Sarcoidosis of the vagina treated with methotrexate.

We describe the first case of mediolateral episiotomic sarcoidosis of the deep vaginal tissue, without involvement of the pulmonary parenchyma or pulmonary symptoms. A 68-year-old female was admitted with a vaginal mass that had developed about 1 month prior. On bimanual examination, we found a painful solid mass approximately 4 cm in diameter on the episiotomy line of the deep vaginal tissue. The patient underwent pelvic magnetic resonance imaging on suspicion of a malignancy, and a vaginal true-cut biopsy was performed. The biopsy specimen exhibited non-caseating, granulomatous inflammation and many multinucleated giant cells, strongly suggesting sarcoidosis. We had excluded other granulomatous diseases; a final diagnosis was made of stage-1 sarcoidosis in the deep vaginal mass. A 3-month course of methotrexate (2.5 mg/week) was commenced to treat a flare-up of rheumatoid arthritis. The vaginal mass resolved. To the best of our knowledge, this is the first case of sarcoidosis in a deep vaginal mass without pulmonary parenchymal or other solid-organ involvement.

A diagnostic dilemma for solid ovarian masses: the clinical and radiological aspects with differential diagnosis of 23 cases.

OBJECTIVE: This study aimed to analyze the clinical characteristics and diagnostic features of ovarian fibromatous masses. MATERIALS AND METHODS: The authors reviewed the records of 23 women who underwent laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 2005 to January 2013. The clinical, ultrasonographic, magnetic resonance imaging, tumor marker, therapeutic, and histologic data were analyzed. RESULTS: The mean age of the patients was 50.9 years. Sixteen patients were menopausal. The preoperative ultrasonography examination incorrectly diagnosed seven lesions as uterine fibromas, and the magnetic resonance imaging examination incorrectly labeled three lesions as pedunculated subserous uterine fibromas. The cancer antigen-125 levels of 17 cases were measured, with four being abnormal. Twenty-three patients underwent a laparotomy. Twenty patients underwent a total hysterectomy with bilateral salpingo-oophorectomy, and three underwent a tumorectomy. The histological diagnosis was fibrothecoma in 21 cases, fibroma in one case, and cellular fibroma in one case. Histopathologic examination of the endometrium of seven of the 20 patients who underwent hysterectomy revealed simple endometrial hyperplasia without atypia. CONCLUSION: Ovarian fibromas and fibrothecomas are often misdiagnosed as uterine fibromas and occasionally mistaken for malignant tumors of the ovary preoperatively. As these tumors originate from ovarian stroma, they may be hormone-active tumors. Therefore, they may lead to premalignant changes in the endometrium. The preoperative evaluation of the endometrium is recommended.

Bilateral Krukenberg tumor in a 16-week pregnant woman.

The authors present the case of a G2P1001 who presented in 16-week gestation with bilateral Krukenberg tumor, abdominal pain, and iterative vomiting episodes. Although a few cases of Krukenberg tumor in pregnant women have been reported, no case reports asymptomatic and free of disease at 18 months were found in the English literature. Early detection followed by surgery and chemotherapy during pregnancy could possibly result in a favorable outcome in such patients.

Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas.

AIM: To investigate the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of abdominal wall endometrioma (AWE) and to compare the ADC (apparent diffusion coefficient) values of AWE with those of the uterine endometrium during two different phases of the menstrual cycle. MATERIALS AND METHODS: A total of 22 women aged between 27 and 42 years (mean 32.8 years) and who had regular menstrual cycles were included in the study. These patients had a total of 25 AWE lesions. The mean and standard deviation of the ADC values of the normal endometrium/AWE were calculated for the menstrual and luteal phases. All examinations were performed using a 1.5 T magnet (b-values of 50, 400, and 800 mm/s(2)). The results were analysed using the Shapiro-Wilk test, the Pearson correlation test, the analysis of variance (ANOVA) test, and the paired sample t-test. RESULTS: The ADC values of the endometrium were different in the two phases of the menstrual cycle (menstrual phase: 0.924 ± 0.171; luteal phase: 1.171 ± 0.135). Similarly, the ADC values of the AWE were different in these phases (menstrual phase: 0.937 ± 0.256, luteal phase: 1.256 ± 0.215). In both AWE and the uterine endometrium, the ADC measurements were significantly lower in the menstrual phase than during the luteal phase. This difference was statistically significant (p < 0.05). There was no significant difference in the ADC values between the endometrial layer and AWE during the same phase (p = 0.216 for menstrual phase, p = 0.104 for luteal phase, paired sample t-test). CONCLUSION: The present study demonstrated that in all patients, the DWI features of AWEs were significantly similar to those of the uterine endometrial tissue. Additionally, the ADC measurements of the patients showed similar cyclical changes. These results suggest that the ADC values of a lesion close to the uterine endometrium may be used to differentiate AWE from the other disease entities of the abdominal wall.

