Associated pathology with Wallenberg's syndrome. A report of three cases

Three cases with Wallenberg's syndrome were reported, in which CT-scan revealed silent old right temporal infarction, right recent cerebellar haematoma and left calcified parietal subdural haematoma evidenced after 10 years since trauma due to a traffic accident. Although Wallenberg's syndrome constitutes a fully clinical diagnosis, CT-scan does not seem to be justified by the management logical deductions of the medical act; however, it is better to perform it in order to identify a possible associated pathology.     

Thromboangiitis obliterans with inaugural rheumatic manifestations. A report of three cases

Thromboangiitis obliterans, or Buerger's disease, is a segmental occlusive inflammatory disorder of the small- and medium-sized arteries and veins seen in young adults and associated with cigarette smoking. The lesions are most marked in the distal limbs. We report three cases in which the first manifestations were rheumatic, consisting in polyarthritis in two cases and carpal tunnel syndrome in one. Rheumatic manifestations are infrequent and rarely inaugural in thromboangiitis obliterans, although they are probably underdiagnosed. Their pathogenesis is unclear but may involve autoimmunity. Heightened awareness of the possibility that rheumatic manifestations can inaugurate thromboangiitis obliterans may allow an earlier diagnosis of this disease, which may improve the functional prognosis. However, recovery can be achieved only if the patient stops smoking.     

Intrapartum amnioinfusion in twin gestation. A preliminary report of three cases

Amnioinfusion is an intrapartum technique that is not usually attempted in twin gestations. This report describes infusion of normal saline into the amniotic sacs of three twin gestations with oligohydramnios. All the twins were safely delivered vaginally. No untoward effects were noted. Ultrasound is advised following amnioinfusion to assess the increase in the amniotic fluid volume.     

Knee dislocation without anterior cruciate ligament disruption. A report of three cases

The development of liver transplantation has led to technical refinements such as liver graft reduction or splitting for transplantation in two recipients, the use of living related donors, and the temporary orthotopic transplantation of auxiliary liver grafts. Regarding immuno-suppression, new drugs are currently under evaluation, such as tacrolimus (FK 506) which could be effective on some severe rejections. On the other hand, the indications of liver transplantation have been revisited according to clinical results. In France, the increasing development of organ and tissue transplantation has led to the creation of the Etablissement Fran?ais des Greffes, which has the following missions: managing the waiting lists, supporting organ donation, ensuring sanitary safety, and evaluating transplantation activities. Future alternatives to allogenic liver transplantation are mainly represented by xenografting with monkey or pig livers, hepatic assistance and bioartificial liver, and gene therapy.     

Microcephaly with chorioretinopathy. A report of two dominant families and three sporadic cases

This study was designed to assess the effect of paraquat on the rat kidney. The experimental animals used were Wistar rats, a strain selected and maintained at the Institut d'hygiène alimentaire. Their diet was well defined and their state of health monitored. Female animals with mean weight of 200 g were used in this study. Doses of 20, 30 and 50 mg/kg were administered via the gastrointestinal route. In this experimentation, performed on 12 rats plus 3 controls, the dose considered to be sublethal was 30 mg/kg administered by gavage. These animals were sacrificed after 24 h, 48 h, 4, 8, 15, 30 and 60 day, selecting those animals with the most severely altered state, at each time. Tubular lesions started to appear by the 24th hour; the proximal tubule was the most sensitive. Lesions of the distal tubule were observed slightly later, from the 48th hour. Lesions became more intense from the 4th day onwards and reached a maximum on the 8th day. The first signs of repair of the proximal tubule and distal tubule were observed on the 15th day, but were less marked for the proximal tubule. This repair was slow and progressive. Persistent lesions of the proximal or distal tubules were still observed after two months. The glomeruli presented several alterations, which were always only moderate. Overall, paraquat induces serious life-threatening lesions of acute tubular necrosis in the absence of adequate intensive care.     

