Idiopathic retroperitoneal fibrosis with bilateral lower ureteric obstruction--a case report with literature review

Whilst prostatic enlargement remains the commonest cause of bilateral hydronephrosis in males greater than 50 years of age, other rarer conditions such as retroperitoneal fibrosis should be borne in mind. We report a case of bilateral hydronephrosis which was eventually diagnosed as idiopathic retroperitoneal fibrosis and treated with open surgical ureterolysis with omental wrapping.     

Adenocarcinoma of the duodenal bulb. A clinical case report

A rare case of adenocarcinoma of the duodenal bulb, arising from adenoma and submitted to Whipple's procedure is presented. A diagnostic delay of about 3 months, according to literature is observed. This delay is generally due to the low incidence of the illness, aspecific symptoms and frequent endoscopic and radiologic false negative, most of all in lesions of the third and fourth duodenal portions. Diagnostic tools for these duodenal tumors are endoscopy and upper gastrointestinal barium studies (UGI). CT is useful to determine preoperatively the stage of the illness and can occasionally show the primary duodenal lesion, as in this case. Surgical approach is still controversial, except in lesions of the second duodenal portion, where Whipple operation is the procedure of choice, if the tumor is resectable, of course. In the other duodenal portions some authors suggest segmental duodenal resections instead of Whipple's procedure.     

Tuberculous thyroiditis: report of a case with a review of the literature

A 49-year-old Japanese woman was referred to our department for evaluation of a thyroid nodule. She underwent subtotal thyroidectomy with modified neck dissection for a follicular thyroid carcinoma, suspected on preoperative diagnosis. The histological diagnosis was tuberculous thyroiditis. She made an uneventful recovery and received antituberculous agents. At follow-up she remains well and is euthyroid. Reports on forty-four patients in the Japanese literature were read. Tuberculous thyroiditis must be differentiated from thyroid cancer and subacute thyroiditis. Surgery plus administration of antituberculous drugs is considered the treatment of choice.     

Iatrogenic perforation of perivaterian duodenal diverticulum: report of a case

The author reports a case of iatrogenic perforation of a duodenal diverticulum, an extremely rare occurrence, during percutaneous radiologic extraction of a retained common-bile-duct-stone. Perforation was related to the perivaterian location of the duodenal diverticulum. Because an inflammatory reactions was present, tube duodenostomy was chosen over excision, closure and drainage to prevent the complication of lateral duodenal fistula and sepsis. Whenever iatrogenic duodenal perforation is suspected, prompt radiologic documentation and early surgical consultation should be sought.     

Multiple organ malrotation syndrome with duodenal atresia: a case report

Allele frequency of D17S855 microsatellite locus, an intragenic polymorphic cytosine-adenine repeat located in the BRCA1 gene, was analyzed in 456 normal tissues of Japanese adults. The frequency of D17S855 microsatellite polymorphism was 77.9% (335/456). The size of D17S855 PCR fragments ranged from 137 to 157 bp. The most frequent allele was 151 bp (29.9%) followed by 149-bp (19.3%), 145-bp (17.5%), and 147-bp (17.0%) fragments. The observed allele distribution of this microsatellite was similar to that of Southern Swedes, while it was quite different from that of European Caucasian specimens deposited in the Genome Database.     

Tuberculous osteitis of the skull: a case report and review of the literature

A 13-year-old girl of Pakistani origin presented with a non-tender, fluctuant swelling over her left parietal area and an underlying skull defect. At the apex of the swelling there was a sinus. Cultures of the discharge were positive for Mycobacterium tuberculosis. We present a case report of tuberculosis of the skull and review of the literature. We highlight the difficulty which still exists in establishing a diagnosis of tuberculosis in countries where it is uncommon.     

Surgical treatment for duodenal involvement in Crohn''s disease: report of a case

