Spontaneous regression of Pituitary Adenomas: Illustrative case and systematic review

INTRODUCTION@#Spontaneous regression of pituitary adenomas is a rare occurrence that is thought to be due to pituitary apoplexy. We would like to review the demograhic data, imaging findings, and neurologic, endocrinologic, and radiologic outcomes of patients who exhibited this unusual phenomenon.@*METHODS@#We present a case of non-functioning pituitary adenoma (NFPA) in a 66-year-old man that underwent spontaneous regression. We also performed a systematic literature review on cases of pituitary adenomas that exhibited spontaneous regression, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.@*RESULTS@#There have been only 27 reported cases of spontaneous regression observed in all pituitary adenomas, 16 of which are NFPAs. Headache was the most common symptom while decreased visual acuity and oculomotor nerve palsy were the most common sign. Pituitary hemorrhage was seen in two-thirds of cases, while findings suggestive of pituitary infarct, such as enhancement of the sphenoid sinus mucosa. were seen in one-third. Complete radiographic remission was observed in 62% of cases, with an 11% recurrence rate seen at least two years after the initial imaging. Neurologic recovery was reported in 88% and endocrinologic recovery from hypopituitarism was 40%.@*CONCLUSION@#Most patients exhibited neurologic and endocrinologic improvement concomitant with the regression of the pituitary adenoma. However, these tumors may recur; thus, regular and long- term neuro-ophthalmologic and radiologic follow-up is advised.

Siringomielia por malformación de Chiari: resolución espontánea. Revisión bibliográfica / Syringomyelia due to Chiari malformation: spontaneous resolution. Bibliographic review

Objetivo: describir y analizar los casos de siringomielia por malformación de Chiari tipo 1 con resolución espontánea. Método: se buscó en Pubmed bajo las palabras clave malformación de Chiari tipo 1, siringomielia y resolución espontánea todos los casos relacionados. Se registraron las características poblacionales de cada caso, evolución y mecanismos propuestos. Resultados: En la población adulta se encontraron 22 casos (edad media: 35,81) y en la población pediátrica se encontraron 37 casos (edad media: 9,82). Las hipótesis sobre los mecanismos que produjeron la resolución espontánea fueron: cambios en la posición de las amígdalas relacionadas con la edad, atrofia del cerebelo, fisura medular, reducción del esfuerzo físico, variaciones de la presión intraespinal, crecimiento del cráneo y disminución de la presión intracraneana. Conclusión: La resolución espontánea es posible en pocos casos. Si bien este hecho invita a realizar controles periódicos y evitar la cirugía, la espera conlleva riesgos ante la posibilidad de un agravamiento agudo o de que surjan secuelas permanentes. La información disponible hoy en día no permite predecir con seguridad la evolución de cada caso

Objective: describe and analyze the cases of syringomyelia caused by Chiari type 1 malformation with spontaneous resolution. Method: we searched in Pubmed with the key words Chiari malformation type 1, syringomyelia and spontaneous resolution all related cases. The population characteristics of each case were recorded along with its outcome and proposed mechanisms. Results: in the adult population there were 22 cases (medium age: 35.81) and in the pediatric population there were 37 cases (medium age: 9.82). The hypothesis about the mechanisms that produce the spontaneous resolution were: changes in tonsils position related to age, cerebellar atrophy, cord fissures, reduction of physical effort, variations in intraspinal pressure, skull growth and decrease in intracranial pressure. Conclusion: the spontaneous resolution of syringomyelia invites to carry out regular check-ups and avoid surgery. However, waiting carries risks with the possibility of acute worsening or permanent sequelae. The information available today does not allow to predict with certainty the evolution of each case.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma / 中华创伤杂志

