An overdose fatality in a child involving disopyramide and sulindac

The results of an accidental overdose fatality in a child involving disopyramide and sulindac are reported in this paper. Quantitation of disopyramide was performed by gas chromatography using codeine as the internal standard. Sulindac was assayed by high- performance liquid chromatography using ketoprofen as the internal standard. The postmortem blood concentrations of disopyramide and sulindac were 41.3 and 12.2 mg/L, respectively. The concentrations of disopyramide and sulindac were also quantitated in the liver, in bile, and in urine.     

Case report of pneumatic staple gun injury to the aorta

We describe an 8-year-old boy who had asymptomatic hypercalcemia 4 years after radiotherapy involving the left orbit and lungs. A right parathyroid adenoma was diagnosed, and normocalcemia was achieved after its removal. Routine monitoring of serum calcium and phosphate levels is recommended for children after head and neck irradiation.     

Oncotic aneurysm. Case report

The author describes a case of intracerebral and subarachnoid hemorrhage associated with an intracranial aneurysm caused by a metastatic tumor. The aneurysm formation is explained as being result of tumor cells invading the vessel wall while still preserving the arterial circulation.     

Kenny-Caffey syndrome. Case report

We investigated whether survival was related to recent childbirth or parity in a cohort of 540 women diagnosed with breast cancer before the age of 45 years who were followed for up to 14 years. Women who had given birth within 2 years before their diagnosis of breast cancer were at increased risk of dying, compared with nulliparous women, with an adjusted relative risk of 3.1 (95% confidence interval = 1.8-5.4). There was a moderate association of parity with mortality, with an adjusted relative risk of 1.8 (95% confidence interval = 1.2-2.9) for women with three or more births, compared with nulliparous women.     

Metastatic oligodendroglioma. Case report

We report a case of remote metastasis of oligodendroglioma. Similar cases are reported in the literature for malignant cerebral tumors. Our case seems rather different because of low grade histology. Potential malignancy was evidenced only by further investigations with labeling indexes.     

Abscess formation within a parasagittal meningioma. Case report

The authors present the case of a 78-year-old woman who developed right lower-extremity paralysis after a focal seizure. Neuroradiological studies revealed a small parasagittal meningioma, which at the time of resection was found to contain a bacterial intratumoral abscess secondary to Proteus mirabilis. This is only the second reported case of intratumoral abscess formation in a meningioma and the first such occurrence to be reported in an otherwise healthy, immunocompetent individual.     

HELLP syndrome. Case report

Genitourinary sarcomas are very rare entities. This paper contributes one case report of an undifferentiated pelvic fibrosarcoma in a 53-year old patient. It also includes some observations on the clinical development, complementary studies used, difficulties for the pathoanatomical diagnosis and treatment issues.     

Systemic lupus erythematosus and pulmonary hypertension during pregnancy: report of a case fatality

The case of a 25-year-old pregnant woman with systemic lupus erythematosus and severe pulmonary hypertension is presented. The pregnancy was complicated by worsening right heart failure and pre-eclampsia, requiring a caesarian section at 29 weeks' gestation. On the fourth day postpartum, the patient's respiratory status worsened and she was transferred to the coronary care unit where she soon died from combined right heart failure and respiratory arrest. The presumed pathogenesis and etiology of lupus-related pulmonary hypertension are discussed, in addition to noninvasive tests and proposed management. Given that the mortality rate is very high during pregnancy and therapy is of limited value, women with lupus-associated pulmonary hypertension should avoid conceiving. Those who choose to become pregnant must be carefully managed by a multidisciplinary team.     

