Anomalous pulmonary venous connection. Medical therapy

Anomalous pulmonary venous connection is a congenital defect which may first be diagnosed in the adult who has developed lung disease or pulmonary vascular obstructive disease. Surgical repair may be inadvisable in such a case. To date, little attention has been paid in the literature to medical management. A case is presented in which medical palliation with nitrate therapy was successful.     

Septic arthritis caused by Streptococcus suis serotype 2

A case of septic arthritis and septicaemia due to Streptococcus suis serotype 2 is reported. To our knowledge, this is the first case in which the causative organism has been isolated from the joint-fluid. Involvement of joints is a feature of S. suis infection in pigs, and may be more common in human beings than previously realised. Infectious arthritis caused by beta-haemolytic streptococci may be due to S. suis and result from contact with pigs or raw pork.     

An unusual case of colonic leiomyosarcoma presenting with fever--significant uptake of radioactivity of gallium-67 in the tumor

Leiomyosarcoma of the large intestine, excluding the rectum, is a rare lesion and only 58 cases have been previously reported. Significant uptake of radioactivity of gallium-67 to the tumor has not been reported and this report may be the first case. Although preoperative diagnosis is considered to be difficult, barium enema study and colonofiberscopy disclosed the findings suggesting extracolic growth of the tumor in our case, which are thought to be characteristics of nonepithelial tumors. Gallium-67 citrate scanning may be useful for confirming the diagnosis.     

Early cancer of duodenal duplication. A case report.

A case which presented with early cancer of the duodenal duplication in addition to a gallbladder defect is reported. This may be the first case of its kind reported in the literature.     

Percutaneous endoscopic gastrostomy associated gastric metastasis

An interesting case of gastric metastasis of head and neck cancer after percutaneous endoscopic gastrostomy (PEG) placement is presented. Gastric metastases may appear in 3 morphologic varieties endoscopically. They may be multiple nodules of varying size, submucosal tumor masses with tip ulceration, or nonulcerated masses. Histologically, they may be seen as microscopic infiltration, a gross nodule, gross ulceration, or a gross hypertrophied wall. A case of PEG associated gastric metastasis has been reported almost every year since 1989. Even then, PEG placement by pull method continues to be a common procedure for patients diagnosed with head and neck cancer. The mechanism of gastric metastasis in patients with PEG is unclear. Seeding as well as hematogenous and lymphatic spread to traumatized tissue may be the cause.     

Acquired factor V deficiency in a patient with pulmonary tuberculosis

A 29 yr old man with pulmonary tuberculosis and concomitant acquired plasma coagulation factor V deficiency is reported. The case is discussed together with three previously described cases. The bleeding tendency in a patient with pulmonary tuberculosis may be caused by a coagulation factor antibody and may be corrected by chemotherapy, as in the case described. Special therapeutic approaches are required in some cases.     

Acute pleurisy revealing post-myocardial infarction syndrome

We report a case of Dressler's syndrome in which the diagnosis was made following an investigation of pleurisy which the laboratory data revealed as inflammatory. A myocardial infarction which had occurred two months earlier had passed unnoticed. The principal value of this case was to draw attention to the syndrome which may initially be a pleurisy but also clinically the picture may mimic pneumonia, both alone or together may be associated with classical pericarditis. Pleurisy occurs in Dressler's syndrome but it is rarely the presenting diagnosis as the cardiac picture tends to predominate.     

Use of cardiopulmonary bypass for thrombectomy in acute superior vena cava syndrome

An increasing incidence of nonmalignant, indwelling catheter cases has been reported in relation to superior vena cava syndrome. Such cases may be life-threatening, with rapid development of facial and neck edema and the production of respiratory distress. This is the first reported case of atrial and superior vena caval thrombectomy requiring cardiopulmonary bypass; it is only the second case reported in which operative thrombectomy has been used. Because of the problems associated with an increase in the use of indwelling venous catheters and the satisfactory results we obtained in this case, such an aggressive form of treatment for acute, benign superior vena cava syndrome may be used more frequently in the future.     

Infections caused by Pseudomonas maltophilia. Expanding clinical spectrum

Pseudomonas maltophilia (Xanthomonas maltophilia) is a frequently isolated commensal that is gaining increasing recognition as an opportunistic pathogen in debilitated hosts. We report three unusual infections due to P maltophilia that illustrate the ability of the organism to cause life-threatening illness. We describe a case of postoperative meningitis, a case of recurrent bacteremia complicated by ecthyma gangrenosum, and a case of native valve endocarditis in a drug addict. Because of frequent isolation from noninfected sites, the pathogenic potential of P maltophilia may be overlooked. The notable resistance of this organism is commonly used beta-lactam and aminoglycoside antibiotics may complicate therapy.     

Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis： Egg or hen？

Intraductal papillary mucinous neoplasm (IPMN) is an increasingly reported entity. Extensive pancreatic calcification is generally thought to be a sign of chronic pancreatitis, but it may occur simultaneously with IPMN leading to diagnostic difficulties. We report a case of a patient initially diagnosed with chronic calcifying pancreatitis who was later shown to have a malignant IPMN. This case illustrates potential pitfalls in the diagnosis of IPMN in the case of extensive pancreatic calcification as well as clues that may lead the clinician to suspecting the diagnosis. The possible mechanisms of the relation between pancreatic calcification and IPMN are also reviewed.     

Discussing hidden bias in observational studies

In observational studies or nonrandomized experiments, treated and control groups may differ in their outcomes even if the treatment has no effect; this may happen if the groups were not comparable before the start of treatment. The groups may fail to be comparable in either of two ways: They may differ with respect to characteristics that have been measured, in which case there is an overt bias, or they may differ in ways that have not been measured, in which case there is a hidden bias. Overt biases are controlled through adjustments, such as matching. Hidden bias is more difficult to address because the relevant measurements are not available. A sensitivity analysis asks how much hidden bias would need to be present if hidden bias were to explain the differing outcomes in the treated and control groups. A sensitivity analysis provides a tangible and specific framework for discussing hidden biases.     

