Acute occlusion of the iliac arteries due to blunt trauma

Two cases of acute iliac occlusion due to blunt trauma are presented. The cause of injuries were a fall from bicycle in case 1 and a compression between an automobile and a wall in case 2. The end-to-end anastomosis was possible in case 2, but an interposition of an artificial prosthesis was necessary because of the length of damaged artery in case 1. Both cases were associated with the pelvic fracture, adding the perforation of small bowels and the bladder in case 2. Postoperative course was almost uneventful except fasciotomy was needed for the compartment syndrome of the right lower extremity in case 2.     

Renal lymphoma. Report of 2 cases and review of the literature]

Two cases of renal lymphoma were reported. Case 1 was a 73-year-old, and case 2 was a 59-year-old female. Their chief complaint was flank pain. The findings obtained by CT and angiography were not compatible with renal cancer. The tentative diagnosis of case 1 was inflammatory disease or soft tissue tumor, and that of case 2 was renal subcapsular tumor. Histological specimen was obtained by open biopsy from case 1, and by nephrectomy from case 2. Immunohistochemical surface marker study revealed both tumors were B cell lymphoma. Chemotherapy (CHOP-Bleo, or PPA) in both cases and additional radiotherapy in case 2 markedly reduced the tumor size. Nevertheless, case 1 died 5 months later from recurrence, and case 2 died 14 months later of gastrointestinal bleeding. At autopsy, the renal subcapsular layer was infiltrated by lymphoma cells in both cases, and lymphadenopathy was not observed. Reviewing 16 cases previously reported as renal lymphoma, the capsular or subcapsular diffuse infiltration to the kidney is considered to be a characteristic feature of renal lymphoma.     

2 cases of brain abscess as a complication of direct cranial traction

Two cases of brain abscess as a complication of direct cranial traction have been presented. In the first case traction was used in the treatment of aneurysmatic cyst of the cervical spine, in the second case for cervical spine trauma. In the first case development of abscess was related with local infection in the site of localization of traction, and in the second case, most probably, with direct contamination of the brain tissue in the site of dura mater perforation. In both cases abscess was treated surgically; in the first case, a female patient was discharged with severe neurological deficit and in the second case, the male patient recovered without neurological deficit.     

腹腔镜辅助结直肠癌切除术14例报告

目的:探讨腹腔镜技术在结直肠癌切除术中的应用。方法:回顾分析腹腔镜辅助结直肠癌切除术14例的临床资料。结果:本组右半结肠、横结肠、左半结肠以及乙状结肠根治性切除各1例,D ixon术5例,M iles术3例;1例左半结肠癌患者探查见左肾有浸润性转移而中转开腹;1例横结肠癌患者探查见肿瘤腹腔广泛转移而放弃手术;全组无手术死亡。术后1例Dukes D期患者因肿瘤转移死亡,1例Dukes C期患者1年后肠道复发,其余患者未见肿瘤复发及转移。结论:腹腔镜辅助结直肠癌根治术安全可行。     

Two cases of spontaneous fistula between urinary tract and gastrointestinal tract

This is a report of two cases of a fistula between the urinary and gastrointestinal tracts. One case was a 56-year-old female patient with a right pyeloduodenal fistula, and the other was a 38-year-old female with a left ureterodescending colon fistula. The chief complaint was right lumbago in the first case, and fever and left lumbago in the second case. Both cases were diagnosed by retrograde pyelography. In both cases, the ailing kidney appeared to be non-functioning, and the former was operated by nephrectomy, fistulectomy, and duodenectomy in the cuneate form, while the latter was operated by nephrectomy and fistulectomy. The cause of the formation of the fistula was considered to be chronic pyelonephritis accompanied by renal stones in the first case, and rupture of the colon diverticulitis in the second case. Postoperative prognosis was satisfactory in both cases.     

A surgical case of primary lung cancer with peripheral intrapulmonary lymph node metastasis.