Objective@#To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution.@*Methods@#A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness≥5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018. There were 37 males and 23 females, aged 18-80 years [(47.0±16.9)years]. There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group. Coagulation function [prothrombin time (PT) and international normalized ratio (INR)] on admission, hospital stay, Glasgow outcome scale (GOS), and brain CT results were compared between the two groups.@*Results@#The PT and INR values in the rapid resolution group were (11.9±2.1)s and 1.1±0.2 respectively, while those in the non-rapid resolution group were (10.8±1.0)s and 1.0±0.1 respectively, with significant differences (P<0.05). There was no significant difference in hospital stay and GOS between the two groups (P>0.05). The thickness of subdural hematoma of the two groups in the first CT scanning was (8.2±2.3)mm and (7.3±1.8)mm, respectively, with no statistically significant difference (P>0.05). In the second CT scanning, the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs. (6.6±2.1)mm] (P<0.01). The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group (93% vs. 36%) (P<0.01). The incidence of subarachnoid hemorrhage(SAH) increase was significantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan (74% vs. 15%) (P<0.01). The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4% in the rapid resolution group, which was significantly lower than 18% in the non rapid resolution group (P<0.05).@*Conclusions@#The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma. The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma, suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma / 中华创伤杂志

Objective To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution.Methods A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness ≥ 5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018.There were 37 males and 23 females,aged 18-80 years [(47.0±16.9)years].There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group.Coagulation function [prothrombin time(PT)and international normalized ratio(INR)] on admission,hospital stay,Glasgow outcome scale(GOS),and brain CT results were compared between the two groups.Results The PT and INR values in the rapid resolution group were(11.9±2.1)s and 1.1±0.2 respectively,while those in the non-rapid resolution group were(10.8±1.0)s and 1.0±0.1 respectively,with significant differences(P＜0.05).There was no significant difference in hospital stay and GOS between the two groups(P＞0.05).The thickness of subdural hematoma of the two groups in the first CT scanning was(8.2±2.3)mm and(7.3±1.8)mm,respectively,with no statistically significant difference(P＞0.05).In the second CT scanning,the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs.(6.6±2.1)mm](P＜0.01).The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group(93％vs.36％)(P＜0.01).The incidence of subarachnoid hemorrhage(SAH)increase wassignificantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan(74％vs.15％)(P＜0.01).The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4％in the rapid resolution group,which was significantly lower than 18％in the non rapid resolution group(P＜0.05).Conclusions The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma.The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma,suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients.

Atelectasia maxilar crónica bilateral con resolución espontánea / Bilateral chronic maxillary atelectasis with spontaneous resolution

RESUMEN La atelectasia maxilar crónica (AMC) es una condición adquirida y rara que consiste en la disminución persistente y progresiva del volumen del seno maxilar, con retracción centrípeta de sus paredes secundaria a la oclusión completa de tipo valvular del ostium natural. Esta condición genera presión negativa dentro del seno maxilar, conduciendo a atelectasia y colapso de la pared. La fisiopatología es compartida con síndrome de seno silente, por lo que se postula que se podrían englobar a ambas dentro de la misma enfermedad. Presentamos el caso de un paciente con diagnóstico de AMC bilateral por tomografía axial computarizada a la edad de 3 años, que se resolvió en forma espontánea en forma bilateral; el maxilar derecho a los 6 años y el izquierdo a los 10 años.

ABSTRACT Chronic maxillary atelectasis (CMA) is a rare and developed condition that consists in the progressive and persistent decrease volume of the maxillary sinus, with centripetal retraction of the walls secondary to the complete occlusion of the natural ostium. This condition generates negative pressure inside the maxillary sinus, heading to atelectasis and collapse of the walls. It is proposed that the disease includes the silent sinus syndrome, as the physiopathology is shared between them. We present the case of a 3 years old boy with bilateral chronic maxillary atelectasis observed in the CT scan, who evolved with spontaneous bilateral resolution. The right maxillary sinus CMA resolved at 6 years old, and the left at 10 years old.

