1/322. thrombosis of mitral valve prosthesis presenting as abdominal pain.A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.- - - - - - - - - - ranking = 1keywords = bile (Clic here for more details about this article) |
2/322. The 'true' splenic wanderer.wandering spleen is an unusual entity and remains an elusive clinical diagnosis. Among the modern imaging modalities including computed tomography, magnetic resonance imaging, nuclear scans and ultrasonography, the latter appears to be the least invasive and the most effective in reaching a definitive diagnosis. A patient with 'true' wandering spleen who presented with chronic, intermittent abdominal pain, weight loss and a right lower quadrant mass that was interpreted as a pelvic lymphoma or a primary pelvic malignancy on computed abdominal tomography (CAT) scan is presented. Abdominal ultrasonography conducted a few weeks before the CAT scan showed a normal splenic shadow in the left upper abdomen.- - - - - - - - - - ranking = 0.4379050706501keywords = duct (Clic here for more details about this article) |
3/322. Sclerosing mesenteritis seen clinically as pancreatic pseudotumor: two cases and a review.Sclerosing mesenteritis is an uncommon nonneoplastic inflammatory process in the mesentery that is seen as a pseudotumor, usually involving the small bowel mesentery, the mesenteric fat, and less commonly, the mesentery of the large bowel. We report two cases of sclerosing mesenteritis and review the literature on this rare disease. Both patients had pain, profound weight loss, and a mass on computed tomography (CT) scan of the abdomen. The provisional diagnosis was pancreatic neoplasm on the basis of clinical presentation and imaging studies. The diagnosis of sclerosing mesenteritis was established by histologic findings in biopsy material obtained at laparotomy in both cases. Interval histologic studies in one patient who had a high CA 19-9 level, progressive biliary ductal and partial duodenal compression, revealed a transitional histologic pattern from predominant inflammation and fat necrosis to predominant fibrosis. This may explain the varied descriptive terms used in the literature to describe this entity.- - - - - - - - - - ranking = 0.4379050706501keywords = duct (Clic here for more details about this article) |
4/322. hyperparathyroidism and chronic pancreatitis.hyperparathyroidism is a rare cause of pancreatitis. The nature of the relationship between the two entities is not well defined, i.e. is it casual or causal? We describe 2 patients with chronic pancreatitis and hyperparathyroidism who presented with epigastric pain and were initially treated unsuccessfully by surgical drainage of the pancreatic ducts. In 1 case the hyperparathyroidism was only recognised after the pancreatic surgery. In both the symptoms of chronic pancreatitis responded well to parathyroidectomy. We believe that our cases add support to a causal relationship between pancreatitis and hyperparathyroidism. Whatever the true relationship, management of these patients should initially be directed at the hyperparathyroidism, followed by appropriate treatment of the pancreatitis.- - - - - - - - - - ranking = 0.4379050706501keywords = duct (Clic here for more details about this article) |
5/322. Four cases with chronic intestinal pseudo-obstruction due to hollow visceral myopathy.BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction is a rare clinical syndrome characterized by symptoms and signs of intestinal obstruction without any organic lesion obstructing the intestine. Visceral myopathy is one of the etiological causes and full thickness intestinal biopsy is essential for reaching a diagnosis. In this article we describe 4 cases of hollow visceral myopathy; our aim is to stress the importance of full thickness biopsy. METHODOLOGY: Four cases of hollow visceral myopathy are studied herein. All the patients had recurrent abdominal pain and constipation. The onset of symptoms was early in life or in the second to third decade. A diagnosis was established in all cases by full thickness intestinal biopsy obtained during laparotomy. Associated disorders were noted in 2 cases. One patient had Axenfelt syndrome, non-descended testicles and primary hypogonadism, and another had a diagnosis of Kleinfelter syndrome. RESULTS: All of the 4 cases were diagnosed to be suffering from hollow visceral myopathy by full thickness intestinal biopsy and 2 had additional disorders as well. CONCLUSIONS: patients with chronic intestinal pseudo-obstruction should be carefully evaluated as to whether there is an associated disorder and the diagnosis may be delayed unless full thickness intestinal biopsy is obtained.- - - - - - - - - - ranking = 42.220072363536keywords = obstruction (Clic here for more details about this article) |
