Hypertrophic osteoarthropathy in renal cell carcinoma - A case report -

Hypertrophic osteoarthropathy (HOA) is a rare clinical condition including an abnormal periosteal reaction in the long bones that causes painful swelling and tenderness of the extremities, digital clubbing, arthritis, synovitis, and joint effusions. Most cases are associated with tumorous conditions and most commonly with lung cancer. HOA has been rarely reported in association with other cancers. A patient with a history of recurrent renal cell carcinoma was referred to our clinic with bilateral leg pain, knee joint effusion, and arthritis. Simple radiography and bone scintigraphy confirmed a diagnosis of HOA. Oral non-steroidal anti-inflammatory drugs, joint fluid aspiration, and intra-articular injection of pain medications were found to be effective in the management of HOA pain. HOA prognosis depends on the underlying disease, therefore, cancer treatment is critical. This case demonstrates the need to consider HOA in patients with various malignancies who present with bone or joint pain of the extremities.

Ultrasound-guided treatment of common peroneal neuropathy caused by Baker’s cyst: a clinical note - A case report -

Baker’s cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy. We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait. In this case, we found the Baker’s cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.

Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery: A case report

Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomy-Trendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.

Anesthetic management of a patient with glucose-6-phosphate dehydrogenase deficiency undergoing robot-assisted laparoscopic surgery: A case report

The authors describe the successful perioperative management of a 3-year-old boy from Dubai with glucose-6-phosphate dehydrogenase (G6PD) deficiency, who underwent robot-assisted laparoscopic pyeloplasty for complete right ureteropelvic junction obstruction. G6PD deficiency is a genetic disorder predisposing patients to hemolytic anemia from oxidative stress. Important considerations in anesthetic management include avoiding oxidative stress, which can be caused by various conditions, and monitoring for hypercapnia, which can cause acidosis and hemolysis. Laparoscopic surgery is usually associated with hypercapnia and therefore an increased risk for respiratory acidosis. During surgery in this particular case, efforts were made to avoid carbon dioxide retention and to keep the patient warm. General anesthesia was induced with thiopental sodium, rocuronium, and fentanyl, and maintained with sevoflurane. There were no signs of hemolysis in the perioperative period and he was discharged owing to his improved condition.

Intraoperative ventilation and hemodynamic change due to bladder perforation during transurethral resection of a bladder tumor: A case report

Transurethral resection is the most efficacious and safest urologic procedure for the treatment of benign prostatic hypertrophy, prostate cancer, and bladder cancer. Complications of transurethral resection include hemorrhage, infection, transurethral resection syndrome, and bladder perforation. Early detection of bladder perforation is important because it can cause critical ventilation and hemodynamic changes. In this case, we detected bladder perforation as the cause of ventilation and hemodynamic change intraoperatively and treated it by immediate surgical repair.

Intraoperative ventilation and hemodynamic change due to bladder perforation during transurethral resection of a bladder tumor: A case report

Transurethral resection is the most efficacious and safest urologic procedure for the treatment of benign prostatic hypertrophy, prostate cancer, and bladder cancer. Complications of transurethral resection include hemorrhage, infection, transurethral resection syndrome, and bladder perforation. Early detection of bladder perforation is important because it can cause critical ventilation and hemodynamic changes. In this case, we detected bladder perforation as the cause of ventilation and hemodynamic change intraoperatively and treated it by immediate surgical repair.

Effect of capsicum plaster at the P6 acupoint on postoperative nausea and vomiting in patients undergoing endoscopic sinus surgery