We report on a case of a patient with lung adenocarcinoma and peripheral intrapulmonary lymph node (IPLN) metastasis who was misdiagnosed as having intrapulmonary metastasis. A subpleural nodular shadow visualized by radiography was diagnosed as an intrapulmonary metastasis originating from primary lung cancer. Preoperative evaluation indicated that this case was a clinical T4N1 lung adenocarcinoma with metastasis in the same lobe. However, postoperative evaluation showed that it was a peripheral IPLN metastasis, and this was actually a case of pathologic T2N1 adenocarcinoma. It may have been possible to treat this case non-surgically with the possibility of radical cure. This case suggests that a nodule is present in the same lobe with lung cancer, and it must be borne in mind that IPLN metastasis may be misdiagnosed as intrapulmonary metastasis.     

Urethral duplication in boys: report of 4 cases

Urethral duplication is a rare anomaly, affecting mainly boys. The clinical presentation varies because of the different anatomical patterns of this abnormality. We report 4 cases of urethral duplication in children. An epispadiac duplication was present in 1 case, hypospadiac duplication in 1 case, Y-duplication in 1 case and a congenital prepubic sinus in the last case. The pre-operative probe was based on urethrocystography and fistulography. The surgical management included excision of the duplicated urethra in 3 cases. Transurethral incision of the intra-urethral septum was performed in the case of hypospadiac duplication. The characteristics of male urethral duplication are reviewed.     

Our experience with duodenal tumors

The authors report 3 cases of benign duodenal tumors and one case of duodenal cancer. In two cases the benign tumors were adenomatous polyps, in one case with signs of dysplasia. One case of benign tumor was a lipoma. All the three benign tumors were removed through a duodenotomy, in one case associated with a sphincteroplasty. The case of duodenal cancer, arisen in a patient operated since 24 years with a gastric resection, was treated with a Whipple technique but for the very old age and the bad health conditions, the patient died in 11th post-operative day for myocardium infarct.     

Intravesical formalin for the treatment of massive hemorrhagic cystitis: retrospective review of 25 cases

Between 1980 and 1988 25 patients with massive bladder hemorrhage were treated with intravesical instillation of 4% formalin in 19 cases and 10% in the remaining 6 cases; the contact time was 15 min in 20 cases. The etiology of the hemorrhage was cyclophosphamide therapy (1 case), pelvic radiotherapy (15 cases) and infiltrating bladder cancer in the remaining 9 cases. In 10 cases, the instillation of formalin was performed in bladders with a prior supravesical diversion. Complications included 1 case of vesicorectal fistula, 1 case of uretero-hydronephrosis and 1 case of vesical extravasation of formalin when a concentration of 10% was used at a volume superior to 50 ml. The only complication seen with 4% formalin was 1 case of upper urinary tract dilatation. Good results were obtained in 88% of cases, who achieved correct hemostasis during a mean of 4 months.     

General Anesthesia for a Child With Landau-Kleffner Syndrome, a Case Report

Landau-Kleffner syndrome is a rare, epileptiform disorder with a pathognomonic sudden aphasia, epilepsy, and electroencephalographic abnormalities. It was first described in 1957. No case reports are included in the anesthesia literature. This case report describes a 9-year-old male who was treated for dental caries while under intubated general anesthesia. The case was successful and uneventful, with multiple precautions taken to prevent seizures or other complications. The authors hope that this report will provoke communication and additional case reports.     

Two case reports of hydronephroureterosis associated with complete double pelvis-ureter accompanied by pyuria and hematuria

We report two cases of hydronephroureterosis of the upper moiety in the complete duplex kidney disclosed by urological examination for pyuria and hematuria. The first case was in a 64-year old female and the second case was in a 68-year old female. Urinary incontinence was not seen in either case. Heminephrectomy was performed because the upper moiety was non-functioning and the upper ureter opened at the vesical neck in these cases. The postoperative course was uneventful.     

Congenital intrarenal teratoma arising from a horseshoe kidney

We report a case of intrarenal teratoma arising from a horseshoe kidney. A 6-day-old girl was admitted with an abdominal mass that had been noticed at 37 weeks gestation by routine ultrasonography. At 20 days of age, a tumorectomy with a right nephrectomy was performed. The pathological diagnosis was an immature teratoma. An intrarenal teratoma is extremely rare. In addition, we believe that this case represents the first case of an immature teratoma occurring in a horseshoe kidney. The diagnosis in this type of case is difficult, but we recommend that such tumors be included in the differential diagnosis.     