Clinic analysis of rapid spontaneous resolution of acute subdural hematoma in children: a retrospective study of nine cases / 中国医师进修杂志

Objective To investigate the mechanism and clinical characteristics of rapid spontaneous resolution of acute subdural hematoma in children. Methods The clinical data of 9 children with rapid spontaneous resolution of acute subdural hematoma were retrospective analyzed. Results Subdural hematoma of three cases were completely dissolved within 8 h, while those of the other 6 cases were significantly reduced which were completely dissolved in 48-72 h. Conclusions Rapid spontaneous resolution of acute subdural hematoma in children is rare in clinical practice. The redistribution and dilution of hematoma and the anatomical characteristics of the children patient determine the possibility of hematoma dissipation. The conservative treatment can get a good prognosis.

High Spontaneous Resolution Rates of Severe Primary Vesicoureteral Reflux and Minimal Development of New Renal Scars

PURPOSE: The previous reports regarding VUR resolution were not precise due to early frequent surgical intervention. We evaluated the spontaneous resolution (SR) rate and the incidence of new renal scars in primary VUR, focusing on severe reflux. METHODS: Medical records of 334 patients with primary VUR who were on medical prophylaxis without surgery for 1 to 9 years, were retrospectively reviewed. Medical prophylaxis was initiated with low-dose antibiotic prophylaxis or probiotics. Radioisotope cystourethrography was performed every 1 to 3 years until SR of reflux. New renal scar was evaluated with follow-up 99mTc DMSA renal scan. RESULTS: The SR rates decreased as VUR grades were getting higher (P=0.00). The overall and annual SR were 58.4% and 14.9%/yr in grade IV reflux and 37.5% and 9.3%/yr in grade V reflux. The median times of SR were 38 months in grade IV reflux and 66 months in grade V reflux. The probable SR rates in grade IV and V reflux were 7.8% and 8.9% in the 1st year, 46.0% and 30.8% in the 3rd year and 74.4% and 64.4% in the 5th year. The incidences of new renal scars between low to moderate reflux and severe reflux showed no significant difference (P=0.32). CONCLUSION: The SR rates of severe primary VUR were higher than previously reported and most new renal scars were focal and mild.

ALERGIA A LA PROTEíNA DE LA LECHE DE VACA. EVALUACIóN DE SU RESOLUCIóN ESPONTáNEA POR MEDIO DE DESAFíOS DOBLE CIEGO PLACEBO CONTROLADOS / cows milk allergy. an assesment of its spontaneous resolution through double blind placebo controlled challenges.

Introducción. la alergia a la leche de vaca (aplv) es un problema sanitario global. Su diagnóstico adecuado y su seguimiento son esenciales ya que la leche de vaca es un alimento importante en la dieta de muchos lactantes. los desafíos orales doble ciego controlados por placebo (ddcpc) son la herramienta ideal para el diagnóstico y seguimiento de las alergias alimentarias. este estudio describe las características evolutivas de pacientes con aplv y las posibles variables que la pudieran modificar. material y métodos. Se estudiaron pacientes con diagnóstico de aplv previo con desafíos abiertos. Se catalogaron las reacciones de acuerdo a la normativa dracma. positivas fueron las pruebas en las que se presentaron alteraciones clínicas o variaciones hemodinámicas. negativas fueron aquellas en las que el paciente toleró la leche. Se consideraron edades de inicio y de realización del ddcpc, sexo y patología de aplv. resultados. Se estudiaron 106 pacientes (50 masculinos, 56 femeninos), promedio edad de inicio de síntomas 5,31 m (rango: 1-48 meses) y al procedimiento 23,14 m (5 meses - 5 años), y 13 pruebas positivas. un conjunto se refirió al mecanismo fisiopatológico y se dividió en ige mediadas (n=55) con 8 pruebas positivas y mixtas/celulares (n=51) con 5 pruebas positivas. otro conjunto fueron no gastrointestinales (n=61) con 7 pruebas positivas y gastrointestinales (n=45) con 6 pruebas positivas. todos los grupos fueron similares en cuanto a las variables demográficas. el sexo masculino y el diagnóstico de anafilaxia fueron factores de riesgo para no resolver su aplv (p=0,0125 y p=0,002 respectivamente). conclusiones. el momento de resolución de la aplv es independiente del mecanismo fisiopatológico subyacente o la edad de inicio de los síntomas. en general resuelven el problema de manera espontánea hacia los dos años de vida en más de un 87% de los casos. el sexo masculino (en ige mediadas) y el antecedente de anafilaxia podrían ser factores de riesgo para tener menos probabilidades de resolver la APLV. (AU)

