Extrafollicular variant of centrally located adenomatoid odontogenic tumor]

Primary intramedullary anaplastic oligodendroglioma is a rare tumor, only four cases of which have been reported. The authors present the case of a 38-month-old boy with primary intramedullary anaplastic oligodendroglioma. He underwent partial removal of the tumor and spinal radiation therapy. The residual tumor disappeared 12 months after radiation, and 48 months after treatment there was no evidence of recurrence. This case shows that in primary intramedullary anaplastic oligodendroglioma, postoperative radiation therapy confined to the spinal cord can yield an optimal result.     

Transitional cell carcinoma of the bladder in an HIV-infected patient

A case of transitional cell carcinoma of the urinary bladder in a patient infected with the human immunodeficiency virus is reported. The tumour was very large, occupying most of the bladder, however cystoscopic removal of the tumour was successful with no recurrence after one year. This association has never reported before. The possible contribution of human immunodeficiency virus infection to its occurrence is discussed.     

Management of bronchobiliary fistula as a late complication of hepatic resection

Bronchobiliary fistula is an uncommon but remarkable complication after hepatic resection. The case reported illustrates the clinical presentation and preferred initial management of these fistulae. A 61-year-old white male underwent two wedge resections for colorectal metastases to the liver with removal of a portion of the right diaphragm. Four years later, he developed obstructive jaundice secondary to tumor recurrence in the porta hepatis, which required endoscopic stent placement, radiation, and chemotherapy. Almost 2 years later, he developed frank biliptysis. Percutaneous transhepatic cholangiography (PTC) revealed occlusion of the common hepatic duct stent and a bronchobiliary fistula. With adequate reestablishment of common duct drainage, the patient rapidly improved and was discharged free of symptoms. Bronchobiliary fistulae are rare complications of hepatic resection that can present from days to years after operation. Endoscopic retrograde cholangiopancreatography and PTC are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of bronchobiliary fistulae, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical interventions via endoscopic retrograde cholangiopancreatography or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained.     

Contralateral recurrent cerebellar hemangioblastoma--a case report

Hemangioblastomas are regarded as benign neoplasms. They may recur in 3 to 10% of cases after apparently total excision. The opposite site recurrence is not found in the reported literature. A case is described in which, after successful removal of a cerebellar hemangioblastoma followed by two years of freedom from symptoms, developed a new growth of cerebellar hemangioblastoma contralaterally again. The histology of the tumor tissue is in no way different from that of a conventional hemangioblastoma. This case gives us some insights into the biological multipotentiality of cerebellar hemangioblastoma. We stress that close observation is absolutely necessary for this unique group of tumors, even after total removal.     

Magnetic resonance imaging of Long-Evans cinnamon rats as a new model of hepatocellular carcinoma

A case of recurrent and metastatic nonfunctioning adrenocortical carcinoma in a 40-year-old woman is reported. The patient received 4 laparotomies and 1 thoracotomy for recurrent and metastatic disease after removal of the primary adrenal tumor. She has been alive for over 18 years following multiple surgery for diseases after the first adrenalectomy. In selected patients with recurrence and/or metastasis, repeated surgical resection offers the possibility of a cure or extended palliation.     

Association of extrarenal Wilms'' tumor with a horseshoe kidney

Nephroblastoma (Wilms' tumor) is the most common renal malignancy in childhood. Extrarenal Wilms' tumor is uncommon, and the diagnosis is almost always postsurgical. The authors report two cases, located in the sigmoid mesocolon, one of these having an associated horseshoe kidney. Both were treated with excision followed by chemotherapy. They are now 36 months and 7 months postchemotherapy, respectively, and are symptom and recurrence free. Both had favorable histological findings. Association with a horseshoe kidney raises an important issue regarding the histogenesis of these tumors. The authors believe that there is a nexus between the fusion of metanephric blastema during the sixth to seventh week of intrauterine life and the "ectopic" metanephric blastema cells that may give rise to extrarenal Wilms' tumor. Association with a horseshoe kidney with an extrarenal Wilms' tumor has been reported on five previous occasions. The authors closely examine the link between the two.     

