General anesthesia and methylenetetrahydrofolate reductase deficiency

Methylenetetrahydrofolate reductase (MTHFR) deficiency is an autosomal recessive disorder with a spectrum of manifestations including neurological symptoms, premature arteriosclerosis, and venous and arterial thrombosis. Most patients are heterozygous for multiple MTHFR substitutions; small minorities are homozygous for mutations at this locus. Among these mutations, the C677T polymorphism is the most deleterious. Nitrous oxide use in anesthesia leads to significant increases in plasma homocysteine. We present a patient undergoing urgent surgery with a preoperative diagnosis of homozygous MTHFR deficiency.     

Intrauterine device migration to the bladder: four case reports

The intrauterine device has been commonly used in our population for many years as contraceptive method. One of the complications is the device migration out of the uterus. One of the most uncommon fait of this migration is the bladder, with few reports on the literature. In this work, four cases are reported with their clinical presentation, study and treatment.     

Hand infections secondary to catfish spines: case reports and literature review

Catfish are one of the few freshwater fishes known to be venomous. Although "finning" of the hand is a frequent injury incurred by catfish anglers that results in intense pain, it rarely results in any long-term sequelae. We present three cases in which acute soft-tissue infections developed, necessitating ray amputations in two patients. The unique habitat and anatomy of the catfish are described and preventive and therapeutic measures are discussed.     

Myelopathy secondary to spinal epidural abscess: case reports and a review

Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996. The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. Leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes. All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory.     

Anesthesia for cesarean section in a patient with placenta previa and methylenetetrahydrofolate reductase deficiency

We describe the anesthetic management of a patient with placenta previa presenting for a cesarean section, who had methylenetetrahydrofolate reductase (MTHFR) deficiency. Methylenetetrahydrofolate reductase deficiency increases homocysteine levels in the body and, therefore, predisposes to thrombosis. After a cerebrovascular accident at 8 weeks of gestational age, the patient received anticoagulants throughout the course of her pregnancy. Bleeding from the placenta previa occurred at 30 weeks of gestational age. Although general anesthesia was indicated for this patient because of her hemodynamic instability and an anticoagulated state, nitrous oxide is contraindicated in such patients. Thus, we chose a subarachnoid block because the patient remained hemodynamically stable, and anticoagulation had been stopped 8 hours before surgery. To our knowledge, there is no reported case of a parturient with MTHFR deficiency complicated with a cerebrovascular accident and associated with placenta previa presenting for a cesarean section. Anesthetic considerations are discussed in patients presenting with placenta previa associated with MTHFR deficiency.     

Papaverine-induced priapism: 2 case reports

Intracorporeal papaverine injection therapy for impotence has been reported recently as a therapeutic option with low morbidity. We report 2 cases of papaverine-induced priapism that required surgical intervention.     

Monoarthritis secondary to joint metastasis. Two case reports and literature review

Synovial metastases from neoplasms are uncommon. We report two cases of knee monoarthritis due to joint metastasis. Joint fluid cytology established the diagnosis. In one patient, an epidermoid carcinoma of the ureter metastasized to the left knee. The other patient had chronic monoarthritis of the left knee unresponsive to conventional treatment and was found to have distal femoral metastases from a lung adenocarcinoma. Only 28 cases of synovial metastases from solid tumors have been reported in the literature. The knee is the most common target, the lung the most common site of the primary (12 cases), and adenocarcinoma the most common histological type (12 cases). Joint metastasis carries a poor prognosis with a mean survival of less than 5 months.     

Partial cardio-pulmonary bypass in peripheral vascular surgery: case reports.

Two cases of aneurysmatic vascular lesions (a large cranio-encephalic angiodysplasia with arterio-venous communications and a post-traumatic aneurysm of the vertebral artery) are reported; both were of a very difficult surgical approach and were successfully treated with the use of extra-corporeal circulation. The partial cardiopulmonary bypass, with femoro-femoral cannulation, allowed complete recovery of the lost blood, controlled hypotension, and a certain degree of hypothermia. These factors were decisive for the good outcome of the operations.     

