 59 cases the hematoma extended beyond the sinuses to the occipital area ("mixed" PFEDH). In the pure PFEDHs, the bleeder could be identified in only six cases and in five cases the source was a bleeding transverse sinus. The bleeders disclosed in the mixed PFEDHs were a torn transverse sinus in 28 cases, a meningeal artery in three cases, and a bony fracture in three cases. The possibility of a PFEDH should be kept in mind when evaluating patients who have suffered an occipital blow resulting in a frontal or temporal hematoma. In our series, patients with the pure PFEDHs with no associated intracranial hematomas had the best prognoses. Nine patients developed a PFEDH after surgery for a supratentorial hematoma. In 14 cases the PFEDH was treated at the subacute or chronic stage. All but one patient survived with a good recovery. Children generally had better prognoses.     

A reconsideration of the ischiorectal fossa

The ischiorectal fossae of one fresh and 47 preserved cadaver specimens were dissected to elucidate its fascial boundaries, neurovascular relationships, spatial orientation, and possible functions. Based upon measurements of approximately half of the dissected specimens, a three-dimensional model of the ischiorectal fossa was developed to clarify visually its fascial relationships and orientation within the perineum. Seven fetal specimens were also dissected for comparative purposes. A distinct fascial septum, the lamina terminalis, connecting the medial and lateral walls of the fossa to form its anterior boundary, was consistently found as a dense fibrous component attaching inferiorly to the posterior aspect of the urogenital diaphragm. The functional significance of the ischiorectal fossa in supporting the urogenital diaphragm, in anal activities, and in sparing the compression of the neurovascular supply to the perineum is discussed.     

Urothelial carcinoma of the navicular fossa

We report a case of transitional cell carcinoma arising in the fossa navicularis. The patient was a 74-year-old man. He had no history of sexually transmitted disease or urethral stricture. Clinically, the tumor was suspected to be a condyloma acuminatum; however, the pathological diagnosis yielded an unexpected result: transitional cell carcinoma. Radiological examinations and cystoscopy showed no other tumor besides the primary cancer in the fossa navicularis. Partial resection of the urethra was performed and the patient has been without evidence of disease for 3 years.     

Sonography of malignant pleural effusion

Two hundred and ten patients with exudative pleural effusion were studied by ultrasound for sonographic signs of pleural carcinomatosis. Images were evaluated for echoes within the fluid, septations, sheet-like or nodular pleural masses, and associated lesions of the lung. Our results showed that sonographic findings of echogenic or septated fluid were unspecific for malignancy. Only the evidence of pleural masses was characteristic of malignant effusion. Ultrasound of the chest should therefore be carried out before invasive diagnostic procedures are planned.