Subcapsular hematoma as a complication of acute pyelonephritis: a case report

A case of subcapsular hematoma, a rare complication of acute pyelonephritis (APN) is described. A 60-year-old diabetic woman was admitted with a 3 day history of fever and left flank pain due to acute pyelonephritis. On the third day in hospital, left flank pain worsened despite use of antibiotics available for the treatments of APN and hemoglobin rapidly decreased from 11.1 to 7.9 g/dL. Ultrasonography and abdominal CT showed left subcapsular hematoma. Renal angiography demonstrated an ovoid avascular zone between the capsular artery and parenchyme of the left kidney with no evidence of tumors or vascular abnormalities, such as arteriovenous malformation or fistula. Subsequent percutaneous drainage of this subcapsular hematoma was performed and showed old blood-colored drainage. Hereby, the possibility of subcapsular renal hematoma in the course of acute pyelonephritis is stressed as a rare complication.     

Transdiscal lumbar sympathetic block: a new technique for a chemical sympathectomy

Genitofemoral neuritis, which occurs when the neurolytic solution spreads into the psoas muscle, is the most common complication after neurolytic lumbar sympathetic block. We developed a transdiscal approach for neurolytic lumbar sympathetic block to reduce the danger of genitofemoral neuritis by making a sympathectomy without penetration of the psoas muscle, through which the genitofemoral nerve passes. We attempted transdiscal lumbar sympathetic block in 14 patients for whom the last previous lumbar sympathetic block performed by using the conventional paravertebral method was unsuccessful. Under fluoroscopic guidance, the needle was inserted transdiscally at L2-3 and/or L3-4 and was advanced until its tip pierced the anterior longitudinal ligament. Radiography and computed tomography revealed that the injected contrast media spread along the anterolateral surface of the vertebral column without any flow into the psoas muscle. Alcohol was injected successfully in all patients. During the 1-mo follow-up period, no patients had any symptom of genitofemoral neuritis. Thirteen patients who had been suffering from lower extremity pain achieved partial or complete pain relief. One patient with plantar hyperhidrosis achieved persistent anhidrosis. These results suggest that the transdiscal approach can be a technical option for neurolytic lumbar sympathetic block. Implications: Neurolytic lumbar sympathetic block was performed with the needle advanced through the intervertebral disc. With this technique, the risk of genitofemoral neuritis, the most common complication after neurolytic lumbar sympathetic block, was reduced because the needle does not penetrate the psoas muscle, through which the genitofemoral nerve passes.     

Cecal volvulus as a complication in Cornelia de Lange syndrome. A case report and literature review

Colonic volvulus in children is a rare, but serious and important differential diagnosis in acute abdominal illness. Our patient with Cornelia de Lange's syndrome, was admitted with an acute onset of abdominal pain and in a critical condition. Explorative laparotomy revealed a caecal volvulus with necrosis of the distal ileum, caecum and proximal colon. The syndrome is characterized by typical facial expression, both growth and mental retardation, and various gastrointestinal and cardiac anomalies. Predisposing factors contributing to volvulus in this syndrome are mental retardation and a higher incidence of malrotation and nonfixation of the caecum and ascending colon. The parents of children with Cornelia de Lange's syndrome should therefore be counselled so that they are able to provide essential information in the event of their children experiencing acute illness.     

Acquired atrial septal defect as a complication of endocarditis--a case report

BACKGROUND: An original technique for the treatment of inguinal hernia is described: this operative technique consists of a Marlex (mono-filament knitted polypropylene) mesh sutured in the preperitoneal space under the fascia trasversalis. METHODS: A total of 202 hernioplasties have been treated: 100 of these have been controlled after six months to detect complications and recurrencies. RESULTS: One recurrency (1%) was found. No previous selection of patients was done. The mesh-repair is simple, rapid, and causes less discomfort than conventional sutured herniorraphy. This technique is compared with the other tension-free mesh hernioplasties. CONCLUSIONS: This operative technique is a prophylaxis for the femoral hernia described as later complication of other techniques.     

Middle fossa cyst presenting as a delayed complication of temporal lobectomy: case report

The antibiotic susceptibilities of 43 strains of Escherichia coli O157:H7 identified in the summer of 1996 in Japan were investigated. Growth of 90% of O157 strains was inhibited at a concentration of < or = 0.5 micro/ml by several agents including fosfomycin with glucose-6-phosphate.     

Reflex sympathetic dystrophy in childhood: a case report

A case report is presented of a 15-year-old girl with reflex sympathetic dystrophy (RSD). She was referred to hospital because of left upper limb pain. Her left upper limb was cold, edematous and blue with a limited active range of movement. The serum concentration of noradrenaline was lower on the painful side than on the healthy side, and neurotropin, which has an antinociceptive effect to hyperalgesia, was clearly effective. Early diagnosis and management is essential in the treatment of RSD and administration of neurotropin is a useful and non-invasive treatment without severe adverse effects.     

Mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with complete atrioventricular block: a case report

A pacemaker was implanted into a 17-year-old man with cardiac failure due to complete atrioventricular block complicated by mitochondrial encephalomyopathy (Kearns-Sayre syndrome). Due to the possible complication of latent myocardial dysfunction, it was decided to implant the dual chamber pacemaker (DDD) and the operation mode was set to DDD 70 ppm 1 year after implantation; this alleviated the cardiac failure. In this case, the necessity of preventive pacemaker implantation in the early stage of cardiac failure was recognized.     

Sneddon syndrome: a case report

Doxorubicin is cardiotoxic and its use must be monitored carefully. Incidence of refractory cardiac failure is shown to increase once the cumulative dose exceeds 450 mg/m2. However, significant decline of ejection fraction (EF) may occur even at lower dose levels. EF was monitored using Multigated Radionuclide Angiography (MUGA) scan of all consecutive lung cancer patients, treated with Doxorubicin based regimens. Thirteen of 82 patients showed a significant (more than 15%) decline of left ventricular EF. The dose of doxorubicin producing this decline ranged between 91-180 mg/m2. Actual decline in EF ranged between 16-45%. Only 5 of 13 patients developed symptoms attributable to the cardiac disease. Doxorubicin can alter EF significantly in lung cancer patients at levels well below which are considered 'safe'. The reason for massive decline in ejection fraction in these patients has been hypothesized.     

Mycoplasma pneumoniae infection presenting as Stevens-Johnson syndrome: a case report

A case of Mycoplasma pneumoniae infection as a precipitating factor in Stevens-Johnson Syndrome is presented. As the dentist may well be the first to see this syndrome, it is appropriate to highlight the condition and this particular organism as an infective cause.     

Changes in symptom and thermography images after lumbar sympathetic ganglion block

In 35 lower limbs of 22 patients with peripheral circulation disturbance, we evaluated the effects of lumbar sympathetic ganglion block (LSGB) by skin temperature difference (delta T) between the two measured by thermography before and after LSGB. We divided the patients into two groups; ASO group (n = 15): patients with chronic arterial occulusive diseases, and nonASO group (n = 7): those with peripheral circulation disturbance partly due to decrease nervous function. After LSGB, we recognized a significant increase in delta T and remission of ischemic symptoms in all the patients of nonASO group and those in early stage of ASO group. This suggests that in ASO group LSGB should be applied as soon as possible to obtain good outcome, and thermography is useful to evaluate the effects of LSGB in patients with peripheral circulation disturbance of the lower limbs.     

Hermansky-Pudlak syndrome: a case report and discussion

Hermansky-Pudlak syndrome is a rare, inherited, autosomal recessive disease. Diagnosis is based on a triad of signs: oculocutaneous albinism, a hemorrhagic tendency due to a platelet disorder, and an accumulation of lipopigments in different organs, particularly the medullary macrophages. We describe a child with the characteristic findings of this syndrome, which often goes unrecognized because of the discrete nature of the cutaneous and hemorrhagic manifestations. This diagnosis is important because of the risk not only of hemorrhage but also of granulomatous colitis and long-term pulmonary fibrosis.     

Syringohydromyelia as a complication of Goldenhar syndrome

Goldenhar syndrome is a multifocal developmental disorder consisting of ocular, auricular and vertebral anomalies. A case of Goldenhar syndrome is presented with a previously undescribed association with syringohydromelia. The pertinent literature is reviewed and possible mechanisms of the pathogenesis of syringohydromyelia in this syndrome are discussed.     

Charles Bonnet syndrome: a case report

Gastrointestinal lipomas are benign but rare lesions, mainly located in the colon. Depending on their size they are responsible for obstructive bowel symptoms. Diagnostic tools are either the endoscopy or computer tomography. It is recommended to investigate the entire large bowel as other pathologies are often found. Any lipoma found should be removed. Two cases with symptomatic lipoma are presented. In both cases the lipoma was removed by open surgery.     

Retinoic acid syndrome: a case report

The objective of this study was to investigate the impact of allergy to hymenoptera venom on the occupational activities of patients undergoing immunologic treatment for insect sting anaphylaxis. The design was a cross-sectional study conducted in a sample of 500 out of 1,500 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. A self-administered questionnaire was used to collect data about demographic characteristics of patients, severity of the allergic reaction and adverse effects on occupational activities. Of the 204 respondents who were part of the labour force, 48.5% reported adverse effects on routine occupational activities. The factors with a significant influence on the probability of adverse occupational effects were: (1) patient's type of work (blue collar vs. white collar: OR = 3.22, p < 0.001: army vs. white collar: OR = 5.28, p = 0.001); (2) severity of the allergic reaction (severe reaction vs. mild/moderate reaction: OR = 2.34, p = 0.007). Our findings suggest that severe insect sting allergy has an adverse impact on patients' occupational activities. This factor requires special attention by the medical community. Social workers and occupational physicians should collaborate in the assessment and management of these patients.