Cerebral venous sinus thrombosis associated with iron deficiency: two case reports

Two patients presented with cerebral venous sinus thrombosis (CVST) associated with iron deficiency. A 14-year-old man had thrombosis extending from the end of the superior sagittal sinus to the left transverse sinus. Severe dehydration after competitive sport had induced CVST. The laboratory findings showed severe iron deficiency anemia which persisted for 1 year. A 47-year-old man had thrombosis in the entire superior sagittal sinus. Dehydration caused by poor nutrition had induced CVST. The laboratory findings showed transient iron deficiency in the acute phase. Both patients received conservative treatment for dehydration and iron supplementation. These two cases indicate that iron deficiency is a risk factor for CVST.     

A case of isolated gonadotropin deficiency secondary to glioma in septum pellucidum

A 21-year-old man, who had had normal sexuality, noticed a decrease in libido and potency as well as loss of ejaculation. Endocrinological evaluation showed normal serum levels of gonadotropins but a low testosterone level. The response to clomiphene citrate was poor while the response to luteinizing hormone-releasing hormone and human chorionic gonadotropin were within normal limits. By the examination of brain computerized tomography a tumor was detected in the septum pellucidum and was resected. Histologically it proved to be a mixed tumor composed of astrocytoma and oligodendroglioma. Two months after the operation the patient had recovered normal sexual functions and the endocrinological functions, including the responsiveness to clomiphene citrate, had been restored. This case suggests the existence of some stimulatory fiber for the secretion of luteinizing hormone in the septum pellucidum.     

Vesical endometriosis: a review and 2 case reports

Vesical endometriosis is uncommon and can result in months or years of morbidity if undetected. We report 2 cases that demonstrate that increased awareness of this entity and expeditious use of appropriate diagnostic techniques can lead to earlier diagnosis and definitive treatment.     

Neurinoma of the brachial plexus: 2 case reports

Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.     

Intraspinal lymphangioma: 2 case reports and literature review

BACKGROUND: Lymphangioma of the soft tissue is not uncommon. However, as far as the authors know, intraspinal lymphangioma is clinically rare and very few cases have been reported previously. METHODS: Two patients who had backache and acratia of the lower limbs and difficulty in relieving themselves were examined by plain radiography and magnetic resonance imaging before surgery. Treatment consisted of the usual technique of surgical resection of the tumor microscopically. Histological examination of the resected material confirmed the diagnosis. Postoperative follow-up assessment was performed by magnetic resonance imaging. RESULTS: Intraspinal lymphangioma is very rare clinically and its cause remains controversial. Magnetic resonance imaging can obtain precise position fixing, but it is hard to make preoperative qualitative determination. The most effective treatment of intraspinal lymphangioma is to excise it totally. CONCLUSIONS: The clinical appearance of intraspinal lymphangioma has no character. Magnetic resonance imaging is important in diagnosing it. The most effective treatment of intraspinal lymphangioma is to excise it totally. Further observation is recommended because of the possibility of local recurrence.     

Hemangiopericytoma: case reports

The authors' experience with two recent cases and their review of the literature suggest that the behaviour of hemangiopericytoma is unpredictable and that wide surgical excision is the treatment of choice because of the potential for malignant change.     

Allergic reaction to epinephrine preparation in 2% lidocaine: two case reports

We report 2 cases of hypersensitivity to an epinephrine preparation in local anesthetics which were found by skin tests for local anesthetics. Both patients had uncomfortable episodes to local anesthetics at dental treatment. In both cases, the skin tests showed positive reactions to 2% lidocaine with 1:80,000 epinephrine. Furthermore drug lymphocyte stimulation test revealed positive reaction to epinephrine hydrochloride, epinephrine bitartrate in case 1, whereas in case 2, the drug lymphocyte stimulation test showed positive response to epinephrine bitartrate. Attention should be paid to exogenous epinephrine preparations that have the potential to induce hypersensitivity during dental treatment.     

Neurogenic bladder due to the anterior spinal artery syndrome: 2 case reports

A 43-year-old woman with anterior spinal artery syndrome was admitted with complaints of tetraplegia and urinary retention. Her bladder had capacity of more than 500 ml and was inactive, with low voltage of external urethral sphincter. She was treated with distigmine bromide and intermittent catheterization. 50 days later, urodynamic study showed normal bladder and incomplete coordination of external sphincter. A 78-year-old man had chief complaints of urinary retention and paraplegia. A catheter was left indwell for 6 months. Then he was treated with intermittent catheterization, but urgency incontinence was still observed. We discussed the therapy of neurogenic bladder due to the anterior spinal artery syndrome.