Fetal hyperechogenic kidney with normal amniotic fluid volume: a diagnostic dilemma

OBJECTIVE: To determine the prognostic value of sonographically detected fetal hyperechogenic kidneys with normal amniotic fluid volume. METHODS: Seven cases of hyperechogenic fetal kidneys were identified by sonography over a 7-year period (1996--2002). Increased renal echogenicity was diagnosed when the renal parenchyma was of greater echogenicity than adjacent liver tissue. Amniotic fluid volume was measured by the semiquantitative sonographic technique known as the amniotic fluid index (AFI). RESULTS: Three of the live-born infants had autosomal dominant polycystic kidney disease and one had autosomal recessive polycystic kidney. In the remainder, autopsy study revealed multifocal renal dysplasia in two cases and normal kidneys in one. CONCLUSIONS: Increased renal echogenicity with normal amniotic fluid volume in a fetus without other anomalies is a difficult diagnostic dilemma. Although it is usually indicative of renal parenchymal disease with possible renal failure after birth or in early childhood, in some cases, it represents a normal variant. .     

Pseudorheumatoid nodules in adults: a juxta-articular form of nodular granuloma annulare

Pseudorheumatoid nodules are considered a deep form of granuloma annulare. Most cases are described in children, occur mainly on the lower legs and scalp, and have favorable prognosis. Their appearance in adults is rare. In this series, fourteen women with pseudorheumatoid nodules were studied. The average age of onset was 36 years old. Lesions consisted of erythematous, violaceous, or skin-colored nodules located mainly on the small joints of the hands. None of the patients developed collagen vascular disease. Persistence was common. Biopsy specimens showed deep dermal nodules composed of epithelioid granulomata separated by thickened collagen bundles. In some areas eosinophilic material was surrounded by histiocytes in a palisaded array. Granuloma annulare was present at the periphery of eight cases. Special stains revealed that most of the eosinophilic material was collagen and mucin was present in eleven cases. In sum these findings demonstrate that pseudorheumatoid nodules in adults are a distinct clinical and pathologic entity, which may be mistaken for rheumatoid nodules. They are probably a juxta-articular variant of granuloma annulare.     

Placental Findings Contributing to Fetal Death, a Study of 120 Stillbirths between 23 and 40 Weeks Gestation

BackgroundIntrauterine fetal death is an agonizing, often unpredictable event. Autopsies of stillborn fetuses, including placentas, are performed to clarify the cause of death. Autopsy results are not always easily understood by the patients or their healthcare providers.ObjectiveTo evaluate placental causes of death in stillbirths based on autopsy and placental findings that are related to maternal underperfusion, fetal underperfusion, or inflammatory etiologies in hierarchical order.MethodsRetrospective review of 120 autopsy reports of singleton stillborn fetuses and placentas from 23 to 40 weeks of gestation.ResultsAmong the placental causes of death there were 54(51%) cases with direct cause or major contributor to death in the etiology of maternal vascular supply abnormalities, 28(26%) cases in the etiology of fetal vascular supply abnormalities and 13(12%) in the etiology of inflammatory lesions. Maternal vascular supply abnormalities were more common in preterm stillbirths and fetal vascular supply abnormalities were more common among term stillbirths. In 88% of stillbirths, the direct cause or a major contributor to death was found in the placentas. The incidence of unexplained death was 8%.ConclusionsPathological analysis of the placenta is essential for clarifying causes of stillbirths. Using specific simplified categories for abnormal placental findings may increase the benefits of the autopsy report.     

Malignant Bronchial Carcinoid Tumor Metastatic to the Pituitary in a Thyroid Carcinoma Patient: Successful Treatment with Surgery,Radiotherapy and Somatostatin Analog

A carcinoid pituitary metastasis is very rare, and is reported scarcely in a few patients. We describe an unusual case of metastatic atypical bronchial carcinoid to the anterior pituitary gland in a 47-year-old male who presented with bitemporal hemianopsia and hypopituitarism. His primary bronchial carcinoid was resected two years previously. Foci of metastatic papillary thyroid carcinoma were also identified in the lung resected for the bronchial carcinoid. He thereby underwent total thyroidectomy followed by radioiodine ablative treatment. Transsphenoidal partial removal of the suprasellar mass was performed, and atypical carcinoid metastasis was identified. He received conventional fractionated sellar radiotherapy, which was supplemented with octreotide (Sandostatin LAR) injections following a positive pituitary uptake on octreotide scan. This treatment suppressed his elevated 5-HIAA urinary excretion to a normal level. His vision has returned to normal and the pituitary mass diminished in size.     

Effect of Octreotide (SMS 201-995) on Meal-Stimulated Pancreatic Secretion in Three Patients with External Pancreatic Fistula

Octreotide (SMS 201-995) is a long-acting somatostatin analogue that inhibits both basal and secretin-cholecystokinin-stimulated pancreatic secretion. This study assesses the effect of this compound on pancreatic secretion induced by ordinary meals. Three patients with stable secretion of pure pancreatic juice from high output pancreatic fistula were studied. In all three, meal ingestion caused a marked and prolonged increase in pancreatic juice flow, and in bicarbonate and protein output. The subcutaneous injection of 50 micrograms octreotide before meals almost totally prevented (by about 90%) this increase. The inhibitory effect of octreotide on postprandial pancreatic secretion appeared soon, and persisted for the duration of the study period (8 h).     

The Value of Precise Preoperative Localization of Colonic Arteriovenous Malformation in Childhood

Massive hemorrhage from the gastrointestinal tract in a 12-yr-old boy caused by a congenital atypically located colonic arteriovenous malformation is described. Guided and "clean" resection of the involved colon was possible due to preoperative selective angiography, Which proved to be the most efficient diagnostic tool. Histologic documentation of this rare pathology in childhood is presented, and the classification and features of the disease are briefly reviewed.