Unusual case of skull metastasis secondary to pancreatic adenocarcinoma

Skull metastasis must be kept in mind when considering the differential diagnosis of a skull tumor. Skull metastases cause local swelling that is usually painless, and rarely they lead to neurologic dysfunction. Despite the fact that hematogenous skull metastases can be caused by nearly all types of tumors (lung, prostate, thyroid carcinoma, malignant melanoma), breast cancer is associated with the highest rate of metastatic skull lesions. We report an extremely rare case of skull metastasis from a pancreatic adenocarcinoma, in a 65-year-old woman, presented with painless frontoparietal scalp swelling which developed within three months. To the best of our knowledge, this is the second case involving the skull secondary to a pancreatic adenocarcinoma, and the first case when skull metastasis was the first evidence of a pancreatic adenocarcinoma.     

An Unusual Case of Self-Injected Bovine Fat in Liquid Form to the Face for Cosmetic Reasons

A 45-year-old woman injected bovine fat in liquid form in to her periorbital area and nasolabial folds near the lip margin and glabellar area to look younger. She was influenced by a TV program about fat augmentation of the aging face and collagen injection to the wrinkles. Major depression had been diagnosed for this woman 5 years previously, after which she used antidepressants and hypnotics irregularly. The prolonged edema of her face subsided within 3 months, along with the erythema, itching, and firmness at the injection sites. No liposuction of the injected material was planned because it had changed to solid form as soon as it was injected. Additionally, it was thought that surgical excision of the fat would not be effective and could harm the facial nerve branches because magnetic resonance imaging showed diffuse enlargement of subcutaneous tissue. Therefore, a conservative approach, such as medical treatment with close follow-up evaluation was preferred. The reported case is presented not only to add an interesting self-injection case to the literature, but also to show that patients with psychological problems may harm themselves by using inappropriate methods for cosmetic reasons under the effect of inaccurate information obtained from TV programs, press, family, and friends.     

Anterior cervicothoracic meningocele treated by cystopleural shunt. Case report and review of the literature

Anterior meningocele is a rare disease which is commonly observed in the sacral region. Anterio cervicothoracic meningocele is generally diagnosed in adult age and there are few reports in infancy. Different treatment procedures are performed such as ligation, resection and wrapping. The case of a 9-month-old male infant with acute respiratory distress and cyanosis is described. He had also recurrent lung infections for 3 months. The magnetic resonance imaging revealed an anterior cervicothoracic meningocele which was compressing the lung, aorta, esophagus and trachea associated with skeletal abnormalities and C2 - C7 syringohydromyelia. There was no evidence of neurofibromatosis. He was submitted to thoracotomy and treated with cystopleural shunt without valve system. Postoperatively his respiratory distress improved dramatically. Radiologically, the size of meningocele decreased and the syringomyelic cavity disappeared. There was no evidence of recurrence during his followup. Cystopleural shunt procedure is a reliable, simple and effective treatment modality in anterior cervicothoracic meningocele cases. This treatment regimen prevents possible neural damage and also treatments to the associated anomalies such as syringohydromyelia.     

Improved early muscle recovery using FK506 in a rat nerve-repair model

The authors hypothesized that FK506 improves maximal muscle force (P (0)) recovery during early muscle reinnervation. Rat peroneal nerve was unilaterally cut and repaired. Rats received subcutaneous injections of vehicle (controls) or FK506 at 1 mg/kg (FK506-1MG) or 5 mg/kg (FK506-5MG) for 3 weeks. Extensor digitorum longus (EDL) isometric muscle P (0) was measured bilaterally 4 weeks postoperatively. FK506 treatment adversely affected body mass. With body mass as a covariate, the P (0) for denervated-reinnervated muscle in the FK506-5MG group was statistically significantly higher by 34 percent and 32 percent, compared with controls and FK506-1MG groups. There was no group difference for the contralateral, nerve-intact EDL muscle P (0), when loss of body mass was considered. NCAM immunohistologic data showed significantly better reinnervation of the denervated muscle in a dose-dependent fashion. Thus, FK506 treatment at high dose improves early recovery of force in denervated-reinnervated muscle, following nerve repair, when loss of body mass is considered.     

Effects of clonidine pre-treatment on bupivacaine and ropivacaine cardiotoxicity in rats

