A tennis ball and music as a patients solution for pulsatile tinnitus.

We present the case of a 74-year-old man with a pulsatile somatosound causing insomnia and day-time irritation. Given the lack of salvation after medical therapy the patient went in search for a solution and found it in a tennis ball and radio. In this case, the somatosound was due to an extracranial arteriovenous malformation, but the differential diagnosis of pulsatile somatosounds is quit extended, ranging form vascular disorders to tumoral processes. This makes these cases challenging for all caretakers.

Nephrotic syndrome as first manifestation of a bronchopulmonary malignancy. A case report.

We present two cases of a bronchopulmonary tumor with paraneoplastic nephrotic syndrome as initial manifestation. After surgical resection of the tumor, regression of the nephrotic syndrome occurred.

Emergency balloon sealing of a ruptured giant anastomotic aneurysm of the groin.

An 85-year-old patient presented with a giant pseudo-aneurysm in the groin fifteen years after placement of an aortobifemoral graft (ABG). The pseudo-aneurysm was expanding rapidly. To prevent massive haemorrhage an inflatable balloon was inserted into the native distal aorta. The balloon was inserted via the contralateral groin. After inflation, the pseudo-aneurysm was safely excluded by the interposition of a new prosthetic segment between the left prosthetic branch of the ABG and the common femoral artery. This technique, which has been used for more than 50 years in several other indications, is an elegant method to minimise blood loss in the treatment of large pseudoaneurysms of the groin.

Destroyed lung due to aspiration of phenolphthalein.

A 76-year-old female, presented with a recurrent cough and haemoptysis after an aspiration of a 'grain de Valls'. Chest radiography and computed tomography demonstrated an atelectasis of the medial segment of the right middle pulmonary lobe. Bronchoscopy was negative for any malignancy but the onco-PET-scan showed a pathologic hypermetabolic lesion in the right middle lobe. A lobectomy was performed and pathology revealed a 'destroyed lung' with images of foreign body reactions and microabscesses without any sign of malignancy. Postoperatively, clinical improvement with complete resolution of the symptoms was observed. With this case report we demonstrate the irritative and clastogenic characteristics of phenolphtalein, the main active ingredient of the 'grain de Valls'. This case also illustrates an example of a false positive PET-scan.

Ileal carcinoid tumors and intestinal ischemia.

Three patients with carcinoid tumors of the ileum are presented; two had severe intestinal ischemia, one with infarction of the small intestine. In all three cases, histopathological examination revealed elastic vascular sclerosis (EVS) in the mesenteric blood vessels. Intestinal ischemia in the presence of a carcinoid tumor is probably due to a combination of tumoral secretion products, vascular changes, mesenterial retraction and nodal involvement. Selective superior mesenteric artery arteriography is diagnostic. All the reported carcinoid tumors with ischemic manifestations are ileal and invaded the mesentery or had positive nodes or metastases; two-thirds had EVS, and one-third mesenterial vascular luminal narrowing. Intestinal ischemia may be the underlying cause of vague symptoms in patients with a carcinoid tumor. This tumor may be small and must be looked for during laparotomy, mild intestinal ischemia or mesenterial thickening are important signs. Early resection can prevent intestinal complications. An aggressive attitude, including debulking of metastases, is justifiable.

Emergency aorto-iliac aneurysm surgery with low mortality and morbidity.

A retrospective review of urgently operated aortic or iliac aneurysms over a 13 1/2 year period identified 51 patients (50 male, one female). In our consecutive series, 45 patients underwent an emergency operation for an abdominal aortic aneurysm (AAA) and six patients for an iliac aneurysm (IA). Mean age was 69 years. All patients had prominent symptoms: acute low abdominal pain or low back pain in 20 patients, shock in six patients, shock and pain in 25 patients. Free rupture was found in 28 cases, retroperitoneal rupture in 14 cases, fissurisation in seven and arterio-venous fistulisation in two cases. All reconstructions were done by the same vascular surgeon using Dacron prostheses. Intra-operative mortality rate was 3.9% (n = 2), 30-day mortality was 21.6% (n = 11) and cumulative hospital mortality was 23.5% (n = 12). The morbidity was 59%.

Emergency aorto-iliac aneurysm surgery with low mortality and morbidity.

