Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings

Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Cardiac MRI in Congenital Heart Disease – Our Experience

A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.Key Words: Cardiac MRI, Congenital heart disease, Cyanotic and Acyanotic heart disease     

Interpectoral nodes as the initial site of recurrence in breast cancer

HYPOTHESIS: Interpectoral nodes can be the initial site of recurrent breast cancer. DESIGN: Retrospective review. SETTING: Comprehensive breast center, located in a university-based tertiary care center. PATIENTS: All patients undergoing operations for breast cancer at our breast center from 1995 to 2002 were reviewed. MAIN OUTCOME MEASURES: Patients with interpectoral node recurrence as the initial site of recurrent breast cancer were identified. RESULTS: During the 8-year period, 4097 patients underwent surgical management for breast cancer. During this time, 4 patients (0.1%) had recurrence at the interpectoral nodes. Three of the 4 patients were node-negative at the original operation. All lesions were mammographically occult. Preoperative needle biopsy was effective in the confirmation of malignancy. All 4 underwent excision without complications. CONCLUSIONS: Recurrence at the interpectoral nodes can be the initial site of surgical failure. These nodes may represent the site of primary drainage in a percentage of patients. The sentinel node identification technique, therefore, should diminish the number of patients affected by recurrence at this site. In patients with a palpable mass in the infraclavicular location, however, a high index of suspicion should be maintained. Workup should include additional breast imaging and needle biopsy prior to operation.     

Fitz-Hugh-Curtis syndrome after laparoscopic tubal ligation. A case report

BACKGROUND: Minimally invasive techniques are being used throughout all fields of surgery. With the increasing use and complexity of these cases, new complications will also develop. Fitz-Hugh-Curtis syndrome is an uncommon finding from the spread of infection in pelvic inflammatory disease, causing perihepatitis. CASE: A 29-year-old woman presented 2 weeks after an apparently uneventful laparoscopic tubal ligation with a complaint of right upper quadrant pain. She also had elevated liver function tests but normal ultrasound of the gallbladder. Eventually an intravenous pyelogram showed a bladder injury. Computed tomography revealed fluid in the pelvis and enhancement around the liver. During surgery, intense inflammation with multiple adhesions throughout the peritoneal cavity and around the liver were found. CONCLUSION: The findings were similar to the perihepatitis that occurs when Fitz-Hugh-Curtis syndrome complicates pelvic inflammatory disease. The unusual presentation in this patient made diagnosis very difficult and should remind physicians that unusual complications must be considered as technology evolves and spreads throughout all surgical fields.     

Recurrent eosinophilic mastitis

Systemic diseases rarely present with manifestations in the breast. Disorders such as sarcoidosis and pyoderma gangrenosum have been described to produce signs and symptoms in the breast. Peripheral eosinophilia is a systemic disease associated with a finite group of conditions including asthma, allergic or atopic disease, collagen vascular disease, and parasitic infection. In addition it has been described in association with several malignancies. A 50-year-old woman with a history of asthma and significant eosinophilia presented with an enlarging breast mass. Complete excision of the mass revealed eosinophilic mastitis. Two years later the patient again presented with a large mass in the same breast. Repeat excision demonstrated the same pathology. The clinical significance of this lesion is important because it presents as an enlarging, painless, dominant mass. Excision is necessary for management and to conclusively rule out malignancy. Its recurrence despite excision to negative margins, however, may indicate that control of the eosinophilia--and possibly the underlying disorder--is important to prevent further recurrence.     

A "clean" technique for managing bleeding duodenal ulcer with a new aortic prosthesis: endoscopic-assisted repair of bleeding duodenal ulcer

Aortic graft infection is one of the most dreaded surgical complications. In the perioperative patient with fresh aortic prosthesis, this is a particularly complex problem. Opening the bowel changes an operation to a "clean-contaminated" or "contaminated" case. This increases the risk of all infectious complications in the patient. Theoretically, our method of repair reduces the risk of infection by eliminating the duodenotomy. The direct visualization with the endoscope replaces the need to open the potentially contaminated bowel and reduces the risk of bacterial translocation and bacteremia. By not opening the bowel, this keeps the case "clean," and likely reduces the risk of contamination and subsequent infection of the prosthetic graft. As the potential morbidity of aortic graft infection is so devastating, and now that we have the available technology and operative skill, we propose our technique as a potential alternative to possibly reduce the incidence of aortic graft infection.