Portal thrombosis. A rare complication of laparoscopic splenectomy

Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis, while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed 1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening risks and assure complete remission.     

Cholecystogastrocolonic fistula with intrahepatic abscess: a rare complication of biliary stone disease

A 49-year-old female presented with a rare meningioma in the petrous bone. High resolution computed tomography and magnetic resonance imaging demonstrated that the tumor had developed in the jugular foramen and extended into the infralabyrinthine area of the petrous bone and intracranially into the cerebellopontine angle. The operative findings confirmed these observations. Meningiomas of the petrous bone may originate from the jugular foramen.     

Intrahepatic subcapsular hematoma. A rare postoperative complication of laparoscopic cholecystectomy

OBJECTIVE: To determine whether mode of arrival is associated with seriousness of etiology and use of diagnostic testing in patients treated in the emergency department for headache. METHODS: This observational, retrospective study was conducted by consecutive review of the records of patients presenting to the emergency department with a chief complaint of headache from December 1994 through May 1995. Patients with altered mental status or seizures were excluded. Mode of arrival was classified as either by EMS or other (e.g., private vehicle). Patients with a final diagnosis of meningitis, intracranial hemorrhage, or central nervous system tumor were classified as having serious causes, whereas those with headache due to migraine, tension headache, or headache that was otherwise unspecified were classified as nonserious. The use of diagnostic studies, such as lumbar puncture or CT scan, and their results, was recorded. Patients were included in the category of patients having serious intracranial pathology even if the diagnosis was delayed. Statistical analysis was performed using the Yates-corrected chi-square test, and by determining odds ratios (ORs) with 95% confidence intervals. RESULTS: For 967 patients presenting with a chief complaint of headache, 837 charts were included in the analysis. A total of 102 patients arrived by EMS, and 735 arrived by other means. Patients arriving by EMS had a higher rate of serious cause of headache than did those arriving by other means (OR = 18.5, p < 0.0001). EMS patients tended to undergo additional diagnostic testing (OR = 4.4, p < 0.0001), and those tests were more likely to be abnormal than for those arriving by other means (OR = 9.4, p < 0.0001). Males had a somewhat higher rate of serious diagnosis (OR = 2.6, p < 0.05). CONCLUSIONS: In this EMS system, patients with headache who arrive by EMS are more likely to have serious causes. Mode of arrival may be of use to the clinician in assessing risk of serious illness among patients with headache. Whether this observation represents an element of self-triage or a combination of other factors remains to be determined.     

Dissection of the inferior vena cava by Fogarty balloon maneuver. A rare complication in venous surgery]

Laceration of the inferior vena cava is an uncommon complication of vascular surgery. This report describes the radiologic features (CT and venography) of a patient with iatrogenic dissection and perforation of the vessel as a sequel of a Fogarty balloon procedure for deep venous thrombosis.     

Small-bowel obstruction and perforation. A rare complication of an esophageal stent

To bridge a malignant stenosis after esophageal cancer recurrence two silicon-coated wall stents were inplanted in a 52-year-old patient within 6 months. Two weeks after the second stent was implanted, clinical examination showed dislocation of the prosthesis. Intraoperatively the two stents were found sticking in the side-to-side jejunostomy of a former Billroth II operation, leading to perforation there.     

Anterior spinal artery syndrome after thoraco-abdominal esophagus resection. A rare complication

We report a case of postoperative paraplegia resembling an anterior spinal artery syndrome after curative esophagectomy in a patient with carcinoma of esophagus and clinical stage III (UICC). Neurologic deficit was characterized by loss of sensibility at the level of T12/L1 together with paraparesis of both lower extremities. Furthermore, dissociated sensorimotor depletion at C6/C7 (right-sided) and at T5 (left-sided) was noted. This severe complication was most probably caused by peeling of an arteriosclerotic plaque of the thoracic aorta due to preexisting advanced arteriosclerosis, leading to a partial occlusion of the great radicular artery of Adamkiewicz. Even though anterior spinal artery syndrome is a well-known problem in the operative management of thoracic aortic aneurysms, this complication has not previously been reported after esophagectomy.     