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy

BACKGROUND: Endoscopic sphincterotomy (EST) is widely used for the removal of stones from the bile duct, but stones recur in about one fifth of patients. AIMS: To investigate hepatic clearance by quantitative cholescintigraphy (QC) in patients after EST and to discern the relationship between biliary emptying and stone recurrence. METHODS: One hundred and forty nine patients who had EST and clearance of the bile duct for choledocholithiasis were selected. All patients were confirmed to have complete EST by sphincter of Oddi manometry and underwent QC soon after normalisation of liver function. Regular clinical follow up was performed for each patient. RESULTS: During a mean 36 month follow up, 22 (14.8%) patients developed recurrent stones in the bile duct. Irrespective of the status of the gall bladder, patients with recurrent stones had a slower hepatic clearance of radioisotope during QC compared with patients without stone recurrence, but only the differences in cholecystectomised patients had statistical significance. After carrying out multivariate analysis, one parameter of QC, percentage clearance of maximal count at 45 minutes, was found to be the only significant factor for stone recurrence. All recurrent stones in the common bile duct were successfully removed at endoscopy. CONCLUSION: Slower hepatic clearance as shown by QC is an important factor responsible for stone recurrence after sphincter ablation.     

Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results

The authors have reported on 108 patients with pituitary macroadenomas (measuring 2 cm in at least one diameter) who underwent 117 transsphenoidal operations and five craniotomies, and were followed for periods ranging from 6 months to 14 years. Vision improved in 90% of the patients. Gross total tumor removal with no evidence of residual tumor tissue demonstrable on the postoperative computerized tomography scan was accomplished in 41% of cases. However, gross total tumor removal is not synonymous with complete tumor removal. Endocrine cure was possible in 25% of prolactin-secreting and 20% of growth hormone-secreting adenomas. The incidence of recurrence was 12%, with the majority occurring from 4 to 8 years postoperatively. Both the tumors with suprasellar extension of more than 2 cm and the hard fibrotic tumors had a higher recurrence rate. Postoperative administration of radiation therapy has been associated with a significantly lower recurrence rate than when this therapy was withheld. Transsphenoidal surgery of pituitary macroadenomas confined to the extra-arachnoid space is associated with a relatively small number of complications. The operative technique used in this series is described.     

Chemical form of selenium greatly affects metal uptake and responses by cultured human lymphocytes

Pythiosis is a cosmopolitan granulomatous disease caused by an aquatic fungus Pythium insidiosum which usually occurs in horses, cattle, dogs, cats or fishes. There have been 28 cases of human pythiosis published in the literature. Twenty three patients have been reported from all over Thailand. Human pythiosis presents in one of three clinical forms: cutaneous or subcutaneous, systemic or vascular and ophthalmic (e.g., corneal ulcer or keratitis). Systemic antibiotics or antimycotics are not effective in the treatment of this infection. A saturated solution of KI gives a beneficial result only in the subcutaneous form. Surgical removal of the source of infection is the method of therapy of vascular and ophthalmic forms.     

Surgical management for lymph node recurrence of resected fibrolamellar carcinoma of the liver: a case report

Fibrolamellar carcinoma of the liver (FLC), which is very rare in Japan, is reported to be frequently accompanied by lymph node metastasis in Europe and the United States. We describe a 22-year-old man with recurrent FLC in the lymph nodes after undergoing partial hepatectomy. He underwent a second operation for removal of recurrent lymph node tumors in the mediastinum and abdominal cavity one year after initial surgery. However, a third operation became necessary seven months later, because of recurrence in a lymph node in the abdominal cavity. We discuss the management of lymph node metastasis from FLC.     

Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses

Three adult horses underwent aggressive treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses, using course-fractionated cobalt 60 radiotherapy. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is not commonly diagnosed in horses. Historically, horses with this type of neoplasm have not been treated or have undergone some form of surgery. The prognosis for long-term survival or cure has been poor. Long-term results of cobalt 60 radiotherapy were good to excellent and exceeded those usually reported for horses treated surgically. On the basis of these results, use of radiotherapy for these neoplasms is recommended.     

