Spontaneous uterine rupture in the first trimester: a case report

Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. Most of the cases have various risk factors and mainly occur during the second or third trimester. However, spontaneous uterine rupture during the first trimester is extremely rare. We experienced a case of spontaneous uterine rupture in a 36-yr-old multiparous woman without definite risk factors. The initial impression was a hemoperitoneum of an unknown origin with normal early pregnancy. Intensive surgical method would be needed for accurate diagnosis and immediate management in bad situation by hemoperitoneum even though a patient was early pregnancy.     

Spontaneous rupture of the left external iliac vein

Recently, we have experienced a case of spontaneous rupture of the left iliac vein in a 62-year-old woman, who had been suffering from hemiparesis and chronic constipation. An urgent laparotomy was performed for massive hemoperitoneum without knowing the bleeding point, and laceration on the left external iliac vein was repaired. Spontaneous rupture of the iliac vein is extremely rare. However, it should be included in differential diagnoses of the patient with massive hemoperitoneum who have no known pathology or any evidence of blunt trauma.     

A spontaneously ruptured gastric stromal tumor with cystic degeneration presenting as hemoperitoneum: a case report

We report a case of a 38-yr-old man with a spontaneously ruptured gastric stromal tumor presenting as hemoperitoneum in outpatient clinic. He visited our hospital with generalized abdominal pain after abdominal CT scan for the evaluation of the asymptomatic palpable abdominal mass. Repeated abdominal CT scan showed a size decrement of cystic mass compared with the previous abdominal CT scan, and newly developed fluid collection in the left paracolic gutter. An emergency laparotomy revealed a ruptured gastric stromal tumor with bloody fluid in the peritoneal cavity. Immunohistochemical examination revealed positive reactivity to C-kit protein and CD34. The patient presented with hemoperitoneum due to spontaneous rupture of the tumor, which is an extremely rare complication.     

Segmental Takayasu (giant cell) aortitis with rupture and limited dissection

Takayasu arteritis is a chronic inflammatory disease of the aorta and its main branches, with variable extents of involvement. Rarely is it sharply localized in an isolated segment of the aorta, and it seldom occurs in an elderly person. Clinically, Takayasu arteritis produces symptoms of vascular insufficiency, predominantly because of the occlusive disease and less commonly because of aneurysmal disease of the affected arteries. An unusual case of segmental Takayasu arteritis confined to the infrarenal abdominal aorta in an elderly woman is described, in which rupture and fatal hemoperitoneum were the initial manifestations of the disease.     

Hepatic rupture due to metastatic lung carcinoma

A 62-year-old man died from hemoperitoneum secondary to nontraumatic hepatic rupture. At autopsy, the liver was massively enlarged by undiagnosed metastatic small cell carcinoma of the lung. The site of exsanguination was distended by tumor, culminating in sudden bursting of the hepatic capsule. Nontraumatic rupture may result from a variety of neoplastic and nonneoplastic diseases. Hemoperitoneum secondary to lung carcinoma is rare, and even more so is the association with sudden unexpected death.     

Spontaneous splenic rupture in a hemodialysis patient

Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy.     

Spontaneous hemoperitoneum caused by a diverticulum of the sigmoid colon

The diverticulum of the sigmoid colon is relatively common in the gastrointestinal tract, with the majority of cases being asymptomatic. A non-traumatic hemoperitoneum secondary to colonic diverticulum is very rare. Here, we report the case of a 35-year-old woman with hemoperitoneum caused by the bleeding of the serosal vessel of the sigmoid colon diverticulum. The bleeding focus was identified and ligated, and the diverticulum was invaginated laparoscopically. No blood vessel malformation was detected.     

Angiodysplasia of the duodenum with arteriovenous shunts, sub-serosal prevalence and interstitial elastosis; peritonitis and rupture of sub-serous dysplasic vessels and hemoperitoneum. Description of a case and review of the literature]

We present a case report of a 74 year old man, affected by angiodysplasia of the duodenum, which developed in peritonitis and hemoperitoneum. After undergoing two surgical interventions, it is 14 days since he died. First of all, the importance of this case is due to the extreme rarity of the angiodysplasia of the duodenum, specially when it becomes worse in peritonitis and hemoperitoneum, this case having been described only one time till now, then the localization mainly sub-serousal and lastly the presence of a component, characterized by an elastotic nature, disposed in islets and interstitial widespread also among the glands, which we have first described in literature.     

An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immunoglobulin deficiency

Wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. It is usually described in adults, being most common in the multiparous women of childbearing age. A case of a 14-year-old girl with a past history of splenomegaly and immunoglobulin A (IgA) deficiency, who presented with a sudden onset of abdominal pain, is presented. Diagnosis of hemoperitoneum secondary to torsion of a wandering spleen was made by computed tomography scan and Doppler ultrasound. Laparoscopy revealed hemoperitoneum owing to a ruptured and infarcted spleen. Laparotomy was undertaken and open splenectomy was successfully performed. The patient was discharged after an uneventful postoperative course that was not punctuated by any major complication. Management of this rare surgical emergency is discussed. Based on the details of this case, the authors hypothesize that IgA deficiency causes splenomegaly, which in turn predisposes to ligamentous laxity and splenic torsion.     

