Desmoid tumour of the thoracic outlet: an unusual cause of thoracic outlet syndrome

Several electrocardiographic anomalies have been described in association with hypoglycaemia. We report the case of a 70-year-old woman with hypoglycaemic coma whose electrocardiogram showed significant conduction anomalies, including atrioventricular block and intraventricular conduction disturbances, and repolarization abnormalities. These electrocardiographic changes disappeared after intravenous glucose administration.     

Desmoid tumor of the vulva associated with pregnancy

Extra-abdominal desmoid tumor is a locally aggressive neoplasm that occurs most commonly in the pelvic or shoulder region in the third or fourth decade. We have identified one previously reported case of primary desmoid tumor of the vulva. Herein, we describe another case and, to our knowledge, the first reported case of vulvar desmoid tumor associated with pregnancy.     

Chondrosarcoma of the thoracic wall

In this paper, three placebo-controlled trials of moclobemide, and four three-way comparison trials of moclobemide, placebo and one of the standard tricyclic antidepressants, imipramine, clomipramine, or amitriptyline, are reviewed. The results of the placebo-controlled trials indicate that about twice as many of the patients receiving moclobemide showed a marked improvement during a four-week treatment period, as compared with patients receiving placebo. Of the three-way trials, two studies indicated that the efficacy of moclobemide was significantly greater than that of placebo and similar to that of other antidepressants (imipramine or amitriptyline). Tolerance of moclobemide was good and better than that of the tricyclic antidepressants. In the other three-way comparison trials, the differences in efficacy between the placebo, moclobemide, and the tricyclic antidepressant were not significant.     

A surgical case of liposarcoma in the chest wall within the thoracic cavity of a young patient

A 21-year-old man presented to our hospital on June 7, 1990, asymptomatic but with an abnormal shadow in his chest roentgenogram. A well-demarcated tumorous shadow was seen in the left hilum of the lung in the frontal view of the chest X-ray, and adjacent to the posterior chest wall in the lateral view. A percutaneous needle biopsy was performed, and since there were no malignant findings, the tumor was left untreated for future examinations. However, since the tumor was observed to be enlarging gradually in subsequent chest X-rays, it was resected surgically on June 18, 1991. The tumor was fist-sized and its surface smooth, and was protruding into the thoracic cavity. At surgery, the tumor was separated from the chest wall. The tumor, weighing 170 grams, was diagnosed pathologically as a liposarcoma (myxoid type). It was confirmed that there was no infiltration into the surrounding tissue and that total resection had been performed. There are few reports of liposarcomas within the thoracic cavity developing in the extra-mediastinal chest wall. As our case is the second in Japan occurring in a young patient, we present it here together with a review of the literature.     

Spontaneous thoracic spinal cord herniation. A case report

STUDY DESIGN: This is a case report. OBJECTIVE: To focus attention on spontaneous spinal cord herniation as a rare cause of myelopathy that can be diagnosed preoperatively and can be corrected surgically. SUMMARY OF BACKGROUND DATA: A 34-year-old woman presented with spastic paraparesis. Magnetic resonance imaging scan of the thoracic spine revealed anterior displacement and tethering of the cord at T6-T7 and a dorsal intradural arachnoid cyst. Excision of the cyst was performed without improvement in symptomatology. During reoperation the thoracic spinal cord hernia was discovered and was reduced intradurally. METHODS: The authors describe the clinical, radiographic, and surgical findings of this patient and review the findings from other reported cases. They discuss the proposed theories for the pathophysiology of the cord herniation and the surgical management. RESULTS: The patient had idiopathic thoracic spinal cord herniation as there was no history of previous spine surgery or injury. The authors believe that the cord herniated through a congenital dural defect, which resulted in the development of a pseudoarachnoid cyst dorsally to the hernia. The patient improved after intradural reduction of the hernia and closure of the dural defect. CONCLUSION: Idiopathic spinal cord herniation should be recognized as a cause of progressive myelopathy that can be managed successfully with microsurgical techniques.     