6/322. Detection of a variant SYT-SSX1 fusion in a case of predominantly epithelioid synovial sarcoma.BACKGROUND: The translocation t(X;18)(p11.2;q11.2) characterizes synovial sarcoma, fusing the SYT gene at 18q11.2 to either SSX1 or SSX2 at Xp11.2. The usual chimeric product fuses SYT codon 379 to SSX1 or SSX2 codon 111. To date only three variant fusions have been identified. A predominantly epithelioid synovial sarcoma that expressed a novel variant of the SYT-SSX1 fusion is described. methods AND RESULTS: The current case was tested for the SYT-SSX fusion by reverse transcriptase polymerase chain reaction (PCR) followed by sequencing of the PCR product. Analysis revealed a 673 bp SYT-SSX1 chimeric product characterized by a novel junction of SYT codon 379 to SSX1 codon 83 with a 6 bp insertion at the fusion junction. CONCLUSION: As the number of reported variations of the SYT-SSX chimeric fusion increases in synovial sarcoma, the mechanics of the translocation machinery and the functional significance of these chimeric fusions will be better understood.- - - - - - - - - - ranking = 1.3137152119503keywords = duct (Clic here for more details about this article) |
7/322. Small bowel carcinoid presenting as a barolith.Baroliths are rare complications of barium contrast roentgenography that occur almost exclusively in the colon. Baroliths are often asymptomatic, but may be associated with abdominal pain, appendicitis, bowel obstruction, or perforation. We present an unusual case of a barolith which developed within the lumen of the small bowel, and resulted in the detection of an otherwise occult carcinoid tumor of the ileum.- - - - - - - - - - ranking = 6.0314389090765keywords = obstruction (Clic here for more details about this article) |
8/322. Ruptured tuboovarian abscess in late pregnancy. A case report.BACKGROUND: Tuboovarian abscess is an unusual obstetric complication that causes maternal and fetal morbidity and mortality. CASE: A woman, G1, P0, with a 32-week pregnancy presented with abdominal pain. physical examination on admission revealed fever and unremarkable abdominal signs. Eleven hours after admission, signs of peritonitis became prominent, necessitating emergency laparotomy. Surgical findings included an 8-cm, right, ruptured tuboovarian abscess with massive purulent contamination of the abdominal cavity. Cesarean hysterectomy with bilateral salpingo-oophorectomy was performed. Neither the newborn nor the mother had postoperative complications. CONCLUSION: Since there are discrepancies in the incidences of tuboovarian abscess in pregnant and nonpregnant groups, the pathogenesis of tuboovarian abscess may be different in the two populations. In pregnancy, diagnosis and management are also more difficult than in the nonpregnant state. Clinical data may not reveal the diagnosis until surgery is mandatory. Because most pregnant women with tuboovarian abscesses are young, conservative surgery should be attempted if the pathology is limited to only one side of the adnexa and further reproduction is desired.- - - - - - - - - - ranking = 0.4379050706501keywords = duct (Clic here for more details about this article) |
9/322. Premenstrual attacks of acute intermittent porphyria: hormonal and metabolic aspects - a case report.We report the case of a 38-year-old woman with acute intermittent porphyria (AIP). Following the observation of an acute AIP attack in the patient's father, the diagnosis was established after genetic and biochemical examinations. At the age of 29, eight months after delivery of her first and only child, the patient was hospitalized due to a first proven attack of AIP. In the following years she suffered several premenstrual AIP attacks, with clinical symptoms ranging from abdominal pain to paralysis. One attack was accompanied by an increased urinary catecholamine output, strongly indicating adrenergic hyperactivity. The precipitation of acute episodes by secretion of gonadotrophins and a severe hyponatraemia due to a syndrome of inappropriate anti-diuretic hormone secretion indicated hypothalamic involvement in the pathogenesis of AIP. This patient has experienced an evolution of treatment regimens. At first, acute attacks were treated by i.v. hypertonic glucose. Afterwards propranolol was instituted as a maintenance therapy. Later on, i.v. injections of haem arginate were very successful in resolving acute AIP episodes. However, until therapy with an LHRH analogue was started, the patient continued to suffer premenstrual AIP attacks. These LHRH analogues cause hypothalamic inhibition of gonadotrophin secretion, with stabilization of endogenous ovarian steroid production at a low level, and therefore may be effective in preventing acute exacerbations of this disease. Since this patient went on a fixed regimen of an LHRH analogue combined with the lowest dose oestrogen patch her quality of life has improved substantially and she has not required hospitalization, now for over 3 years.- - - - - - - - - - ranking = 0.4379050706501keywords = duct (Clic here for more details about this article) |
10/322. Ileosigmoid knotting in a 6-year-old child.Ileosigmoid knotting occurs when the ileum wraps around the base of an elongated sigmoid colon, thus producing two closed-loop obstructions with the possibility of ischemia and necrosis of either the ileum or sigmoid colon. It occurs more commonly in African, Asian, and Middle Eastern countries, although there have been three Americans previously reported with this problem. The 6-year-old child presented here is the youngest person ever reported with ileosigmoid knotting.- - - - - - - - - - ranking = 6.0314389090765keywords = obstruction (Clic here for more details about this article) |
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