‘Opening a can of worms’: Bilateral varicoceles as an indicator of underlying portal-hypertension

The scrotal varicocele is a common finding encountered during clinical examination. A porto-systemic shunt presenting with an associated varicocele is exceptionally rarely reported. Herein, we report such a case in an HIV positive man who presented with bilateral varicoceles. This is only the fifth case of such an association in the world literature. A literature review and the possible underlying pathophysiological mechanisms of this rare association are expanded further.     

Presence of both testes in an inguinal hernial sac

A unique case with fully developed testes and epididymis on the same side has been presented. The hypothesis to explain such a rare occurrence is a failure of the development of one-sided gubernaculums coupled with intra-abdominal adhesions of both the cords resulting in unilateral descent of both the testes. In females, the Mullerian ducts fuse to form the uterus; such a phenomenon in the case of Wolffian ducts is an impossibility, but fusion of vasa deferens and cords in this case point to such a happening.     

Carotid injury and cerebral infarction in a revascularization hand injury case

A case of internal carotid artery thrombosis with cerebral infarction occurring in a patient with a massive hand injury is presented. In this case it can be postulated that the mechanism of injury was that of traction of the carotid during the patient's attempts at release of an immobilized extremity. Although the diagnosis of such an injury is difficult, the knowledge that such injuries occur and a suspicion of the examining physician at the time of the initial examination may help avoid such problems in the future.     

Bilateral pertrochanteric fractures with bilateral patellar fractures with missed medial process fracture of talus in a young adult: a case report and review of literature

Management of polytrauma patients is one the most difficult and challenging tasks for an orthopaedic surgeon, and it includes different aspects of intervention: emergent resuscitative care, early surgical care, post-operative care and delayed rehabilitative care. We report an interesting case of multiple skeletal injuries with a coexisting pattern of fractures of bilateral patellae with bilateral pertrochanteric fractures of femur with a missed talar fracture following a dashboard type of injury in a road traffic accident. We are not aware of a similar case reported in literature in the past. We highlight the management protocol in such a case and review the available literature regarding such a presentation.     

Failure of intramedullary femoral nail with segmental breakage of distal locking bolts: a case report and review of the literature

Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual case of intramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this case with exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.     

Failure of intramedullary femoral nail with segmental breakage of distal locking bolts: a case report and review of the literature

Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual case of intramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this case with exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.     

Laparoscopic removal of gonads in a Turner's syndrome mosaic female patient with isodicentric Y chromosome.

We report a case of laparoscopic adnexectomy in a prepubertal girl with an isodicentric Y chromosome and mosaic Turner's syndrome. This is the second reported case of laparoscopic adnexectomy in such patients.     

Ureteral reimplantation for inadvertent ureteral injury during radical perineal prostatectomy

We report on a rare case of bilateral ureteral injury in a patient undergoing radical perineal prostatectomy and a unique approach to his treatment. Potential risk factors for such an injury include previous prostatic cryotherapy, transurethral resection, or radiotherapy. Intraoperative recognition of the injury is paramount and may be facilitated by intravenous administration of indigo carmine. While distal ureter ligation, urinary diversion, and delayed ureteroneocystostomy may be regarded as standard management for ureteral injury during radical perineal prostatectomy, this case was treated with a primary bilateral transperineal ureteral reimplantation. Although technically challenging, the described case demonstrates the feasibility and success of such an approach.     

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.     

Parry-Romberg syndrome with a giant internal carotid artery aneurysm

BACKGROUND: Parry-Romberg syndrome or progressive facial hemiatrophy is a rare clinical entity of an unknown etiology. We present the case of a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. CASE DESCRIPTION: The case was a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. Its association was extremely rare. Our report and some other reports of Parry-Romberg syndrome with cerebral aneurysms suggest the hypothesis that Parry-Romberg syndrome could be related to some inflammatory causes such as an autoimmune disease. CONCLUSION: We present the case of a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. Its association is extremely rare and will support the hypothesis that Parry-Romberg syndrome could be related to some inflammatory causes such as an autoimmune disease.     

Spontaneous rupture of the renal collecting system during pregnancy: successful management with a temporary ureteral catheter

Spontaneous rupture of the kidney or collecting system during pregnancy is an unusual condition. We report the sixteenth such case and, to our knowledge, the first case managed successfully with temporary insertion of a ureteral catheter. Based on our experience in this case, we recommend a modified approach to therapy for this condition.     

