A Patient with Mixed Squamous Cell and Papillary Thyroid Carcinoma

Mixed squamous cell carcinoma and papillary carcinoma in the thyroid gland is a very rare malignant tumor. Primary squamous cell carcinoma of the thyroid may develop from squamous metaplasia of the follicular epithelium in a variety of pathologic conditions, such as other differentiated carcinomas of the thyroid. A 70-year-old man presented with a palpable mass on the right side of the thyroid gland. The patient underwent a right lobectomy without neck lymph node dissection. Histopathological findings revealed primary squamous carcinoma mixed papillary thyroid carcinoma. He underwent a completion thyroidectomy and radioactive iodine therapy. Adjuvant radiotherapy and chemotherapy were not performed.

Intramural and Intraluminal Hematoma of the Small Bowel as the Lead Point of Intussusception in an Adult Patient with Warfarinization

We report a case in which an intramural and intraluminal hematoma of the jejunum served as the lead point of intussusception in a 77-year-old man with warfarinization. The patient presented with cramping abdominal pain and vomiting. Palpation of the abdomen revealed periumbilical tenderness. Abdominal computed tomography revealed a circular mass with a concentric ring, consistent with an intussuscepted jejunum. Because of warfarinization, which was due to atrial fibrillation and lacunar infarction, the patient's prothrombin time was prolonged. Laparotomy revealed reducible jejuno-jejunal intussusception, and we performed a segmental resection of the intussuscepted jejunum. We identified an intramural and intraluminal jejunal hematoma as the lead point. Upon histopathological examination, angiodysplasia of the intussuscepted jejunum was found to be the bleeding focus. No similar case was found in the literature.

Posterior Tibial Artery Aneurysm: A Case Report

Aneurysms of the infrapopliteal arteries are rare and they are commonly associated with trauma. We report here on a rare case of a true aneurysm of the posterior tibial artery in a sixty-year-old female. There was no history of trauma, and the serologic tests for the possibility of vasculitis were all negative. The color Doppler ultrasound examination and the multi-detector computed tomographic scan confirmed the diagnosis of a posterior tibial artery aneurysm and these tests revealed no evidence of aneurysms or occlusive lesions in the other arteries. Aneurysmectomy and end-to-end microvascular anastomosis were performed successfully. Preoperative multi- detector computed tomographic scanning is a valuable, noninvasive diagnostic tool to delineate not only the state of the aneurysm, but also that of the distal arterial tree.

Endovascular Treatment in the Trauma Patients with Vascular Injury

PURPOSE: The role of vascular and interventional radiology in trauma patients is evolving. Endovascular treatments are helpful in treating vascular injuries in trauma patients. In some situations, endovascular treatments are as effective or more effective than surgery, but less invasive. We performed this study to evaluate the efficacy of endovascular treatments in the trauma patients with vascular injury. METHOD: Between September 2000 and September 2003, a total of 10 consecutive trauma patients with vascular injury who received endovascular treatments were included in this study. RESULT: Of the 10 patients, the most common injured arteries were the iliac arteries (5 patients), and the most common associated injuries were pelvic (8 patients) and long bone (6 patients) fractures. Transarterial embolization was performed in 9 patients, and stent-graft placement in 1. Clinical success was achieved in all 10 patients. After endovascular treatments, 3 patients with fluid collections were treated with ultrasound-guided, percutaneous drainage. Two of 10 patients died of complications other than hemorrhage. CONCLUSION: This initial experience suggests that endovascular treatment for trauma patients with vascular injury is safe and effective, and that it can also reduce the unnecessary laparotomies in these difficult cases.

Endovascular Management of Iliofemoral Deep Venous Thrombosis due to Iliac Vein Compression Syndrome in Patients with Protein C and/or S Deficiency

The purpose of this study was to evaluate the early outcome of endovascular management in patients with iliofemoral deep venous thrombosis (DVT) due to iliac vein compression syndrome (IVCS) and protein C and/or S deficiency. Between September 2000 and January 2003, catheter-directed thrombolysis was performed in 11 patients with a diagnosis of acute iliofemoral DVT: 7 with protein C and/or S deficiency and 4 without protein C and/or S deficiency. After thrombolysis, the diagnosis of IVCS was confirmed in 6 patients: 4 with protein C and/or S deficiency and 2 without protein C and/or S deficiency. Further intervention consisted of angioplasty and stent placement was performed. Four patients with IVCS and protein C and/or S deficiency were included in this study. The immediate technical and clinical success rates were 100% in all 4 patients. There were no complications or clinically detectable pulmonary emboli. This initial experience suggests that endovascular management of iliofemoral DVT due to IVCS in patients with protein C and/or S deficiency is safe and effective.