Multidetector computed tomography findings of an asymptomatic levoatrial cardinal vein with an interatrial course.

A 57-year-old female patient with a family history of coronary artery disease admitted to our hospital for the coronary check-up. A coronary angiography was performed with ECG-gated 128 slice dual source computed tomography.Multidetector computed tomography (MDCT) showed, in addition to the normal coronary arteries, a persistent levoatrial cardinal vein (LCV) draining into vena cava superior. ECG-gated cardiac MDCT is a useful tool showing the origin, course, and drainage site of LCV.

Do amniotic fluid leptin levels decrease in pregnancies with fetal trisomy 21?

The objective of this study was to find a possible correlation between Down syndrome and amniotic fluid leptin. We compared 2nd trimester amniotic fluid leptin levels of fetuses with normal karyotype and with trisomy 21. We retrospectively found 15 fetuses with Down syndrome and we randomly selected 48 fetuses with normal karyotype as controls from our perinatology record database, in order to analyse their 2nd trimester amniotic fluid leptin levels. Amniotic fluid leptin levels were analysed by enzyme-linked immunosorbent assay (ELISA). The results were evaluated by Mann-Whitney U test. It was found that amniotic fluid leptin levels did not show any significant difference between amniotic fluids of fetuses with normal karyotype and those with trisomy 21 (p = 0.061). Median level of leptin was 10.06 ng/ml (range 2.10-36.69) for trisomy 21 fetuses and 14.53 ng/ml (range 2.30-67.33) for normal fetuses. In conclusion, leptin levels were not found to change in the amniotic fluids of fetuses with trisomy 21. This excludes a possible involvement of leptin in pathogenic processes associated with trisomy 21 during the fetal period and its potential employment as a diagnostic tool.

Non-visualization of the internal carotid artery with a normal ipsilateral common carotid artery Doppler waveform: a finding suggesting congenital absence of the ICA on colour Doppler ultrasound.

We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness. On MRI of the brain, occlusion of the left cavernous ICA was suggested. On colour Doppler ultrasound (CDS), the left ICA was not visualized and the ipsilateral common carotid artery (CCA) showed normal flow in systole and diastole. Combined with the correct identification of the left external carotid artery (ECA), these findings were suggestive of congenital absence of the ICA rather than occlusion. The final diagnosis of congenital absence of the ICA was confirmed with CT of the skull base.

Does bilateral total knee arthroplasty affect gait in women?: comparison of gait analyses before and after total knee arthroplasty compared with normal knees.

We performed gait analysis of 24 patients with bilateral knee osteoarthritis (OA) before, 1 year, and 2 years after bilateral total knee arthroplasty and compared these results to 12 normal controls. Cadence was significantly decreased in OA patients when compared with controls. Step and stride lengths were significantly different preoperatively (shorter) and postoperatively (P < .05), but postoperative results showed no significant difference when compared with normal controls (P < .05). Step and stride times were significantly different (P < .05) between the preoperative OA group and controls, but no difference was seen with the postoperative measurements when compared with controls. In the OA group, the mean vertical component of the ground reaction forces expressed as percent body weight was significantly lower when compared with controls and postoperative results. No correlation was found between the preoperative and postoperative clinical scores and objective data obtained from gait analysis. Our results demonstrate that gait analysis is not a useful tool in evaluating the success of total knee arthroplasty patient.

Malignant triton tumor of the lumbar spine.