Telomerase activity in giant condyloma acuminatum

A 46-year-old male came to our hospital 1 month after noticing a 2-cm penile tumor. Since malignant findings such as atypical cells and mitosis were not observed in the frozen sections obtained at operation, the pathological diagnosis of this tumor was giant condyloma acuminatum. This tumor was analyzed by a telomeric repeat amplification protocol method, and telomerase activity was revealed. For comparison, a case of squamous cell carcinoma and a case of condyloma acuminatum were examined. Telomerase activity was observed in our case and in the case of squamous cell carcinoma. To our knowledge, this is the first case of telomerase activity in giant condyloma acuminatum ever reported. In addition to the histological examination, measurement of telomerase activity may provide valuable objective diagnostic information on evaluating the degree of malignancy of giant condyloma acuminatum and in obtaining a differential diagnosis between the benign and malignant.     

Laparoscopic wedge resection with handsewn closure for gastroduodenal tumors

PURPOSE: To evaluate the feasibility and efficacy of laparoscopic wedge resection with handsewn closure in gastroduodenal tumors. METHODS: Laparoscopic wedge resection was performed in 16 patients with gastroduodenal tumor between May 2000 and December 2002. Every case, except one, was performed via an extragastric approach; a transgastric approach was adopted in a single case. Excision of the lesion was performed manually by means of electrocautery or ultrasonic coagulating shears and closed by manual intracorporeal running suture. RESULTS: Among the 16 cases, two cases were treated using a laparoscope-assisted method, but there was no case of conversion to open surgery. Mean size of lesions was 27.9 mm in diameter and the mean operation time was 219 minutes. In all cases, a complete tumor excision with negative surgical margins was obtained. The final pathologic diagnoses were ectopic pancreas (4 cases), gastrointestinal stromal tumor (3 cases), leiomyoma (2 cases), adenomyoma (2 cases), tubular adenoma (1 case), Brunner's gland hyperplasia (1 case), carcinoid tumor (1 case), eosinophilic granuloma (1 case), and post-endoscopic mucosectomy state for early gastric cancer (1 case). The average numbers of days to first postoperative oral food intake and hospital stay were 3.1 days and 6.0 days, respectively. There were no postoperative complications. CONCLUSIONS: Laparoscopic wedge resection with handsewn closure should be considered as a valid treatment option for selected gastroduodenal tumors in terms of feasibility, safety, and cost. A more efficient surgical instrument and technique should be developed in future.     

Cricothyroidotomy: a short-term measure for elective ventilation in a patient with challenging neck anatomy

Cricothyroidotomy is a well established technique of airway management in emergency situations where translaryngeal intubation cannot be achieved. This case report describes a case where cricothyroidotomy was used for elective ventilation for short period of 48 hours in a patient who had a vocal cord palsy, supraglottic oedema and inflammation. Surgical tracheostomy was considered the preferred option, but this was deemed impossible due to the challenging neck anatomy in this case.     

Bilateral traumatic abducens nerve paralysis with cervical spine flexion injury

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with cervical spine flexion injury. This may be the first such case report, as no similar case was found in our review of the literature. The mechanisms of injury in this case are relevant to theories that explain hyperextension injuries.     

Primary colonic intussusception protruding from the anus in adults. Two cases]

The authors report two cases of colonic intussusception in the adult protruding from the anus--or colo-anal intussusception--, not due to a tumor. The first case was a chronic ileo-caeco-colique intussusception, the second case was an acute colo-rectal intussusception. Colo-anal intussusceptions are very rare: less than twenty cases have been described since 1925 in adults. The absence of a tumor origin in our cases represents a special feature, as only three other similar cases have been described. The surgical treatment in both cases was primary colonic resection without colostomy. The surgical treatment of the first case was subtotal colectomy with ileo-rectal anastomosis. The second case was primarily reduced by barium enema which allowed optimal secondary surgical resection of a prepared colon.     

Multiple argentaffin tumors (carcinoids) of the rectum

A case of multiple argentaffin tumors (carcinoids) occurring in the rectum is reported from an autopsy case. The wall, for approximately 15 cm. was infiltrated with nodules varying in diameter from a few millimeters to 1.0 centimeter. The surface over these tumors was not ulcerated and there was no evidence of metastases. Apparently this is the fourteenth case of an argentaffin tumor occurring in the rectum to be reported, and the first case in which the nodules are multiplied.