Introduction: cow´s milk allergy (cma) is a global health issue. a proper diagnosis and follow up become essential. double blind placebo controlled challenges (dbpcc) is the gold standard for this purpose. this paper describes clinical evolution and characteristics of cma, as well as variables that may modify the affection course. methods & material: a group of patients, with a previous diagnosis of cma by open challenges, has been studied and its results cataloged according to dracma guidelines. tests with hemodynamic changes or clinical symptoms were considered as positives, while those with no clinical reaction were considered as negatives. variables involved were: age of symptoms starting, age of dbpcc performing, gender and cma clinical manifestations. results: 106 patients has been studied (50 male, 56 female), with a median age of 5,31 mo (range 5 ­ 48 mo) at the starting symptoms, and a median age of 23,14 mo (range 5 mo ­ 5 y) at the performing of dbpcc. 13 tests were negative. as regards to the different immune mechanisms, 55 were ige dependent (8 negative), and 51 were mediated by mixed/cellular (5 negative). patients were divided into two groups: with gastrointestinal symptoms (n=45) and with no gastrointestinal symptoms (n=61). they showed 6 and 7 negative results, respectively. all groups were similar. male gender, and anaphylaxis diagnosis turned out to be risk factors not to resolve cma (p=0,0125 and p=0,002 respectively). conclusions: cma resolution is independent of the immune mechanisms involved or the age of its symptoms starting. cma is solved spontaneously towards the age of two in 87% of the cases. male gender, and anaphylaxis may become risk factors not to resolve cma.(AU)

Colonization or spontaneous resolution: expanding the role for Burkholderia pseudomallei

A 19-year-old Asian Indian female presented with productive cough since the past one month and low grade fever since the past two weeks. She was diagnosed with pulmonary tuberculosis and treated with antitubercular drugs. Subsequently, delayed cultures of bronchoalveolar lavage fluid grew Burkholderia pseudomallei (B. pseudomallei). On follow up the patient reported significant subjective improvement and ESR progressively returned to normal. In summary, this case report raises two distinct and equally intriguing roles for B. pseudomallei, i.e. respiratory colonization and spontaneously resolving pulmonary infection. The pathogenic potential of B. pseudomallei, the etiologic agent of melioidosis, is well known. Confirmation of either colonization or spontaneous resolution, would potentially spare many patients unnecessary and expensive therapy with broad-spectrum antibiotics, and contribute to more rational usage of antibiotics, especially in co-infection with Mycobacterium tuberculosis and B. pseudomallei-two bacterial diseases with closely similar clinical, radiologic and histopathologic features.

Clinical Characteristics and Prognostic Factors of Vesicoureteral Reflux

INTRODUCTION: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. METHODS: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. RESULTS: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. CONCLUSION: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.

Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear / Resolução espontânea da lesão alça de balde do menisco medial associado com rotura de LCA

We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB.

Neste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB), que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA). O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.

Microperimetry and optical coherence tomography in a case of traumatic macular hole and associated macular detachment with spontaneous resolution.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.