STUDY DESIGN: A case report of surgically treated malignant triton tumor of the L2 nerve root. OBJECTIVES: To discuss treatment methods of the rare malignant triton tumor. SUMMARY OF BACKGROUND DATA: Malignant peripheral nerve sheath tumors are neoplasms that most often arise in peripheral nerves or in neurofibromas. Malignant triton tumor is a histologic variant of those tumors. METHODS: A 58-years-old male patient was admitted with severe back and leg pain. Magnetic resonance imaging revealed a dumbbell-shaped tumor over the right L2 nerve root. The tumor mass was removed posteriorly and the spine was stabilized by transpedicular screws followed by radiation therapy. RESULTS: The tumor was diagnosed as "malignant triton tumor." There was no sign of metastasis during the 8 months of follow up. CONCLUSIONS: In this case, the diagnosis of triton tumor is based solely on microscopic evidence of the neural tissue accompanied by rhabdomyoblasts and immunohistochemical examination. Patients with malignant triton tumors are usually younger than age 35. Our patient is 1 of the oldest patients with tumor occurrence in the spinal canal. Although our patient still has no evidence of recurrence, the prognosis is poor for this group of patients.

Electrochemical behavior of 2'-halogenated derivatives of N,N-dimethyl-4-aminoazobenzene at mercury electrode.

The electrochemical behavior of 2'-halogeno-N,N-dimethyl-4-aminoazobenzene derivatives was investigated using various polarographic and voltammetric methods. The peak potentials of these derivatives were observed to shift towards negative values along with an increase in the pH. A reduction of the azo linkage took place via two electrons at pH > 4, but four electrons at pH < 4 in aqueous-ethanol mixtures. The standard rate constants were determined with (Laviron technique) or without (Nicholson technique) taking the adsorption phenomena into account. The diffusion coefficients were calculated from the cyclic voltammetric data using a method developed by Garrido. The amount of adsorbed substances and transfer coefficients for the electron transfer were also determined. A mechanism for the electrode reaction is proposed. These compounds can be quantitatively determined between 1 x 10(-5) M and 1 x 10(-7) with DPP and CV.

Electrochemical behaviour of 3,8-difluorobenzo[c]cinnoline at mercury electrode.

Voltametric and coulometric methods have been used to study the electroanalytical behaviour of 3,8-difluorobenzo[c]cinnoline. The number of electrons transferred, the wave characteristics, diffusion coefficient and reversibility of the reactions have been investigated in ethyl alcohol-BR. Adsorption of the molecule on the surface of the mercury drop electrode was analyzed and this phenomena was exploited to calculate the diffusion coefficient of 3,8-difluorobenzo[c]cinnoline. A mechanism for the electrode reaction was proposed.

Z-plate instrumentation in thoracolumbar spinal fractures.

Anterior decompression enables direct access and good canal clearance of the injury level in thoracolumbar spinal fractures, and decompressing the neural elements is shown to be an important factor for neurologic improvement and pain relief in many cases. In this study, results with anterior decompression and Z-plate instrumentation in thoracolumbar spinal fractures are reviewed. Nineteen patients with old spinal fracture (average: 3 years) and neural compression, and 15 patients with fresh thoracolumbar fractures with neurologic deficit and/or major anterior spinal canal obstruction had anterior decompression and Z-plate instrumentation with anterior fusion. Stabilization was protected with thoracolumbar thermoplastic braces for six months. Preoperative kyphotic deformity averaged 20.9 degrees (range: 7 degrees to 64 degrees), while it was an average of 8.0 degrees (range: -12 degrees to 35 degrees) postoperatively. Medullary canal compromise was 41% an average (range: 13% to 67%) and postoperatively it had an average value of 6% (range: 0% to 18%). Patients were followed up an average of 30 months (range: 25 to 36 months). The unchanged positions of bone grafts and statistically insignificant loss of correction in the sagittal plane are accepted as evidence for bony fusion in all patients. Z-plate instrumentation provides stable fixation. Additionally, the technique can be performed easily and has the added benefit of being MRI-compatible.

Portal venous system aneurysms: report of five cases.

Until recently aneurysms in the portal venous system were considered to be very rare lesions. This opinion has largely been changed by the increasing number of cases reported in recent years. In this paper we report the cases of five patients with portal venous system aneurysms, including one with splenic vein aneurysm. One patient had associated portal hypertension. The reexamination of two patients 2 years later showed no change in the aneurysms. The sonographic features and related literature are reviewed. In the light of this series and the information in the literature, we recommend that portal venous system aneurysms should no longer be considered exceptionally rare entities.