Autonomic hyperreflexia in a pregnant paraplegic patient. Case report

BACKGROUND AND OBJECTIVES: Pregnant patients with spinal cord injuries are predisposed to autonomic hyperreflexia, which if unrecognized or untreated can lead to death. Hypertension occurring in laboring patients at risk for autonomic hyperreflexia must be managed aggressively. METHODS: Epidural anesthesia can safely control autonomic hyperreflexia during labor and delivery, but because spinal cord impaired patients lack sensory and motor function below the level of injury, it is difficult to determine the dermatomal spread of epidural anesthesia by the usual methods. This difficulty is highlighted by the following case, reporting an epidural that failed during labor, with the subsequent development of autonomic hyperreflexia. RESULTS: Previously, autonomic hyperreflexia occurring in pregnant patients (undergoing surgical procedures) was treated with intravenous antihypertensive agents. During labor, however, titrating these agents to coincide with uterine contractions is difficult. In this case, epidural anesthesia was repeated and the autonomic hyperreflexia resolved. CONCLUSIONS: Autonomic hyperreflexia can develop in unanesthetized laboring paraplegic patients (failed epidural) but it can be successfully managed with adequate epidural anesthesia.     

Manson's schistosomiasis presenting as a brain tumor. Case report

Neurological complications arising from schistosomiasis are uncommon, and reports of Manson's schistosomiasis presenting as an intracerebral mass lesion are particularly rare. The authors describe the case of a 26-year-old man with a 3-month history of headaches and visual abnormalities. He had immigrated to Canada from Brazil 4 years previously. The patient's general physical and neurological examinations were unremarkable. Magnetic resonance (MR) imaging revealed an enhancing lesion with surrounding edema and mild mass effect in the right occipital lobe. A stereotactic brain biopsy demonstrated intraparenchymal granulomas surrounding Schistosoma masoni eggs. The patient's symptoms resolved following treatment with praziquantel and steroid medications; follow-up MR imaging yielded normal findings. This case demonstrates that neuroschistosomiasis should be considered when an individual presenting with an intracerebral mass has lived in a region in which this disease is endemic.     

Intracranial repair of a divided trochlear nerve. Case report

The authors report the case of a 37-year-old woman in whom the trochlear nerve was transected during removal of a meningioma in the cavernous sinus and subsequently repaired by using microsurgical techniques. This patient presented with a tumor in the posterior part of the right cavernous sinus with expansion over the tentorium. Preoperatively, she suffered from partial deficit of the right trochlear nerve. Intraoperatively, the trochlear nerve was noted to be completely encased by the tumor and was totally divided during removal of the lesion. After tumor resection, the trochlear nerve was repaired by using a sural nerve fascicle secured with sutures and fibrin glue. Six months after the operation, trochlear nerve regeneration became evident as the patient's binocular vision gradually improved. The patient regained normal functioning of the superior oblique muscle 3.5 years after surgery. It is concluded that repair of a divided trochlear nerve is worthwhile and can be followed by successful regeneration and an excellent functional recovery of the superior oblique muscle.     

Thoracoscopic microsurgical excision of a thoracic schwannoma. Case report

A 6-cm-diameter schwannoma located at T-2 was resected completely by using transthoracic microsurgical endoscopy. The partially cystic tumor widened the neural foramen and extended into the apex of the right thoracic cavity but did not extend intradurally. The tumor was accessed by means of three 15-mm incisions made in the intercostal spaces. The operative blood loss was only 200 ml, and there were no complications. The patient was discharged on the 2nd postoperative day and returned to full activity 1 week after surgery. Thoracoscopy provides an excellent alternative to thoracotomy for peripheral thoracic nerve sheath tumors that originate within the neural foramen or more distally along the intercostal nerves within the thorax. An anterior approach is required for intrathoracic tumors but is not suited for intradural tumors. An open posterior or posterolateral approach to the thoracic spine is required for intradural tumors to allow the dura to be closed adequately.     

CHILD syndrome. Case report of a rare genetic dermatosis

We report on a 2-month-old girl who developed unilateral ichthyosiform erythrodermia on the right side of her trunk and the right leg 1 week after birth. In addition, there was hexadactyly of her right hand. Apart from that, close physical examinations did not reveal any other defects. We diagnosed this condition as CHILD syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects).     

Benign symmetrical lipomatosis. Case report

We present a patient who had benign symmetrical lipomatosis. He was treated surgically (6 operations), and the results were satisfactory. we discuss various factors in this disease and suggest the possibility of a nonsurgical treatment being developed in the future.