A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder / Un caso de metástasis cerebrales y leptomeníngeas de un carcinoma urotelial de vejiga

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases (AU)

Las metástasis cerebrales del carcinoma urotelial de vejiga son poco habituales y, en particular, las metástasis leptomeníngeas son extremadamente raras, siendo pocos los casos descritos en la literatura. Presentamos un hombre de 45 años con metástasis cerebral como primera manifestación secundaria de un carcinoma urotelial de vejiga seguido de metástasis leptomeníngeas sin otra afectación sistémica. Once meses después del diagnóstico de un carcinoma urotelial de vejiga (T2N0M0), se detectaron metástasis cerebrales por RM. El estudio de estadificación con FDG PET/TC no demostró captación anormal en otra parte del cuerpo a excepción del cerebro. El examen histopatológico de una lesión cerebral demostró metástasis del carcinoma urotelial. Dos meses después, una RM descubrió metástasis leptomeníngeas. La situación clínica del paciente se deterioró gradualmente, y falleció 3 meses después del diagnóstico de las metástasis leptomeníngeas (AU)

A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder.

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases.

Morgagni hernia: diagnosis with multidetector computed tomography and treatment.

PURPOSE: We aimed to retrospectively evaluate morbidity, mortality and treatment outcomes in 12 cases of Morgagni hernia diagnosed with multidetector computed tomography (MDCT) and treated appropriately. METHODS: This is a retrospective study and data on the demographics, presenting symptoms, MDCT images, operative approach, morbidity and mortality were collected from hospital records. RESULTS: Of 12 patients with a mean age of 60 years, ten were female. The diagnosis was made with MDCT before surgery. All hernias were unilateral and located in the right part of the thorax. The contents of the hernias were omentum and colon in the majority of the patients, and the contents of the hernia as diagnosed with CT was confirmed at surgery. Six patients had surgery. Of these, one had emergency surgery for hernia, two laparoscopic hernia repair, three transabdominal repair and one transthoracic repair. CONCLUSIONS: MDCT is a good imaging technique to be used before surgery in that it is fast and non-invasive, helps to make an accurate diagnosis of Morgagni hernias and provides detailed information about the contents of the hernia and accompanying complications. Modern surgical techniques, including laparoscopy, help to achieve the repair of Morgagni hernias safely with short hospital stay and with little morbidity and mortality.

Transient hepatitis B surface antigenemia after neonatal hepatitis B immunization.

Following immunization with hepatitis B vaccine, 39 infants were followed prospectively for hepatitis B surface antigen (HBsAg). A total of 69.2% of the infants tested positive for antigenemia at least once. Antigenemia was identified most often at 2-3 days (43.5%) and 5-6 days (43.5%) after immunization. The longest documented duration of antigenemia was 21 days. In all cases the antigenemia was transient and cleared by 28th day post-vaccination.

von Willebrand factor-collagen binding activity is increased in newborns and infants.

von Willebrand factor (vWF) antigen (vWF:Ag) and vWF-collagen binding activity (vWF:CBA) were measured in plasma by parallel quantitative ELISAs in normal newborns and infants (n = 71). The medians for vWF:Ag (IU/ml) and vWF:CBA (U/ml), respectively, were 1.46 and 1.91 for 2-7 day-old (n = 43), 1.22 and 1.40 for 2-4 week-old (n = 14), 1.22 and 1.15 for 2-6-month-old (n = 14) infants and 0.98 and 1.08 (n = 36) in normal adults. Elevated levels of vWF:Ag, but particularly vWF:CBA were seen for up to 4 weeks of life reaching adult levels between 2 and 6 months of life. The elevated levels of the vWF parameters indicate that caution should be exercised when interpreting laboratory data and diagnosing von Willebrand disease in newborns and young infants and warrant the use of age-specific reference ranges. The efficient haemostasis observed during early neonatal life may in part be due to the increased ability of vWF to interact with collagen.

The role of high-dose intravenous methylprednisolone in the treatment of varicella associated thrombocytopenic purpura.

Two children with varicella associated thrombocytopenia are presented. Case 1, evidencing no mucosal or parenchymal bleeding was administered prednisone 2 mg/kg/day therapy after having been put under observation for a period of one week without medical treatment. There was an increase in the platelet count during the period of therapy culminating in a return to normal on the eighth day. Case 2, who was in poor clinical condition at presentation, was treated with high-dose intravenous methylprednisolone (HIVMP) 30 mg/kg/day, resulting in the platelet count returning to a normal level (180,000/mm3) on the second day of therapy. HIVMP therapy is recommended in the treatment of life-threatening cases of thrombocytopenia because of its rapid action, limited side-effects, and its low cost.