Pediatric Vaginal Leech Infestation with Severe Bleeding: A Case Report and Review Article.

BACKGROUND: Vaginal leech infestation is a rare event with vaginal bleeding being its prominent sign. Few cases have been reported in young children. CASE: In this article, we present a case of vaginal leech infestation in a 2-year-old girl who presented with significant vaginal bleeding that caused severe acute anemia, prompting transfusion. On examination, she appeared anemic, but healthy, without any signs of pubertal development. The leech was seen during examination with the patient under anesthesia and was removed. With removal of the leech, bleeding decreased significantly and stopped completely after 2 hours. She was discharged the next day in good condition. SUMMARY AND CONCLUSION: The important concern in vaginal leech infestation is early diagnosis to prevent severe acute anemia and shock.

Malignant superior vena cava syndrome: is this a medical emergency?

BACKGROUND: Superior vena cava syndrome (SVCS) is an association with a variety of benign and malignant etiologies. The aim of this study was to evaluate if malignant SVCS is a real medical emergency or if we are able to obtain a definite histological diagnosis before chemoradiotherapy. MATERIALS AND METHODS: In this prospective case series study, we have evaluated epidemiological characteristics and the ability to obtain a definitive histological diagnosis before chemoradiotherapy and the role of chemoradiotherapy prior to obtaining tissue specimens on the results of diagnostic interventions in patients with malignant SVCS who came to thoracic surgery wards of Imam Khomeini (Tehran) and Ghaem and Imam Reza (Mashhad) hospitals in Iran from 2001 to 2006. RESULTS: Among 50 patients with SVCS, the M/F ratio was 32/18. Mean age was 61.7 years, and the most common symptom was dyspnea (86%). We performed successful tissue sampling before chemoradiotherapy in 44 cases (88%), and histological diagnoses in 100% of these cases were established, but among the other 6 patients (12%) who received chemoradiotherapy first because of unstable general conditions, histological diagnoses were obtained in only one patient (16.7%) after chemoradiotherapy (P<0.01). No in-hospital deaths were reported among our cases. CONCLUSION: Because we are able to establish tissue specimens by minimally invasive methods in most SVCS cases and because chemoradiation may preclude obtaining an exact pathological diagnosis, we suggest performing diagnostic interventions prior to chemoradiation in patients with SVC syndrome and without emergent clinical conditions.