Multiple genotypes of mitochondrial DNA within a horse population from a small region in Yunnan Province of China

mtDNA genotypes of six domestic horses (three adult short horses whose heights are under 1 m and three common domestic horses) from a small region of 15 km2 in Malipo county of Yunnan province of China were investigated by the technique of restriction fragment length polymorphism (RFLP) with 16 restriction endonucleases which recognize 6-bp sequences. An average of 56 fragments for an individual was obtained. Unlike other domestic animals, this population of horses exhibits high mtDNA genetic diversity. Each of the six horses has a specific mtDNA genotype showing a pattern of multiple maternal origins, as suggested by fossil and literature records. We think the population of horses is an amazing seed-resource pool of horses and hence deserves to be paid more attention from the view of conservation genetics. However, it is also remarkable that we did not find any typical mtDNA genetic markers which would discriminate between short horses and common domestic horses.     

Primary non-Hodgkin's lymphoma of the common bile duct

Primary non-Hodgkin's lymphoma of the common bile duct is rare. To date, nine cases have been recorded in the literature. We report an additional case of a 39-yr-old woman presented with obstructive jaundice. Pathological studies of the surgical specimen disclosed that the wall of the common bile duct was transmurally infiltrated by non-Hodgkin's lymphoma of diffuse large cell type of B-cell lineage intimately associated with reticular fibers. The patient received postoperative brachytherapy, followed by six cycles of chemotherapy according to the CHOP regimen. There is no evidence of lymphoma recurrence 13 months after the surgery. Our analysis of the reported cases indicates that common bile duct non-Hodgkin's lymphoma is a rapidly progressive disease, terminating in death within a year. A complete surgical resection of the lymphoma followed by chemotherapy has shown a promising result.     

Prolonged exposure of Plasmodium falciparum to ciprofloxacin increases anti-malarial activity

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.     

Expression of Fos protein in the rat central nervous system in response to noxious stimulation: effects of chronic inflammation of the superior cervical ganglion

OBJECTIVES: To compare treatments of complete fractures of the third metacarpal (MC) or metatarsal (MT) bone in horses and to identify factors that could impact prognosis. DESIGN: Retrospective case series. ANIMALS: 25 horses with fractures of the third MC or MT bone that were treated by use of internal fixation, external coaptation, or both. PROCEDURE: Medical records from the Veterinary Medical Data Base of horses treated for fractures of third MC or MT bone at Texas A&M University from 1980 to 1994 and Purdue University from 1980 to 1996 were reviewed. Information on signalment, results of physical and radiographic examinations, treatment, and outcome were obtained. For horses that had radiographic evidence of healing, long-term follow-up information was obtained by telephone contact with owners or referring veterinarians. RESULTS: Age, sex, weight, and limb affected were not related to outcome; however, affected horses were younger than the general hospital populations. Seventeen horses had open fractures at referral. Infection was the most common complication after surgery, with open fractures more likely to become infected. Nonunion in an infected fracture was the most common reason for postoperative failure (7 horses). Long-term follow-up was available for 16 horses; 11 of these had no complications related to surgical repair. CLINICAL IMPLICATIONS: Fractures of the MC or MT bone are not always associated with a poor prognosis in horses. Proper case selection, rigid fracture stabilization, and efforts to prevent or treat infection will improve success rate.     

