SPLENIC ABSCESS

Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non-specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases. Pseudomonas species as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choice.     

Retrobulbar haemorrhage: can blindness be prevented?

Retrobulbar haemorrhage is a rare complication following orbital trauma or surgery occurring in less than 1 per cent of cases. Early diagnosis and treatment of this complication may save the vision of the affected eye. This paper illustrates cases where diagnosis was not made and blindness resulted. We also present two cases of successful treatment due to early diagnosis.     

Traumatic rupture of the diaphragm: a difficult diagnosis

Rupture of the diaphragm occurs in approximately 5 per cent of cases of severe blunt trauma to the trunk, and the mortality may be as high as 50 per cent. The diagnosis is important because of the high incidence of associated organ damage and complications of a missed injury. Successful diagnosis requires a high index of suspicion but can be made from the chest radiograph in 90 per cent of cases if visceral herniation has occurred. We present three cases of rupture of the diaphragm which highlight the frequent occurrence of a delayed or missed diagnosis.     

Penetrating abdominal aortic ulcers: case reports and review of the literature

Atherosclerotic abdominal aortic ulcers are uncommon in contrast to those of the thoracic aorta. They present with a variety of symptoms. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are the methods of diagnosis. Treatment is made easier with the use of endovascular techniques, which have less mortality and morbidity than open repair. In this paper, we present three cases of penetrating aortic ulcers presenting with abdominal pain. In two of those cases, the diagnosis was made by MRI and missed by CT scan. We present a review of the literature.     

Tubercular splenic abscess in immunocompetent patients: a rare entity

Splenic abscess is an unusual, potentially life threatening condition associated with septiceamic conditions. Splenic abscess due to tuberculosis is a rare entity, specifically seen in immunocompromised individuals. However splenic tubercular abscess in immunocompetent individuals is rarer. We present two cases of splenic tubercular abscess in immunocompetent persons where a diagnosis of tuberculosis was made after splenectomy. The aim of presenting these cases is to stress the fact that tuberculosis should be considered as a differential diagnosis in all cases of splenic abscesses in areas where tuberculosis is endemic.     

Pinworm infestation of the appendix

The Authors present 2 cases of enterobiasis of appendix observed on a total of 186 appendicectomies. Enterobius infestation is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible without clinical suspect. Parasites may produce symptoms which resemble acute appendicitis but parasitic infection rarely causes it. It is also important considered in the differential diagnosis cases that mimic Crohn's disease.     

Mitochondrial myopathies: an unusual cause of hypotonia in infants and children

Children frequently undergo muscle biopsy for the workup of hypotonia under general anaesthesia which poses unique risks in patients with undiagnosed muscle disease. Mitochondrial myopathies are a relatively newly recognized cause of myopathy and multisystem disease in both adults and children. The diagnosis is complex. In addition to causing myopathy, there are metabolic derangements present in some cases that may be life-threatening. We present three cases of children with hypotonia where the diagnosis was suspected in two patients, and confirmed in the third. The question of whether patients with mitochondrial myopathies are at increased risk for developing malignant hyperthermia is discussed.     

Laryngeal foreign body aspiration misdiagnosed as asthma: two case reports and a review of the literature

Children who aspirate a foreign body initially present with choking and subsequently present with respiratory syndrome symptoms. However, foreign body aspiration can mimic other illnesses, causing some difficulties in diagnosis. Here we report two cases that were treated with glucocorticoids for several weeks after an initial diagnosis of asthma. When there was no response to treatment, further examination revealed laryngeal foreign body aspiration in both cases. Foreign body aspiration should be considered a differential diagnosis for asthma. The delay in diagnosis could have been avoided by paying more attention to the medical history and by performing a more through initial examination.     

Carcinoma of the urachus: report of two cases

Carcinoma of the urachus is a rare disease with poor prognosis. This is probably due to the difficulty of preoperative diagnosis. Radiological modalities have been considered to be of little value, but in many cases, preoperative diagnosis can be established with the aid of CT scan. In patients with urachal carcinoma, CT scan visualize the primary tumor and its extension beyond the bladder wall into the space of Retzius. Although about 150 cases of urachal tumor have been reported in the English literature, computerized tomographic findings have not been established. We present two cases and emphasize the usefulness of CT scan in preoperative diagnosis.     