BACKGROUND: We evaluated the efficacy of capsicum plaster, applied to the Chinese acupuncture point (acupoint) Pericardium 6 (P6), in reducing postoperative nausea and vomiting (PONV) in patients who underwent endoscopic sinus surgery (ESS). METHODS: One hundred and fifty patients scheduled for ESS were randomly placed in one of 3 groups. Each group had 50 patients. Inactive tape was affixed at both P6 acupoints and both shoulders in the control (placebo) group. Capsicum plaster was affixed at both P6 acupoints and inactive tape was affixed at both shoulders in the capsicum plaster (P6) group. Capsicum plaster was affixed at both shoulders and inactive tape at both P6 acupoints in the sham group. Plasters and tapes were affixed before the induction and removed 8 hours after surgery. RESULTS: The incidence of PONV and requirement for antiemetics were significantly lower in the P6 group than in the control and sham groups during the 24 hours after surgery. At postoperative 0-24 hour, nausea was 42% in the control group, 2% in the P6 group, and 38% in the sham group. Postoperative vomiting was 28%, 0% and 26%, respectively, and the use of antiemetics was 34%, 0% and 32%, respectively. CONCLUSIONS: Stimulation of the P6 acupoint with capsicum plaster is effective for preventing PONV at postoperative 0-24 hour in patients undergoing ESS.

Infratentorial and Intraparenchymal Subependymoma in the Cerebellum: Case Report

Subependymomas are rare benign tumors located in the ventricular system. Intraparenchymal subependymoma is extremely rare; only 6 cases have been reported, and all were located in the supratentorial region. We describe a case of infratentorial, intraparenchymal subependymoma in a 28-year-old man with intermittent headache. Imaging revealed a well-demarcated cystic and solid cerebellar mass near the fourth ventricle. The mass had a microcystic component and calcification without contrast enhancement. Complete surgical excision was performed, and histopathology confirmed a subependymoma.

A Case of Langerhans Cell Histiocytosis Involving the Thyroid Gland: Ultrasonographic Finding

Langerhans cell histiocytosis is a rare, proliferative monoclonal histiocytic disease of unknown cause. Primary involvement of the thyroid gland by LCH is very rare, and most cases show evidence of LCH involving other organs. Herein, we report on a case of thyroid LCH in a patient diagnosed as pituitary gland LCH. When a patient with a history of LCH presents with enlargement of the thyroid gland or a neck mass, and ultrasonography shows a well-defined low echoic mass, LCH should be included in differential diagnosis. Fine needle aspiration can be useful for initial diagnosis; however, for differentiation with thyroiditis or thyroid cancer, core biopsy, positive S-100 protein, and CD1a immunohistochemical staining are needed.

MR Imaging of Primary Retroperitoneal Mucinous Cystadenocarcinoma in Pregnant Woman

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy. To date, 51 cases have been reported, including 3 in pregnant women. Herein, we report magnetic resonance findings of a 31-year-old Korean woman (15 weeks and 3 days pregnant) with primary retroperitoneal mucinous cystadenocarcinoma. On abdominal magnetic resonance imaging (MRI), a mass was identified in the retroperitoneal area with a nodular lesion showing heterogeneous signal intensity and focal wall thickening on T1- and T2-weighted images. Exploratory laparotomy and tumor excision were performed. Histological examination revealed primary retroperitoneal mucinous cystadenocarcinoma. The patient subsequently underwent total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for metastatic mucinous cystadenocarcinoma of both ovaries 15 months after her initial surgery.

Evaluation of the Effect of Hemoglobin or Hematocrit Level on Dural Sinus Density Using Unenhanced Computed Tomography

PURPOSE: To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). MATERIALS AND METHODS: Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. RESULTS: The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). CONCLUSION: Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.

Spontaneous Esophageal Perforation and Hypopharyngeal Abscess in Adult Dermatomyositis: A Case Report

In patients with dermatomyositis, chronic inflammation of the pharynx and esophagus results in coughing and difficulty in swallowing. These become important clinical symptoms, especially if they contribute to malnutrition or aspiration pneumonia. They can ultimately reduce the quality of life. In rare cases, if the symptoms worsen despite proper treatment, serious complications may arise, a reason to suspect an esophageal perforation or abscess. The authors report a case of dermatomyositis in an adult patient with rare complications of spontaneous esophageal perforation and hypopharyngeal abscess. The patient received non-surgical treatment and was able to resume oral intake of food.

Indirect Inguinal Hernia Containing the Uterus, Both Ovaries, and Fallopian Tubes in an Infant: A Case Report

In female infants, an inguinal hernia containing an ovary with or without Fallopian tubes is not uncommon. However, an inguinal hernia containing the entire uterus and both ovaries is extremely rare. Herein, we report on a case of an inguinal hernia containing the uterus, both ovaries, and both Fallopian tubes, diagnosed by ultrasonography. We discuss the case and review the relevant literature.

