Two cases of synchronous multiple thymoma

We report two cases of synchronous double primary thymoma without myasthenia gravis. These cases suggest the possibility of multicentric thymoma and confirm the validity of a complete thymectomy.     

Two cases of adult Still''s disease with atypical rash

Previous studies on baseline pulmonary function testing (PFT) abnormalities in patients with inflammatory bowel disease (IBD) are conflicting because most of them have incorporated patients suffering from both ulcerative colitis (UC) and Crohn's disease (CD). The aim of the study is to investigate whether any PFT abnormalities could be detected in a large group of IBD patients and whether there are differences between the two IBD entities. A total of 132 patients, 47 with CD (mean age 35 years) and 85 with UC (mean age 40 years) were studied. Pulmonary function tests (PFTs), lung transfer factor for carbon monoxide (TLCO) were examined and compared with those of 36 healthy controls. No significant difference of mean values of spirometric indices, TLCO and ABG was found between the two groups of patients and controls, or between patients with CD and UC. However, nine (19%) patients with CD and 15 (17.6%) with UC had a reduction in TLCO, a percentage significantly higher than in controls (P < 0.05). The majority of the patients with TLCO reduction were in an active phase of disease (P < 0.05). Our results suggest that there is no difference in routine PFTs between UC and CD patients, as well as between both these groups and normal controls. However, TLCO abnormalities related to the degree of disease activity are found in patients with both UC and CD.     

Malignant thymoma: a review of 44 cases

Trisomy 12 is a frequent abnormality in chronic lymphocytic leukaemia (CLL). The biological importance of trisomy 12 is still poorly understood but it has been suggested that one or several genes are duplicated leading to malignant transformation. We present a case with amplification of 12q13-22 found in a clinically aggressive relapse of CLL. A smaller region, 12q13-15, was amplified most frequently and a YAC containing the MDM2 gene gave the highest number of signals. Additionally, in a subclone an amplicon containing at least 5 copies of a cosmid from 12q23-24 was detected. The case shows that small duplications of chromosome 12, not revealed by cytogenetic analysis, may occur in CLL. Also, it shows that cytogenetic clonal evolution can occur in CLL without morphological evidence of blast transformation. Our results indicate that the 12q13-15 region carries an important gene for CLL progression.     

Cytomegalovirus-related sequence in an atypical cytopathic virus repeatedly isolated from a patient with chronic fatigue syndrome

An atypical virus, cytopathic for human and animal fibroblasts, was repeatedly cultured from a patient with chronic fatigue syndrome. Viral particles, suggestive of cytomegalovirus (CMV) were seen by electron microscopy. Infected cells did not, however, stain with antisera specific for CMV, herpes, simplex virus, or human herpes-virus-6. Polymerase chain reaction (PCR) assays for these viruses were also negative. Two distinct products of approximately 1.5 kilobase pairs were amplified from virally infected cells using the human T lymphotropic virus-II tax gene reactive primer, SK44, in low stringency PCR. Sequencing of one of the amplified products showed a region of highly significant partial homology with the UL34 gene of CMV. The sequence of the other PCR product did not correspond with CMV or any other virus. DNA was extracted from the material pelleted by ultracentrifugation of filtered culture supernatants. It migrated in agarose gels as a single band of approximately 20 kpb. The banded DNA was digested with EcoRI and cloned. A 2.2 kbp plasmid containing the CMV-related sequence identified within the PCR product was recovered. Sequencing of this plasmid extended the region of partial sequence homology with CMV to include a portion of the UL35 gene of CMV. Initial sequencing of additional plasmids has confirmed the partial relatedness to CMV. The data indicate a novel type of CMV-related "stealth" virus that is able to establish a clinically persistent human infection.     

Removal of a thymoma via median sternotomy in a rabbit with recurrent appendicular neurofibrosarcoma

A 9-year-old rabbit was evaluated for a mass on the right elbow. As a result of preoperative radiography, another mass was identified in the cranial portion of the mediastinum. Ultrasound guided fine needle aspiration was used for cytologic evaluation of the mass in the mediastinum and resulted in a presumptive diagnosis of thymoma. A median sternotomy approach was chosen to allow wide exposure for meticulous dissection in the cranial portion of the thoracic region. Histologic examination and immunoperoxidase labeling of lymphocytes with CD3 (a T cell marker) confirmed the diagnosis. The mass on the right elbow was subsequently removed and identified as a neurofibrosarcoma. Multiple appendicular masses that developed at separate locations and distinct times were excised and classified as locally invasive primary neurofibrosarcomas. Postmortem examination 9 months after initial evaluation confirmed recurrence of the neurofibrosarcoma at previous surgical sites. Gross or histologic evidence of thymoma was not evident. Prognosis is dismal for incompletely excised soft tissue sarcomas, because they are locally invasive and often recur.     

