ABSTRACT
The patient was a 78-year-old female. At the age of 76, the patient had undergone computed tomographic scanning for left lower abdominal pain. A retroperitoneal mass was detected on the right side of the abdomen. The patient had been subject to right nephrectomy due to renal calculus at the age of 33. With Doppler echocardiography and magnetic resonance imaging (MRI), based on the nephrectomy the patient was diagnosed with a renal arteriovenous fistula developed in the right renal bed. Following the wishes of the patient a follow-up examination was conducted. Because of poor heart condition and renal dysfunction, percutaneous arterial embolization was performed. After the embolization, the heart condition and renal dysfunction indicators improved and the blood flow in the arteriovenous fistula disappeared. Cases of renal arteriovenous fistulae after nephrectomy are rare, with only 90 reported worldwide, and percutaneous arterial embolization has been used as the first choice of treatment in recent years.
Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic , Kidney/blood supply , Renal Artery/diagnostic imaging , Aged , Arteriovenous Fistula/diagnostic imaging , Embolization, Therapeutic/methods , Female , Humans , Nephrectomy , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: In daily practice, it is common to experience difficulty in treating decubitus ulcers (pressure ulcers, also known as decubitus ulcers) and stasis dermatitis of the lower limbs. We hereby report that omega-3-acid ethyl esters were remarkably effective when administered to cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving the blood flow and promoting blood circulation. CASE PRESENTATION: Case 1: A 21-year-old Japanese female with lower-body paralysis. Pressure ulcers appeared on the heel and first toe of her left lower extremity. Although the patient had been treated with various ointments such as dimethyl isopropylazulene and 0.9% iodine-containing ointment, the course showed no improvement, so omega-3-acid ethyl esters was administered orally, completely healing the ulcer of the first toe in 10 weeks. Case 2: A 76-year-old Japanese male. The patient had been treated on an outpatient basis for 15 years due to hypertension, heart failure, type 2 diabetes mellitus, and hyperlipidemia. Two years prior to this presentation, stasis dermatitis occurred in the lower limbs and at the end of last year, erosive ulcers appeared on the front part of the lower-right thigh and shin. Although treatment with various topical ointment and dressings was performed, the course showed no improvement. Oral administration of omega-3-acid ethyl esters was initiated. At 12 weeks, his condition entered the white phase and healed almost completely. CONCLUSIONS: This report is the first to document other treatment possibilities for pressure ulcer and/or stasis dermatitis in cases where the use of topical applied ointments and medications is difficult. This new therapy may therefore help physicians to treat pressure ulcers and stasis dermatitis.
ABSTRACT
INTRODUCTION: Idiopathic sclerosing orbital inflammation is a rare and ill-defined heterogeneous entity, and a distinct subset of orbital inflammation. Recently, attention has been focused on immunoglobulin G4-related disease complicated with fibrotic changes in some other organs with high serum immunoglobulin G4 levels. This report presents a case of suspected idiopathic sclerosing orbital inflammation complicated with high serum immunoglobulin G4 levels. CASE PRESENTATION: An 82-year-old Japanese woman had a 30-year history of chronic thyroiditis. She experienced right ptosis and eyelid swelling. These symptoms gradually developed over five years. The clinical and radiographic findings suggested that our patient had idiopathic sclerosing orbital inflammation. We were unable to obtain our patient's consent to perform a biopsy. While the serum immunoglobulin G level was within the normal limits, the serum immunoglobulin G4 level was significantly elevated. The serum immunoglobulin G4 levels decreased after the administration of oral prednisolone at a daily dose of 20 mg. In addition, the swelling and ptosis of the right upper eyelid disappeared gradually after four weeks. Our patient was then suspected to have idiopathic sclerosing orbital inflammation complicated with immunoglobulin G4-related disease and chronic thyroiditis. CONCLUSION: An orbital pseudotumor of this type is indicative of idiopathic sclerosing orbital inflammation immunoglobulin G4-related disease. Immunoglobulin G4 may thus be considered a subclass of immunoglobulin G when the serum immunoglobulin G level is within normal limits.
ABSTRACT
This report presents three cases of IgG4 related sclerosing disease complicated with chronic sclerosing sialadenitis. The clinical, radiographic and pathologic findings later suggested that the patients had chronic sclerosing sialadenitis. The submandibular gland tumour regressed in two patients. These patients were suspected to have Mikulicz's disease or Sjögren's syndrome, but the diagnostic criteria were not satisfied. The workup for chronic sclerosing sialadenitis revealed a significantly elevated value of serum IgG4. The patient was then diagnosed with IgG4 related sclerosing disease complicated with chronic sclerosing sialadenitis. After administering prednisolone to these patients, the serum IgG4 values decreased after 4 weeks. The current cases may represent a new category for Mikulicz's disease or Sjögren's syndrome as an IgG4 related sclerosing disease.
ABSTRACT
The authors describe a case of SAPHO syndrome with bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. The patient had undergone transurethral resection (TUR) and was treated with BCG immunotherapy following TUR. Two years after treatment for bladder cancer, the patient had palmoplantar pustulosis, and in the past 1 month suffered from pain localised to the anterior chest wall. The bone scintigraphy showed a strong focal enrichment in the right chest wall, suggesting spondyloarthropathy rather than malignant disease. On the basis of clinical and scintigraphy findings, SAPHO syndrome was diagnosed. The patient was treated with topical therapy and non-steroidal anti-inflammatory drugs and symptoms improved. The authors suggest that SAPHO syndrome might be caused by an association with BCG immunotherapy.
Subject(s)
Acquired Hyperostosis Syndrome/chemically induced , Acquired Hyperostosis Syndrome/diagnosis , BCG Vaccine/adverse effects , Urinary Bladder Neoplasms/drug therapy , Acquired Hyperostosis Syndrome/therapy , Aged, 80 and over , Diagnosis, Differential , Female , HumansABSTRACT
OBJECTIVE: To describe the computed tomography appearance, embryology, and clinical implications of right double inferior vena cava (IVC). METHODS: Computed tomography imaging findings were retrospectively reviewed in our 5 patients and in 2 cases reported in the literature with right double IVC. The relationship of the 2 postrenal IVCs, their diameter, level of confluence of the 2 IVCs, course of the left common iliac vein, draining site of the right gonadal vein, and the presence of retrocaval ureter were evaluated. RESULTS: In all cases, the relationship of 2 IVCs was ventral-dorsal, and the left common iliac vein passed ventral to the aortic bifurcation or the right common iliac artery. The relationship of the diameters and level of confluence of the 2 IVCs were variable. The right gonadal vein drained into the ventral vessel in 4 cases and into the IVC between the renal venous confluence and the confluence of the 2 vessels in 1 case. In all cases, the retrocaval ureter was not identified. CONCLUSIONS: Characteristic computed tomography findings of right double IVC were a ventral-dorsal relationship between the 2 vessels and the unusual course of the left common iliac vein. Embryologically, the ventral vessel originates from the right subcardinal vein, whereas the dorsal vessel originates from the right supracardinal vein. Although this anomaly is extremely rare, radiologists should recognize it.