Cystic transphyseal bone tuberculosis: a report of two cases

We present two cases of tuberculosis osteomyelitis mimicking subacute osteomyelitis and treated without extensive debridement. Tuberculous osteomyelitis should be considered in the differential diagnosis of proximal tibial infections in children and early diagnosis and treatment is possible without extensive debridement.     

Technic and results of fine needle biopsy, cylinder biopsy and surgical biopsy

Mammography-screening contributes new diagnostic problems. In spite of sophisticated diagnostic procedures, surgical excision is the only way to diagnosis in microcalcifications. Triple-diagnosis may lead to the correct diagnosis of a carcinoma, but in most cases a tumor has to be excised if present. Specialists in senology tend to expensive and complicated diagnosis.     

Pelvic lipomatosis: diagnosis using computed tomography.

Pelvic lipomatosis is a rare, benign disease in which the characteristic roentgenographic findings may mimic those of pelvic malignancy. In the past more than two-thirds of reported cases have been explored surgically for diagnosis. We present 2 cases to demonstrate how the definitive diagnosis of pelvic lipomatosis can be made with the aid of computed tomography to avoid invasive techniques.     

Adnexal torsion in children

Adnexal torsion is rare in children and is usually reported as small series or case reports. We reviewed a series of 19 consecutive cases of children aged 3 to 19 years (mean, 9.6 years) who were treated in our institution between 1977 and 1988. Thirteen patients presented with torsion of a previously normal adnexa, while six presented with torsion of a diseased adnexa. The right adnexa was involved in 84% of cases. Detorsion with recovery of vascularization of the adnexa was possible in only four cases. All patients presented with lower abdominal pain, and onset was sudden in 78% of cases with an average of 5.2 days between the first symptom and hospital admission and a mean delay of 30.2 hours between consultation and surgical intervention. A previous history of abdominal pain was present in nine cases. Nausea or vomiting were present in 84% of cases. An abdominal mass was palpable in 42% of the patients and was associated with a delay in surgical intervention. Ultrasound confirmed the presence of a mass in 94% of cases. The preoperative diagnosis was accurate in 37% of cases, and the most common inaccurate diagnosis was appendicitis or appendiceal abcess. Our series confirms the predominance of right-sided lesions as reported in the literature. It is not clear whether this is an anatomic phenomenon or whether the suspicion of appendicitis leads to the more frequent diagnosis of right-sided lesions, whereas many left-sided adnexal torsions are being missed. We therefore advocate pelvic ultrasound in female patients who present with left lower quadrant pain.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hernia through the foramen of Winslow

A case of hernia through the foramen of Winslow diagnosed preoperatively is reported. Although the preoperative diagnosis is difficult to make because of the nonspecific symptoms presented and the rarity of the disease, careful evaluation of the plain abdominal X-ray and barium enema study gave the clue in the present case. Review of the literature including those from Japan revealed 115 cases up to 1976, of which diagnosis was established preoperatively in 11 cases.     

Malignant mesothelioma of the peritoneum presenting as an inflammatory lesion: a report of four cases

Most cases of malignant mesothelioma present with obvious diffuse tumor, and the presence of grossly visible diffuse tumor is usually cited as an important criterion for making the diagnosis. We report four cases of unsuspected malignant mesothelioma of the peritoneum presenting as localized acute inflammatory lesions. The clinical diagnoses were acute appendicitis in two cases, acute cholecystitis in the third case, and incarcerated umbilical hernia in the fourth case. In all cases tumor was not evident at initial surgical exploration or on gross pathologic examination, and the diagnosis was only made on microscopic examination of the resected specimens. All cases showed a tubulopapillary form of epithelial mesothelioma with obvious tissue invasion, but the foci of tumor were too small to be seen grossly or were present deep in fibrous tissue. On follow-up all patients developed grossly evident tumor, and one of these patients is alive without evidence of disease 5 years after presentation. We conclude that peritoneal mesotheliomas may occasionally present as inflammatory processes without grossly evident tumor and can be diagnosed by microscopic findings alone.     