Unilateral Hydronephrosis and Hydroureter by Foreign Body in Urinary Bladder: A Case Report

Foreign bodies inserted through the urethra are often found in the urinary bladder. We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain. Computed tomography indicated a convoluted, high-attenuation mass in the urinary bladder; unilateral hydronephrosis and hydroureter were also present due to direct compression by the mass. The foreign body was removed using a cystoscope. This foreign body was proven to be silicon.

Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.

Polypoid cystitis in an adult without history of catheterization

Polypoid cystitis is a benign exophytic mucosal lesion of the bladder. Differentiating it from papillary transitional cell carcinoma is difficult due to their similar characteristics. Although indwelling catheter is the main well-known cause of polypoid cystitis, some case reports unrelated to catheterization have been described. However, the radiological findings of polypoid cystitis have rarely been reported. We hereby describe polypoid cystitis in a 20-year-old man without a history of catheterization along with the computed tomographic findings

Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. We describe the magnetic resonance imaging (MRI) findings, including the diffusion-weighted imaging (DWI) findings, of ISCA in a 78-year-old man. The initial conventional MRI of the thoracic spine demonstrated a subtle enhancing nodule accompanied by significant edema. On the follow-up MRI after seven days, the nodule appeared as a ring-enhancing nodule. The non-enhancing central portion of the nodule appeared hyperintense on DWI with a decreased apparent diffusion coefficient (ADC) value on the ADC map. We performed myelotomy and surgical drainage, and thick, yellowish pus was drained.

Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.

CellprepPlus(R) Liquid-based Smear in Sono-guided Thyroid Fine Needle Aspiration: A Comparison of Conventional Method and CellprepPlus(R) Liquid-based Cytology

BACKGROUND: Fine needle aspiration (FNA) of the thyroid is a useful tool for the evaluation of benign or malignant thyroid nodules. The improvements in the quality of cytological preparations using the liquid-based cytology (LBC) method have been well-documented. The principal objective of this study was designed to evaluate the diagnostic adequacy, sensitivity, and specificity of the thyroid FNA comparing a conventional smear with the LBC adapted with the filtration method described herein. METHODS: One hundred ninety eight cases of FNA samples obtained from May 2009 to September 2009 were included in this study. All patients were subjected to ultrasound-guided aspiration twice at a target lesion by a radiologist and two types of slides were prepared using conventional smear and LBC. RESULTS: When compared with conventional method, the cellularity was reduced in LBC. However, the malignant tumor cells evidenced the larger and more vesicular nuclei, prominent nucleoli, and distinct nuclear membranes in LBC. Thirty two cases (16.16%) of conventional smear were inadequate, but 96 cases (48.49%) of LBC were inadequate. CONCLUSIONS: Most of the slides using CellprepPlus(R) LBC evidenced lower cellularity and clearer background. However, the conventional smears were found to generate much more applicable samples than CellprepPlus(R) LBC.

Gastroduodenal Intussusception Caused by a Peutz-Jeghers Polyp in a Young Child: A Case Report

Gastroduodenal intussusception is a rare condition caused by the prolapse of a gastric tumor with subsequent invagination of a portion of the gastric wall into the duodenum. Various gastric lesions including adenoma, lipoma, leiomyoma, hamartoma, adenocarcinoma, gastrointestinal stromal tumor (GIST), and as in our case a Peutz-Jeghers polyp, can serve as a lead point of intussusception. Only three cases of gastroduodenal intussusception secondary to a Peutz-Jeghers polyp have been reported. We experienced a case of gastroduodenal intussusception in a 36-month-old boy who presented with intermittent nonbilious vomiting, abdominal pain, and anemia. An abdominal ultrasound and contrast enhanced CT scan showed gastrointestinal intussusception and a mass-like lesion in the second portion of duodenum. A laparotomy revealed a 7x8 cm sized mass at the gastric body, which was pathologically confirmed as a Peutz-Jeghers polyp.