Inflammatory aneurysms of the abdominal aorta: a five years experience.

During a five-year period, seven out of 85 patients undergoing surgery for abdominal aortic aneurysm, were identified as having the inflammatory variant. The clinical data, management and follow-up are reported. Computed tomography is the preferred examination for the disclosure of the nature of the aneurysm. Aneurysmectomy with graft replacement is advocated as the treatment of choice and requires a specific technique. Inflammatory abdominal aortic aneurysms are a clinical distinct entity but are considered as being a variant of the atherosclerotic abdominal aneurysm. The etiology has as yet not been clarified, even though various theories have been proposed.

Primary mediastinal leiomyosarcoma.

A 44-year-old woman complaining of thoracic back pain was found to have a large mediastinal leiomyosarcoma. This was completely excised. No adjuvant treatment was given. Follow-up after 24 months showed no evidence of disease. For these rare tumours surgery offers the best treatment, although local recurrence and metastases do occur.

Massive intestinal haemorrhage due to a solitary jejunal metastasis of a primary bronchogenic tumour.

A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss due to a solitary jejunal metastasis of a poorly differentiated adenocarcinoma of the right lung resected two years earlier. After diagnostic workup and stabilization a small bowel resection with end to end anastomosis was performed. Patient is alive and well 5 months after operation. Solitary bleeding intestinal metastasis of a primary bronchogenic tumour are extremely rare but should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumour. Resection with end to end anastomosis is the treatment of choice.

Hyperfunctioning metastatic follicular thyroid carcinoma in Pendred's syndrome.

A 66-year-old woman with Pendred's syndrome underwent a partial thyroidectomy when she was 17 years old. At the age of 52 years, she had a second thyroid operation because of hyperthyroidism due to a toxic multinodular goiter with a mediastinal extension consisting of several separate nodules. Five years later a hyperfunctioning metastatic follicular carcinoma was diagnosed histologically. After treatment with radioactive iodine, the patient was well. To the authors' knowledge, this is the first description of a metastatic follicular thyroid carcinoma in Pendred's syndrome and the first report of hyperthyroidism occurring after malignant degeneration of a dyshormonogenetic goiter.

Division and reanastomosis of the internal carotid artery for endarterectomy.

In an attempt to meet superior hemodynamic criteria without patch angioplasty and to prevent recurrent stenosis, Division-Endarterectomy-Reanastomosis (D.E.R.) was used as a routine technique in a prospective study on 26 consecutive interventions in 25 patients. One patient had a residual technical stenosis of less than 30%. Eight patients died during the one and a half year follow-up from nonstroke-related causes. After on an average 14 months flow parameters were evaluated with Color Duplex Sonography to detect recurrent stenosis. One (5.5%) mild asymptomatic recurrent stenosis of less than 50% was diagnosed. The residual stenosis remained unchanged and all other sites showed normal flow patterns. Division-Endarterectomy-Reanastomosis of the internal carotid artery, as described, meets all requirements for safe carotid restoration.

Bronchogenic cysts in children.

Three children with symptomatic bronchogenic cysts are presented. Because of the variability in clinical presentation and the shortcomings of diagnostic procedures, bronchogenic cysts present a diagnostical problem. In view of the risk of serious complications an aggressive attitude towards all congenital cystic lung lesions is advised, even when they are asymptomatic. Surgical excision assures an excellent outcome in most cases, and is therefore the treatment of choice.

Deep venous thrombosis of the upper extremity: case reports and review of the literature.

The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.

Primary intrathoracic goitre.

A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.

Surgical excision of pulmonary metastases from primary testicular cancer--case reports.

In disseminated nonseminomatous testicular cancer, chemotherapy is the first choice because this treatment can be curative. To illustrate the particular indications for surgical excision of pulmonary metastases from primary nonseminomatous testicular cancer three patients are presented who were operated on during the past two years. Surgery is recommended to ascertain the histologic nature of remaining metastases after chemotherapy, when there is no further response to chemotherapy or a partial response only. Histologic findings range from necrotic pulmonary lesions to benign transformation or viable tumor. These results should guide further therapy, particularly to decide whether chemotherapy should be continued or changed.

The value of mediastinoscopy in preoperative staging of bronchogenic carcinoma.

To determine more precisely the role of mediastinoscopy in the preoperative staging of bronchogenic carcinoma, we studied 85 patients in the period 1983 to 1985 and compared the results of mediastinoscopy and computed tomographic scanning with the findings at thoracotomy. Mediastinoscopy was performed in 48 patients when mediastinal nodes larger than 1 cm were found at computed tomographic scanning. Only 21 of them (44%) were found to have metastatic nodes. Of the remaining patients, 22 were operated on and two showed false negative results (9%). Mediastinoscopy had a sensitivity of 91% and a specificity of 100%. The positive predictive value of computed tomographic scanning was only 54%. Thirty-seven patients underwent thoracotomy after having negative computed tomographic scan results. Eleven of them (30%) were found to have metastatic mediastinal lymph nodes. The negative predictive value of computed tomographic scanning was 70%. When results from both series of patients were compared, the sensitivity and specificity of computed tomographic scanning proved to be 68% and 57%, respectively, with an accuracy of 61%. Because of the low accuracy rate of computed tomographic scanning, a more routine use of mediastinoscopy seems to be justified.