Venous hemangioma of the mesoappendix: Report of a case and a brief review of the Japanese literature

We present herein the rare case of a 48-year-old man in whom an abdominal mass, revealed by celiotomy to be a solid tumor of the mesoappendix, was histologically diagnosed as having a venous hemangioma. To our knowledge, only 18 cases of mesenteric hemangioma have been reported in Japan, including the present case. However, establishing a correct diagnosis preoperatively is extremely difficult despite advanced imaging techniques. In fact, a mesenteric mass was diagnosed preoperatively in only 3 of these 18 cases. Complete excision with or without bowel resection was performed in 16 cases. Interestingly, the histological diagnosis of all the previous cases was cavernous hemangioma, confirming that this report decuments the first case of venous hemangioma of the mesentery in the Japanese literature.     

Bêta-thalassémie intermédiaire compliquée d’une compression médullaire. Étude de trois observations et méta-analyse

Extramedullary hematopoiesis is common in patients who suffer from beta-thalassemia. Extramedullary hematopoiesis is a compensatory mechanism of chronic anemia. Although the diagnosis is relatively easy, management is still the subject of considerable controversy. The aim of the present paper is to report three cases of spinal cord compression due to beta-thalassemia followed by a meta-analysis. In one of the three cases reported, spinal compression revealed beta-thalassemia. Forty-three cases have been reported in the last 10 years, i.e., four cases per year. The diagnosis was made by CT and myelography and confirmed by histology after surgical treatment. Two patients were followed in the hematology department. Young patients accounted for 95.45% of cases. The time to diagnosis was 3.33 months (3 days to 12 months). The most sensitive exam for diagnosis is magnetic resonance imaging before surgery. The MR image shows a hypointense lesion on T1-weighted sequences in 30.43% of cases or isointense on T2-weighted sequences in 34.78% of cases, and hypointense on T1-weighted sequences enhanced with gadolinium in 42.85% of cases. When MRI is absent, as in our patients, myelography can provide the diagnosis. The vertebrae are enlarged and translucent in 85.71% of cases with a hypodense lesion compressing the spinal cord. Laboratory tests show chronic microcytosis hemolytic anemia in 97.17% of cases. The diagnosis was established by histology performed after surgical removal. The patients recovered 97.5% of their neurologic deficiency after specific treatment. The mean follow-up was 2 years (4 weeks to 15 years).     

The reliability of needle puncture in the diagnosis of benign renal cysts? (author's transl)]

Confirmation of the diagnosis of a benign renal cyst through needle puncture is being reported with increased frequency. The puncture reveals either a clear, cloudy or bloody fluid, or no fluid at all. The authors analyze 88 of their own and 805 cyst punctures from the literature. A benign cyst was always present when the aspirated fluid was clear (763 cases). When the aspirated fluid was cloudy or bloody (130 cases) a malignant kidney tumor was found in 35% of the cases. Complications from cyst punctures are described. The authors feel that needle puncture is a highly effective method in the differential diagnosis of renal masses. It can also be used when multiple cysts are present on one or both sides.     

纵隔囊肿的外科治疗：（附72例报告）

外科治疗纵隔囊肿７２例，其中支气管囊肿３２例，心包囊肿１１例，心包憩室３例，皮样囊肿９例，胸腺囊肿３例，食管囊肿８例及囊状淋巴管瘤６例。本病无特异性临床症状或Ｘ线表现，术前确诊困难；针吸活检可提高诊断率。作者报告了本病诊断与治疗的体会。     

Metastatic involvement of the cavernous sinus from primary pharyngolaryngeal tumors

The cavernous sinus is an unusual site for metastases from tumors of the larynx and pharynx. In postmortem studies of patients with cancers of the larynx, hypopharynx, and other sites, cavernous sinus metastases have been detected in very few cases. We present 3 cases of metastatic cavernous sinus disease. Despite the lack of pathologic diagnosis by biopsy, we feel that the clinical presentation combined with computed tomography provides an accurate diagnosis.