Case report: Sclerosed hemangioma of the liver: A diagnostic challenge.

Hemangiomas are the most common noncystic benign hepatic tumors and are usually incidentally discovered during routine radiological examinations. The diagnosis of hepatic hemangiomas with a typical presentation is generally easy with plain and cross-sectional imaging; however, it can be complicated when hemangiomas undergo histological changes such as fibrosis. Sclerosed hepatic hemangioma (SHH) is the extreme presentation of this fibrotic process. These atypical lesions can be misdiagnosed as primary hepatic malignancies or metastasis. Their diagnosis is established by histological examination. We report the case of a patient with an SHH, which was misdiagnosed as an intrahepatic cholangiocarcinoma. This article's aim is to draw attention to this infrequent pathology and underline the features of this benign tumor that could suggest its diagnosis prior to surgery to avoid unnecessary hepatic resections.

[Treatment of bilateral spontaneous pneumothorax during pazopanib therapy for pulmonary soft tissue sarcoma metastases. What to do when there is so few evidence?] / Traitement d'un pneumothorax spontané bilatéral au cours d'un traitement par pazopanib pour la prise en charge de métastases pulmonaires d'un sarcome. Quelle conduite à tenir ?

Soft tissue sarcomas are rare malignant tumors with a great variety of histological types and different response to multimodality treatment. Pazopanib has been recently introduced for the treatment of non-adipocytic metastatic soft tissue sarcomas which are resistant to conventional chemotherapy. Spontaneous pneumothorax is a rare but well recognized complication of this molecule and its treatment is quite challenging. The case reported herein describes the surgical management of a simultaneous bilateral spontaneous pneumothorax in a patient with pulmonary metastases treated with pazopanib. It underlines the fact that the main objective should be the maintenance of the treatment in patients who benefit from it. Close oncologic and surgical collaboration is crucial in order to deal with adverse effects due to the anti-angiogenic action of pazopanib.

[Staple line presenting as a suspicious pulmonary nodule]. / Une ligne d'agrafage imitant un nodule pulmonaire suspect.

The case reported herein concerns a 47-year-old female patient with a right apical pulmonary nodule, which was hypermetabolic on positron emission tomography scan. Eighteen years ago, she underwent a right axillary thoracotomy with apical blebectomy and pleurectomy for a recurrent primary spontaneous pneumothorax. Percutaneous transthoracic needle biopsy was unsuccessful. Surgical exploration revealed that the lesion was in fact the reinforcement material of the staple line that was used in the previous operation. Even though it is a rare presentation, previous use of surgical staples should alert the care team, especially when a new nodule is located near the ancient staple line, in order to avoid unnecessary invasive procedures.

A Rare Case of Ileocolic Obstruction Due to Lithophagia Associated with Cervical Oesophageal Perforation.

Lithophagia is a rare syndrome characterized by a repetitive ingestion of stones and pebbles. We herein report a case of a 61-year old mentally retarded man, with a past surgical history of multiple laparotomies for stone ingestion, presenting with cervical oesophagus perforation due to a large butterfly screw and massive impaction of 89 stones and other foreign bodies in the caecum, with consequent mechanical bowel obstruction.

Enhanced recovery after elective colorectal resection outside a strict fast-track protocol. A single centre experience.

INTRODUCTION: Optimising the management of hospitalised patients is a major concern. In colorectal surgery, the concept of enhanced recovery has been popularised by means of "fast-track" protocols, aiming at patient's discharge on the second postoperative day. Nevertheless, a strict fast-track protocol has several limitations. It is very demanding for the patient and therefore applicable only to a limited number of patients. AIM: In order to optimise, in every aspect, the postoperative recovery of each patient undergoing an elective colorectal resection inside our institution, we set up a "soft" enhanced recovery programme. MATERIAL-METHODS: A retrospective analysis was conducted in 92 patients evaluating the respective impact of protocol application throughout the duration of the hospital stay. RESULTS: When all the required measures of our protocol were correctly implemented, the median discharge day was postoperative day 3 (range 3-5 days). On the contrary, when deviations occurred, they resulted in longer hospital stay (p < 0.001). Patients operated by laparoscopy were discharged earlier than patients operated by laparotomy (p < 0.001). The use of nasogastric tube and postoperative drainage prolonged significantly the length of stay (p = 0.001 and p < 0.001 respectively). When the urinary catheter was not removed or oral feeding not resumed on postoperative day 1, the patients were discharged later (p < 0.001). CONCLUSIONS: There are substantial possibilities of optimising the recovery process after an elective colorectal resection, outside a strict fast-track protocol.

Ruptured aneurysm of the popliteal artery. Is the diagnosis still difficult?

