Thrombosis of superior vena cava during total parenteral nutrition, managed successfully with low dose streptokinase.

Superior vena cava syndrome due to catheter related thrombosis, developed in a patient receiving total parenteral nutrition. Local infusion of low dose streptokinase immediately proximal to the thrombus, was strikingly successful and may be the treatment of choice for this condition.

Solitary eosinophilic granuloma of sternum: case report with review of the literature.

A solitary lesion in the distal sternum in a 30-year-old woman caused by eosinophilic granuloma (EG) is reported. Bone scan with 99Tcm was negative. Laboratory tests were completely normal. Although EG bone lesions have been discussed extensively in the literature only one similar case of solitary EG of the sternum has been published to date. A comprehensive summary of the literature is presented.

Use of percutaneous nephrostomy in hydronephrosis of pregnancy.

Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.

[Spontaneous rupture of a hepatocellular carcinoma successfully managed by embolization of the hepatic artery].

An 87-year old woman was admitted with a clinical picture of hypovolemic shock, preceded by a few weeks of abdominal pain. On admission, blood urea was high, the hemoglobin 5 g% and the CT scan revealed a large mass in the right hepatic lobe and free fluid in the abdominal cavity. A tentative diagnosis of ruptured hepatoma with spontaneous intraperitoneal bleeding was made. The diagnosis was confirmed by angiography and selective embolization of the hepatic artery stopped the bleeding. The patient left hospital a few days later.

[Local thrombolytic therapy for axillary vein thrombosis].

Deep vein thrombosis of the upper limb is much rarer than that of the lower limb. Despite conventional treatment with systemic heparin, there are residual symptoms in many patients. An alternative method of local thrombolytic therapy was used with success in a 30-year-old-women with thrombosis in his arm. 1 year later s/he is well and symptom-free.

"Rendez-vous" procedure (RVP) for obstructive jaundice.

Seven patients with obstructive jaundice were palliatively treated with the "rendez-vous" procedure, which combines a percutaneous and an endoscopic approach to stent insertion into the biliary system. In six cases, pretreatment papillotomy was not needed. Endoscopy was also not really necessary for stenting in one patient. This procedure should be restricted for use in cases of endoscopic failure.

Intrahepatic abscess due to gallbladder perforation.

BACKGROUND: Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment. METHODS: The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis. RESULTS: Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions. CONCLUSION: Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.

Varicocele in youth. A therapeutic dilemma.

The need for treatment of asymptomatic varicocele in youth is controversial. In the current study testicular volume and seminal variables were evaluated in three groups: young varicocele patients with undetermined fertility potential, infertile varicocele patients, and a control group of young males. The testicular volume was determined by ultrasonographic measurements. The results revealed a significant loss of "testicular mass" in both varicocele groups compared with the control group. The seminal findings disclosed a severe disturbance of spermatogenesis in the older varicocele group, whereas in the younger varicocele patients only the total spermatic count was significantly depressed. This difference in severity of functional impairment between the younger and older varicocele groups possibly points towards progressiveness of damage to the testicles. A more decisive therapeutic approach to the young male with asymptomatic varicocele and unknown fertility status could be justified.

Buerger's disease presenting as acute small bowel ischemia.

The case of a young man with an unusual presentation of thromboangiitis obliterans with ischemia of the small bowel, 2 years before peripheral vascular disease of the extremities was clinically expressed, is reported.

Diagnosis of varicocele and postoperative evaluation using inguinal ultrasonography.

Ultrasonographic real-time imaging and measurements of spermatic veins in the inguinal canal were evaluated in two groups of patients: 20 young men with varicocele and 18 controls. Examinations were performed with the patient in an upright relaxed position, and performing the Valsalva maneuver. The increase in diameter of the main vein during Valsalva maneuver was considered to quantitatively represent venous reflux. The data obtained were correlated with pre- and postoperative clinical findings. This method of evaluation proved to be a useful noninvasive diagnostic modality for detecting varicocele and for assessing treatment results. On the basis of venous diameters and reflux values, a classification of varicocele is proposed. Such an objective method of grading would eliminate the subjective impression and interpretation factors of the examiner.

Transcatheter occlusion of inferior mesenteric arteriovenous fistula: a case report.

Transcatheter embolization of the inferior mesenteric artery with steel coils was performed for the control of massive lower gastrointestinal bleeding and sepsis. The bleeding and sepsis was caused by a very large arteriovenous fistula of the inferior mesenteric vessels. This iatrogenic lesion developed and became symptomatic just 5 weeks after an anterior resection of the rectum was performed. Following embolization, the patient made a speedy recovery from the sepsis and no recurrent bleeding was noted.