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Pancreaticopleural fistula is a rare complication of pancreatic diseases. It results from communication between a pancreatic duct and the pleural space, either directly, or through a pseudocyst. The treatment is medical or surgical. We report a case of pancreaticopleural fistula occurring in a man suffering from chronic pancreatitis, and treated by endoscopy.
Arterial thrombotic accidents in the course of inflammatory bowel disease are rare. They generally affect young adults whose disease is active. We observed a case of aortic and renal arterial thrombosis in a 40-year-old woman who was suffering from ulcerative colitis. Surgical thrombectomy ensured good postoperative results, without any ischemic or renal sequelae. Six days later the patient presented with distal thrombosis of the splenic artery, which receded under anticoagulant treatment. The physiopathology of thromboembolic events in the course of inflammatory bowel disease is uncertain. Such events result from a state of hypercoagulability of various mechanisms, which can be observed in active inflammatory bowel disease. This possibility of serious arterial thrombosis argues in favor of long-term anticoagulant treatment when inflammatory bowel disease is active.
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We used quantal dose-titration of a mouse-adapted human transmissible spongiform encephalopathy strain (M470) to compare different analytical methods for their ability to detect asymptomatic brain prion infection after low dose inoculation. At a time point approximately 2.5-fold beyond the mean incubation period of high dose inocula, asymptomatic brain infection was commonly observed using histologic examination, Western blot, and "blind" bioassay following intracerebral inoculation with low titer inocula. At this time point, when a clinical end-point titration would usually be determined, evidence of infection was seen in all healthy animals inoculated with up to 100-fold lower inoculation doses than the lowest causing consistent clinical disease. For the assessment of the presence of asymptomatic infection, we compared different Western immunoblot and histopathological methods in relation to "blind" bioassay using transgenic Tga/20 mice overexpressing mouse prion protein (PrP). Sodium phosphotungstic acid (NaPTA) precipitation of protease-resistant PrP isoforms (PrP(res)) prior to Western blotting was found to approach the sensitivity of the Tga/20 bioassay and was superior to conventional Western blot and histopathological methods, wherein infectivity was commonly found when both of the latter were negative. Re-scaling the original titer by incorporating "blind" transmission data from surviving asymptomatic mice revises the estimate two orders of magnitude higher than the value derived using the conventional clinical disease outcome approach. We also found that the sensitivity of the NaPTA Western blot technique, if used with a diluent such as PBS compared with 10% normal brain homogenate, is adversely affected by up to around 20-fold. We postulate that infectious titer estimates based on more sensitive detection systems such as we report provide a more accurate indication of ultimate transmission risk.
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Multifocal fibrosclerosis is a term used to denote a combination of similar fibrous disorders occurring at different anatomical sites and including idiopathic mediastinal and retroperitoneal fibrosis, sclerosing cholangitis, Riedel's thyroiditis, and orbital pseudotumour. This paper reports a patient, known to have retroperitoneal and testicular fibrosis, who suffered visual loss resulting from marked changes in the macular region of one eye and suprasellar extension of a mass in the pituitary fossa. These lesions appear to represent very uncommon manifestations of multifocal fibrosclerosis.
This report describes two female patients, 69 and 79 years old, with squamous cell carcinoma (SCC) developing from erythema ab igne (EAI) due to thermal irradiation from a sunken hearth (irori in Japanese) or an underfloor brazier covered with a quilt (kotatsu in Japanese). EAI on the knees and lower thighs showed reticular pigmentation at its periphery and poikiloderma in the center with many keratotic nodules. In both cases, the SCCs were located almost symmetrically on an anterior site 1/3 of the way down both lower thighs. They were surrounded by many keratotic nodules. Histologically, these nodules showed an atypia of the epidermal cells, indicating carcinoma in situ resembling actinic keratosis ro Bowen's disease. It was also strongly suggested that the SCCs in these patients had developed from the keratotic nodules. EAI appeared to have played a pathogenetic role in the cutaneous carcinoma.
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The EEG, as recorded from electrodes in deep structures of the brain in cases of intractable seizures, has been surveyed to assess its predictive value in the partial epilepsies. In addition to scalp EEGs and depth EEGs in control situations, ictal recordings of tape-recorded seizures and the interictal enhancement of EEG signs by benzodiazepines have been analyzed. All results have been quantified by computer analysis. The predictive value of the EEGs has been assessed in 2 ways: (1) by comparison with the pathology found after surgery and (2) by the long-term clinical status of the patient postoperatively. Twelve cases with lesions found in limbic structures and 6 with cortical involvement are reported. In the latter cases secondary firing of the hippocampus, with its low threshold for seizures, frequently followed, though more rapidly than could be timed by visual inspection alone. Bilateral signs both in scalp EEGs and in depth were a common finding in the cases with limbic lesions. In those patients with marked clinical improvement, follow-up computerized studies of pre- and post-operative scalp EEGs revealed normalization in both hemispheres, leading to the proposal that a focus of defective tissue may impair neuronal function in widely distant regions of the brain.
A patient presented with a cholangiocarcinoma of the common bile duct; it was initially considered unresectable leading to the placement of the metallic stent whose upper end extended beyond the convergence of the hepatic ducts. The metallic biliary stent became obstructed and so encrusted as to be unremovable; the patient required a left hepatectomy with resection of the stent and the biliary convergence in addition to a pancreatoduodenectomy in order to resect his primary lesion This difficult situation emphasizes that, whenever there is doubt as to the resectability of a biliary lesion, the decision to place a metallic stent should be the fruit of a thorough medico-surgical discussion; where there is any doubt, a plastic stent which is more easily removable should be placed.
Two patients with an atypical form of band keratopathy following long-term pilocarpine treatment are described. The keratopathy is thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine drops. Symptoms of reduced acuity, visual haloes, and recurrent epithelial erosions were relieved by removal of the opacities.
We report two cases of uniocular hemianopia that we first detected on Humphrey visual field analysis, with one patient having additional constriction of his peripheral visual fields bilaterally. These field defects were confirmed to be functional in nature after characteristic changes on Goldmann perimetry and spontaneous improvement towards normal. This type of functional field loss is rare and the unusual pattern on computerised perimetry should be recognised for managing the patient appropriately.
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UNLABELLED: This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magnetic resonance imaging(MRI)-scan. The epidural needle was inserted with the aid of image intensifier and CT-scan to guide the needle to the precise site of the CSF leak. Blood mixed with gadolinium was injected, and subsequent MRI scanning provided the first description of spread of blood after cervical epidural blood patch. IMPLICATIONS: Low cerebrospinal fluid (CSF) pressure may cause severe posturally-related headache. In the patient, a vertebral disc protrusion in the neck seems to have contributed to a CSF leak. An injection of blood into the epidural space at the precise site of the CSF leak was followed by complete and lasting resolution of the headache.
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