Metastatic hypernephroma to the larynx: an unusual presentation

We report a renal cell carcinoma which presented as a metastasis to the larynx. The only preoperative clue to the diagnosis was its hypervascularity.     

Consensus statement on the diagnosis of multiple system atrophy

We report the results of a consensus conference on the diagnosis of multiple system atrophy (MSA). We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible MSA requires one criterion plus two features from separate other domains. The diagnosis of probable MSA requires the criterion for autonomic failure/urinary dysfunction plus poorly levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite MSA requires pathological confirmation.     

Case report: The "veiled right kidney sign"--an ultrasound finding in retroperitoneal perforation of the duodenum

We report a case of traumatic duodenal perforation where the diagnosis was first considered during abdominal ultrasound examination. A subsequent CT scan identified the site of perforation which was confirmed at laparotomy. This condition typically produces few clinical signs or symptoms initially but has a high mortality related to delayed diagnosis. The ultrasound findings that prompted early diagnosis are described.     

Nursing care in common breast problems in early breast feeding]

We examined and contrasted morning reports at two hospitals, university and community, that have a pediatric residency program. Patient diagnoses assigned at morning report were compared with final diagnoses to assess disease categories discussed and the value of including outpatient follow-up in this educational forum. Data were obtained during morning reports for 6 months by chief residents at university and private community hospitals. Pertinent history, physical examination, and laboratory and radiologic findings were recorded and were assigned a tentative morning report diagnosis based on morning report discussion. Cases were then reviewed at discharge and at 6 months to determine final diagnoses. At the university hospital, 58% of the cases were undiagnosed before presentation at morning report. Of those cases, 23% were assigned a diagnosis at morning report that differed from the final diagnosis. Similarly, at the private community hospital, 28% of cases were undiagnosed before presentation at morning report. Of those cases, 73% were assigned a diagnosis that differed from the final diagnosis. We conclude that the provision of follow-up at morning report is important for maximizing resident education.     

Utilization of a direct sandwich ELISA kit for rapid diagnosis of adenovirus hemorrhagic cystitis in a patient with adult T-cell leukemia

We report on a case of adenovirus hemorrhagi cystitis that developed in a 49-year-old woman during intensive chemotherapy for adult T-cell leukemia. Although rapid etiologic diagnosis is essential for the effective management of viral hemorrhagic cystitis, the isolation of adenovirus from urine is often too time-cousuming. We detected the adenovirus antigen in the patient's urine using an Adenoclone direct sandwich ELISA kit (Cambridge Bio Science), which is commonly employed for the diagnosis of adenovirus conjunctivitis. Treatment consisted of intravenous vidarabine and bladder irrigation, which resulted in prompt clinical improvement. The Adenoclone kit was useful for the rapid etiologic diagnosis of adenovirus hemmorrhagic cystitis.     

Reactivity of skin blood flow and heart rate to external thermal stimulation in anencephaly

Stromal endometriosis refers to the presence of endometriotic stroma without the presence of endometrial glands. We report a case in the uterine cervix in which the diagnosis of Kaposi's sarcoma was considered before being discounted on histological and immunohistochemical grounds.     

Improving influenza immunization among healthcare workers

Infected cystic duplication of the duodenum is an unusual lesion. We report a case in which pre-operative MR imaging revealed a huge multicystic mass masquerading as a cystic lymphangioma or mesenteric cyst. The differential diagnosis of this unusual appearance is discussed.     

Prevalence of Helicobacter pylori(Hp) infection in the department of gastroenterology staff members in Nanjing

The intraneural ganglion of the peroneal nerve is a rare lesion. The differential diagnosis includes lesions of the knee especially the tendinopathia of the knee flexors. Clinical examination, electrophysiological investigations, ultrasound imaging and magnetic resonance tomography will establish the diagnosis. We report a case in which an artificial puncture of the ganglion caused a temporary peroneal palsy. Surgical procedure led to complete restoration of the nerve function.     

Studies with a behavior-oriented evaluation scale for depressive inhibition and agitation. Results of a video-documented amitriptyline-mianserine study

This is the first report of a new approach which is concerned with the registration and graded judgement of non-verbal behavior. We have tried to show that this is a method which helps to unveil the role of non-verbal behavior in the process of making a diagnosis and to define the concepts used.     

An analysis of morning report at a pediatric hospital

The purpose of this study was to determine the types of cases residents select for morning report discussion and the educational value of postdischarge follow-up of unknown cases. Between April and December of 1994, at Cardinal Glennon Children's Hospital in St. Louis, Missouri, random, resident, and group-selected patients listed at morning report were followed up throughout hospitalization. Patients were categorized based upon whether or not their morning report and discharge diagnoses were the same or different. Patients discharged without a diagnosis were followed up by chart review at 6 months to determine whether a diagnosis had been made. Data were analyzed by Chi-square analysis with Bonfferoni adjustment factor for multiple comparisons. Residents were more than two times more likely to select cases for discussion in which the diagnosis changed during hospitalization (P < 0.01). The 6-month follow-up yielded new diagnoses in only 21% of previously unknown cases. We concluded that residents do an exceptional job of selecting difficult diagnostic cases for discussion at morning report. Postdischarge follow up of unknown cases adds little new information for discussion at morning report.     