NUT Carcinoma Arising from the Parotid Gland: A Case Report and Review of the Literature

NUT carcinoma is an aggressive carcinoma with an overall poor survival outcome. The mediastinum and head and neck area, especially the sinonasal region, are among the common sites of disease. Histopathological diagnosis of NUT carcinoma is often very challenging due to its overlapping features with other poorly differentiated carcinomas. We report a case of NUT carcinoma arising from the parotid gland of a young female patient. Primary NUT carcinoma of salivary gland is very rare, with only 15 such cases reported in the literature to date. Our case highlights the diagnostic challenges associated with such lesions.     

Cytomegalovirus and gastric cancer after renal transplantation: a possible interplay

We herein have described a case of de novo gastric cancer in a renal transplant recipient with a concomitant diagnosis of gastrointestinal cytomegalovirus (CMV) disease. We hypothesize that CMV, through causing an imbalance between cell proliferation and cell death, functions as the causative agent for the progression of the gastric tumor in this case after gastric colonization. To the best of our knowledge, this is the second such case ever reported of such kind and may represent a platform for investigations aimed at understanding the possible interplay between CMV and gastric cancer.     

Unilocular macrocystic serous cystadenoma of the pancreas: a morphologic variant to be considered

Serous cystadenoma of the pancreas is a benign cystic tumor, which radiological diagnosis is easy in its typical microcystic variant. The macrocystic variant is uncommon and raises diagnostic problems with other macrocystic lesions of the pancreas such as pseudocysts and mucinous cystadenomas. We report the case of a young woman with a unilocular macrocystic serous cystadenoma of the pancreas which was identified on pathologic examination of the surgical specimen, after unconclusive abdominal ultrasound and CT-scan. This case describes an unusual clinical presentation of this cystic tumor and emphasizes that the diagnosis of such an entity is still based on pathological examination after cyst removal.     

Lower abdominal phlegmon due to spontaneous rupture of an ileal neobladder

A case is presented of spontaneous rupture of an ileal orthotopic neobladder due to a large residual urine volume. The present case is the 13th such case reported; however, this case is the first to show lower abdominal phlegmon and in which the perforation site was detected using computed tomography scanning. The indications for neobladder should be considered with great care. If spontaneous rupture is suspected, an early diagnosis of the perforation site and a measure of the extravasation volume using computed tomography are necessary. Appropriate treatment should include laparotomy.     

A new approach in the management of incarcerated hernia

The authors describe the case of a 74-year-old male presenting with an incarcerated epigastric hernia. An algorithm for successful management of such a case is proposed. Received: 18 November 1996/Accepted: 26 December 1996     

Aneurysmal subarachnoid haemorrhage in a patient with thyrotoxicosis

A case of subarachnoid haemorrhage secondary to rupture of an intracranial aneurysm occurring in a patient with new-onset, frank thyrotoxicosis is described. This unusual case highlights the dilemma of whether to continue beta-blockers such as propanolol for frank thyrotoxicosis, or whether to assign higher priority to maintaining adequate cerebral perfusion pressure in established ischaemic deficit due to vasospasm. In a complicated case such as this, the Maudsley Mentation Test score and perfusion CT scanning are two useful adjuncts for the early detection and evaluation of the course of ischaemic deficit.     

Pseudoaneurysm of the anterior tibial artery: A rare complication of proximal tibial steinman pin insertion

An anterior tibial artery pseudoaneurysm is a rare and unexpected complication of Steinmann pin insertion. We describe the case of an 18-year-old boy, who sustained such an injury to the anterior tibial artery during this procedure. Diagnosis was confirmed on a magnetic resonance (MR) angiogram. Aneurysmal sac excision with lateral repair of the vessel wall was performed. Postoperatively, a good flow was documented on a follow-up MR angiogram. This case highlights a major and unexpected complication of a so-called minor procedure. Too posterior a pin placement in the proximal tibia should be avoided to prevent such injuries.     

Malignant urothelial tumors in childhood

A case is presented of an adolescent male with a transitional cell tumor in a solitary kidney. This is the first such case reported in the literature. A brief review of epithelial tumors in children is included.     

Neonatal Bartter syndrome with unilateral multicystic dysplastic kidney disease

Neonatal Bartter syndrome is characterized by antenatal presentation with polyhydramnios. In this paper, we report a case of neonatal Bartter syndrome associated with unilateral multicystic dysplastic kidney disease. To our knowledge, this is the first case report of such an association.