Transitory headaches caused by a colloid cyst of the third ventricle

A 34-year-old man had a history of short-lasting episodes of rotatory vertigo followed by severe headache, provoked by sudden movements of the head and body. MRI of the brain revealed hydrocephalus secondary to a colloid cyst at the level of the foramen of Monro. The patient underwent microsurgery, after which he remained without symptoms. Colloid cysts are rare, benign tumours accounting for 0.5-1.0% of all primary brain tumours. They are attached by a stalklike appendage to the roof of the third ventricle between the fornices. Typical symptoms include intermittent headache, vomiting, occasional dizziness and blurred vision. These symptoms may be secondary to intermittent obstruction of cerebrospinal-fluid outflow through the foramen of Monro. The results of clinical and neurological examination are usually normal. In any patient with short-lasting episodes of severe headache, provoked by changes in position, an MRI of the brain should be done to exclude a colloid cyst. In general, these patients do not fulfil the criteria of the International Headache Society for migraine because of the short-lasting nature of the pain.     

Nonoprerative management of obstructive jaundice caused by a benign hepatic cyst

A 64-year-old man with a 9.0 cm benign hepatic cyst near the hepatic hilum presented with obstructive jaundice caused by the compression of the hepatic ducts. The cyst was aspirated percutaneously, and minocycline hydrochloride was instilled as a sclerosant through a catheter inserted into the cyst. The cyst gradually became smaller, relieving the obstructive jaundice. There were no complications or side-effects. The instillation of minocycline hydrochloride is a useful alternative to ethanol instillation for treating benign hepatic cysts, even when the cyst is causing obstructive jaundice.     

Acute abdomen caused by a large vesical cystine calculus

A 73-year-old man underwent an emergency laparotomy because of acute abdominal pain and a palpable mass in the lower abdomen. A giant vesical calculus was found which had perforated the bladder, small intestine and sigmoid colon due to pressure necrosis. The stone had a length of 11.5 cm and weighed 1280 g. Further analysis revealed benign prostate hyperplasia, bladder diverticula and cystinuria as underlying causes. Initial therapy consisted of stone removal, partial bladder resection, a Hartmann procedure and partial resection of the small intestine. Secondarily, lifestyle advice was given and transurethral resection of the prostate followed later.     

A swelling in the knee cavity, not caused by a Baker's cyst but by a nerve sheath tumour

In a woman, aged 30 years, who presented with a right popliteal mass, a Baker's cyst (popliteal cyst) was diagnosed. Five years later she developed symptoms that were attributed to compression of the peroneal nerve by the mass. Because of the troublesome nature of these symptoms, it was decided to excise the mass. Immediately after the operation, a complete loss offunction ofthe common peroneal nerve was apparent. Histopathologic examination revealed an ancient schwannoma (nerve sheath tumour). The most important reason for not having diagnosed the schwannoma was that it was not considered in the differential diagnosis of the popliteal mass. Although Baker's cysts are the most common popliteal masses, nerve sheath tumours should also be considered in the differential diagnosis.     

Acute cholangitis caused by intra-biliary rupture of pancreatic hydatid cyst

A case of intra-biliary rupture of pancreatic hydatid cyst is presented. The site of the cyst in the pancreatic head, cholangitis, the advanced age of patient, previous history of cholecystectomy, liver hydatidosis and gastrectomy for ulcer disease, led to diagnostic and therapeutic difficulties. As in some cases of intra-biliary rupture of the liver hydatid cyst, surgical treatment of this pancreatic hydatid cyst included evacuation of cystic contents through choledocotomy and biliary-enteric anastomosis with uneventful postoperative course.     

Acceptability of a nonsurgical method to terminate very early pregnancy in comparison to vacuum aspiration.