Treatment of severe and difficult cases of systemic lupus erythematosus with tacrolimus. A report of three cases

OBJECTIVES: An analysis of the efficacy of tacrolimus treatment in three patients with difficult and severe systemic lupus erythematosus (SLE) whose active disease had been previously poorly controlled by cyclosporine and cyclophosphamide. METHODS: A review of patient notes. RESULTS: Two patients are well controlled after six and nine months of treatment with tacrolimus 0.06 mg/kg/day and 0.18 mg/kg/day. Previous persistent vasculitis had resolved and other features of active disease were controlled. The third patient's vasculitis had not improved significantly after two months of treatment and tacrolimus 0.17 mg/kg/day was discontinued because of nephrotoxicity. CONCLUSION: Tacrolimus may be a useful additional immunosuppressive agent in some patients whose SLE is not well controlled by conventional treatments.     

Hypersensitivity reactions to etoposide. A report of three cases and review of the literature

Etoposide (VP 16) is an antineoplastic agent that has major activity against a number of tumors, including germ cell neoplasms, small cell lung cancer, and malignant lymphoma. It is a derivative of podophyllin, and acts by inhibiting mitosis. Common side effects include bone marrow suppression, alopecia, and gastrointestinal symptoms. Hypersensitivity reactions are uncommon however, and the underlying mechanism is unclear. We report three cases of etoposide hypersensitivity and review the literature.     

Lingual thyroid: report of three cases

Lingual thyroid is a rare developmental disorder and is more frequent in women. The pathogenesis is unclear but may be related to the presence of maternal blocking autoantibodies against the thyroid. Treatment of this disorder includes the use of levothyroxine in order to correct the hypothyroidism, which is very frequent and to induce the shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report three cases and discuss the approach to diagnosis and a strategy for management.     

Colorectal schistosomiasis: report of three cases

The facility for mass movement of segments of our world populations creates the need for physicians to recognize and manage diseases not seen in native patients. Such a need has occurred in New York City, where schistosomiasis, with its protean manifestations has been seen with increasing frequency. The cases of three patients who had different clinical manifestations of infestation by S. mansoni are presented. Clinical, radiologic, and pathologic features are discussed. To avoid delay in treatment, physicians must consider the possibility of this disorder in cases of patients from areas of endemic schistosomiasis.     

Bullous sarcoidosis: a report of three cases

Three cases of pulmonary sarcoidosis presented as bullous emphysema with severe airflow obstruction, and the diagnosis of sarcoidosis was unsuspected for at least 2 years. Potential mechanisms of bullous emphysema from sarcoidosis are discussed. The physician should suspect sarcoidosis as the cause of bullous emphysema when young patients who have smoked relatively few pack-years present with emphysema or severe airflow obstruction. Additional clues are the presence of mediastinal adenopathy on a chest radiograph or a CT scan and a history consistent with extrapulmonary sarcoidosis.     

Congenital dyserythropoietic anaemia: report of three cases

Between January 1985 and June 1992, the Paediatric Department of Hospital Universiti Sains Malaysia has diagnosed congenital dyserythropoietic anaemia in three children, two of whom were siblings. The age of onset ranged from 1 to 3 years. All of them became transfusion-dependent before the age of 4 months. One of them was successfully treated with bone marrow transplantation.     

Endolymphatic sac tumors: report of three cases

OBJECTIVE AND IMPORTANCE: We present three cases of endolymphatic sac tumors and review the previously published cases. Despite frequent extension to the cerebellopontine angle, these rare tumors have only recently been recognized by neurosurgeons. CLINICAL PRESENTATION: A 26-year-old man developed a progressive hearing loss, revealing an intrapetrous retrolabyrinthine tumor on the right side. A 28-year-old woman experienced a left cerebellopontine angle syndrome, with a lytic intrapetrous mass extending into the cerebellopontine angle. A 38-year-old woman presented with an intracranial hypertension syndrome caused by a tumor of the jugular foramen. INTERVENTION: For the first and second patients, the tumors originated from the operculum of the endolymphatic sac. Total removal was achieved, via a transpetrosal approach, in these two cases. No recurrence was detected after a 20-month follow-up period. For the third patient, the tumor originated from the distal part of the sac. Recurrence was observed 8 years after subtotal removal via a retrosigmoid route. Histological analysis revealed a papillary-cystic adenocarcinomatous pattern in all cases, without features of aggressiveness. CONCLUSION: Endolymphatic sac tumors are locally invasive neoplasms characterized by bipolar intrapetrous and posterior fossa involvement. The anatomic complexity of the endolymphatic sac may explain the distinct patterns of extension of these tumors. Early radical surgery is related to good outcomes.     