BACKGROUND AND OBJECTIVE: Clonidine has cardiac and systemic effects that can modify the potentially lethal cardiovascular effects of local anaesthetics. We evaluated the effects of clonidine pre-treatment on cardiotoxicity induced by an infusion of bupivacaine or ropivacaine and the success rate of resuscitation in anaesthetized rats. METHODS: Thirty-two Sprague-Dawley rats (250-300 g) were anaesthetized with thiopental and ketamine. Lung ventilation was maintained mechanically, and the electrocardiograph and invasive blood pressure were recorded continuously. Two separate groups of rats were treated with intravenous clonidine 5 microg kg(-1) (n = 16) or saline (n = 16) in a randomized fashion. Fifteen minutes later, each group was randomly subdivided into two equal groups and an infusion of bupivacaine or ropivacaine, 3 mg kg(-1) min(-1), was given until cardiac arrest (asystole) occurred. The times when the cardiotoxic events (25%, 50% and 75% reduction of arterial pressure and heart rate, first dysrhythmia and asystole, respectively), induced by the local anaesthetic, occurred and the resuscitation outcome scores were recorded. RESULTS: Clonidine reduced heart rate and arterial pressure (P < 0.01). Clonidine did not alter cardiotoxicity or the success rate of resuscitation in bupivacaine-treated rats. In the ropivacaine group, clonidine increased the 25%, 50% and 75% reduction times of arterial pressure and the 50% and 75% reduction times of heart rate, times to first dysrhythmia and asystole (P < 0.05). Clonidine also increased the success rate of resuscitation in ropivacaine-treated rats (P < 0.05). CONCLUSIONS: Although pre-treatment with clonidine protects the effects of ropivacaine cardiotoxicity and increases the success rate of resuscitation, it does not affect bupivacaine toxicity.     

Modification of meatal advancement and glanuloplasty for correction of distal hypospadias

OBJECTIVE: The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias. MATERIAL AND METHODS: Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull-out, tag-shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained. RESULTS: After 1-3 years of follow-up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure. CONCLUSIONS: Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit-like), wide meatus was obtained, the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.     

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.     

Changes in Leptin,Plasminogen Activator Factor and Oxidative Stress in Morbidly Obese Patients following Open and Laparoscopic Swedish Adjustable Gastric Banding

Background: Oxidative stress is increased in obesity, leading to endothelial dysfunction, atherogenesis, and platelet aggregation. The purpose of this study was to determine the effects of weight loss after bariatric surgery on serum lipids, malondialdehyde (MDA, a marker of oxidative stress), oxidized low-density lipoprotein (oxLDL, which is increased in obesity and causes endothelial dysfunction), paraoxonase (PON-1, which inhibits lipid peroxidation), leptin and plasminogen activator inhibitor type-1 (PAI-1, which contributes to a thrombotic state). Methods: 40 morbidly obese patients had insertion of a Swedish adjustable gastric band (SAGB). A lipid profile, MDA, oxLDL, PON-1, leptin and PAI-1 levels were drawn before and 6 months after the operation. 20 patients underwent open (Group 1) and 20 laparoscopic (Group 2) SAGB, to compare the systemic inflammatory response of the two approaches. Results: Patient demographics, indications for surgery, and postoperative results were no different between the groups. Postoperative BMI and concentrations of lipid, MDA, oxLDL, leptin and PAI-1 decreased significantly in both groups. PON-1 activity increased and was negatively correlated with BMI (r=-0.618, P< 0.01), MDA (r=-0.735, P<0.001), oxLDL (r=-0.701, P< 0.01), leptin (r=-0.626, P<0.01) and PAI-1 (r=-0.461, P<0.05). There was a correlation between BMI and MDA (r=0.790, P <0.001), and also leptin (r=0.900, P<0.001) and PAI-1 (r=0.888, P=0.001). There was no correlation between BMI and oxLDL. Conclusion: These findings support the hypothesis that in morbid obesity, weight loss after surgery has positive effects on fibrinolytic function, oxidative stress and antioxidant activity. Both operative approaches had similar effects in this study.     

Subcutaneous injection of insecticide for attempted suicide: a report of two cases

We present two patients (30-year-old female, and 20-year-old male) who attempted suicide by injecting commercially available insecticides into the forearm. No systemic signs of intoxication were observed during the acute and subacute periods. Since both patients had severe swelling, pain, and tension in the affected limb, suggesting acute atraumatic compartment syndrome, immediate fasciotomy and surgical debridement were performed. At surgery, extensive subcutaneous necrosis was observed. During long-term follow-ups, no motor and sensory deficits or contractures were seen.     

Intradural disc mimicking: a spinal tumor lesion

STUDY DESIGN: A case report of intradural disc hernia mimicking an intradural extramedullary spinal tumor lesion in radiological evaluation. OBJECTIVE: To describe a lumbar intradural disc herniation with atypical radiological appearance and point out the role of contrast magnetic resonance imaging (MRI) of the lumbar spine. SETTING: Turkey. CASE REPORT: A 58-year-old man with suspected lumbar intradural mass and neurological involvement received L5 total laminectomy. L5 total laminectomy was performed, and on inspection dura was swollen and immobile. A longitudinal incision was made in the dura and an intradural-free disc fragment was removed. The patient's postoperative period was uneventful and he had full recovery in 3 months. CONCLUSIONS: Lumbar intradural disc rupture must be considered in the differential diagnosis of mass lesions causing nerve root or cauda equina syndromes. Contrast-enhanced MRI scans are useful to differentiate a herniated disc from a disc space infection or tumor. This case demonstrates the role and the importance of contrast MRI in the diagnosis of intradural disc herniation.