A case of ureteral tuberculosis appearing as a ureteral tumor

A 53-year-old female was admitted to our hospital after right hydronephrosis was found on the CT scan taken at another hospital. The urinary cytology and culture findings as well as the urinary culture for acid-fast bacilli results were all negative. At our hospital, CT scan revealed a thickening of the right ureteral wall, and right hydronephrosis. In spite of the fact that retrograde pyeloureterography showed a right ureteric obstruction at the ureterovesical junction, cystoscopic examination demonstrated a normal bladder. Since right lower tract carcinoma was suggested, we performed right nephroureterectomy with bladder cuff. Histopathological diagnosis, however, revealed renal and ureteral tuberculosis.     

Solid papillary tumor of the pancreas. A clinical case

A method is presented for the investigation of surfactant function after isolation and preparation of pulmonary surfactant from tracheobronchial aspirates of mechanically ventilated infants and children. This method involved purification of surfactant from contaminating non-surfactant phospholipids and mucus by sodium bromide density gradient centrifugation. The surfactant concentration in undiluted fluids (3.5 +/- 0.8 mg mL-1; mean +/- SD) was calculated by extrapolating from the urea concentration in aspirates and serum. Phospholipid concentration was adjusted to approximately 3 mg mL-1 and the surface activity was determined by means of a pulsating bubble surfactometer. Mean minimal and maximal tension values of all cycles were calculated after reaching steady state. Measurements obtained from surfactant isolated with this method showed a high reproducibility: the coefficient of variation for minimal surface tension was 6.1%. Therefore this method enables functional surfactant analysis in tracheobronchial aspirates.     

Emergency diagnostic imaging in thoracic trauma. A clinical case

The authors report a case of thoracic trauma with pulmonary contusion in which chest X-ray was not significant, nevertheless severe clinical state. They underline the importance of CT in the early evaluation of pulmonary lesions and in their development.     

Adenocarcinoma of the cecum manifesting as intussesception in a 16-year-old patient: report of a case

A 16-year-old Negro girl underwent exploratory laparotomy for ileocecal intussusception and was found to have moderately well-differentiated mucin-producing adenocarcinoma of the ileocecal valve. Specific aspects of this disease in children are discussed and an appeal for early diagnostic studies in cases of children who complain of weight loss, chronic constipation, and abdominal pain is made. Finially, on the basis of the natural history of the disease, a "second-look" operation is recommended.     

Glomus tumor in the upper lip. A case report

A glomus tumor arising in the upper lip of a 54-year-old Japanese man is presented.     

Silicone elastomer microshards in fluid from a painful metatarsophalangeal implant site. A case report

Histopathologic studies have demonstrated microshards from silicone elastomer metatarsophalangeal joint implants in adjacent tissues in a setting of chronic inflammation and in inguinal lymph nodes. Cytologic smears of synovial fluid from symptomatic implanted joints should show these refractile, nonpolarizing microshards in the reactive inflammatory context. Nonspecific enzymatic inflammatory activity contributes to further destabilization of the implants, eventuating in symptoms and signs requiring prosthesis removal. Cytopathologic examination of aspirated fluid from the vicinity of a symptomatic implanted joint demonstrates foreign body reaction to silicone elastomer, predicting a need for intervention before the local damage is severe and disabling.     

A case of chest wall Castleman''s disease

The status of speech processing for cochlear implants is reviewed. Points of interest to enhance further speech intelligibility based on improved signal processing, are discussed.     

Solitary plasmacytoma in the thoracic spine. Two case reports

Where a leptomeningeal carcinomatosis is clinically diagnosed, evidence should be provided of tumor cells in the CSF. Not necessarily in the first specimen, but in the course of the illness. The staining of the cells with the Pappenheim method generally provides sufficient information about the cells. The identification of cells in metastases of epithelial tumours is not difficult for anyone with some experience. Identifying cells from primary brain tumours - which however only rarely cause meningosis - can sometimes be more difficult. Attention should be paid to whether the cells occur in clusters or singly. However, extreme caution is called for. The cytological monitoring of the CSF is an essential part of chemotherapy or radiation treatment.