BACKGROUND: Aerobic bacterial pathogens are recovered from 65 to 85% of patients with acute otitis media (AOM). Although Chlamydia pneumoniae is a common pathogen of pediatric pneumonia, it has rarely been cultured from children with chronic otitis media and its role in AOM is unknown. METHODS: We cultured for C. pneumoniae in tympanocentesis aspirates and nasopharyngeal swabs from 101 consecutive, otherwise healthy children with AOM or refractory AOM. A control group of 50 similarly aged, healthy children was evaluated for nasopharyngeal carriage of C. pneumoniae. Specimens were also evaluated by PCR for C. pneumoniae. RESULTS: C. pneumoniae was recovered by tympanocentesis in 8 (8%) of 101 children with AOM. Among the 8 children with C. pneumoniae-positive-AOM, 5 had C. pneumoniae detected by PCR in middle ear fluid, none had C. pneumoniae recovered by nasopharyngeal culture or PCR and 5 were younger than 16 months. C. pneumoniae was the sole pathogen isolated in 2 patients. Copathogens included beta-lactamase-positive positive Haemophilus influenzae (2), beta-lactamase positive Moraxella catarrhalis (1), penicillin-resistant Streptococcus pneumoniae (2) and penicillin-susceptible S. pneumoniae (1). C. pneumoniae was recovered from nasopharyngeal culture in 2 additional patients with C. pneumoniae-negative AOM and in none of 50 healthy control children, although 2 controls were positive by PCR from the nasopharynx. CONCLUSIONS: This is the first study to report the isolation of C. pneumoniae in middle ear fluid of children with AOM.     

Tuberculous abscess of the brachialis and biceps brachii muscles without osseous involvement. A case report

In July 1997 Professor Harry Rilbe passed away at the age of 84. Harry Rilbe was an outstanding personality skilled in chemistry, optics and mathematics, and he will be remembered for his important contributions to the development of separation methods, notably moving boundary electrophoresis and isoelectric focusing. The latter method is used for analytical and preparative purposes in thousands of laboratories worldwide. Isoelectric focusing is indispensable for characterization of proteins from humans, animals, plants and microorganisms. Isoelectric focusing is thus useful for the understanding of the function of genes and, accordingly, for progress in the life sciences. A biographical retrospect, "A scientific life with chemistry, optics and mathematics", was published by Harry Rilbe in Electrophoresis 1984, 5, 1-17.     

Upper airway obstruction--a rare complication after anti-coagulant therapy

A case of progressive, spontaneous, nontraumatic hemorrhage into the tonsil, soft palate, hypopharynx, and larynx in a patient receiving oral anticoagulants is presented. There was no evidence of bleeding into other parts of the body. The presenting symptoms of sore-throat, dysphagia and hoarseness were mild at the time of admission. However, the bleeding later caused upper airway obstruction and aspiration, and the clinical picture during hospitalization became dramatic and life-threatening. Physicians should be aware of such possible complications in anticoagulant-treated patients, and if a hematoma is found in the pharynx or larynx the patient should be admitted for close observation and treatment. To the best of our knowledge this is the first reported case of spontaneous hemorrhage into the tonsil in a patient on oral anticoagulation.     

Tuberculous meningitis. A case with severe ocular complications

Tuberculosis in the world is the mean cause of death from single infectious agent. It is reported increase not only in underdeveloped countries but in developed too. Tuberculosis meningitis is a very serious form of tuberculosis. Outcome in tuberculosis meningitis is associated with the stage of the disease at presentation. When the child at presentation is extremely ill with coma the completely recovery is seen only in about 20% of cases. In our case patient had severe ocular complications: optochiasmatic tuberculomas. It is difficult recognize the two forms of tuberculomas intra- and perichiasmatic even with RNM. The good response at intrathecal therapy with recovery of the visus proves the perichiamsatic localitation of tuberculomas.     

Tuberculous pancreatic abscess in a case of miliary lung tuberculosis

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).     

Autopsy case of duodenal obstruction from impacted mushroom

A 50-year-old diabetic man developed necrotizing scleritis with adjacent keratitis 4 weeks after uncomplicated cataract extraction and intraocular lens implantation through a scleral tunnel incision. Cultures of the necrotic sclera grew Rizopus species. Severe destruction of the globe ensued despite topical, subconjunctival, and intravenous amphotericin B, in combination with hyperbaric oxygen therapy. Histopathological examination of the enucleated globe was consistent with Rhizopus infection. One year later, the patient was well without signs of recurrence.     

Tuberculous skeletal muscle involvement in acute leukemia: report on two cases

The role of thrombolysis in brain ischemia in patients with atrial myxoma is unknown. A patient with acute brain ischemia and previously undiagnosed atrial myxoma recanalized an occluded middle cerebral artery with intra-arterial thrombolysis. Arterial occlusion from presumed myxoma may be amenable to fibrinolysis. Angiography before treatment in patients with atrial myxoma excludes a myxomatous pseudoaneurysm and permits site-specific thrombolytic instillment.