Pulmonary cement embolism during cement augmentation of pedicle screw fixation: a case report

We present a case of pulmonary cement embolism during cement augmentation of pedicle screw fixation for severe degenerative scoliosis. During intra-operative C-arm fluoroscopy, a radio-opaque substance was incidentally noted to pulsate in synchrony with the patient's heartbeat. A diagnosis of pulmonary cement embolism was made. The patient was treated with coumarin for 6 months. He made a good recovery.     

Post-traumatic brain stem distortion: a case report

BACKGROUND

Primary traumatic brain stem injury (BSI) lesions are found most frequently in the dorsal or dorsolateral midbrain, whereas distortion of the brain stem itself is exceedingly rare.

CASE REPORT

We present a 20-year-old woman with a rare brain stem injury caused by a violent motor vehicle collision. Magnetic resonance imaging at 2 months after injury revealed marked brain stem distortion with loss of the normal shape at the midbrain and pons, which were displaced anteriorly in association with the fracture of the clivus. Moreover, the medulla oblongata showed a loose winding configuration. At discharge about 5 months after injury, the Glasgow Outcome Scale was severe disability.

CONCLUSION

This BSI was caused by reciprocal actions of fracture of the clivus and the direct effect on the brain stem caused by acceleration or rotational forces.     

Penile metastasis from ascending colon carcinoma: a case report]

A 63-year-old man was referred to our hospital with the chief complaint of penile pain. Four hard tumors existed in his glans. He had priapism and perineal pain thereafter. Close examination revealed that the penile tumors were metastatic cancer from the adenocarcinoma of the ascending colon. Radical operation could not be performed because he was already suffering from peritonitis carcinomatosa. He died about four months after his first visit to our hospital.     

Bilateral breast metastases from prostatic carcinoma: a case report]

We report a case of bilateral breast metastases from prostatic carcinoma. A 49-year-old man with stage D2 prostate cancer, who had been treated by chemoendocrine therapy and radiotherapy for 2 years, complained of bilateral enlarged breasts. Oral administration of diethylstilbestrol diphosphate was started 2 months before the onset of this symptom. A firm mass that was not tender was palpable beneath the skin without fixation on each side. A needle biopsy of the masses showed poorly differentiated adenocarcinoma with positive immunohistopathological staining for prostate-specific antigen. The masses were diagnosed as metastatic adenocarcinoma of prostate gland origin. The patient died 3 months after the diagnosis of breast metastases. Autopsy revealed diffuse lymphogenous metastatic disease. Metastatic prostatic carcinoma to the breast is uncommon. Breast metastases in this patient might be associated with diffuse lymphogenous metastases as well as increased local blood and lymphatic supply caused by extrinsic estrogens.     

Metastatic bladder tumor from gastric carcinoma: a case report]

A 63-year-old man with a two-month history of nocturia and dysuria consulted his family doctor. As renal dysfunction and bilateral hydronephrosis were indicated, he was admitted to our hospital on November 28, 1988. Cystoscopy revealed a non-papillary and flat tumor from the ureteral orifice to the back wall of the bladder. A biopsy of the bladder wall revealed signet-ring cell carcinoma. A metastatic bladder tumor was suspected and laboratory tests of tumor markers showed a carcinoembryonic antigen value (CEA) of 1,000 ng/ml and CA19-9 of 12,210 U/ml. Upper gastrointestinal examination revealed carcinomatosis involving the stomach. A biopsy specimen of the stomach revealed the same pathological finding as the bladder wall. A metastatic bladder tumor was confirmed. The patient died of pulmonary emboli on December 11, 1988.     

Osteoma cutis, a case report from the orthopedic viewpoint]

Osteoma cutis is a benign cutaneous disease which causes a primary heterotopic ossification of the skin. Corresponding to the appearance it is possible to distinguish four modifications. The enlargement of osteoma cutis can disturb the function of joints and statics. The etiology of the disease is unknown. Hamartoma or metaplasia is subject of discussion. It is important to mark off osteoma cutis from pseudohypoparathyreoidism (Albright-syndrome++).     

