Primary psoas abscess. A review of 16 cases

OBJECTIVE: Most psoas abscesses are secondary. The objective of this study was to report on the clinical features, diagnosis and treatment of primary psoas abscess. METHODS: We retrospectively studied 16 cases seen over a ten-year period (1987-1997) and compared our findings to published data. RESULTS: There were 14 men and two women, with a mean age of 6 years (range, 17-57 years). The right side was affected in nine cases, the left side in six, and both sides in one. Fever, pain and psoas spasm were the presenting symptoms. Laboratory tests for inflammation were positive; four patients had a high neutrophil count. Ultrasonography demonstrated a fluid collection in the psoas in 13 patients. A computed tomography scan was done in 14 patients and showed either a fluid collection (n = 11) or a presuppurative abscess (n = 3). Magnetic resonance imaging was not used. The organism was recovered in nine patients and was a Staphylococcus aureus in seven, an Escherichia coli in one and a Pseudomonas aeruginosa in one. The Brucella agglutination test was strongly positive in two patients. Findings were negative from investigations done to look for a cause (discitis, urinary tract infection, Crohn's disease, ulcerative colitis, malignancy or infection in the vicinity of the psoas muscle). All patients received antimicrobial therapy. Drainage was percutaneous in six patients and surgical in ten. The outcome was favorable in every case.     

Hematoma of the iliac psoas muscle. 29 cases]

We present 29 cases of haematoma of the iliac psoas muscle, following anticoagulant treatment and review 158 cases so far published. In 60 p. 100 of cases, the anticoagulant was some form of intravenous or subcutaneous heparin; prescribed in 40 p. 100 of cases for venous thrombosis followed rapidly by pulmonary embolism, in half the cases between the 3rd and the 14th day. Hypocoagulation was excessive in 64 p. 100 of the cases. Clinically the onset is marked in all cases by a violent pain in the territory of femoral nerve, anaemia (40 p. 100) pso?tis (32 p. 100) and iliac mass (51 p. 100), ecchymosis (13 p. 100) and particularly 23 among 29 cases an early or late femoral paralysis. The clinical diagnosis has been confirmed by echography 21 cases an or CT scan (7 cases). Our approach has been definitely surgical. The surgical procedure carried out in 20 p. 100 of the cases published, and in 23 of our ones, relieves the pain, provides for an early efficient physiotherapy, and a regression of the femoral paralysis, much more rapidly and completely than in the absence of surgery. The anatomical lesions, and the condition of the femoral nerve are described in the operative records, account for that evolution and explain our position. Traumatic and hemophilic have evocated.     

Bilateral superior ophthalmic vein enlargement associated with diffuse cerebral swelling. Report of 11 cases

Bilateral superior ophthalmic vein (SOV) enlargement has rarely been shown to occur in patients with septic and aseptic cavernous sinus thrombosis, Graves' disease due to obstruction of the SOV by enlarged extraocular muscles, or carotid-cavernous fistulas caused by retrograde flow. The authors describe 11 patients with bilateral SOV enlargement associated with cerebral swelling as detected by computerized tomography scanning. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and elevated intracranial pressure. To the authors' knowledge, this is the first report of bilateral SOV enlargement associated with diffuse cerebral swelling that subsequently resolved after treatment of the cerebral edema. The authors believe that the bilateral SOV enlargement was caused by mechanical cavernous sinus venous stagnation due to cerebral swelling, a syndrome that occurs more commonly than currently appreciated.     

Leptospirosis. Review of 11 cases]

Eleven cases of leptospirosis diagnosed from 1988 to 1994 were retrospectively reviewed. The mean age of the patients was 52 years. Epidemiologic factors were found in 10 patients. Hepatorenal involvement was observed in 7 cases (64%), cardiac involvement in 3 (27%), bleeding episodes in 5 (45%) and central nervous system involvement in one case (9%). The Leptospira serogroups identified were: Icterohaemorrhage in 6 cases, Pomona in 1, Sejroe in and could not be determined in 3. One patient died because of multiorgan failure. The epidemiologic, clinical, analytical and therapeutic aspects are discussed.     

