Acute appendicitis in Amyand's hernia: ultrasound findings and histopathology correlation. A case report.

Amyand's hernia is an uncommon form of inguinal hernia. It represents <1% of all hernias and its complication with appendicitis is still rarer with 0.1-0.13% being reported. A 78-year-old woman was taken to the emergency room with pain in the right groin. The patient was assessed by ultrasound with the clinical suspicion of an inguinal hernia. We present the ultrasonographic features of appendicitis within an inguinal hernia sac. A tubular image that terminated in a blind-ended tip in the longitudinal plane and a target image on the cross-sectional plane were consistent with the sonographically demonstrated appendix. The diagnosis of Amyand's hernia is difficult in the clinical setting. The patient is frequently referred to surgery with the diagnosis of an incarcerated hernia. Ultrasound is a good imaging modality that detects and characterizes this uncommon condition.

D-dimer from central and peripheral blood samples in asymptomatic central venous catheter-related thrombosis in patients with cancer.

OBJECTIVES: To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. METHODS: D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman's limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. RESULTS: Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland-Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. CONCLUSIONS: A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.

The Importance of Esophagography in Patients With Recessive Dystrophic Epidermolysis Bullosa.

OBJECTIVE: The purpose of this study was to assess esophageal damage in patients with recessive dystrophic epidermolysis bullosa (RDEB) with or without dysphagia. SUBJECTS AND METHODS: Fourteen patients with either severe generalized or another generalized form of RDEB recruited through a research and support foundation were evaluated for obstructive esophageal lesions by means of barium esophagography. RESULTS: All patients, even those without dysphagia, had at least one stenosis; five patients had two stenoses. Stenotic lesions occurred most often (74%) in the upper third of the esophagus. CONCLUSION: Esophageal stenosis is a common complication in patients with RDEB, even when they do not have dysphagia. We recommend regular esophagographic examinations of all patients with RDEB.

Chondroblastoma of the fourth lumbar vertebra diagnosed by aspiration biopsy: case report and review of the literature.

BACKGROUND: A chondroblastoma is a primary benign bone tumor typically involving the epiphysis of long tubular bones. The occurrence of chondroblastoma in the vertebral column is exceptional. To the best of our knowledge, aspiration biopsy (AB) findings of a lumbar chondroblastoma have only been reported in 1 previous case. CASE: A 30-year-old female presented with lower back pain with a duration of 1 month. A CT scan of the 4th lumbar vertebra showed a heterogeneous lytic zone within the body and the right side pedicle surrounded by marginal sclerosis. A CT-fluoroscopy-guided AB was performed and rendered a relatively cellular material with round to oval-shaped cells with a discrete amount of cytoplasm and small nuclei. These cells were distributed in a single-cell manner as well as in groups along with multinucleated osteoclast-like cells. A cytological diagnosis of chondroblastoma was issued. CONCLUSION: Identification of infrequent benign bone lesions in the vertebral column through AB is a challenge, yet it is of the utmost importance in order to render a correct diagnosis.