Adrenal pseudocyst: a case report]

A 23-year-old man presented with high fever and left abdominal pain. Ultrasonography, CT scan and angiography visualized a left adrenal cyst. Cyst fluid obtained preoperatively by percutaneous needle puncture under ultrasonographic guidance was purulent, and had a higher level of aldosterone, and lower level of amylase than the plasma. These findings suggested that this cyst originated from the adrenal gland. Histopathological examination of the surgically removed specimen confirmed the adrenal pseudocyst.     

Silica calculi: a case report]

A 66-year-old female visited our university hospital with the chief complaint of right lower abdominal pain in July, 1984. Kidney-ureter-bladder roentgenograms disclosed the right ureter stone and several left renal stones. She passed the right ureter stone composed of calcium oxalate. Thereafter, she passed small stones twice and sand stones twice until September, 1985. The stone analysis revealed two of them as silica. Although most patients with silica stones reported in Japan had a history of long-term medication of magnesium trisilicate, this patient had not taken this drug. Silica stones are rare and fifteen cases including the present case have been reported in Japan.     

Retroperitoneal xanthogranuloma: a case report]

A case of retroperitoneal xanthogranuloma is reported. A 51-year-old man was referred to our hospital for the evaluation and treatment of right flank pain and hydronephrosis. Intravenous urography (DIP) and retrograde pyelography revealed the stricture in the middle portion of the right ureter. Ureteroscopy revealed no mucosal lesions. Computed tomography revealed the paraureteric mass lesion. Partial ureterectomy, mass resection and uretero-ureterostomy were performed. Then a double J stent was left in place for 6 weeks. The stricture was due to a yellowish mass adhered to the right side of the ureter. The resected mass measured 1.0 x 2.0 x 1.0 cm. The histopathological diagnosis was xanthogranuloma. The patient is in good health without recurrence 4 months after the surgery.     

Syphilitic orchitis: a case report]

Syphilitic orchitis is recently a rare disease in Japan. A 75-year-old man was referred to our hospital with the complaint of persistent swelling of the left scrotal contents in spite of prior antibiotic therapy. We suspected a testicular tumor because of lack of pain, and performed high orchiectomy. The specimen showed wide-ranged necrosis with a non-specific inflammatory change of the testis on hematoxylin-eosin stain. After performing analysis using a polymerase chain reaction method, we reached the final diagnosis of syphilitic orchitis.     

Silicate urolithiasis: a case report]

A 62-year-old male visited our department complaining of left flank pain and urinary retention on November 6, 1989. Intravenous pyelography showed small stone shadows in bilateral ureters and lower calyx of kidney and the left kidney was not visualized. Endoscopically, calculi were seen in bilateral ureteral orifice. An ureteral catheter could not be passed up from there bilaterally. On November 13, 1989, January 24 and 26, 1990, calculi were passed out spontaneously. Analysis of the stones revealed silica calculus. The patient had a past history of duodenal ulcers. He was administered magnesium silicate and magnesium alminometasilicate as an anti-acid drug for ten years. Sixteen cases of silica calculus in Japan are reviewed.     

Iliac vessel injury by a cement spacer: report of a case

The use of antibiotic-impregnated acrylic cement as a bone spacer between the intervals of revision hip arthroplasty for infection has been widely practiced. Vascular injuries caused by the migration of a cement spacer with subsequent erosion of the vessel wall have never been reported. A 67-year-old woman presented with tense swelling over her left lower extremity and hemarthroses of the left hip after implantation of a cement spacer for infected hip arthroplasty. Complete external compression of the external iliac vein and laceration of the iliac artery by the spacer were found. The symptoms were resolved after surgical debridement, removal of the spacer and femoral stem, and repair of the vessel. Cautious placement of a cement spacer in the acetabular fossa accompanied with poor bone stock must be emphasized.     

