Angiosarcoma at the site of a Dacron vascular prosthesis: a case report and literature review.

Four of 32 reported sarcomas related to the aorta have arisen around previously placed aortic vascular prostheses suggesting that the graft may have been an etiologic factor. Our recent experience with such an angiosarcoma arising around a Dacron aortic graft prompted a review of the lesion to identify risk factors, diagnostic approaches, and treatment options. The diagnosis of these sarcomas is seldom made before operation. Animal studies have implicated plastic polymers including Dacron as carcinogenic materials capable of inducing sarcoma in 7% to 50% of exposures. Because of the rarity of these tumors and the thousands of vascular implants used over the past 30 years, it is unlikely that this degree of risk can be extrapolated to humans. However, a tumor should be included in the differential diagnosis of any mass or thromboembolic event associated with a vascular prosthesis.     

Fungal graft infections: case report and review of the literature

Fungal intravascular graft infections are rare. In addition to our case, which forms the basis of this article, only 13 documented instances could be found in the literature in the 20-year period from 1966 to 1986. Three of these cases (21%) had both fungus and bacteria grown in culture. Candida and Aspergillus species constituted most of the infecting organisms (79%). There was no obvious difference in the clinical presentations between fungal and bacterial infections. In two cases (14%), there was a strong predisposition toward fungal infection: one in a patient with pulmonary histoplasmosis and one in a patient with leukemia. Appropriate intervention appears to be graft excision and extra-anatomic bypass with concomitant therapy with amphotericin B. Survival with this approach was 84%, whereas other methods yielded a survival rate of 20%.     

小肠移植术后慢性移植物失功1例报道及文献复习

目的探讨小肠移植术后慢性移植物失功(chronic graft dysfunction,CGD)的诊断及治疗。方法报道国内首例同种异体小肠移植患者术后CGD的临床资料,复习相关文献。结果患者因"门静脉血栓、脾静脉血栓致肠系膜血栓"切除了大部分小肠,后行同种异体小肠移植术。术后长期服用他克莫司(FK506),屡次发生排斥反应。术后3次因"小肠狭窄、不全性肠梗阻"行"小肠节段切除吻合术"。其中术后576d第3次出现肠梗阻,予经皮内镜下胃空肠造瘘术胃肠减压等治疗,确定移植肠不可逆性失功后行移植小肠切除术。结论 CGD治疗困难,预后不佳,预防胜于治疗。在确诊CGD不可逆后应尽快切除移植小肠,挽救患者生命,有条件应尽快安排再次移植。     

Aneurysm of aortocoronary saphenous vein graft: case report and literature review

True aneurysms of aortocoronary saphenous vein bypass grafts are a relatively rare complication of bypass surgery, but because the complications of thrombosis, embolization, or rupture are potentially fatal, this condition requires immediate surgical intervention. We describe a 78-year-old man who had undergone coronary bypass 15 years previously and who presented with a saphenous vein graft that was severely degenerated and aneurysmally enlarged throughout its course, measuring as much as 5 to 6 cm in certain locations. Redo coronary artery bypass grafting using the right and left internal thoracic arteries and resection of the aneurysm were performed. We also present a review of the literature regarding diagnosis, management, and treatment of this condition.     

慢性移植物抗宿主病相关性肌炎一例

目的总结1例异基因造血干细胞移植后并发与慢性移植物抗宿主病(cGVHD)相关的多发性肌炎的诊治体会。方法1例急性淋巴细胞白血病患者在处于完全缓解状态下接受同胞间供髓异基因造血干细胞移植,移植后采用环孢素A和甲氨蝶呤预防移植物抗宿主病(GVHD)。结果移植后11 d,WBC＞0．5×10~9/L,移植后13 d,血小板＞20×10~9/L；27 d时,骨髓细胞染色体分析显示99%为供者型。移植后17 d,发生Ⅰ度急性皮肤型GVHD,经静脉注射地塞米松及甲氨蝶呤后,GVHD被完全控制。移植后8个月,患者发生轻度肝脏cGVHD,经他克莫司及硫唑嘌呤治疗,效果不佳,血清肝酶升高,后改为他克莫司和西罗莫司治疗,血清肝酶逐渐下降,但肌酸激酶从9 U/L上升至272 U/L,随后患者出现全身乏力,并逐渐加重,上下肢近端处活动出现障碍,肌酸激酶升至3010 U/L,股四头肌、肱二头肌的肌电图表现为肌源性损害,双侧大腿磁共振成像符合多发性肌炎表现,给予甲泼尼龙、血浆置换治疗,但无显著效果,患者突发阵发性呼吸困难,经抢救无效,患者死亡,死亡时肌酸激酶为21 010 U/L。结论多发性肌炎为cGVHD的一种较少见形式,累及重要肌组织者预后较差。     