Seventy-seven patients applying for abortion during early pregnancy consented to be treated by prostaglandin vaginal suppositories or vacuum aspiration by Kahrman catheter in a random design. They also consented to participate in an acceptability study of the two procedures. Attitude and preference measures were obtained by interviewing and rating scales on three occasions: before assignment to abortion procedure, immediately after treatment, and two weeks later. The first 30 patients with complete abortion by either procedure participated in the acceptability study. Both treatments were positively evaluated but perceived to have very different characteristics. The preference for the method used for own treatment increased in both groups. Before treatment 1/3 of the patients in each group had a positive attitude to a self-administered method to induce abortion outside clinics. This proportion increased significantly after treatment but only in the group that received prostaglandin by the vaginal route.     

Uterine muscle as a potential target of polychlorinated biphenyls during pregnancy

Because of their once-popular commercial uses, improper disposal and environmental persistence, polychlorinated biphenyls (PCBs) are common environmental contaminants found in many designated Superfund sites. Several epidemiology studies associated PCB exposure with decreased length of gestation. Recent laboratory studies, described in this review, examined PCB actions in uterine muscle in order to investigate mechanisms by which PCBs may stimulate early onset of parturition. Because increased frequency, force and coordination of oscillatory uterine contractions are the defining characteristics of parturition, the laboratory studies used uterine muscle tissue and cells to study PCB actions on uterine contraction. Acute in vitro exposures to commercial PCB mixtures and microbially dechlorinated commercial PCB mixtures increased the frequency of spontaneous oscillatory contractions of uteri from pregnant rats. Increased uterine stimulation was observed with PCB mixtures containing increased abundance of lesser-chlorinated, ortho-substituted congeners. Similarly, in vitro exposures to PCB congeners increased the frequency of spontaneous uterine oscillatory contractions in a structurally related manner, with ortho-substitution of four or fewer chlorines associated with increased stimulation. Moreover, inhibitors of phospholipase A2 prevented stimulation of oscillatory uterine contractions by the commercial PCB mixture Aroclor 1242, suggesting involvement of arachidonic acid in the Aroclor 1242-induced stimulation. Acute exposure to a hydroxylated estrogenic PCB inhibited uterine contraction acutely, but a 42-h exposure increased uterine sensitivity to the uterotonic hormone oxytocin in a manner similar to 17 beta-estradiol, suggesting an estrogenic mechanism by which some PCBs could decrease gestation length. These studies show that PCBs stimulate uterine contraction in vitro, providing biologically plausible mechanisms in support of previous epidemiology findings associating PCB exposure with decreased gestation length. Further conclusions regarding human health should be considered in the context of human exposure and the experimental limitations of the in vitro studies.     

A very serious course of psittacosis in pregnancy

A 33-year-old pregnant woman was admitted because of atypical pneumonia. She developed adult respiratory distress syndrome complicated by premature birth and perinatal mortality. The diagnosis 'psittacosis' was established on clinical grounds and confirmed serologically (complement fixation test). She was treated with doxycycline 200 mg i.v. daily for 3 weeks and was discharged in good condition after three months. Indirect case history revealed infected birds from the neighbours as the likely source of infection. Psittacosis is caused by Chlamydia psittaci and is acquired after inhalation of dry secreta or excreta from infected animals. Retrospective direct questioning often reveals contact with birds. Diagnostic delay can be considerable. Doxycycline is contraindicated in pregnant women, but erythromycine can be prescribed. Pregnant women should be advised to avoid contact with infected birds as they run an increased risk of a severe disease course.     

晚期妊娠合并卵巢黄素囊肿10例分析

目的 加强认识晚期妊娠合并卵巢黄素囊肿的诊断和处理.方法 对我院4年来发现晚期妊娠合并卵巢黄素囊肿10例及同期发现晚期妊娠合并卵巢肿瘤16例从孕妇年龄、孕周、卵巢性状、处理等方面进行回顾性比较分析.结果 晚期妊娠合并卵巢黄素囊肿或合并卵巢肿瘤均容易漏诊、误诊.两者治疗方法 不尽相同.结论 提高对晚期妊娠合并卵巢黄素囊肿的鉴别能力,避免不必要的手术.