Rol del seguimiento ultrasonográfico en la toma de decisiones en niños con sospecha de abdomen agudo de origen apendicular / Role of ultrasonographic follow-up in the decision-making in children with acute abdominal pain

Patients with unspecific acute abdominal pain and patients with nonspecific acute abdominal pain and no conclusive physical examination for appendicitis are usually kept under medical control. In our Emergency Department, some pediatricians and surgeons have added a second ultrasound (US) examination to clinical follow-up in patients with low suspicion of appendicitis and discordant or no conclusive initial findings. The objective of this study was to evaluate the role of a second US scan in medical or surgical treatment. We retrospectively evaluated medical records (from november 2006 to June 2008) of 1.959 patients with a history of acute abdominal pain referred for abdominal US examination. Fifty-four patients, 22 males and 32 females aged between 3 and 14 years, received clinical indication for a second US study during that period. US monitoring was performed between 5 to 36 hours after the first examination. Patient history details, ultrasonographic characterization of cecal appendix, and clinical evolution were registered. Ten patients had progressive inflammatory appendicular changes. All of them underwent surgery and appendicitis was confirmed in eight cases (80 percent). Ten patients showed no changes on the second US scan; 40 percent of patients underwent surgery with biopsies confirming lymphoid hyperplasia (2), and congestive changes (2). Fifteen patients had a second US study that showed regression of inflammatory changes; all of them received medical treatment. In 19 patients, comparison was not feasible since appendixes appeared normal on US examination, or due to insufficient visualization of appendix. Our results suggest that ultrasound follow-up promotes adequate decision-making when facing surgical or medical treatment options for pediatric patients presenting with abdominal pain with initial clinical and imaging findings inconclusive for acute appendicitis.

Pacientes con dolor abdominal no específico o examen físico no concluyente para apendicitis aguda son usualmente mantenidos en control médico. En nuestro Sevicio de Urgencia algunos pediatras y cirujanos agregan una ultrasonografía (US) de control en la evolución de cuadros no concluyentes. El objetivo de este trabajo fue evaluar el rol de este segundo US en la toma de decisiones médicas o quirúrgicas. Para esto evaluamos retrospectivamente las fichas de 1959 pacientes referidos del Servicio de Urgencia para US abdominal con historia de dolor abdominal entre noviembre del 2006 y junio del 2008. Cincuenta y cuatro pacientes, 22 niños y 32 niñas entre 3 y 14 años recibieron durante ese período indicación de un segundo US. Estos exámenes fueron realizados entre 5 y 36 horas luego del primer estudio ultrasonográfico. Se registraron datos relacionados a la historia, caracterización ultrasongráfica del apéndice y evolución clínica. Diez pacientes tuvieron cambios inflamatorios progresivos. Todos fueron a cirugía y la apendicitis fue confirmada en ocho casos (80 por ciento). Diez pacientes tuvieron cambios inflamatorios que no se modificaron en el segundo US; 40 por ciento fue a cirugía con biopsias que demostraron hiperplasia linfoide (2) y cambios congestivos (2). Quince pacientes mostraron regresión de los cambios inflamatorios en el segundo US; todos recibieron tratamiento médico. En 19 pacientes la comparación no fue posible, por tratarse de apéndices ecográficamente normales o debido a insuficiente visualización del apéndice. Nuestros resultados sugieren que el seguimiento ecográfico ayuda en la decisión de tratamiento médico o quirúrgico en pacientes que se presentan con dolor abdominal cuyos hallazgos clínicos e imaginológicos iniciales no son concluyentes de apendicitis aguda.

Rapid Spontaneous Resolution of Idiopathic Cervico-thoracic Ventral Epidural Hematoma

Spontaneous spinal epidural hematoma (SSEH) has been rarely reported in the literature. Prompt surgical intervention is recommended for patients with neurologic deficit. However. in rare cases, spontaneous resolution of the SSEH with recovery of the neurological deficit has also been reported. We report a case of SSEH in a 55-year-old woman with a rapidly progressing neurological deficit. Her neurological deficits gradually improved sponta- neously during preoperative evaluation. Serial magnetic resonance imaging(MRI) demonstrated disappearance of the hematoma. Since her neurological status improved within a few hours, we recommended conservative care. Patients initially presenting with severe neurologic dysfunction are potential candidates for conservative management if they demonstrate rapid and progressive improvement in neurologic function. Thus, immediate surgical decompression may not be necessary if neuroimaging and clinical examinations suggest that spinal epidural hematoma will spontaneously resolve.