Contralateral ureteral metastasis from renal cell carcinoma: a case report]

A case of contralateral ureteral metastasis from renal cell carcinoma is reported. A 52-year-old man underwent left nephrectomy for renal cell carcinoma of November 20, 1986. He was clinically asymptomatic for 4 years 8 months after the operation. He was admitted on August 14, 1991, because of right loin pain. Right retrograde pyelography and percutaneous pyelography showed a filling defect in the right ureter at the level of L3. After the right ureter was explored, the tumor lesion of ureter was resected and end to end anastomosis of the ureter was performed. Histopathologic examination showed a metastatic clear cell carcinoma consistent with a renal primary. The contralateral ureteral metastasis from renal cell carcinoma is very rare and only 15 cases have been reported previously.     

High-pressure cement injection injury of the hand: a case report

Modern equipment allows injection of substances at much higher pressures than previously. We describe a high-pressure cement injection injury to the hand and how its management differs from other injection injuries. This injury was treated by the established standard for this surgical wound: immediate debridement. The wound had the same mechanism, pathology, bacteriology, and treatment as other similar wounds. Prognosis after high-pressure injection injuries, however, also depends on the substance injected. Treatment for cement injection injuries differs because of the unique properties of cement. Immediate intervention is necessary for decompression and minimization of chemical burn. Removing the final few fragments of cement after they have hardened may decrease the number of debridements and soft tissue destruction. Serial x-rays can be used to guide debridements, but if serial x-ray films are not obtained, a final x-ray is mandatory to ensure removal of all cement.     

Retroperitoneal schwannoma arising from the adrenal area: a case report]

A 67-year-old woman presented with upper abdominal pain and was found to have a suprarenal tumor by ultrasonography and CT scanning. Under a diagnosis of non-functioning adrenal tumor, we made an extraperitoneal approach via a lumbar incision and removed the tumor together with the left adrenal gland. There was minimal blood loss. The resected tumor was firm and had a yellowish-white cut surface. The lesion measured 60 x 40 x 35 mm and weighed 50 g. The pathological diagnosis was benign schwannoma, mainly of the Antoni type A. This is the 27th case of benign schwannoma in the adrenal area reported in the Japanese literature.     

Kallmann's syndrome in a child--a case report]

The patient was a male child 6 years and 6 months old. He visited our hospital because of bilateral cryptorchism and true phimosis. Since he was found to have fairly small testis, micropenis, and anosmia, endocrinological examination was performed. The plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were at the lower limit of normal values. LH gave a low reaction to the LH-releasing hormone test, while the reaction of FSH was near the lower limit of normal values. In the human chorionic gonadotropin test, there was no rise in the plasma levels of testosterone. Nor was there any reaction to the venous olfactory test with Alinamine (thiamine propyldisulfide). Accordingly, the patient was diagnosed as having Kallmann's syndrome. A search of the literature reveals few reports that deal with Kallmann's syndrome in infancy. Early diagnosis seems to be of significance, however, to institute early appropriate treatment to prompt the development of proper secondary sexual characteristics and ensure normal future fertility.     

Tunica albuginea cyst: a case report]

A 47-year-old male visited our hospital complaining of painless swelling of the right scrotum. Ultrasonography demonstrated hydrocele and a 13 x 12 x 10 mm cystic space along the margin of the right testis. Hydrocelectomy and simple resection of the cyst were performed. Pathologic examination of the excised cyst showed a serous cyst lined with simple flattened epithelium. Ultrasonography is useful for the diagnosis of tunica albuginea cyst.     

Adrenocortical carcinoma: report of a case]

A 24-year-old man visited our hospital complaining of hypertension and headache. Endocrinological findings revealed no abnormalities except for a slight decrease in serum adrenocorticotropic hormone (ACTH), a slight increase in urine 17-ketosteroid (17-KS), and a marked increase in serum pregnenolone. Computed tomography and magnetic resonance imaging revealed a 3 x 3 cm mass in the right adrenal area and I131-aldosterol scintigraphy demonstrated a high absorption of the isotope in the right adrenal area. Vena cavography suggested a 2 x 2 cm tumor thrombus originating in the right adrenal. Under the diagnosis of the right adrenocortical carcinoma, adrenalectomy and removal of the tumor thrombus were performed. Both serum pregnenolone and urine 17-KS returned to the normal level within a week after the operation and blood pressure was well controlled without any medication 3 months after the operation. Thus, the tumor seemed to be endocrinologically active.