Cardio-renal-anemia syndrome: a report of three cases

Patients with chronic kidney diseases (CKDs) and cardiovascular diseases (CVDs) present with various degree of anemia. Anemia has been associated with poor outcome in patients with CKD and CVD. CVD is the commonest cause of morbidity and mortality in patients with CKD. CKD causes anemia and CVD, and this rapidly deteriorates when anemia is not corrected. This triad of CVD, CKD, and anemia has been termed cardio-renal-anemia syndrome. The objective of this study is to highlight the importance of cardio-renal-anemia syndrome, their relationship, and management. Three patients with various stages of CKD who presented with anemia and cardiovascular abnormalities are reported. The patients responded well to various interventional measures, with improvement in their clinical and laboratory parameters. Cardio-renal-anemia syndrome is an entity that should be identified. Early and appropriate intervention leads to better outcome.     

XYY syndrome: report of three cases

Three cases of XYY syndrome (YY syndrome) were experienced. Two cases had such rare associated anomalies as hypospadias and cryptorchism. Pathogenesis, incidence, clinical symptoms, gonadal function and fertility of the patients with XYY syndrome are briefly discussed.     

Artefactual breast disease: a report of three cases

Three cases of suspected artefactual conditions of the breast are presented, one case each of recurrent bleeding, recurrent infection and atypical eczema. Involvement of the breast is rare, but may go undiagnosed in many cases. Patients are usually married and in the second half of their reproductive life. An unusual pattern of disease appearance and behavior, lack of response to treatment, inappropriate affect and a request for mastectomy are helpful in suggesting the diagnosis. A disturbance in personal relationships can often be elucidated by psychiatric assessment. Treatment is difficult and may be limited to suspecting the diagnosis, excluding organic disease and avoiding unnecessary and repetitive surgery.     

Kawasaki syndrome: report of four cases with acute gallbladder hydrops

We studied gallbladder involvement in 19 patients with Kawasaki syndrome who presented over a 4-year period from 1979 to 1982. Diagnosis and follow-up of gallbladder disease were defined by real-time ultrasound. Complete spontaneous resolution of abdominal symptomatology related to the hydropic gallbladder occurred without complication and did not require surgical intervention. We suggest that the incidence of hydrops of the gallbladder in mucocutaneous lymph node syndrome is higher than commonly appreciated, since diagnosis may be missed unless ultrasound is performed.     

马凡氏综合征伴脊柱侧凸一家系3例报告

马凡氏综合征(Marian syndrome,MFS)是一种遗传性结缔组织病,由法国医生Antoine Marfan在1896年首先描述[1].它是一组因先天性间质组织缺陷导致的临床综合征,临床表现复杂多样,可累及骨骼系统、心血管系统、视觉系统、肺及中枢神经系统等.MFS常合并脊柱畸形,其中以脊柱侧凸最为常见,且偶可累及同一家族中多名成员.目前国内关于MFS伴发脊柱侧凸的家系报道较少,现将我院诊断为MFS伴脊柱侧凸的一家系3例患者报告如下.     

Anti-cardiolipin antibody and renal disease: a report three cases

Anti-cardiolipin antibodies have been linked to recurrent arterial and venous thrombosis in multiple organs. We present a biopsy-documented report of thrombotic renal disease apparently attributable to circulating anti-cardiolipin antibodies. One patient had primary anti-cardiolipin syndrome, one had mild SLE, and the third had a mild lupus-like syndrome. All three patients had a clinical course dominated by repeated multi-organ system thrombosis. Renal biopsy disclosed thrombosis at the level of the glomerular capillaries, arterioles, and interlobular arteries--similar to that described in other thrombotic microangiopathies. Renal thrombosis was not associated with active endocapillary proliferative lupus nephritis, suggesting a mechanism independent of subendothelial immune deposit injury. Renal presentation was variable, ranging from asymptomatic mild proteinuria to nephrotic-range proteinuria, renal insufficiency, and hypertension.     