Amyloid goiter. Report of two cases

Congenital pedicle abnormalities are rare. Unilateral aplastic and hypoplastic lumbar pedicles have been reported, but these were usually discovered incidentally and did not need surgical treatment. We present a case of absence of both pedicles and the neural arch of L2, with associated kyphoscoliosis with neurological involvement, that needed a two-stage corrective surgery. An L1-L4 fusion was achieved with relief of the symptoms.     

Hereditary neurocutaneous angiomatosis. Report of four cases

The authors report the coexistence of vascular nevi (hemangiomas and arteriovenous malformations (AVMs) of the skin) with AVMs and venous malformations of the brain in male siblings from two related but nonconsanguineous families of three generations. The proband, his siblings, parents, aunts, uncles, and cousins were examined, underwent magnetic resonance (MR) imaging and MR angiography, and when appropriate, cerebral angiography. A father had vascular nevi and a mother, his sister, had an azygos anterior cerebral artery. No other cutaneous or cerebrovascular malformations were present in the parents. Each of the two families had two boys and one girl, 9 to 18 years of age. All the children had vascular nevi and all of the boys had coexisting cerebrovascular malformations: AVMs in three, and a venous malformation in another. One boy had three cerebral AVMs. Two boys had a cerebral hemorrhage, and one also had focal motor seizures. The skin lesions were not those of the Sturge-Weber-Dimitri, Rendu-Osler-Weber, or Wybum-Mason syndromes. The association of cutaneous and cerebrovascular malformations was seen only in males in these families. but females have also been reported in the literature. The results obtained in these families and three other families reported from Western and Central Europe indicate that the association of cerebral and cutaneous vascular hamartomas constitutes a distinct, hereditary clinicopathological entity with autosomal dominant inheritance and variable penetrance. The clinical manifestations of this syndrome are visible, painful vascular nevi, epilepsy, cerebral hemorrhage, and focal neurological deficits. The preponderance of male patients with the full expression of the syndrome suggests a possible hormonal influence on the expression of the gene.     

Escherichia vulneris infection. Report of 2 cases

BACKGROUND: Escherichia vulneris is an enterobacteriaceae seldom isolated in microbiology laboratories. We report two cases of infection with positive cultures for this microorganism. METHODS: Microbiological cultures of wound secretion and peritoneal fluid on usual media. Identification by PASCO and API 20E systems. Antimicrobial sensitivity was performed by a commercial microdilution system. RESULTS: The first case is a postsurgical hand infection from which was isolated Escherichia vulneris with Enterococcus faecium, it shows the typical presentation of infection by this bacteria. The second case consists of a peritonitis after aggressive abdominal surgery. In the peritoneal fluid culture, Escherichia vulneris and Cedecea neteri were recovered. CONCLUSIONS: The isolation of Escherichia vulneris has not been reported previously in Spain. We contribute towards its better knowledge with two clinical reports: a typical infection and an exceptional isolation from peritoneal fluid.     

Familial myasthenia gravis. Report of four cases

Total entry rate of blood glucose and the rate of irreversible loss of blood acetate and its oxidation have been examined in sheep at rest and while walking on a horizontal treadmill at 5 km/h for 2 h. Sheep were given their daily ration of 1000 g chaff in 24 eaual portions at hourly intervals and received multiple intravenous injections of [2-3H]glucose and intravenous infusions of [1-14C]acetate and NaH14CO3. At rest the total entry rate of blood glucose was 0-44 +/- 0-03 mmol/min (values given as mean +/- s.e.m. for four sheep), the glucose pool was 23 +/- 1 mmol and the rate of irreversible loss of blood acetate was 2-3 +/- 0-1 mmol/min. During exercise, the total entry rate of blood glucose was 0-84 +/- 0-04 mmol/min, the glucose pool was 27 +/- 2 mmol and the rate of irreversible loss of blood acetate was 2-6 +/- 0-1 mmol/min. Gluconeogenesis apparently increased markedly in response to exercise as indicated by the incorporation of 14C from blood bicarbonate into blood glucose. Despite the substantial increase in the rate of irreversible loss of blood bicarbonate (from 11-6 +/- 1 to 20-2 +/- 2 mmol C/min), and hence energy expenditure with exercise, only a slight change was recorded in the proportion of the irreversible loss rate of acetate that was oxidized.     