Mediastinal thymic cyst.

A symptomatic anterior mediastinal mass in a 44-year-old woman was found to be a benign thymic cyst. Complete excision was made by anterolateral thoracotomy. Congenital cysts are benign but differentiation from malignant cystic degeneration should be made.

Occlusion of the left common femoral artery after total hip replacement. Report of a case and review of the literature.

Total occlusion of the left common femoral artery occurred after total hip replacement. Presumably the occlusion was caused by polymerization heat produced by the methyl-methacrylate. Only two similar cases have been reported previously. The vascular complications after hip surgery are discussed.

Fracture of the body of the hamate bone. Case report.

A patient with a fracture of the body of the hamate bone associated with a proximal and dorsal subluxation of the fifth metacarpal is reported. Treatment consisted of closed reduction and Kirschner wire fixation. A short discussion on fractures of the hamate bone is given.

Peliosis hepatis associated with liver and retroperitoneal abscesses.

A 33-year-old woman was admitted because of coma and severe shock. CT-scan of the abdomen showed the presence of multiple liver abscesses associated with a retroperitoneal abscess which were drained percutaneously. A liver biopsy showed diffuse peliosis. After resolution of the abscesses the patient's general condition improved and she could be discharged from hospital. Peliosis hepatis is an uncommon disorder characterized by dilated sinusoids with formation of blood lakes. Many pathogenetic mechanisms and causal agents have been proposed. Liver biopsy is necessary to establish diagnosis. By withdrawing the offending drug or treatment of the underlying disorder, regression may be observed.

[Membranous obstruction of the inferior vena cava]. / Membraneuze obstructie van de vena cava inferior.

A case of idiopathic membranous obstruction of the inferior vena cava (MOVC) is reported. Varicose veins of both lower limbs associated with dermatitis and venous ulceration were the presenting symptoms. Diagnosis was made by cavography after phlebography of both legs had revealed a normal deep system. Ultrasonography demonstrated a 4 mm thick membrane in the inferior vena cava just above the level of the hepatic veins. Stripping of the greater saphenous vein and ligation of incompetent perforating veins was performed to partially correct the venous insufficiency of the most affected limb. The patient refused further treatment of the MOVC. Concise review of the literature. Up to date therapeutic possibilities are discussed.

Evaluation of magnesium before and after jejuno-ileal versus gastric bypass surgery for morbid obesity.

Jejuno-ileal bypass surgery for morbid obesity can cause metabolic and electrolyte imbalances. Another case of severe, symptomatic magnesium deficiency after jejuno-ileal bypass surgery is described. This complication was not encountered in a prospective evaluation of the magnesium status after gastric restrictive bypass surgery. Significant (p less than 0.005) body weight decrease was not accompanied by any (serum, erythrocyte or urinary) evidence of magnesium loss for 12 months after surgery.

The management of bronchopleural fistulas.

Bronchopleural fistulas remain a severe complication of pulmonary surgery and pulmonary disease. Treatment often requires multiple surgical interventions. The etiology, the methods for diagnosis and the different possible therapeutic procedures are discussed.

[Current status of fibrinolysis--a literature review of 25 years of fibrinolytic treatment]. / "Current state of fibrinolysis" een literatuuroverzicht van 25 jaar fibrinolytische behandeling.

Thrombolytic therapy is an effective, rapid method in treatment of massive lung embolism and major deep venous thrombosis extending to the caval vein. Besides resolution of the thrombus and improving hemodynamics, it prevents evolution to chronic pulmonary hypertension or postphlebitic syndrome. To have a beneficial effect in the early course of acute myocardial infarction, thrombolytic therapy should be instored within about three hours after the onset of pain; a real brief time limit. Intracoronary or systemic fibrinolysis later than the three hours period does not improve cardiac wall motion and hemodynamics and cannot assure infarct size reduction in spite of reestablished coronary flow. In peripheral arterial disease, fibrinolytic therapy of thrombosed grafts or vessels facilitates detection and unmasking of the underlying anatomical lesion permitting definite therapy (graft revision, percutaneous transluminal angioplasty). Selective intraarterial infusion has given encouraging results. Thrombolysis is a reasonably safe therapeutic method, on the condition of respecting all contraindications and avoiding unnecessary punctions. Allergy and hyperthermia are mostly benign and responsive to medical treatment. Cost-effectiveness renders streptokinase the most applicated thrombolytic agent.