Developmental surface dyslexia: a case study of the efficacy of a remediation programme

Abstract

A remedial training programme was devised and implemented in a single case of developmental dyslexia. Extensive pre-therapy psycholinguistic assessment determined the developmental stage at which the acquisition of reading skills had arrested. Subject DF had failed to develop orthographic skills; his pattern of performance resembled that of surface dyslexics. Remediation focused on development of the strategy DF had failed to acquire. The efficacy of remediation was investigated employing a single subject case study incorporating a crossover design with multiple baseline and repeated pre- and post-therapy measures. DF indicated significant positive effects of therapy, which could only be ascribed to the treatment. Theoretical explanations and practical implications of the results are discussed.     

Splenic pregnancy: a case report and review of the literature

Primary splenic pregnancy is the least common form of extrauterine pregnancy. We report a case of splenic pregnancy occurring in a 29-year-old woman presenting with acute abdomen and hemoperitoneum. Recognition of this rare form of gestation is of critical importance, owing to the risk of exsanguination and death, and should be considered in the differential diagnosis of acute abdomen in women of reproductive age.     

Desmoplastic fibroma of the rib with cystic change

Desmoplastic fibroma (DF) is a rare, locally aggressive bone tumour, first described by Jaffe in 1958. DF earned its appellation as a result of its morphological resemblance to desmoid-type fibromatosis. The majority of DFs occur in the long bones, mandible and ilium. Presentation in the rib is extremely rare with only six cases reported previously. We report a case of a 42-year-old woman with DF of the rib. Microscopically the tumour was paucicellular comprising bland slender stellate to spindle cells, embedded in abundant loose myxocollagenous stroma. In addition, focal cystic change was noted. There was no specific immunohistochemical staining and importantly B-catenin stain showed a predominantly cytoplasmic staining. DF is associated with an indolent clinical course if adequately excised. As these tumours share morphological similarities with other fibrous/fibro-osseous tumours of bone and soft tissue, awareness is crucial to avoid misdiagnoses.     

Benign fibrous histiocytoma of the skin with potential for local recurrence: a tumor to be distinguished from dermatofibroma

We studied eight patients with benign fibrous histiocytoma (BFH) of the skin that differed, morphologically and biologically, from ordinary dermatofibroma (DF) and compared their tumors with a consecutive series of 141 DF. The patients ranged in age from 13 to 49 yr. Their lesions consisted of cutaneous nodules, 2 cm or less in size, that had been present for less than 1 yr. Seven were located on an extremity. Three of six patients (50%) who could be followed had recurrences 2, 5, and 8 mo following excision of their tumors. Microscopically, seven of the eight cutaneous BFH (CBFH) involved both dermis and subcutis. Five were distinctly multinodular. Subcutaneous involvement and/or multinodularity were present in each case. Fibroblastic and histiocytic cells were arranged in a monotonous storiform pattern throughout most or all of each lesion. There was moderate nuclear variability, but pleomorphism was absent. Several of the tumors contained sparse inflammatory, multinucleate, and foam cells and hemosiderin deposits. Vascularity was prominent. We believe that the multinodular architecture of CBFH and its involvement of both dermis and subcutis usually allow distinction from DF. The latter is uninodular, centered in the dermis, and exhibits only minor subcutaneous extension. Most DF lack the diffuse, well developed storiform appearance of CBFH. Local recurrence further distinguishes CBFH from DF, which rarely recurs. Rather than representing an aberrant form of DF, the clinical and microscopic features of CBFH suggest that it is closely related to, if not identical with, BFH of other tissues and organs.     

Acute bacterial aortitis resulting in an aortoesophageal fistula. A fatal complication of untreated esophageal carcinoma

Exsanguination in a case of esophageal carcinoma resulted from an aortoesophageal fistula. The squamous carcinoma was undiagnosed clinically and was untreated. Ulceration of the carcinoma gave rise to mediastinitis and an abscess containing necrotic tumor and bacteria. Infection spread from the abscess to the adjacent aorta, producing focal bacterial aortitis, necrosis of the aortic media, and aortic perforation. A fistula was thus established between the aorta, the abscess cavity, and the esophagus. Terminally, the patient had a large hematemesis, and massive hemorrhage acutely distended the stomach which ruptured to produce a large hemoperitoneum.     

