1/25. Extraction of a rubber bullet from a bronchus after 1 year: complete resolution of chronic pulmonary damage.inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose. The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe. Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia. The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchoscopy can be avoided.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/25. mirizzi syndrome. Case presentation with review of the literature.mirizzi syndrome is a rare pathology of the extrahepatic biliary system caused by a large gallbladder calculous either compressing or eroding into the collecting biliary tree. This paper describes a case of mirizzi syndrome with atypical presentation. A review of the literature including diagnostic and therapeutic modalities are reported.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/25. Total occlusion of left main coronary artery in a patient with chronic, stable angina.We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/25. Molecular evidence of persistent echovirus 13 meningoencephalitis in a patient with relapsed lymphoma after an outbreak of meningitis in 2000.Enteroviral meningoencephalitis was diagnosed in a patient with an immunodeficiency syndrome acquired after treatment with rituximab for a relapsed primary B-cell lymphoma. A second meningoencephalitic episode was diagnosed 6 months later and was successfully treated with a combination of immunoglobulins and pleconaril. The infection was persistent since the enterovirus genome was detected in five sequential specimens of cerebrospinal fluid collected over 9 months. An echovirus 13 isolate was isolated in the first three samples. The viral sequence encoding the VP1 capsid protein of the three isolates was determined and was compared with that of four control viruses. The virus isolates recovered from the patient shared >99% nucleotide sequence similarity with one another. In a phylogenetic tree, they were directly related to a control virus obtained from a patient hospitalized in 2000 during an outbreak of enterovirus meningitis. The epidemiological origin of a chronic echovirus infection in a patient with immune deficiency suggests that the echovirus had been continuously circulating in the general population after the outbreak that had revealed its emergence.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/25. Pancreatic pseudotumor with sclerosing pancreato-cholangitis: is this a systemic disease?OBJECTIVE AND METHOD: Primary sclerosing cholangitis (PSC) is a disease that predominantly affects the biliary tree, although the pancreas may also be affected. A review of the presenting features of all patients given a diagnosis of PSC at a single center was conducted. The aim was to clarify the presentation of patients with pseudotumor of the pancreas in this patient population. RESULTS: Seventy-two patients were diagnosed with PSC either by ERCP (63/72 = 88%) or by liver biopsy (9/72 = 12%). The diagnosis of PSC was made following referral for abnormal liver tests (67%), jaundice (17%), and acute cholangitis (5%). Inflammatory bowel disease (IBD) (60%), non-insulin-dependent diabetes mellitus (NIDDM) (13%), thyroid disease (8%), and pancreatic disease (7%) were the major coexistent extrahepatic diseases. Three patients, all with marked weight loss, who presented with jaundice, abdominal pain, and/or diarrhea were found to have a pancreatic mass at first presentation. Clinical and radiological findings suggested pancreatic malignancy, and only later was advanced sclerosing cholangitis identified. The biopsy of the pancreas in two of these three patients revealed chronic pancreatitis. The long-term follow-up and good clinical response to medical therapy confirmed lack of pancreatic malignancy. These three patients all had other evidence of systemic involvement: submandibular gland fibrosis and urethral stricture in one, fibromuscular dysplasia of the renal artery in another, and retroperitoneal fibrosis in the third. None had IBD. CONCLUSION: Pancreatic pseudotumor with sclerosing pancreato-cholangitis may be a manifestation of a systemic disease characterized by nonmalignant strictures and multifocal fibroinflammatory processes, unlike classical PSC.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/25. Unusual case of single coronary artery: questions of methods and basic concepts.Coronary artery anomalies continue to constitute a confusing subject in modern cardiology. While most anomalies are considered to have a benign prognosis, the literature and cardiologic culture frequently imply an intrinsic, systematic association of coronary anomalies with severe clinical presentations. We present a case of unusual single coronary artery, in order to elucidate the logical process that should be used to study similar cases. A 56-year-old female presented with a 6-year history of atypical chest pain and an abnormal electrocardiogram. heart catheterization revealed an abnormal coronary tree interpreted by some observers as a benign coronary anomaly, by others to indicate the need for coronary angioplasty. A nuclear stress test was performed after 1 year of unrelenting symptoms and showed mildly abnormal findings, leading to a more definitive angiographic study that clarified the anatomy and the prognosis. The case is essentially and only an example of single coronary artery with origin of all branches from the right coronary sinus, but with an unusual triple origin of the branches serving the left anterior descending territory. The notion that a case of single coronary artery may have significant prognostic and clinical repercussion is frequently repeated in the current inconclusive literature. A rational discussion should deal both with individual case objective evidence and theoretical general consideration.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/25. A "fishy" cough: hepatobronchial fistula due to a pyogenic liver abscess.A hepatobronchial fistula is an anatomic communication between the liver parenchyma and the bronchial tree. Major causes of such fistulae include inflammatory conditions resulting from obstruction of the biliary tract and infectious processes, such as pyogenic liver abscesses, amoebiasis, and hydatid cysts. We report a rare case of a patient (with a chronic, recurrent hepatic abscess) who suffered a persistent, productive cough resulting from a hepatobronchial fistula.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/25. bile duct carcinoma mimicking chronic liver disease.In a case of cholangiocarcinoma involving the bifurcation of the common duct, the association with striking intermittence of jaundice and with signs of chronic liver disease presented a diagnostic enigma. Disappearance of jaundice does not rule out the diagnosis of bifurcation tumors and may be misleading. Adequate demonstration of the biliary tree, best achieved with percutaneous transhepatic cholangiography, is essential for early diagnosis of this entity.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/25. bile duct carcinoma and biliary tract dysplasia in chronic ulcerative colitis.A case of chronic ulcerative colitis with a moderately differentiated adenocarcinoma of the common hepatic duct is described. Throughout the entire biliary tree, there was extensive epithelial dysplasia associated with changes of primary sclerosing cholangitis. The development of primary sclerosing cholangitis in the biliary tract of patients with ulcerative colitis appears to precede dysplasia and may be a marker of patients at risk for developing biliary tract carcinomas.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/25. An unusual complication of chronic pancreatitis: a recanalized portal tree communicating with a pancreatic pseudocyst.A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst. splenectomy, partial left pancreatectomy, Roux en Y pancreatico-cysto-jejunostomy, and external drainage of the portal tree were performed. The postoperative course was uneventful and the patient is symptom-free and doing well 2 yr after surgery.- - - - - - - - - - ranking = 6keywords = tree (Clic here for more details about this article) |
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