Subdural empyema as a complication of sinusitis. Association with Streptococcus milleri

Intracranial complications of sinusitis now are unusual and subdural empyema is even more infrequent. Furthermore, subdural empyema usually is related to sinus infections, particularly those caused by Streptococcus milleri, an anaerobic organism. Although clinical suspicion is fundamental, computed tomography and magnetic resonance imaging are essential for discovering these complications. These studies enable early diagnosis and prompt treatment, thus reducing the high mortality of this disease. We report two cases of subdural empyema secondary to sinusitis in persons without impaired immunity. Streptococcus milleri was isolated in one of them. A review of the literature disclosed that this is the most frequently involved organism, so the empirical selection of antibiotics targeted this organism.     

Pituitary abscess: a series of six cases

This study examined the influence of zopiclone, a third generation hypnotic, on the transition from slow wave sleep to paradoxical sleep (PS) which is increased at the expense of PS by barbiturates and benzodiazepines. The compound decreased sleep latency and increased the latency of the intermediate stage (IS) and PS at 2.5, 5 and 7.5 mg/kg IP. The amount of the IS was decreased because of the decrease in phase number up to 6 h at all doses. PS amount was decreased during 2 h at 2.5 mg/kg and during 4 h at 5 and 7.5 mg/kg also because of the decrease in phase number. The IS never substituted for PS. The IS spindle characteristics were not modified and the theta rhythm frequency slightly decreased at 5 mg/kg (IS) and 7.5 mg/kg (PS).     

Volvulus of the Roux-en-Y hepaticojejunostomy. A rare complication manifested by recurrent ascending cholangitis

A case of volvulus of a Roux-en-Y hepaticojejunostomy causing recurrent ascending cholangitis is reported. This rare complication of biliary reconstruction was diagnosed preoperatively by percutaneous transhepatic cholangiogram, and successfully treated by resection of the involved segment. The impaired myoelectric activity of the isolated Roux limb may contribute to this pathology.     

Case report: A rare complication of Hickman line insertion

The objective evaluation of smell is the least used functional ear, nose and throat exploration. Evoked potentials can be recorded after chemical olfactory stimulation using a method similar to recording cortical auditory evoked potentials. Our results with this technique and peppermint oil as the stimulant were fully satisfactory. In 10 patients with normal smell, a characteristic wave with a long latency was recorded in the absence of auditory and visual stimuli. In contrast, in 10 anosmic patients this characteristic recording was absent. The easy recording technique proposed here can be useful for olfactory assessment of objective disorders, detection of malingers, and medical-legal reports.     

A rare complication of dental treatment: Streptococcus oralis meningitis

A case of Streptococcus oralis meningitis is reported. This followed extraction of a normal tooth during routine orthodontic treatment. No focus of infection could be demonstrated, either local to or distant from the extraction site. Full recovery followed hospital admission and intravenous benzyl penicillin.     

Hairs causing pulmonary emboli. A rare complication in long-term intravenous studies in dogs

From a study of 320 individuals superoxide dismutase (SOD) variants are shown to be present in Iraq, and it is suggested that this genetic system may be useful for the study of historical population movement in the Middle East. The esterase D gene frequencies show no significant heterogeneity among the different regions of the country.     

Cervical actinomycosis. A rare differential diagnosis of parotid tumor]