Cauda equina syndrome following sacral fractures: a report of three cases

We report 3 patients with cauda equina syndrome (CES) secondary to a sacral fracture. The difficulty in early diagnosis of CES and the lack of evidence and guidance on treatment are highlighted. When there is a sacral fracture, CES should be suspected. Thorough clinical examination including digital rectal examinations and bladder function quantification is advised. The threshold for performing computed tomography and/or magnetic resonance imaging of the pelvis should be low. Patients should be treated by a multi-disciplinary team with both orthopaedic and neurosurgical input. Further studies are needed to identify the timing and to which patients surgical decompression should be performed.     

Shelf syndrome of the knee in elderly people: a report of three cases

Shelf syndrome occurs mainly in younger people (particularly athletes) and rarely in elderly people. We report on 3 elderly patients with a medial synovial plica causing severe pain and locked knees. They had had no symptoms in their early or middle life. After removal of the shelf, the symptoms improved considerably. Although shelf syndrome is rare in the elderly, it should be suspected whenever severe pain and a locked knee are present.     

Observations on the pathophysiology of Nelson's syndrome: a report of three cases

Nelson's syndrome is generally regarded as an unusual sequela of primary bilateral adrenalectomy when performed for Cushing's disease. It is classically defined by cutaneous hyperpigmentation, considerably elevated adrenocorticotropic hormone (ACTH) levels, and an enlarged sella turcica. In this report, we present three cases initially treated by transsphenoidal sellar exploration for Cushing's disease. In two of these cases, remission of hypercortisolism did not occur after the initial pituitary exploration. A microadenomectomy was performed in one case and, in the other, no microadenoma was found. In both, Nelson's syndrome occurred after adrenalectomy. A second transsphenoidal operation and radiotherapy were required to control tumor growth. In another case, transsphenoidal adenomectomy of an ACTH-secreting tumor initially led to a remission of hypercortisolism for 4 years, but recurrent Cushing's disease necessitated adrenalectomy, and again Nelson's syndrome occurred. The documentation of a pre-existing ACTH-secreting basophilic pituitary microadenoma before adrenalectomy, as seen in two of our cases, has not been previously reported, and these observations of "non-classical" courses have major implications for the pathophysiology of Nelson's syndrome.     

Macrostomia: a report of three cases

Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus. It is usually partial, but rarely complete. Transverse facial clefts are more common in males, and commoner on the left when unilateral. We report on 3 patients with macrostomia managed in our unit. There were 2 girls with a bilateral transverse facial cleft and a boy with a left unilateral transverse facial cleft. All had a 3 layered repair of their clefts with Z-plasty repair of the skin. The longest duration of follow-up was 2 weeks. Strict adherence to the principles of surgical reconstruction is advised in the repair of macrostomia to prevent a poor treatment outcome.     

Thymolipoma: a report of three cases

Three cases of thymolipoma, seen in a 6 year old boy, a 34 year old woman and a 24 year old man are presented herein. The weight of each tumor was 1380 g, 670 g and 560 g respectively. The 2 male patients had no symptoms and the woman only complained of a fever. On CT scan the thymic tissue was recognized as islands of soft tissue density within a fatty mass, and T1 weighted MRI was helpful in demonstrating the predominant fatty nature of this tumor. Thus, our experience demonstrates that CT and MRI are valuable for establishing a diagnosis of thymolipoma. In a review of the literature on the subject, some clinical features of this non-malignant tumor in the mediastinum are discussed. Although rare, thymolipoma should be considered in the differential diagnosis of mediastinal tumors.     

Nephrotic syndrome and primary tubular amyloidosis in a child: a case report

Nephrotic syndrome in a 19-month-old child was associated with an unusual form of primary renal amyloidosis. The amyloid deposit was in the tubulo-interstitium and not in the glomeruli. Although the deposit did not stain with Congo red, it had the ultrastructural characteristics of amyloid. The patient had resistant nephrotic syndrome, and he subsequently developed microhaematuria and glucosuria.