Giant aneurysm of the inter-atrial septum

We report the case of a large atrial septal aneurysm and a review of the literature. Atrial septal aneurysm is found in 1-8% of normal subjects. Its prevalence is higher among patients with ischemic stroke. Transesophageal echocardiography is an optimal tool for the diagnosis of atrial septal aneurysm. The clinical course may be complicated by arterial embolism, but mechanical complications may also occur, as in this case. Due to the lack of general agreement, treatment options should be discussed on an individual basis for patients with atrial septal aneurysm.     

Lacrimo-auriculo-dento-digital syndrome with QT prolongation

We present a case of a young boy in whom lacrimo-auriculo-dental-digital (LADD) syndrome with QT prolongation was detected. According to Bazett's formula, corrected QT was 504 ms. There were no published data about LADD syndrome with QT prolongation. This is the first case concerning LADD syndrome associated with QT prolongation. It is known that deafness and QT prolongation occur in potassium channel dysfunction. QT prolongation and deafness may be associated with potassium channel dysfunction in patients with LADD syndrome. As a result QT prolongation may be a new component of the LADD syndrome.     

Marked hypocomplementemia and tubulointerstitial nephritis in a male patient with Sjögren’s syndrome

Abstract

We report a case of marked hypocomplementemia and tubulointerstitial nephritis associated with Sjögren’s syndrome (SS) in a male patient. Renal biopsy revealed tubulointerstitial nephritis but did not identify specific immune deposits of the tubulointerstitium. After steroid therapy, the renal failure and hypocomplementemia diminished. Hypocomplementemia without cryoglobulinemia is not commonly observed in SS patients, and hypocomplementemic tubulointerstitial nephritis was strongly suspected. Hypocomplementemic tubulointerstitial nephritis is rare; only one case has been described in the literature. In our case and the previous case, the patients were elderly men, and they had some similar clinical characteristics. Idiopathic hypocomplementemic tubulointerstitial nephritis resembling our case has been reported. These facts suggest that hypocomplementemic tubulointerstitial nephritis may occur in patients with SS, and such cases may not be as rare as once thought because it might be appropriate to include them in the category of idiopathic cases. Such a syndrome should be included in the differential diagnosis of hypocomplementemia.     

Filovirus hemorrhagic fever outbreak case management: a review of current and future treatment options

Testing an innovative therapy for filovirus hemorrhagic fever (FHF) in an outbreak setting may be years away. Moreover, beyond anecdotal evidence, little is known about best practice for outbreak case management. Currently, Médecins Sans Frontières and others provide FHF patients with basic supportive treatment. We describe and discuss treatment possibilities, challenges, and potential next steps for FHF outbreak case management. More comprehensive supportive treatment, including vital sign monitoring, intensive care components, and goal-directed interventions may contribute to improved clinical outcome; the feasibility and effectiveness of this more comprehensive supportive treatment should be assessed. Our outlined summary may assist future FHF outbreak case management teams to create collaborative platforms and develop relevant treatment protocols aimed at improving clinical outcome.     

Eikenella corrodens as a cause of brain abscess

A case of brain abscess due to Eikenella corrodens in a 67-year-old woman is reported. To our knowledge, this is the first case in which the causative organism has been isolated from the occipital lobe. E. corrodens may be the cause of apparently sterile brain abscesses encountered in neurosurgery and should be considered in the differential etiology of brain abscess.     

Chronic occlusive arterial disease (arteriosclerosis obliterans), associated with retinitis pigmentosa: Case report

A case of retinitis pigmentosa, associated with chronic, occlusive, peripheral vascular disease, is presented. Although the cause of retinitis pigmentosa is still disputed, this case suggests that the pathologic changes in the retinae may not be localized there, but may occur as a part of a similar disorder elsewhere in the body.     

A case of infective endocarditis in a farmer caused by Streptococcus equinus

The following is a case report of a farmer with documented aorticvalve disease who developed bacterial endocarditis secondaryto Streptococcus equinus. This is a rare pathogen in man andits acquisition in this case may be related to the subject'soccupation.     

Splenic involvement in infectious endocarditis. 5 clinical cases and 78 necropsies

Splenic involvement is a classical complication of infective endocarditis (IE). Clinical manifestations are rare, 5 out of 100 IE: unexpected rupture (1 case), abscess causing reinfection (2 cases), pseudo-tumour (1 case) and terminal infarction (1 case). In addition to a review of the literature, a post mortem histological study of the spleen of 78 cases of IE was undertaken. Splenic involvement did not seem to be the direct cause of death. Three types of lesions which may or may not be associated were observed: congestive inflammatory lesions, infarction (48 p. 100), abscess (6 p. 100). Splenic infarction usually results in scarring but may progress to abscess formation. Rupture was not observed in this autopsy series. Although splenic involvement is common at post mortem it gives rise to few symptoms. Persistant pyrexia and the appearance of local signs should lead to investigation of splenic complications and eventually, to surgical ablation.     

Enterocutaneous fistulization due toActinomyces odontolyticus

A case of abdominal actinomycosis originating from the sigmoid colon is presented.Actinomyces odontolyticus was isolated; it is a rarity, but should be suspected in the case of a palpable mass and several fistulas developing after a latent period of weeks to months following surgical or inflammatory trauma. The diagnosis is made by anaerobic cultivation. Primary treatment with large doses of penicillin for several weeks may be supplemented by surgery. The strain isolated in the present case was only moderately sensitive to penicillin and was successfully treated with erythromycin.