Brodie's syndrome. A report of 2 atypical cases

The aim of the authors is to show the treatment of Brodie's syndrome even in atypical cases where this pathology can not offer typical signs but can be associated to other skeletal deformities of the face. There are two atypical cases of Brodie's syndrome both of them came to our out patient's department. They were grown-up (one 20 one 22 years old), one of them with an extreme vertical expansion of lower third of the face and with a big transverse expansion of the upper maxillary bone, all typical signs of Brodie's syndrome; the other patient was with an extreme transverse expansion of the upper maxilla associated to a II class and a defect of 11, 12, 21, 22. The first patient was treated with orthodontic Tweed technique continued with surgical operation setting out to the contraction of the transverse diameter of the upper maxilla, associated to a Le Fort I osteotomy and an Epker osteotomy of the jaw. This orthodontic-surgical correction, allowed us to achieve a good aesthetic and functional result. The second patient was treated with orthodontics followed by surgical correction of the excessive transverse expansion of the upper maxilla after a Le Fort I osteotomy; a sagittal split of the jaw on Gotte technique was performed to correct the III class. We gave the patient a good aesthetic result with the restoration of the lost teeth in the upper maxilla, reaching in this way a good aesthetic and a well functioning result. We think it's possible to treat patients with atypical Brodie's syndrome with orthodontics or surgery in the same way we treat Brodie's syndrome and other deformities of the face reaching good aesthetic-functional results.     

Two cases of scimitar variant

The scimitar sign is characteristic of partial anomalous pulmonary venous drainage into the inferior vena cava (IVC). We encountered two variant cases of scimitar sign. In one case, the scimitar vein entered both the IVC and the left atrium (LA) without any intracardiac shunts. Surgical repair was made by simple ligation of the scimitar vein to correct the left to right shunt. Retrograde balloon occlusion angiography of the scimitar vein was diagnostic. In the other case, the scimitar vein showed a meandering course, and then drained into the LA without any connection with the IVC, and surgical intervention was not required.     

Two cases of intrapulmonary teratoma

We encountered two unusual cases of intrapulmonary teratoma, one in a 31-year-old female and the other in a 15-year-old female. The chief complaint of both patients was fever, and in both a consolidation was detected in the left upper lobe using routine radiography. We performed left upper lobectomy for the former patient and segmentectomy of the left lingual segment for the latter. Neither tumor communicated with the mediastinum. Histological examination revealed a pulmonary teratoma containing no thymic tissue in both. Intrapulmonary teratoma has been reported to be extremely rare, and only 27 cases including these two have been reported in the literature.     

Two cases of adrenal myelolipoma

The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.     

Two cases of Morgagni's hernia

Two cases of Morgagni's hernia comprising protrusion of the omentum alone are reported. The treated patients were 65- and 63-year-old obese women. They were referred to our hospital because of chest pain or vomiting accompanied by abnormal shadow in right cardiophrenic angle on chest roentgenogram. Computed tomogram (CT) demonstrated a mass of fat density behind the sternum for the both patients. The first patient was diagnosed as Morgagni's hernia by pneumoperitoneum, and surgical repair was done by the transabdominal approach. Magnetic resonance imaging (MRI) was carried out for the second patient, and showed intrathoracic mass lesion which was continuous with the subphrenic tissue. Although the second patient was diagnosed as mediastinal lipoma, median sternotomy revealed that the mass lesion was Morgagni's hernia. Postoperatively, both patients recovered uneventfully. The Morgagni's hernia has been reported to be about 3% of all diaphragmatic hernia. This disease may be discovered either because it causes respiratory or gastrointestinal complaints, or because an abnormal shadow in right cardiophrenic angle on a chest roentgenogram. If air-filled structures are present in the hernia, a barium study will confirm the diagnosis. In a case with a hernia containing only omentum, the diagnosis is difficult. CT has been regarded as the procedure of choice by several authors. The coronal and sagittal views of MRI can demonstrate the relationship between the herniated structures and the diaphragm, heart, pericardium. We emphasize the role of MRI for the diagnosis of Morgagni's hernia.     