Isolation and characterization of two allergens from Dermatophagoides farinae

Two purified allergens, designated as DF1 and DF2, were isolated from the extract of the whole culture of Dermatophagoides farinae by a combination of ammonium sulfate precipitation and ion exchange, hydrophobic, chelate and gel chromatography. DF1 was isolated as a heat-sensitive acidic protein with an apparent molecular weight of 25,000 and an isoelectric point of 4.6-7.2. DF2 was isolated as a heat-stable basic protein with an apparent molecular weight of 15,000 and an isoelectric point of 7.8-8.3. No allergenic cross-reactivity was seen between DF1 and DF2. Both DF1 and DF2 were shown to be the major allergens of D. farinae by the results of radioallergosorbent test and histamine release assay.     

Mesenteric lymph node hemangiomas of Wistar rats.

Vascular tumors in rodent mesenteric lymph nodes are uncommon. Fifty-seven of these neoplasms were identified in control and treated Wistar rats from 6 tumor bioassays. Tumor incidence ranged from 0.75% to 5.50% and was higher in males than females (2:1). Lesions, noted as incidental necropsy findings or in routine histologic sections, were typically solitary and restricted to nodal and perinodal tissue. Additional solitary vascular tumors were identified in skin of 3 rats and pararenal lymph node of 1 rat. Distinct metastases were not evident. When apparent grossly, affected nodes were red to purple, hemorrhagic, and/or enlarged. Histologically, all tumors were composed of variably sized, endothelial-cell-lined, blood-filled spaces separated by variable amounts of poorly cellular stroma. Nodal effacement was common in larger tumors. Approximately half of the tumors had features of typical cavernous hemangiomas. The remaining tumors had slightly more aggressive features consisting of single or multiple foci of lymph node capsule invasion, presence of tumor cells in muscular blood vessels, or cellular atypia with variable mitotic activity. Death due to tumor rupture and consequent hemoperitoneum occurred in 1 rat only.     

Spontaneous rupture of splenic artery aneurysm in pregnancy: a case report

Splenic artery aneurysms (SAA) occur predominantly in women, and the majority of them are asymptomatic until rupture. Over half of those that rupture occur during pregnancy. Spontaneously ruptured SAA during pregnancy is always a life-threatening surgical entity for both the mother and the fetus. We report the case of a 29-year-old woman at 34 weeks' gestation with spontaneous rupture of SAA who underwent emergency exploratory laparotomy and splenectomy. This case illustrates the need to consider ruptured SAA as part of important differential diagnosis in haemodynamically unstable pregnant women.     

DeFries–Fulker and Pearson–Aitken Model-fitting Analyses of Reading Performance Data from Selected and Unselected Twin Pairs

Although a comparison of concordance rates for deviant scores in identical and fraternal twin pairs can provide prima facie evidence for a genetic etiology, information is not fully utilized when continuous measures are analyzed in a dichotomous manner. Thus, DeFries and Fulker (Behav Genet 15:467–473, 1985; Acta Genet Med Gemellol, 37:205–216, 1988) developed a regression-based methodology (DF analysis) to assess genetic etiology in both selected and unselected twin samples. While the DF analysis is a very versatile and relatively powerful statistical approach, it is not easily extended to the multivariate case. In contrast, structural equation models may be readily extended to analyze multivariate data sets (Neale and Cardon, Methodology for genetic studies of twins and families, 1992). However, such methodologies may yield biased estimates of additive genetic, shared environmental, and non-shared environmental influences when multivariate models are fitted to selected twin data. Therefore, the Pearson–Aitken (PA) selection formula (Aitken, Proc Edinburgh Math Soc B, 4:106–110, 1934) was used to analyze reading performance data from twins with reading difficulties (selected sample) and a population of normally-achieving twin pairs (control sample). As a comparison, DF models were also fitted to these same data sets. In general, resulting estimates of additive genetic, shared environmental, and non-shared environmental influences were similar when the DF and PA models were fitted to the data. However, the PA selection formula may be more readily generalized to the multivariate case. Edited by Hermine Maes.     

Dual-frequency chirp imaging for contrast detection

The method of dual-frequency (DF) difference excitation is capable of generating a low-frequency envelope component as the driving force of commercial contrast microbubbles by using a high-frequency pulse. Although the DF difference excitation method provides good lateral resolution in high-frequency contrast imaging, it suffers from degraded axial resolution because a longer-than-usual envelope component is required to induce the oscillation of microbubbles. In this study, a coded excitation technique (i.e. chirp waveform) is combined with the DF difference excitation method (also referred to as the DF chirp excitation method) to improve the axial resolution of contrast imaging while maintaining the impinging insonation energy. B-mode images were constructed to compare the performance of the DF chirp excitation method with the conventional tone-burst pulse method. Results indicate that the proposed DF chirp excitation method can provide better axial resolution after pulse compression. Moreover, as compared to the tone-burst pulse with the same pulse duration, the pulse compression results in a higher signal-to-noise ratio because of the temporal concentration of the received energy. Nevertheless, images with the DF chirp excitation method demonstrated noticeable image artefacts resulting from the range sidelobes. The DF chirp excitation method also produced obvious tissue harmonic generation that could degrade the contrast-to-tissue ratio at higher acoustic pressures.