The authors present a consecutive series of 27 patients (26 men, one woman), urgently operated for aortic or iliac aneurysm during the period 1986-1994. Mean age was 68 years. Free rupture was found in 16 cases, 8 times a rupture with important retroperitoneal haematoma and fissurisation in 4. There were three ruptures of iliac aneurysms. In two cases arterio-venous fistulisation occurred: one ilio-iliac, another aorto-caval. For two juxta-renal aneurysms, supra-renal crossclamping was necessary and nephroplegia was used. Every reconstruction was done by Dacron prosthesis: a straight tube (47%), an aortobi-iliac (15%) or an aorto-bifemoral bifurcation prosthesis (38%). Mortality was 19% (0.0654 to 0.315, 90% confidence limits) with one intra-operative death. The morbidity was 49%, mostly by respiratory and/or renal complications, and mainly transient in nature.

Two-stage orchiopexy.

A number of well known complications and disorders force operative correction of cryptorchism, once the diagnosis of true cryptorchism is certain. In order to perform a successful orchiopexy, an extensive mobilization of the testis, up to the kidney, is sometimes needed. However, one can not always bring the testis down to the bottom of the scrotum. In this case it seems reasonable to bring the testis as low as possible. A second exploration can be planned, a few years later and, in most cases, the testis will then easily be brought down to the bottom of the scrotum. In our series (76 patients with unilateral or bilateral cryptorchism, between January 1967 and December 1978), 7 patients have been treated according to this procedure: four underwent a successful two-stage orchiopexy, two patients are waiting for the second intervention and one had a bilateral orchiectomy. A review of the literature reveals only a small number of attempts to staged orchiopexies. These small series are completely comparable to our series.

[A case of post-traumatic aortic valve insufficiency (author's transl)]. / Een geval van posttraumatische aortaklepinsufficiëntie.

A case of posttraumatic aortic valve insufficiency is presented. A brief discussion of etiology, mechanism, evolution, diagnosis and treatment is included. Some important historical events are reviewed from the literature. The treatment of this uncommon heart injury is aortic valve replacement. In this case an intimal repair also had to be done.

[Surgical therapy of pheochromocytoma (author's transl)]. / Heelkundige behandling van het feochromocytoom.

Between 1958-1978 a total of 19 patients, 11 men and 8 women, were treated for pheochromocytoma. Their age varied between 9 and 67 years (overage 39 years). In all cases with unilateral tumor located in the adrenal gland a lateral approach was preferred. When not certain of the tumor location or when presumed outside the adrenals a laparotomy was deemed necessary. Fourteen thoraco-abdominal lateral approaches and 5 laparotomies were performed. Due to minimal manipulation, especially with the lateral approach, peroperatory hypertensive crises could be reduced to a minimum. Sofar no recurrence has been seen. There was no operative mortality.

Neurovascular compression by a subpectoral lipoma. A case report of a rare cause of thoracic outlet syndrome.

BACKGROUND: Lipomas are benign soft tissue tumours, progressively expanding in volume. Beside frequent aesthetic consequences, lipomas can also exert pressure on surrounding tissues and structures. MATERIALS AND METHODS: A case of a subpectoral infraclavicular lipoma compressing the axillo-subclavicular neurovascular bundle, produced unilateral brachialgia, thereby simulating a Thoracic Outlet Syndrome. The expansive, but non-infiltrative, nature of the lipoma allowed local excision in the vicinity of the brachial plexus and infraclavicular vascular structures. RESULTS: Surgical removal of the lipoma resulted in complete remission of symptoms in the left arm and hand. CONCLUSIONS: In the presence of unilateral brachialgia, a subpectoral tumour causing a Thoracic Outlet Syndrome should always be excluded in the absence of other relevant pathology.

Treatment of alkaline reflux gastritis. A report of twenty cases.

The surgical treatment of twenty patients operated for postoperative alkaline reflux gastritis is discussed together with the pathogenesis of this syndrome as a late postoperative surgery syndrome. Diagnostic procedures and results of investigations and treatment were compared with data of the literature. Surgical treatment is of great benefit. The different surgical technics should be used according their own indication.

Thymic cyst in an unusual site.

The clinical, operative and histologic findings are presented in a patient with a thymic cyst, an uncommon finding presenting as a pericardial cyst or a cardiomegaly. A review of the literature of this rare condition is presented.