Ganglioglioma presenting as a meningioma: case report and review of the literature

OBJECTIVE AND IMPORTANCE: Gangliogliomas are intra-axial, avascular masses located predominantly in the temporal lobe. A ganglioglioma that mimics a meningioma in that it is extra-axial and has a significant extracranial vascular supply has not been reported previously. CLINICAL PRESENTATION: A 12-year-old girl presented with a right temporoparietal mass. A neurological examination revealed nothing abnormal, and the girl's symptoms were limited to headaches. INTERVENTION: Magnetic resonance imaging revealed an extra-axial mass, and cerebral catheter angiography revealed a blood supply mainly from the posterior division of the right middle meningeal artery. Intraoperative findings confirmed the extra-axial location of the tumor, and histological analysis revealed that the tumor was a ganglioglioma. CONCLUSION: This report confirms that gangliogliomas can present as extra-axial, vascular masses that are similar to meningiomas.     

Melorheostosis: a case report and literature review

Melorheostosis is a rare form of cortical hyperostosis that resembles wax dripping down the side of a candle. This disease usually affects the long and short bones of an extremity. Literature review and a case report will be discussed with respect to incidence, clinical presentation, radiographic appearance, and treatment.     

Enchondroma: a case report and literature review

An unusual case of enchondroma located in the distal phalanx of the left third toe is presented with a review of literature. An enchondroma is a benign tumor centrally located in a bone. This osseous dysplasia is characterized by an excess of mature hypertrophic hyaline cartilage that has not resorbed or ossified in the normal fashion. Pathologic, clinical, and radiographic findings will be discussed.     

Incomplete paraplegia following use of heroin: a case report and review of the literature

Neurological complications involving the lumbar spine following intravenous injection of heroin was observed in a 28-year-old man. On admission, steroids were administrated, and the patient had a complete recovery after an interval of 2 days. There have been more than 46 cases reported in the literature with similar findings to the one presented here. The mechanism of neuropathology of heroin abuse is still unknown. Possible mechanisms are a toxic, allergic, or a hypersensitivity reaction. Rare cases of complete recovery have been reported.     

True aneurysm in a femoro-popliteal dacron graft -- a case report and literature review

Infection and anastomotic pseudo-aneurysm formation are the usually reported complications in the use of dacron prosthesis in arterial by-pass surgery. We report a case of true aneurysm formation in the body of a knitted dacron graft used to by-pass a symptomatic above knee occlusion of the superficial femoral artery when suitable long saphenous vein was not available. This was diagnosed 10 years after surgery. A true aneurysm may be a result of pre-implantation trauma to the graft or to late fibre degeneration. Microscopic examination revealed that the dacron fibres had stretched to form a local aneurysm before rupturing to form an associated false aneurysm. Two other areas of the graft had small saccular aneurysms without rupture. The damaged portion was excised and replaced by an interposition graft of the same material.     

Hepatic endometrioma: a case report and review of the literature: report of a case

Hepatic endometriosis has an extremely rare occurrence characterized by the presence of ectopic endometrium in the liver. A diagnosis of hepatic endometriosis is established after surgery. A 51-year-old multiparous female was referred to our unit for investigation of a liver tumor. The patient reported a 6-month history of epigastric pain and vomiting. She had undergone conservative hysterectomy for uterine leiomyomas several years earlier. The results of liver function tests and the levels of tumor markers (CA 19.9, CEA, CA125, αFP) were normal. Radiological imaging (USS, CT and MRI) suggested the presence of liver cystadenoma, liver cystadenocarcinoma or cystic metastasis of the liver in the left liver lobe extending to the diaphragm with left hepatic vein compression. Laparotomy was performed. The intraoperative frozen sections suggested a diagnosis of endometriosis. Anatomical resection was performed, including left lobectomy with diaphragm resection. The final histology confirmed the presence of hepatic endometrioma without malignant transformation. Fourteen cases of hepatic endometrioma have been described in the medical literature. We herein report the 15th case. Making a preoperative diagnosis of hepatic endometriosis is very difficult, despite conducting a complete investigation, in the absence of clinical and radiological characteristics. The diagnosis is made according to a histological examination of the whole surgical sample.     

