Multifocal Osteonecrosis – A Case Report

The pathogenesis of idiopathic multifocal osteonecrosis is poorly understood. It is difficult to diagnose with conventional radiography or computed tomography and poses a great management challenge. A case of idiopathic multifocal osteonecrosis is presented in a young boy illustrating the difficulties in the management of such patients. Received: 10 October 2001 / Accepted: 2 January 2002     

Tuberculous brain abscess–Case eport

In spite of recent advances in understanding of disease, tuberculosis still remains a major health problem, particularly in developing countries. Central nervous system tuberculosis may present as commonly encountered tuberculous meningitis or tuberculous mass lesions and rare tuberculous brain abscess (TBA). We report a case of tuberculous brain abscess in a patient of chronic liver disease with pulmonary hypertension and HCV infection. A 48 years old male presented with headache and abnormal behavior. There was no history of fever, vomiting, loss of consciousness, seizures, trauma and loss of weight and appetite. On examination patient was conscious but confused. No sensory-motor deficit was revealed on neurological examination. Chest x ray showed no abnormality. Mantoux test was positive. Magnetic resonance imaging of brain showed large, well defined marginally enhancing focal mass lesion in left frontal lobe. Evacuation of brain abscess done and frank creamy pus was aspirated and was sent for gram staining, Ziehl Neelsen staining, fungal smear and culture for both pyogenic and Mycobacterium tuberculosis. Gram staining revealed no microorganisms. No growth of pyogenic organisms obtained. No fungal hypha was seen. Ziehl Neelsen staining was positive for acid fast bacilli and growth of Mycobacterium tuberculosis was obtained. Patient was put on anti tubercular treatment. Patient responded well and discharged in satisfactory condition.     

Case Report: Incidental Splenic Granuloma due to Burkholderia pseudomallei: A Case of Asymptomatic Latent Melioidosis?

We report a rare case of an asymptomatic latent melioidosis lesion in a posttraumatic splenectomy specimen from a diabetic patient. The 2-cm yellowish, lobulated lesion was found in the splenic parenchyma well away from the traumatized areas. Microscopically, it consisted of a central area of necrosis and exudate surrounded by macrophages, epithelioid cells, lymphocytes, and occasional multinucleated giant cells. Burkholderia bacilli were detected by a novel in situ hybridization (ISH) assay, and confirmed by polymerase chain reaction and sequencing to be Burkholderia pseudomallei. As melioidosis was not suspected initially, bacterial culture was not done but electron microscopy showed morphologically viable and dividing bacilli in the lesion. Moreover, the surgical wound became infected with B. pseudomallei several days post-surgery. After treatment with ceftazidime and trimethoprim/sulfamethoxazole, the wound infection cleared. We believe this could be a unique case of asymptomatic latent melioidosis in the spleen. In endemic countries, chronic granulomas should be investigated for B. pseudomallei infection, and if available, ISH may be helpful for diagnosis.     

Gallstone ileus: Case report and literature review

Gallstone ileus(GI)is characterized by occlusion of the intestinal lumen as a result of one or more gallstones.GI is a rare complication of gallstones that occurs in1%-4%of all cases of bowel obstruction.The mortality associated with GI ranges between 12%and 27%.Classical findings on plain abdominal radiography include:(1)pneumobilia;(2)intestinal obstruction;(3)an aberrantly located gallstone;and(4)change of location of a previously observed stone.The optimal management of acute GI is controversial and can be:(1)enterotomy with stone extraction alone;(2)enterotomy,stone extraction,cholecystectomy and fistula closure;(3)bowel resection alone;and(4)bowel resection with fistula closure.We describe a case to highlight some of the pertinent issues involved in GI management,and propose a scheme to minimize recurrent disease and postoperative complications.We conclude that GI is a rare condition affecting mainly the older population with a female predominance.The advent of computed tomography and magnetic resonance imaging has made it easier to diagnose GI.Enterotomy with stone extraction alone remains the most common surgical method because of its low incidence of complications.     