The aneurysm of the popliteal artery is the most commonly treated non-aortoiliac aneurysm, accounting for more than 70% of all peripheral aneurysms. The rupture of a popliteal aneurysm is rare and it is often misdiagnosed. In the case of a 46-year old female patient here reported, the patient was referred to our department with the diagnosis of ruptured aneurysm of the right popliteal artery with formation of a large pseudo-aneurysm. We operated the patient on a semi-urgent basis and performed a replacement of the popliteal artery by a saphenous vein graft. Three months after the operation, the patient was free of symptoms. This article's aim was to emphasize on how the pitfalls during clinical examination, as well as the problems of imaging interpretation, can make the diagnosis of ruptured popliteal aneurysm still difficult.

Complicated right-sided Bochdalek hernia in an adult.

Bochdalek hernias on the right side of the diaphragm are very rarely diagnosed in adults. We report a case of a 52-year-old female patient, who presented to the emergency department with acute intestinal obstruction. Plain and cross-sectional imaging identified a large right-sided Bochdalek hernia containing small bowel loops and the right colon. A laparoscopic approach was performed. The herniated intestinal loops and the right colon were reduced into the abdominal cavity. The diaphragmatic defect was closed using clips with reinforcement by a prosthetic polypropylene mesh. A mini median laparotomy was performed to ensure the viability of the bowel and a few stitches were inserted on superficial lesions of the serosa. The recovery was uneventful and the patient was discharged from the hospital 6 days after admission. Nine months later the patient is doing well.

Erythrocyte organic phosphates and whole blood oxygen affinity in patients on continuous ambulatory peritoneal dialysis.

Whole blood oxygen affinity, erythrocyte pH and organic phosphates were studied in five anaemic untransfused patients with end stage renal disease undergoing continuous ambulatory peritoneal dialysis. Decreased whole blood oxygen affinity with increased adenosine triphosphate and normal 2.3 diphosphoglycerate (DPG) values were observed. Normal and stable serum phosphate and permanent mild metabolic acidosis may be important factors contributing to maintain DPG levels within the normal range despite anaemia. Continuous dialysis avoids cyclic fluctuation of blood oxygen affinity as described during and after dialysis sessions in patients on maintenance haemodialysis.

Is cryoglobulin detection of clinical significance in chronic glomerulonephritis not related to systemic disease?

Sera from 105 adult patients with idiopathic chronic glomerulonephritis (GN) were investigated to assess the diagnostic and prognostic value of cryoglobulin (CG) detection. CG+ sera were found in 49% of cases but also in 34% of normal donors. CG composition in these two groups was different. Concentrations of CG greater than micron g/ml were considered as abnormal, since concentrations did not exceed this value in the controls. Using this criterion 30% of patients with GN had CG; most had membrano-proliferative GN, GN with mesangial IgA deposits, and membranous GN. CG occurred with the same frequency but at higher concentrations in the group of patients with diffuse proliferative GN than in other groups; however, there was no difference in the frequency and concentration of CG when GN was thought to be mediated by immune complexes (IC) than when it was not. No relationship was observed with disease activity. In conclusion low CG might represent an in vitro artifact of a common in vivo immunoregulatory mechanism in normal donors. Although they might be a marker for the presence of IC in adult patients with GN not related to systemic disease, CG detection appears to be of little help in diagnosis, assessment of disease activity, or therapeutic monitoring.

[Splenomegaly and displacement of a remaining left kidney (author's transl)]. / Splénomégalie et déplacement à droite d'un rein gauche restant.

A case of displacement of remaining left kidney across the midline because of a big splenic enlargement due to chronic lymphoid leukemia is reported. As observed in the rare cases of the literature, this observation illustrates that the kidney returns to a normal position after disappearance of the splenomegaly, in this case after chemotherapy followed later by splenectomy.

[Acute renal failure during indomethacin treatment. 6 cases (author's transl)]. / Insiffusance rénale aiguë au cours des traitements par l'indométacine. Six observations.

Acute renal failure (ARF) was observed in 6 patients under indomethacin treatment. Before receiving the drug 3 patients had normal, and the other 3 slightly elevated plasma creatinine levels. All patients were also treated with diuretics. ARF developed within the first 48 hours of therapy. Four patients had clear-cut oliguria. The renal disorders proved completely and rapidly reversible after treatment was discontinued, except in one female patient who had to undergo peritoneal dialysis for 12 days and in whom moderate aggravation of the pre-existing renal insufficiency persisted on follow up. The ARF was attributed to a sudden fall in renal blood flow due to the inhibitory effect of indomethacin on prostaglandin synthetase. This complication occurs exclusively in patients with renal hypoperfusion secondary to hypovolaemia, with cardiac insufficiency or with intrarenal vascular lesions. Sodium depletion induced by previous or concomitant diuretic treatment increases the risks. The possibility of ARF warrants careful monitoring of urinary output and renal function at the onset of non-steroidal anti-inflammatory therapy in patients with altered or precarious haemodynamics.