Carpal tunnel syndrome caused by an idiopathic calcified mass

This is a case report of carpal tunnel syndrome caused by an idiopathic calcareous lesion within the carpal canal. The median nerve was trapped between the transverse carpal ligament and the calcified mass. The mass was predominantly composed of calcium phosphate. Surgical release of the transverse carpal ligament and removal of the calcareous mass relieved the symptoms. Received: 12 January 1999     

Medical aerosol propellant interference with infrared anaesthetic gas monitors

Background. 1,1,1,2 Tetrafluoroethane is a hydrofluoroalkane(HFA) that is replacing chlorofluorocarbons (CFC) as a medicalaerosol propellant in an attempt to reduce damage to the ozonelayer. This study compared the effects of HFA- and CFC-basedinhalers on four anaesthetic gas monitoring systems. Methods. The HFA- and CFC-based inhalers were activated in closeproximity to the sample line of two Datex Ohmeda, an Agilentand a Siemens infrared anaesthetic agent monitoring systems.The effects were recorded on each system for five common anaestheticagents. Results. The HFA inhaler caused either maximal false positivereadings (with the exception of desflurane) or transient measurementfailure on all systems. The Datex Ohmeda AS/3 system misidentifiedthe HFA inhaler as carbon dioxide at low concentration (2 ±0 mm Hg). The CFC-based inhaler caused a minor false-positivereading (0.4 ± 0%) for halothane only on the Datex OhmedaAS/3 system only and was misidentified as carbon dioxide at33.3 (SD 2.1) mm Hg and 22.4 (8.9) mm Hg by the Agilent andSiemens systems. Conclusions. The HFA inhaler adversely affected all equipmenttested. The infrared spectra of HFA and the common anaestheticgases have considerable overlap at the 8–12 µm rangethat is not shared by the CFCs. The differences in spectraloverlap explain the different effects of the HFA and CFC propellants.Anaesthetic gas concentration data may be erroneous using theHFA-based inhalers. Br J Anaesth 2004; 92: 865–9     

Two cases of female acute urinary retention caused by an impacted pelvic mass

We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.     

Mediastinal mass caused by syphilitic aortitis.

A 47 year old man presented with hoarseness and chest pain found to be due to proliferative syphilitic aortitis. The case is unusual as the syphilitic aortitis caused a mediastinal mass without affecting the lumen of the aorta.     

Breast mass caused by rib tuberculosis abscess.

Tuberculosis involving ribs and presenting with breast mass is a very rare entity and only a few cases have been reported in the literature previously. A 35 year-old patient had a retromammarial abscess revealed by a mass in the medial quadrant of right breast. Midsternal incision for abscess drainage and a partial resection of involved ribs was performed. Histopathologic evaluation revealed rib tuberculosis and secondary abscess formation in the right breast. This unusual manifestation of tuberculosis should be included in differential diagnosis of high-risk patients presenting with a breast mass.     

Intestinal obstruction caused by intraoperative mass reduction of an incarcerated inguinal hernia--report of a case

Now that inguinal hernia repair is a feasible and safe procedure, mass reduction of an incarcerated inguinal hernia, usually resulting from forceful taxis during non-operative manual reduction, has became a rare occurrence. We present an even rarer complication: intraoperative mass reduction of an incarcerated inguinal hernia. Following herniorrhaphy, the patient was initially well, but symptoms of intestinal obstruction appeared gradually, and he presented with intestinal obstruction 2 weeks after herniorrhaphy. Imaging studies aroused suspicion of mass reduction and surgery confirmed the diagnosis. We highlight some peculiar physical findings and remind readers of the existence of such a rare complication, which can occur following herniorrhaphy, and be masked by a short period of symptomatic relief.     

Cerebellar mass caused by Candida species. Case report

The authors report a case of cerebellar pseudotumor caused by a Candida species without evidence of any underlying systemic disorder or extracranial disease. Total removal followed by treatment with amphotericin B resulted in a favorable outcome.     

False low oximetry reading caused by patent blue vital dye during breast surgery

Patent blue vital (patent blue V; Laboratoire Guerbet, France) is used to identify the sentinel node during surgery for invasive breast cancer. Detecting the sentinel node that first drains the primary tumor reduces the need for total breast and wide axillary node removal, with the problems that such radical surgery involves. Like other dyes, patent blue V can interfere with accurate pulse oximeter reading, leading to underestimation of real values. We report the case of a 31-year-old woman who underwent lumpectomy and removal of the sentinel node. After intradermal injection of patent blue V dye into the left breast (100 mg administered because the sentinel node was difficult to locate) a drop in peripheral oxyhemoglobin saturation from 99% to 93% was detected by the pulse oximeter. When arterial blood gas analysis showed normal values and other causes were ruled out, the diagnosis was false low oximetry reading due to patent blue V dye.     

Argyria caused by an earring.

The staining of skin by silver is termed argyria and is grey-blue in colour. This may be caused by a number of mechanisms such as ingestion and direct implantation. We report an unusual case, caused by an impacted earring, where the skin discoloration was not entirely typical of argyria. This may have been due to copper impurities present in the earring. The literature on the subject is also reviewed.     

Cervical myelopathy caused by soft-tissue mass in diffuse idiopathic skeletal hyperostosis

A rare case of cervical spinal cord compression in diffuse idiopathic skeletal hyperostosis (DISH or Forestier’s Disease) caused by a craniocervical mass of soft-tissue is reported. The objective is to describe an uncommon mechanism of spinal cord compression in DISH. Three weeks after a cardiac infarction a 69-year-old man slowly developed spastic tetraparesis. Magnetic resonance tomography showed a craniocervical tumor compressing the spinal cord and a massive DISH of the cervical spine. An extended mass of yellowish amorphous material was removed from between the dura, the posterior odontoid process and the posterior aspect of vertebral body C2 reaching to the upper part of C3.The histologic appearance indicated connective tissue and cell-degenerated cartilaginous tissue. There was no inflammatory component and no evidence of neoplasia. No ossification of the posterior longitudinal ligament (OPLL) was found. After removal and craniocervical stabilization the patient’s neurologic function improved remarkably. The increase of mechanical stress on the atlantoaxial segment and enhanced proliferation reaction of the connective tissue in DISH are suggested as the underlying pathomechanisms in the formation of this soft-tissue mass.