Small intestinal herniation through the epiploic foramen: 53 cases (1987-1993)

The incidence of epiploic entrapment of the small intestine in horses undergoing celiotomy for colic was 5%. The condition was more prevalent in older (mean 9.81 years) gelding and Thoroughbred horses. Preoperative peritoneal protein level was a good prognostic indicator as it was significantly greater in the nonsurvivor (39.4 +/- 5.10) group than in the survivor group (26.6 +/- 14.0) (P<0.05). Abdominal ultrasonography allowed earlier diagnosis and surgical intervention in nonpainful cases with inconclusive rectal findings. Surgery was completed in 46 horses and 44 horses recovered from anaesthesia. Nine horses were either subjected to euthanasia in surgery (7 horses) or died in recovery (2 horses). Repeat laparotomies were pursued in 27% (12/44) of the horses. Seven horses (16%) showed post operative adynamic ileus which was the most common post operative complication. The incidence (6%) of adhesion formation was lower than previously reported. Other post operative complications included gastric ulceration, liver disease, diarrhoea and weight loss. Short and long term survival rates were 79% (35/44) and 70% (31/44) respectively. Improved rates were attributed to earlier referral and diagnosis and prompt surgical intervention. The aggressive use of repeat celiotomy and a more effective treatment of the endotoxic horse in the perioperative period contributed to survival.     

Clinical use of glycoprotein IIb/IIIa receptor blockers in invasive cardiology

Complete removal of arteriovenous malformations of the hand, without functional impairment of the hand and fingers, is extremely difficult. A dorsalis pedis flap was used to reconstruct a soft-tissue defect, following complete removal of a malformation in the hypothenar region. This method allowed sufficient excision to militate against postoperative recurrence of the abnormality, while maintaining finger function. Two years after the operation, there has been no recurrence of the malformation and nearly normal finger function.     

Dietary control of exertional rhabdomyolysis in horses

OBJECTIVE: To determine whether feeding a low-carbohydrate, high-fat diet would decrease severity of exercise-induced muscle injury in horses with exertional rhabdomyolysis. ANIMALS: 19 horses with a history of exertional rhabdomyolysis. DESIGN: Case series. PROCEDURE: Specimens of the semitendinosus or semimembranosus muscle were obtained for histologic examination, and serum creatine kinase (CK) and aspartate transaminase (AST) activities 4 hours after exercise were determined. Horses were then fed a low-carbohydrate, high-fat diet, and serum CK and AST activities 4 hours after exercise were reevaluated at approximately monthly intervals for 3 to 6 months. RESULTS: Serum CK and AST activities 4 hours after exercise were high before any change in diet. All 19 horses had evidence of chronic myopathic change and abnormal glycogen accumulation in muscle biopsy specimens; 11 horses also had evidence of complex polysaccharide accumulation. Adaptation to diet change required approximately 3 to 6 months. Sixteen horses did not have any episodes of exertional rhabdomyolysis after 3 to 6 months of diet change, and 3 horses had mild episodes of exertional rhabdomyolysis following either a reduction in dietary fat intake or restriction in exercise. Postexercise serum CK and AST activities 3 to 6 months after the change in diet were significantly less than initial values. CLINICAL IMPLICATIONS: Results indicated that exertional rhabdomyolysis may be a result of abnormal carbohydrate metabolism in some horses. Feeding a diet with low carbohydrate and high fat content may reduce severity of exercise-induced injury in some horses with exertional rhabdomyolysis.     

Removal of an infected silicone rod frontalis sling without recurrence of ptosis

We examined a child with congenital ptosis. She underwent a bilateral silicone rod frontalis sling operation. One of the slings became infected and necessitated removal. We noticed no recurrence of her ptosis after sling removal. Removal of a frontalis sling does not invariably lead to recurrence of ptosis. We hypothesize that a scar tract formed in the plane of tissue from which the sling was removed. This band of scar tissue can act as a frontalis sling to elevate the eyelid.     

Cardiovascular causes of exercise intolerance

Exercise intolerance, due to cardiovascular disease in horses, may be caused by cardiac arrhythmias, valvular regurgitation, congenital abnormalities, myocardial dysfunction, pericardial disease, and vascular thrombosis. The most common cardiovascular cause of exercise intolerance in horses is atrial fibrillation. Cardiovascular abnormalities such as cardiac arrhythmias or murmurs, however, are common in athletic horses and are not always associated with exercise intolerance. Use of an electrocardiography (during rest and exercise) and echocardiography may be necessary to better determine the significance of the cardiovascular abnormality.