Case closed? Diverticulitis: epidemiology and fiber

A major advance in understanding diverticular disease occurred decades ago with the epidemiologic association between fiber intake and the development of diverticular disease. This association has been well documented with investigations into the emergence of diverticular disease in underdeveloped countries where the disease had been virtually unknown before the adoption of a westernized diet, low in fiber. The high frequency of right-sided diverticular disease in Asian countries diverges from what is seen in the West. The physiologic effects of insoluble fiber has been well examined as well, increasing bulk and decreasing transit time, with a deficiency contributing to the high pressures implicated in the physiology which leads to diverticular disease. However, at most, 10% to 25% of individuals with diverticular disease will develop diverticulitis. Risk factors for symptomatic diverticular have been increasingly described in recent years with obesity and red meat intake being of particular importance, in addition to age. However, the known factors poorly identify those at increased risk and the predisposing pathophysiology is incompletely understood as well. Insoluble fiber, but not soluble fiber, has been viewed as the principal component which has been deficient in western diets and is the culprit which leads to the establishment of diverticular disease and in turn, diverticulitis. Soluble fiber and its effect on the intestinal flora is proposed as having significant influence on the development of diverticulitis. This understanding, if demonstrated, would have important implications for the primary and secondary prevention of diverticulitis.     

Atherosclerotic Left Main Coronary Artery Aneurysm—Case Reports

Coronary artery aneurysm is uncommon and mostly caused by coronary atherosclerosis. Although usually asymptomatic, it may cause catastrophes due to aneurysm rupture, vasospasm, or thromboembolism formation. Coronary artery aneurysm most frequently involves the right coronary artery, followed in frequency by the left circumflex coronary artery and the left anterior descending coronary artery; it rarely involves the left main coronary artery. Herein present two cases with left main coronary artery aneurysm and briefly discuss their treatment.     

Bochdaleck＇s hernia complicating pregnancy： Case report

Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk's gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek's hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. Postoperative period was uncomplicated. Pregnancy was allowed to continue until 39 wk's gestation at which time elective cesarean delivery was performed. It is concluded that symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.     

Case Report: Novel Swine-Origin Influenza A (H1N1) Virus-Associated Hemophagocytic Syndrome��A First Case Report

Secondary or reactive hemophagocytic syndrome (HPS) is frequently related to viral infections. However, the novel swine-origin influenza A (H1N1) virus associated HPS has never been reported. On October 10, 2009, a 17-year-old female child with no past medical history, complaining of severe asthenia, pneumonia, myalgia, and high fever, was admitted to our department, and H1N1 DNA was detected. Five days after her hospitalization, all signs and symptoms aggravated into HPS. After treatment for H1N1 influenza, the patient had a recovery and clearance of H1N1 infection 10 days after hospitalization. Three weeks later, the patient was discharged without any complaints, indicating the etiological role of H1N1infection in HPS.     

Cervical Lymphadenitis – A Rare Case of Focal Listeriosis

Cervical lymphadenopathy is a condition with a broad differential diagnosis. Malignant tumors, allergic reactions, autoimmune diseases as well as various infectious agents can be the cause. We report the case of a 75-year-old man who had a cervical lymphadenopathy without symptoms of infection. The draining lymph nodes were exised. Histology revealed a granulomatous abscess and culture yielded pure growth of Listeria monocytogenes. Because food is occasionally contaminated with L. monocytogenes, the pathogenesis of this condition may be similar to that of lymph node tuberculosis. Received: July 10, 2000 · Revision accepted: February 16, 2001     

Angioplasty of Coronary Trifurcation Lesion—A Case Report

Angioplasty of bifurcation lesions using double guide wires and kissing-balloon inflations to prevent plaque shifting is well described. We describe angioplasty of a trifurcation lesion with three guide wires and kissing-balloon inflations in adjacent vessels.