Spontaneous resolution of zoonotic sporotrichosis during pregnancy / Regressão espontânea de esporotricose zoonótica durante a gestação

Sporotrichosis is the most common deep mycosis in Latin America. The zoonotic transmission from cats has been demonstrated over the last few decades in many countries. A forty year-old veterinarian examined a cat with multiple ulcerations, which mycological examination isolated Sporothrix schenckii. During the examination, she was bitten in the right index finger by the animal. Two weeks later, an inflammatory lesion appeared, which became ulcerated and was followed by ascendant lymphangitis. The diagnoses of lymphocutaneous sporotrichosis and of a six weeks pregnancy were established. The lesions were not treated and by the 28th week the ulceration healed and the abscesses showed involution. This case illustrates that non-life-threatening forms of sporotrichosis during pregnancy could be treated with systemic antifungals after delivery.

Esporotricose é a micose profunda mais comum na América Latina. Sua transmissão zoonótica a partir de gatos foi documentada nos últimos anos em vários países. Médica veterinária foi mordida por um gato, que apresentava múltiplas ulcerações, das quais foi isolado Sporothrix schenckii . Duas semanas depois surgiu lesão inflamatória e após uma ulceração no dedo mordido, seguida de linfangite ascendente. Esporotricose linfocutânea e de gravidez foram então diagnosticados. As lesões não foram tratadas e na 28ª semana de gravidez a ulceração cicatrizou e os abcessos sofreram involução. Esse caso demonstra que formas menos graves de esporotricose poderiam ser tratadas com antifúngicos sistêmicos depois do parto.

Congenital Hemidiaphragmatic Agenesis Presenting as Reversible Mesenteroaxial Gastric Volvulus and Diaphragmatic Hernia: A Case Report

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

Congenital Hemidiaphragmatic Agenesis Presenting as Reversible Mesenteroaxial Gastric Volvulus and Diaphragmatic Hernia: A Case Report

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

Spontaneous Resolution of Spinal Epidural Hematoma: A Case Report

Spinal epidural hematoma(SEH) is not common in lumbar spine disorders and can be developed spontaneously without direct trauma. According to the neurologic deficit and clinical condition of patient, surgical intervention can be required. Authors report a case of spontaneous lumbar SEH resolved spontaneously without surgery. A 59-year-old man had suffered back pain and left leg pain for three weeks without trauma while working on his farm. Magnetic resonance imaging MRI demonstrated a lumbar epidural hematoma at L3/4 level. After 3 months of conservative treatment, his clini- cal symptoms were disappeared completely without neurologic deficit, and the follow-up myelocomputed tomogram(CT) showed complete resolution of the SEH. The primary treatment modality of SEH is surgical evacuation of hema- toma in case of neurologic deterioration, but conservative treatment may be considered if the patient has no neurologic deficit.

A Case of Giant Colonic Lipoma Showing Spontaneous Resolution after Endoscopic Partial Resection / 대한소화기학회지

Generally, colon lipoma is mildly symptomatic or asymptomatic. However, sometimes it may present with symptoms, such as pain, constipation, obstruction, or bleeding and may be the leading point for intussusception, particularly in large size (>20 mm). Giant colon lipoma may warrant the removal to exclude confusion with other lesions that have a malignant potential and to control symptoms. Currently, surgical resection should be considered for giant lipoma more than 20 mm in diameter due to the high risk of perforation or bleeding, especially when the lesion is broadly-based. We report here a case of spontaneous resolution acquired after endoscopic partial resection for the symptomatic giant colon lipoma with broad-base requiring surgery.