Unilateral lung hypoplasia: report of three cases

The authors describe a unique pulmangiographic picture taken 24 years after the first angiographic examination made on account of repeated haemoptysis associated with Rendu-Osler-Weber s disease. Angiography revealed enlargement of the aneurysm in the lungs and dilatation of the afferent and efferent vessel of the aneurysm. The only treatment of pulmonary arteriovenous fistulas is surgical.     

Paraganglioma of the prostatic urethra. A report of three cases and a review of the literature

OBJECTIVE: To determine the incidence and clinical presentation of prostatic urethral paragangliomas and to compare these findings with paragangliomas occurring in the other sites of the lower urinary tract. PATIENTS AND METHODS: The clinical records of three patients with prostatic urethral paragangliomas were reviewed, as was the histology of each specimen. The tumours were stained immunocytochemically with neuron-specific enolase, chromogranin, S100 protein, protein gene product 9.5, prostate-specific acid phosphatase and prostate-specific antigen. RESULTS: The three tumours occurred in elderly men, two of whom presented with haematuria, one of whom also had a vesical transitional cell carcinoma, and the third patient had obstructive symptoms due to co-existent prostatic hyperplasia. The histological appearances and immunocytochemical findings were consistent with paraganglioma. Treatment consisted of local excision and there were no recurrences or metastases at 5 and 6 years in two patients for whom follow-up was available. CONCLUSION: Urethral paragangliomas are rare tumours arising in elderly men and are hormonally inactive. Although haematuria may be the presenting symptom, it is important to exclude additional more common and possibly more sinister lesions such as transitional cell carcinoma. Local excision appears to be curative.     

Cystic fibrosis in Malay children--a report of three cases

A staining device for sectioned material supported on grids for viewing at the Transmission Electron Microscope is described. The method based in a double side sticky tape is inexpensive, rapid and clean. By using only pipettes and a double side sticky tape the best solution to the tedious problems of sections staining is obtained. The tape is discarded and the staining solution too. Precipitates have not been observed.     

Metastasizing pleomorphic adenoma: a report of three cases

BACKGROUND: This study evaluates the diagnosis and treatment of women with pathologic nipple discharge caused by ductal carcinoma in situ (DCIS). METHODS: Women with unilateral spontaneous bloody, serous, or brown nipple discharge who presented between January 1, 1988 and August 1, 1996 were identified by retrospective chart review. Women with nonspontaneous, physiologic discharge were excluded. RESULTS: Two hundred seventy-seven women with a mean age of 59.5 years (range, 24 to 88 years) underwent duct exploration and biopsy for pathologic discharge, with 43 (15.5%) found to have DCIS. The discharge was bloody in 29, clear in eight, and brown in six women. Seven of 12 (58%) women with an associated breast mass were found to have a microinvasive component with the DCIS. Discharge cytology showed malignant cells in only two of 12 (16%) women examined. A ductogram was performed on 20 women, with filling defects seen in 10, ectasia in 3, narrowing in 4, and normal ducts in 3. The DCIS included 17 (40%) specimens with cribriform pattern, 17 (40%) micropapillary, 8 (18%) comedo, and 2 (2%) solid. Twelve microinvasive cancers were found in combination with DCIS. After duct exploration, 37 (86%) patients were found to have extensive or multifocal DCIS to the margin, or both, with 32 (74%) patients requiring mastectomy to achieve free surgical margins. There was residual disease in 27 of 32 (84%) mastectomy specimens after initial biopsy. Breast conservation was possible in only 11 (26%) women. Forty of 43 (93%) are disease-free with a median follow-up of 37 months. CONCLUSION: Women presenting with pathologic nipple discharge require duct exploration regardless of cytologic or radiologic findings. When discharge is the result of DCIS, extensiveness of disease in relation to central location and intraductal spread may preclude breast conservation in as many as 27 of 43 (63%) cases.