BACKGROUND: Allergic rhinitis is usually treated with oral antihistamines or nasal steroids. Topically active nasal antihistamine is a new treatment modality for allergic rhinitis. The efficacy in comparison to well established topical treatment alternatives is not fully known. OBJECTIVE: To compare the efficacy of intranasally administered azelastine to budesonide, at their respectively recommended dosage, on the symptoms of perennial rhinitis patients. METHODS: A placebo-controlled, randomized, parallel group study was conducted to compare the efficacy and tolerability of intranasal budesonide aqueous suspension (256 microg once daily) with azelastine hydrochloride nasal spray (280 microg twice daily (560 microg/day)) and with placebo in the treatment of perennial allergic rhinitis. The 195 patients (with at least a 2-year history of perennial allergic rhinitis) recorded individual nasal symptom scores, the degree of symptom control achieved and any adverse events experienced over a 2-week baseline period and a 6-week treatment period. RESULTS: Following treatment, the reductions in mean combined and individual nasal symptom scores from baseline values were significantly greater in the budesonide group compared with the placebo group (P < .0001 for all variables except runny nose P = .01). In patients treated with budesonide, there were also significantly larger reductions from baseline values in combined nasal symptom scores (P < .01) and in scores for all individual nasal symptoms (P < or = .05) compared with those treated with azelastine. The reductions from baseline in both combined and individual nasal symptom scores did not differ between azelastine and placebo. The study medications were well tolerated, producing no unexpected or serious treatment-related adverse events. CONCLUSION: A once-daily dose of 256 microg of intranasal budesonide aqueous suspension is significantly more effective at relieving the symptoms of perennial allergic rhinitis compared with a twice daily dose of 280 microg of azelastine nasal spray.     

Symptomatic arteriovenous fistula of the thyrocervical trunk. A rare complication after implanting a subclavian catheter

After the incidental puncture of a sidebranch of the thyreocervical trunk during a subclavian vein catheterization, a symptomatic avfistula developed. The diagnosis was confirmed by angiography. Using a microcatheter system the fistula was occluded with micro-coils.     

Cerebral abscess as a complication of chronic otitis media

BACKGROUND: Airways inflammation is a feature of chronic obstructive pulmonary disease (COPD), but the role of corticosteroids in the management of clinically stable patients has yet to be established. A randomised controlled study was carried out to investigate the effect of high dose inhaled beclomethasone dipropionate (BDP) administered for two months to patients with stable, smoking related COPD. Sputum induction was used to evaluate bronchial inflammation response. METHODS: 34 patients (20 men and 14 women) were examined on three separate occasions. At the initial clinical assessment (visit 0), spirometry and blood gas analysis were performed. On visit 1 (within one week of visit 0) sputum induction was performed and each patient was randomised to receive either BDP 500 micrograms three times daily (treated group) or nothing (control group). After two months (visit 2), all patients underwent repeat clinical assessment, spirometry, and sputum induction. RESULTS: There were no differences in sputum cell counts between the groups at baseline. After two months of treatment, induced sputum samples from patients in the treated group showed a reduction in both neutrophils (-27%) and total cells (-42%) with respect to baseline, while the control group did not (neutrophils +9%, total cells +7%). Macrophages increased in the treated group but not in the control group. The mean final value of sputum neutrophils was 52% in the treated group and 73.3% in the control group (95% confidence interval (CI) -27.2 to -15.4). The mean final value of sputum macrophages was 35.8% in treated group and 19.3% in control group (95% CI 10.3 to 22.8). The differences between the treated and control groups for neutrophils (-21.3%), macrophages (+16.5%), and total cells (-65%) were significant. Spirometry and blood gas data did not change from baseline in either patient group. CONCLUSIONS: A two month course of treatment with high dose inhaled BDP reduces significantly neutrophil cell counts in patients with clinically stable, smoking related COPD. Further studies on the effectiveness of inhaled steroids in COPD are needed to confirm the clinical importance of this observation.     

Cerebral abscess as a complication of the chronic otitis

We constructed previously the expressing library of Leishmania donovani genomic DNA with lambda gt11 as vector. In this paper, 2 x 10(4) phages were plated on E. coli Y1090r-, and screened with a rabbit antiserum prepared by immunization with Leishmania donovani promastigotes. Bound antibodies were detected using alkaline phosphatase labeled anti-rabbit antibodies. A positive expressing clone was detected and transferred into E. coli Y1098r- to prepare lysate, a 39 kDa polypeptide in E. coli Y1089r-lysate was recognized by anti-Leishmania donovani serum. The result indicated that the 39 kDa polypeptide which was not fused with the major portion of beta-galactosidase existed disconnectedly. This finding remained to be further studied.