1/7. Development of progressive pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG) associated with therapy-resistant chronic systemic juvenile arthritis (CJA).A girl aged 5 years with therapy-resistant chronic systemic juvenile arthritis (CJA) developed progressive fibrosing lung disease. histology of an open lung biopsy revealed pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG). Since treatment with steroids and immunosuppressive drugs did not prevent progression of lung fibrosis, an experimental treatment with a tumor necrosis factor alpha (TNF alpha) antagonist etanercept was started. Although development of chronic changes in the lung parenchyma could not be prevented, this treatment brought considerable relief and markedly improved the child's physical capacity. By ruling out other causes for development of PICG, we concluded that the primary disease had caused the development of cholesterol granulomata by macrophage activation. We suggest, therefore, that a trial with etanercept in children with otherwise therapy-resistant CJA should be considered, especially if pulmonary complications have developed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. Penile paraffinoma: self-injection with mineral oil.We present a 64-year-old patient with a 9-cm firm, irregular penile mass associated with phimosis, erectile dysfunction, and voiding difficulty. After he reluctantly admitted to multiple penile mineral oil self-injections for enlargement, surgical excision was performed. Pathologic examination was consistent with mineral oil granuloma (paraffinoma). Within several weeks after surgery, his erectile dysfunction and voiding complaints resolved. Paraffinomas have been encountered with the use of various oily substances injected for cosmetic purposes. Despite early warnings, these agents continued to be used to treat conditions ranging from hemorrhoids to wrinkles and even baldness. Fortunately, most of these fads have been abandoned by medical professionals, but the complicating lesions have been documented as having lag times as long as 30 years. Complete surgical excision remains the treatment of choice to prevent recurrence. Increased public awareness is needed for the prevention of this physically and psychologically debilitating problem.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/7. Laparoscopic resection of an abdominal wall desmoid using a modified suture traction technique: the "marionette trick".Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/7. Corneal intrastromal gatifloxacin crystal deposits after penetrating keratoplasty.BACKGROUND: An 85-year-old man developed faint crystallike white precipitates in the mid peripheral stroma of his left cornea 3 weeks after undergoing penetrating keratoplasty. The patient had been initially treated with 1% prednisolone acetate ophthalmic suspension and 0.3% gatifloxacin eyedrops to his left eye from the first day postoperatively. Three weeks later, the precipitates were more numerous, larger, and diffuse in distribution. Gatifloxacin was discontinued and substituted with a neomycin-polymixin B-dexamethasone ophthalmic ointment. methods: A detailed history, physical examination, laboratory workup, and tandem scanning confocal microscopy were performed. RESULTS: Tandem scanning corneal confocal microscopy confirmed the presence of crystals in the cornea. CONCLUSIONS: Gatifloxacin, a fourth-generation fluoroquinolone, can cause intrastromal macroscopic crystalline deposits through a compromised corneal epithelium, similar to what has been described for ciprofloxacin, a second-generation fluoroquinolone.- - - - - - - - - - ranking = 14.768005540166keywords = physical examination, physical (Clic here for more details about this article) |
5/7. cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor.The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors' clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.- - - - - - - - - - ranking = 14.768005540166keywords = physical examination, physical (Clic here for more details about this article) |
6/7. Paraffinoma and ulcer of the external genitalia after self-injection of vaseline.We present a 42-year-old circumcised man with a 10-cm firm, irregular penile mass associated with multiple penile ulcers, voiding difficulty, and erectile dysfunction. He reluctantly admitted that 8 months previously, he had multiple mineral-oil (vaseline) self-injections to the penis, for penile enlargement purposes. Histopathological examination revealed the condition was consistent with mineral-oil granuloma (paraffinoma). The patient did not accept surgical intervention; therefore, we performed local therapy (intralesional triamcinolone) and hot-water baths. Paraffinoma results from mineral-oil injections. Such injections are rare; however, they are still being performed in some countries in Eastern europe and the far east such as korea. Increased physician and public awareness are needed for prevention and treatment of complications of this physically and psychologically debilitating and destructive problem.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/7. Silicone granuloma in acral skin in a patient with silicone-gel breast implants and systemic sclerosis.A 68-year-old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone-gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured. physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal. According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X-ray energy dispersive analysis by scanning electron-microscopy confirmed the presence of elemental silicon in the small refractile particles. The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow-up.- - - - - - - - - - ranking = 14.768005540166keywords = physical examination, physical (Clic here for more details about this article) |