Fatal gastrointestinal haemorrhage due to coexisting primary aorto-enteric and aorto-colic fistulae. Complicating untreated atheromatous abdominal aortic aneurysm

We report a case of aorto-enteric and aorto-colonic fistulae in a 73 year old man with no previous abdominal surgery which resulted in massive gastrointestinal haemorrhage and death and was undiagnosed despite several hospital admissions and endoscopic examinations. This case serves to highlight an extremely rare but fatal condition, which is potentially treatable, if an early diagnosis is made.     

A novel method of surgical instruction: international telementoring

Immunoglobulin D (IgD) multiple myeloma is a rare disorder with a poor prognosis. We herein report a case of IgD myeloma presenting with renal failure and bicytopenia. A bone marrow biopsy specimen showed infiltration of homogeneous plasma cells, which stained positively for IgD and light chains. We review the literature and discuss the clinical manifestations, diagnosis and treatment strategy for this rare tumor.     

Change in gender identity in male pseudohermaphroditism. Differential diagnosis of transsexualism and intersexuality

Gender identity change in intersexual patients is rare. We report on the transsexual development of a patient with male pseudohermaphroditism. The case report emphasizes the importance of a thorough differential diagnosis.     

Assessment of the accuracy of thoracic radiography in the diagnosis of canine chronic bronchitis

BACKGROUND: Embryonic sarcoma of the liver is uncommon in adults. We report an unusual case presenting as a cyst-like formation of the liver. CASE REPORT: The pre-operative and also the peroperative histology diagnosis was remodelled biliary cyst. The patient was treated accordingly. The final diagnosis of embryonic sarcoma of the liver was made when a local recurrence developed. The patient underwent hepatic resection followed by a chemotherapy and radiotherapy protocol. Tumor markers were measured within the tumor and gave a positive result for CA-125. DISCUSSION: Diagnosis of cystic forms of embryonic sarcoma can be a quite difficult task. Radiological and histological aspects can be helpful. This report is the first case in which tumor markers were measured within the tumor.     

Severe right ventricular contusion mimicking cardiac tamponade: the value of transesophageal echocardiography in blunt chest trauma

Clinically, severe right ventricular contusion may mimic cardiac tamponade. We report two cases of suspected cardiac tamponade after blunt chest trauma in which the diagnosis of severe right ventricular contusion was made only by transesophageal echocardiography, avoiding unnecessary and hazardous pericardiocentesis. These cases illustrate the value of transesophageal echocardiography in diagnosing blunt chest trauma.     

Lissencephaly syndromes: clinical aspects

We report clinical and neurophysiological findings in six children (three female, three male) with type I lissencephaly and three children (all female) with type II lissencephaly (Walker-Warburg syndrome). In type I lissencephaly the diagnosis is based only on electroencephalographic (EEG) signs, whereas in type II lissencephaly the diagnosis rests on clinical signs. In type I lissencephaly the EEG typically shows high alpha-beta activity, which is not seen in type II lissencephaly.     

Metastatic malignant melanoma: an unusual case presentation

Secondary involvement of the genitourinary tract with malignant melanoma is a common autopsy finding, but rarely evident clinically. We report a rare case involving a previously asymptomatic patient presenting with gross hematuria and a large renal mass, which was found to be metastatic melanoma. We propose that metastatic melanoma to the kidney, although rare, be considered in the differential diagnosis of disease processes causing hematuria.     

A case of aortic dissection after the termination of cardiopulmonary bypass

We report, a case of aortic dissection after the termination of cardiopulmonary bypass (CPB), which was diagnosed by transesophageal echocardiography (TEE). A 70-year old male with aortic regurgitation received aortic valve replacement. After the termination of CPB, the aortic dissection was diagnosed by TEE. Furthermore wall motion abnormality was found by TEE, and aorto-coronary bypass was performed after observation by TEE. This case report suggests that TEE is useful not only for diagnosis but also for therapeutic orientation of aortic dissection.     

MRI aspect of hepatic adenomatosis

We report a case of hepatic adenomatosis demonstrated with MR imaging. The diagnosis can be suspected when this technique shows multiple hepatic lesions which present an iso-signal intensity on T1-wi, a hyperintense signal on T2-wi and rapid wash-in and wash-out of gadolinium. Injection of superparamagnetic iron oxide mag be useful in the characterization of the lesion: a decreased signal intensity after injection rules out the diagnosis of metastasis. Because of the unknown course of hepatic adenomatosis, histological proof and radiological follow-up are recommended.     

Report from the XVII Congress of the European Society of Cardiology, Stockholm, Sweden, August 1997

Cardiac dysrhythmias in septic patients often reflect hypovolaemia, hypokalaemia or endocarditis as cardiac manifestation of the infection, but may be indicative for underlying cardiac pathology previously undiagnosed. We report on the case of a patient with severe peritonitis, on whom transoesophageal echocardiography (TEE) had been performed intraoperatively due to progressive circulatory instability. TEE revealed first diagnosis of asymmetric hypertrophic cardiomyopathy, which complicated the features of septic syndrome. Further perioperative treatment to support the circulation was successfully adjusted on the grounds of this diagnosis.