ABSTRACT
A patient with a symptomatic duodenal duplication cyst demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) is presented. This lesion usually does not communicate with duodenal lumen but should be added to the list of cystic duodenal lesions demonstrable by ERCP. ERCP preoperatively is helpful to the surgeon in isolating adjacent duct structures but cyst wall histology is mandatory for correct anatomic diagnosis as this lesion has often been confused with Type III choledochal cysts.
Subject(s)
Cholangiography , Cysts/diagnostic imaging , Duodenal Diseases/diagnostic imaging , Pancreas/diagnostic imaging , Adult , Cysts/pathology , Diagnosis, Differential , Duodenal Diseases/pathology , Humans , MaleABSTRACT
Acute fulminating pulmonary edema developed in three patients after acute airway obstruction secondary to tumor, strangulation, and interrupted hanging (one case each). The common etiologic factor was vigorous inspiratory effort against a totally obstructed upper airway. Acute pulmonary edema followed the event in minutes to hours and required ventilatory assistance to maintain oxygenation. All patients eventually responded to fluid restriction, diuretics, and steroids. One case was complicated by aspiration of gastric contents following respiratory failure. To our knowledge, this condition is previously unreported in English literature. We presume that the pathogenesis is related to alveolar and capillary damage, induced by the severe negative pressure generated by attempting to inspire against the closed upper airway.
Subject(s)
Airway Obstruction/complications , Pulmonary Edema/etiology , Acute Disease , Adult , Airway Obstruction/etiology , Airway Obstruction/therapy , Diuretics/therapeutic use , Female , Humans , Intermittent Positive-Pressure Breathing , Laryngeal Neoplasms/complications , Male , Methylprednisolone/therapeutic use , Middle Aged , Pulmonary Edema/drug therapy , Time FactorsABSTRACT
Injuries of the median nerve cause two major syndromes. Interosseous nerve injury as it branches from the median just below the elbow produces a characteristic deformity. Treatment involves neurolysis, or primary or secondary repair. Various tendon transfers can be used to compensate for lost function. The other syndrome is produced by median nerve injury at the wrist and consists of thenar muscle paralysis and a sensory deficit on the radial aspect of the palm and radial 3 1/2 digits. The carpal tunnel syndrome is the most common cause. Treatment consists of incising the volar carpal ligament. Lacerations at this level should be repaired primarily if possible. Several types of opponensplasties are available to restore thumb opposition. Median nerve injuries impair the ability to pinch and should be carefully evaluated and treated.