Total anterior teno-arthrolysis. Report of 72 cases

This report describes a new technique for treatment of the chronically flexed fingers which applies in particular to fingers previously operated on several times and now presenting cutaneous, tendinous and joint problems. It consists in releasing the entire flexor apparatus through a full length lateral digital incision and a sub periosteal dissection. The volar plates of PIP and DIP are released as a whole with the flexor apparatus. The extended finger and flexor apparatus then are allowed to heal in a new relationship. Straightening of the finger is always possible. The range of motion is maintained or increased. This technique can also be used in stiff PIP joints and in certain serious forms of Dupuytren's contracture. 56 cases are reviewed with 78% with good or fair results.     

Spontaneous renal hemorrhage. Report of 8 cases

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.     

Post-traumatic flank hernias. Report of two cases

Dissecting aneurysms of the hepatic artery are extremely rare. We report herein the case of a 51-year-old man with massive hepatic metastases from rectal carcinoma, who was found incidentally to have a left hepatic artery aneurysm by a preoperative angiography. After replacing the left hepatic artery with a 2-cm segment of long saphenous vein, an extended right lobectomy with partial resection of the left lateral segment for multiple metastases was successfully performed. To prevent thrombus formation at the anastomosis, the Pringle maneuver was not used during dissection of the hepatic parenchyma. Histological examination of the resected specimen showed a dissecting aneurysm of the left hepatic artery, but there were no findings to suggest the etiology of this disease. The patient is currently alive 13 months after his operation without any evidence of further recurrence of the carcinoma. To the best our knowledge, 12 case reports of this anomaly have been documented, but only one of these describes a successful operation. The clinical features and etiology of the hepatic artery aneurysm that develops independent of other vascular diseases are discussed following this case report.     

Spontaneous drainage of syringomyelia. Report of two cases

Two cases are reported of Arnold-Chiari type I malformation associated with syringomyelia, in which magnetic resonance (MR) imaging revealed spontaneous decompression of the syrinx. In one case axial MR imaging sections showed a communication between the syrinx and the spinal subarachnoid space, which supports the hypothesis that fissuring of the cord parenchyma is instrumental in the spontaneous resolution of syringomyelia. The MR imaging changes were not accompanied by variations in the patients' clinical course.     

Myofibroblastoma of the breast. Report of 8 cases

Eight cases of breast myofibroblastomas are reported: two in men and six in post-menopausal women. This study and a review of the 19 published cases permit to define more precisely the particular features of this rare and benign mesenchymal tumour. Good demarcation, lack of necrosis and nuclear atypia argue for the benign nature of the lesion. It is made up of spindle cells (mainles myofibroblasts) which are positive for vimentin and not for S 100 protein or epithelial markers. Alpha-smooth muscle cell actin and desmin labelling are heterogeneous. This immunohistochemical study underlines the variable results of myofibroblasts for smooth muscle markers reflecting different degrees in their differentiation, without resolving the question of their origin. A simple surgical excision is required for this benign lesion. No recurrence has never been observed.     

Pericardial cysts. Report on 9 treated cases

From 1976 to 1993, nine patients (5 men, 4 women) with pericardial cysts were treated in Authors' Department. Of the nine cysts, six were located in the right cardiophrenic angle, one in the subcarinal site, one in the right tracheobronchial angle, and one in the para-auricular site just above the diaphragm. Four patients were asymptomatic. A correct diagnosis was possible preoperatively only in patients with cysts typically located in the cardiophrenic angle. Eight patients were surgically treated by a standard posterolateral or axillary thoracotomy. One patient with a large pericardial cyst underwent needle percutaneous aspiration and CT-guided drainage of the cyst with a positive outcome. There was no operative morbidity or mortality.