The association between thyroid volume, L-thyroxine therapy and hepatocyte growth factor levels among patients with euthyroid and hypothyroid goitrous and non-goitrous Hashimoto's thyroiditis versus healthy subjects.

OBJECTIVE: Hashimoto's thyroiditis (HT) is the most common etiology of hypothyroidism in regions where iodine deficiency is not a concern. To date, many clinical investigations have been conducted to elucidate its pathogenesis. Several growth factors have been shown to have a role in its development. Hepatocyte growth factor (HGF) is one of the aforementioned molecules. We aimed to demonstrate whether HGF is responsible for HT and goiter development. Also, we aimed to test the hypothesis that levo-thyroxine sodium therapy will suppress HGF levels. MATERIALS AND METHODS: Sixty-one premenopausal women who were admitted to our outpatient clinic between November 2010 and September 2011 were enrolled. Three groups were determined according to their thyroid function tests (TFTs) as euthyroid Hashimoto's, control and subclinical hypothyroid Hashimoto's groups. Basal TFTs, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-tg), thyroid ultrasonography (USG) and HGF were studied and recorded. Subclinical hypothyroid HT patients received levo-thyroxine sodium replacement therapy, and were re-assessed for the same laboratory and radiologic features after a median 3.5 month follow-up. RESULTS: Basal HGF levels were not different between groups. In the subclinical hypothyroidism group, HGF levels (752.75 ± 144.91 pg/ml vs. 719.37 ± 128.05 pg/ml; p = 0.496) and thyroid volumes (12.51 ± 3.67 cc vs. 12.18 ± 4.26 cc; p = 0.7) before and after treatment did not change significantly. No correlations were found between HGF and other parameters. HGF levels were similar between subjects with nodular goiter and normal thyroid structure. CONCLUSIONS: HGF was not shown to be associated with HT and goiter development. In addition, levo-thyroxine sodium replacement therapy did not alter serum HGF levels significantly.

Successful treatment with transjugular intrahepatic portosystemic shunt (TIPS) of recurrent massive rectal bleeding due to portal hypertension: case report.

Bleeding from anorectal varices can be massive and life-threatening. Punctual separation between hemorrhoids and anorectal varices is important. Numerous treatment options are available for management of bleeding anorectal varices, but none of them has demonstrated definitive efficacy. We report a case of successful transjugular intrahepatic portosystemic shunt in controlling massive recurrent rectal variceal bleeding in an elderly male patient.

Anaphylaxis due to spontaneous rupture of primary isolated splenic hydatid cyst.

Echinococcosis is a helminthic zoonosis mainly caused by Echinococcus granulosus and commonly encountered in endemic areas. The liver and lung are the most frequently involved organs. A primary isolated hydatid cyst of spleen is an extremely rare disease even in endemic areas. Anaphylactic reaction is a known complication of cystic hydatid disease, a parasitic infestation caused by the larval/cyst stage of E. granulosus that usually occurs after trauma or during interventions. To the best of our knowledge, anaphylaxis with spontaneous rupture of primary isolated splenic hydatidoses had not been reported previously. The main purpose of this report is to highlight life-threatening complications such as anaphylactic shock that should be considered due to primary isolated splenic cyst hydatid rupture in especially endemic regions.

Autologous blood-clot embolisation of cavernosal artery pseudoaneurysm causing delayed high-flow priapism.

BACKGROUND: High-flow priapism is a rare condition characterized by a prolonged and painless erection. Since it may permanently impair erectile function, it must be managed and treated as soon as possible, in order to restore potency. The case we are presenting here was successfully treated by embolizing the penile artery using an autologous clot. CASE REPORT: A case of delayed painless high-flow priapism that occured after blunt straddle-type perineal trauma, that was persistent for more than 30 days is being presented. Doppler ultrasonographic examination of the cavernosal artery revealed a 1.5 cm-diameter pseudoaneurysm at the right cavernosal artery, together with a high-velocity shunt between the two cavernous arteries. Extravasation from the proximal sites of both of the cavernous arteries and a right cavernosal artery pseudoaneurysm was detected on angiography. The patient was successfully treated by embolization of the penile artery with an autologous clot in two sessions with a 3-day interval. CONCLUSIONS: This experience along with a survey of the literature made us conclude that embolization of cavernous artery by means of an autologous clot is a very effective procedure and a method of choice for treatment of high-flow priapism and for restoration of penile erectile function. What makes our case even more interesting and important, is the fact that priapism of one month's duration could well be treated by means of this method.

Cardiac metastasis of renal cell carcinoma without inferior vena cava involvement: case report.

We report the case of a 51-year-old man with advanced renal cell carcinoma (RCC), without inferior vena cava (IVC) involvement, who was treated with chemotherapy. Computed tomography of the thorax and abdomen revealed metastatic invasion of the liver, mediastinal lymph nodes, right adrenal gland, and the head of pancreas. Heart involvement via the IVC is a well-known pattern of metastasis during RCC progression. There are very few cases worldwide that have reported RCC with cardiac metastasis without IVC involvement.

Embolization of Ruptured Hepatic Hydatid Cyst to Pulmonary Artery in an Elderly Patient: Multidetector computed tomography findings.

Pulmonary embolism due to hydatid disease is an unusual condition resulting from the rupture of a hydatic heart cyst or the opening of liver hydatidosis into the venous circulation. A 78-year old male patient complaining of dyspnea, cough and severe chest pain was admitted to our emergency department. A multidetector computed tomography of the chest revealed the presence of multiple nodules in both lungs especially in left and multiple hypodense filling defect in left main pulmonary artery and its branches. In addition, coronal reformatted multidetector computed tomography images also showed two hypodense cystic parenchymal masses on the left lobe of the liver with a cystic embolus in the right atrium. Pulmonary embolism should be kept in mind in patients who have hepatic hydatidosis if suddenly chest pain and dyspnoea occurs, especially in regions where hydatidosis is endemic.

Imaging findings of gallbladder duplication due to two cases: case report and review of literature.

Duplication of the gallbladder, a rare congenital anomaly, is important in clinical practice as it may cause some clinical, surgical, and diagnostic problems. This anomaly is also important for surgeons due to the increased risk of complications especially after laparoscopic cholecystectomy. We report ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography findings in two cases of a symptomatic duplicated gallbladder.

Persistent left superior vena cava draining to the left atrium: A case report and review of the literature.

BACKGROUND: Persistent left superior vena cava is a rare but important congenital vascular anomaly. However, PLSVC with absent RSVC (isolated PLSVC) is a very rare venous malformation We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC). CASE REPORT: This venous malformation was identified incidentally in a 69-year-old woman during chest multi-detector computed tomography (MDCT). On chest MDCT, the SVC was noted on the left side. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the left atrium (LA). The patient had no additional cardiac anomaly. CONCLUSIONS: Isolated PLSVC is usually asymptomatic but it can pose difficulties for establishing central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

Paraesophageal bronchogenic cyst mimicking oesophageal tumour.

Bronchogenic cysts are congenital lesions result from abnormal budding of the ventral foregut and depending on the timing of abnormal development cysts may locate within the mediastinum or lung parenchyma. In the case which the density of the cyst is higher it is possible to different the cyst from the tumoural pathology. In our case report we present a bronchogenic cyst mimicking tumoural pathology. It is always suggested to total removal of the cyst to treatment.

Case report: local allergic reaction of bowel wall secondary to ruptured hydatid cyst.

This is a report of a case of local allergic reaction which developed secondary to a ruptured hydatid cyst with a diffuse bowel thickening detected by computed tomography.