Two cases of Swyer-James syndrome

Case 1: 55-year-old male was admitted to our hospital for further examination of increased transparency of X-ray in the left lower lung. He had history of pneumonia in his childhood. Left bronchography revealed mild cylindrical bronchi-ectasia in the proximal bronchi but poor filling by contrast in the peripheral bronchi. Case 2: 61-year-old male was referred to our hospital with palpitation and dyspnea. Chest X-ray film revealed hyperlucency of the left lower lung. The ventilation scan showed a marked decrease in ventilation to the left lung and air trapping was present in the left lung. The perfusion scan showed a matched decrease in blood supply to the left lung. In both cases, pulmonary arteriogram showed narrowed and withered-tree-like left pulmonary arteries. From these clinical findings, we diagnosed these two cases as Swyer-James syndrome. We are reporting two cases of Swyer-James syndrome and describing the clinical feature, differential diagnosis and etiology of the syndrome.     

Two cases of spontaneous hemopeumothorax

We experienced two cases of spontaneous hemopeumothorax. One case was a 17-year-old male with a complaint of back pain. A chest tube for rapid pleural evacuation disclosed hemorrhage as much as 3,000 ml, with drainage volume being gradually decreased. He needed about two month's admission because of complication of pyothorax. The other case was a 46-year-old male with a complaint of chest pain. Chest X-P gave the diagnosis of right hemopeumothorax. Thirty minutes later, he became shock, and five hours later, we performed an emergency intervention of video-assisted thoracoscopic surgery (VATS). Bleeding site of a funicular structure from the parietal pleura was stopped by clipping, with excellent postoperative results. Spontaneous hemopeumothorax is often indicated for early surgical intervention because of association with a high risk of hemorrhagic shock. In such a case, VATS is very helpful.     

Two cases of accidental hypothermia

We report two cases of accidental and moderate hypothermia in drug/addict subjects who came to our attention in coma, shock and respiratory distress, metabolic acidosis and characteristic ECG alterations. We used the methods of minimal invasivity to rewarm them, with good results. The two cases had a different clinical course: the first one presented some important cardiac and respiratory problems, that required 30 days of permanence in our ICU, while the second one had a quick resolution. We believe that the critical time for arrhythmias goes beyond the hypothermic period.     

Pulmonary hamartoma: atypical cases and current concept of management

Twenty seven cases of surgically excised pulmonary hamartomas were reviewed. Patient's ages varied from twenty eight year-old to seventy seven year-old with an average of fifty three year-old. Of twenty seven cases, seventeen cases were man, seventeen cases has mass on right lung, and twenty six cases has solitary mass. While twenty five cases were asymptomatic, one case had cough, and the other cases had a history of hemoptysis (Case 3). Medical treatment for pulmonary tuberculosis had been continued unless the confirmed diagnosis on two cases. On one case followed as tuberculosis for twelve years, size of tumor shadow grew to two times bigger on chest X-ray films (Case 1). One of 27 cases showed multiple mass (Case 2). Histopathologically, twenty six cases were chondromatous hamartoma, and one case was non-chondromatous hamartoma. Pulmonary hamartoma is a benign tumor, and majority of cases are asymptomatic and not growing. On cases with presumed pulmonary hamartoma, less invasive thoracoscopic surgery seemed valuable for both therapeutic and diagnostic purpose to avoid continuous non-rational treatment and mental pressure of patient by prolonged follow up with unconfirmed diagnosis since complete differentiation from malignant neoplasm should not satisfactory on many cases.     

Tick-borne recurrent fever. Description of 5 cases

The effect of sodium and potassium ions on intracellular acid production and acid excretion by glycolyzing cells of Streptococcus mutans was examined. S. mutans NCTC 10449 grown under glucose-limited and strictly anaerobic conditions in a continuous culture system was loaded with bis(carboxyethyl)-carboxyfluorescein, a pH-sensitive fluorescent dye, washed and suspended in 0.00-0.30 M NaCl/KCl solution. The dye allowed for the continuous monitoring of intracellular pH while proton excretion was measured simultaneously with a pH-stat. Sodium ions inhibited and potassium ions, at low pH, accelerated the amount of measurable acid excreted extracellularly. In the presence of both NaCl and KCl, proton excretion following the addition of glucose was slightly higher or similar to that observed in the presence of 0.15 M KCl alone. Sodium and potassium ions did not affect the proton-ATPase enzyme or the intracellular level of ATP, suggesting that these ions did not directly effect proton pumping activity itself. The inhibition of proton excretion by sodium ions was considered to have probably occurred as a result of an indirect inhibition of proton-ATPase activity by the low intracellular pH induced by sodium ions.     

Two unusual cases of intra-atrial gap

Two cases are described in which, during investigation of rhythm disturbances, it was shown that, by delivering atrial stimuli of increasing prematurity, a point was reached where the artificial stimulus failed to induce an atrial response. However, with even more premature stimulations, atrial responses were again observed. These observations are best explained by a gap phenomenon in which very early stimuli delivered during the effective refractory period of the atria were delayed long enough in the exit area around the pacing electrode to allow atrial recovery.