Polyorchidim: a case report and review of the literature

A 28-year-old male presented with a small painless lump in his left hemiscrotum. A physical examination revealed a non-tender mass that was palpable on the tail of left epididymis, and the testis and spermatic cord were normal. Ultrasonography showed an isoechoic round shaped tumor, 16 mm in diameter. An exploration of the scrotum was performed, based on a preoperative diagnosis of a left epididymal tumor. The tumor was located below the tail of epididymis, and had a whitish capsule, which looked similar to tunica albuginea testis. A frozen section revealed testicular tissue without any malignant change, and therefore polyorchidism was diagnosed. The accessory testis was resected because there was no connection with the epididymis and vas deferens. Polyorchidism is a rare congenital anomaly with 24 cases reported in the Japanese literature. The indications for the resection of an accessory testis are controversial. Patients with intrascrotal polyorchidism might be recommended to undergo a resection of the accessory testes if there are signs of dysplasia during an intraoperative biopsy. Patients must be followed up with regular clinical and ultrasonic examinations when accessory testes are preserved. However, extrascrotal supernumerary testes should be managed by an orchiectomy because of the increased risk of malignancy.     

Polyorchidism: a case report and review of the literature

Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.     

Polyorchidism: a case report and review of the literature

Polyorchidism is defined as the presence of two or more testes. It is a rare anomaly with approximately 77 cases reported in the literature. Polyorchidism is frequently associated with additional urological pathologies such as undescended testis, inguinal hernia, testicular torsion, hydrocoele, malignancy and infertility. Differential diagnosis includes spermatocoele, hydrocoele, epididymal cysts or aberrant epididymis. We report on an interesting case of polyorchidism in a 15-year-old man diagnosed on ultrasound and we review the literature and current management of polyorchidism.     

Meningioangiomatosis: a case report and review of the literature

A case of cerebral meningioangiomatosis in an adult man without any stigmata of neurofibromatosis is reported. A 22 year-old man with no previous neurological history, presented with adversive seizures; clinical examination and electro-encephalogram were normal. CT showed nodular calcified masses in the left frontal lobe and in the left posterior parietal area. A craniotomy was performed and the frontal lesion was excised. Histological examination showed a predominantly intracerebral tumour involving both grey and white matter, with a complex picture of variable cellularity, dense calcification and prominent perivascular arrangements of reticulin-rich spindle cell fascicles with palisade formation widely involving the brain tissue. Immunohistochemistry for S100 protein varied between different parts of the tumour; there was focal positivity for S100 protein and smooth muscle actin in the lesion with no reaction for GFAP or EMA. Immunostaining for Factor 8-related antigen highlighted the perivascular arrangement of lesional cells and demonstrated an increase in the number of small vessels in other areas. Electron microscopy of the main mass showed elongated spindle cells with formation of pericellular basal lamina. The literature on meningioangiomatosis was reviewed. The evidence for meningeal, perivascular neural plexus or pericyte origin does not appear to be well founded. The present case further illustrates the difficulty in identifying an exact histogenetic cell and probably reflects an origin from a primitive perivascular mesenchymal cell.     

Confirmed graft flow following use of recombinant factor VIIa in coronary artery bypass grafting: a case report and literature review

We present our experience of a unique opportunity to survey coronary artery bypass graft (CABG) patency following the administration of recombinant factor VIIa in the early postoperative period. A review of the published literature on use of this medication in cardiothoracic surgery, specifically CABG, is included.     

The use of intra-abdominal tissue expansion for the management of giant omphaloceles: review of literature and a case report

Giant omphaloceles present a reconstructive challenge in planning, management, and eventual closure of the abdominal wall defect. The goal of reconstruction is to recreate a functional abdominal wall domain and return the extra-anatomically placed viscera into the peritoneal cavity in a safe manner. Traditionally, placement of tissue expanders has been in the subcutaneous and intramuscular planes. Recently, however, there have been reports of intra-abdominal placement of expanders. We present a detailed review of the literature regarding the use of tissue expanders in the management of giant omphaloceles with specific emphasis on the intra-abdominal technique of placement. We also present a case report with the longest follow-up till date in which the patient underwent staged reduction using the intra-abdominal approach. Initial reports of this modality are promising both as a primary strategy and in patients in whom conventional techniques have failed. Results from our review of literature and case report suggest that this technique appears to be durable and effective with successful functional and cosmetic outcomes.     

Donor transmission of malignant melanoma to a liver graft recipient: case report and literature review

Abstract:  Post-transplant malignancy of donor origin is a rare complication of organ transplantation, most likely transmitted as micrometastases within the parenchyma of the donor organ or from circulating tumor cells contained within the organ. Patient survival is dependent upon early diagnoses, and differentiation of the malignancy as of donor or recipient derivation is important in developing a treatment modality. The utilization of fluorescent in situ hybridization chromosome analysis and DNA sequence analysis of the tumor cells can assist in this determination. This case report describes the management of donor transmitted malignant melanoma in a liver graft recipient and a review of the current literature.