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.     

Serious renal infection: report of three cases

In renal infections, lack of peculiar symptoms and consequent delay of diagnosis can sometimes lead to a critical condition of the patient. We report three cases of life-threatening renal infections in female patients, two of which were subsequently fata. One patient died of left emphysematous pyelonephritis with bilateral pleuritis. The patient was correctly diagnosed 13 days after the onset of symptoms and expired 2 months later despite nephrectomy on the day of diagnosis. The second patient died of septic shock 3 days following the onset of symptoms. Autopsy revealed multiple perinephric abscess of the left kidney. The non-fatal case was a perinephric abscess spread to the iliopsoas muscle. The patient was diagnosed with perinephric abscess 11 days after the onset of symptoms and eventually underwent nephrectomy 9 days later. Two of the patients were diabetics and the third was a probable diabetic, who died too suddenly to confirm the diagnosis. Herein, we review the literature of, and discuss the diagnosis and management of serious renal infection.     

Wasp envenomation-induced acute renal failure: a report of three cases

Acute renal failure is an unusual complication of wasp stings. We report three cases who developed acute renal failure after multiple wasp stings (Vespa magnifica). Two patients had evidence of intravascular haemolysis and rhabdomyolysis whereas one patient investigation showed no evidence of intravascular haemolysis or rhabdomyolysis. All three cases had impaired liver functions. Oligo-anuria was seen in all three of the patients and all of them required dialytic support. One patient died of massive gastrointestinal bleeding while the remaining two recovered completely. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of haemolysis or rhabdomyolysis, in some patients, renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction to the wasp venom.     

Nephrotic syndrome in Kawasaki disease: a report of three cases

Background

Renal manifestations are rare in Kawasaki disease (KD). Acute renal failure with tubular necrosis, tubulointerstitial nephritis and renovascular hypertension have been reported in KD, but only one case of a patient with KD associated with nephrotic syndrome (NS) has been reported to date, with the patient improving on steroid therapy but dying from coronary aneurysm.

Methods

We report the cases of three children, aged 4, 4.5 and 8?years, respectively, who presented with typical KD symptoms (high fever, diffuse maculopapular rash, conjunctivitis, peripheral oedema, cervical adenopathies and high C reactive protein levels) and developed NS.

Results

Patient 1 had a haemodynamic shock due to cardiac dysfunction and transient renal failure. Ten days later, he developed a NS which spontaneously disappeared 1 week later. Patient 2 had a NS on admission with normal plasma creatinine and no haematuria. Proteinuria disappeared within 10?days. Patient 3 developed NS 5?days after onset with a moderate increase in plasma creatinine. Proteinuria disappeared within 2?weeks. All three patients were treated with intravenous immunoglobulins, antibiotic therapy and aspirin, but none of them received steroid therapy. To date, all three patients have maintained long-term remission.

Conclusions

In conclusion, proteinuria with NS may develop during the acute phase of KD with persistent remission occurring without steroid therapy.     

Bilateral synchronous renal cell carcinoma: report of three cases

We report here three cases of bilateral synchronous renal cell carcinoma. One of the 3 patients underwent bilateral partial nephrectomy, while the other 2 underwent combined partial nephrectomy and radical nephrectomy. All patients received adjuvant therapy of interferon-alpha and tegafur uracil. In the management of synchronous bilateral renal cell carcinoma, we discussed the selection of surgical procedure for primary lesions, i.e., based on the renal function of both sides, and the necessity of adjuvant therapy in such cases.     

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.     

Evidence for antibody and immune-complex deposition in heart transplantation: a report of three cases.

Immunofluorescence microscopy of endomyocardial biopsy specimens from heart allograft recipients identified immunopathologic changes in three of 17 patients. These changes included immunoglobulin G and complement C3 deposition in tissue structures such as capillary endothelium and basal membranes, cardiomyocyte sarcolemma, and interstitial tissue. Moreover, the immunopathologic changes could be correlated with acute cellular rejection episodes evidenced by endomyocardial biopsy criteria.     

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.     

Anterior enterocele: a report of three cases

Anterior enterocele is an uncommon finding in patients with pelvic organ prolapse. We reviewed 490 consecutive operations for pelvic organ prolapse . Three anterior enteroceles were identified in a series of 193 enterocele repairs (1.6%). The presentation and treatment of each of these patients is reviewed.This revised version was published online in June 2004 with corrections to the title.     

后腹腔镜囊肿去顶减压术治疗肾脏囊性疾病57例报告

目的:探讨后腹腔镜囊肿去顶减压术治疗肾脏囊性疾病的临床疗效及手术方法。方法:对57例肾脏囊性疾病患者行后腹腔镜囊肿去顶减压术,其中单纯性肾囊肿51例,多囊肾6例,回顾分析相关资料。结果:57例手术均获成功,无严重并发症发生。镜下操作时间单纯性肾囊肿15～35 min,多囊肾90～120 min;单纯性肾囊肿术中出血5～20 ml,多囊肾30～60 ml。术后随访3～24个月,单纯性囊肿无复发;多囊肾患者术后腰部胀痛缓解,3例合并肾功能不全的患者肾功能改善。结论:后腹腔镜囊肿去顶减压术治疗肾脏囊性疾病患者创伤小,康复快,疗效确切,可作为治疗肾脏囊性疾病的首选方法。     

Hypertrophic cardiomyopathy and hyperthyroidism: a report of three cases

Symons, C., Richardson, P. J., and Feizi, O. (1974).Thorax, 29, 713-719. Hypertrophic cardiomyopathy and hyperthyroidism. The combination of hypertrophic cardiomyopathy and hyperthyroidism gives rise to a complex clinical picture as some of the symptoms and signs may be common to both conditions. The presentation and investigation of three patients are reported. In one patient there was evidence of progression from the hypertrophic obstructive phase to that associated with loss of outflow tract obstruction. The echocardiogram was especially useful in assessing the presence or absence of hypertrophic disease in the thyrotoxic subject. It is suggested that the long continued high-output circulatory state in clinically undetected hyperthyroidism may prove to be a stimulus for unrestrained cardiac muscle hypertrophy.     

Bladder stone at an ureterovesical anastomotic site after renal transplantation: a report of three cases

Three cases of bladder stones at the ureterovesical anastomotic site after renal transplantation (RT) are reported. The three patients were successfully treated with kidney grafts. The method used for the ureter bladder anastomosis in all patients was the extravesical technique with polyglyconate (Maxon) for case 1 and a polydioxanone suture (PDSII) for cases 2 and 3. Calculi formation was found between 3 to 15 months after RT. Endoscopic vesicolithotripsy was performed and the stones adherent to the ureterovesical anastomotic site were removed successfully in all cases. Stone analysis revealed uric acid (case 1), CaOx and CaP (case 2). Stone analysis was not done in case 3. The patients' symptoms improved and no bladder stones could be discerned postoperatively.