Gallstones and biliary sludge in Greek patients with complete high spinal cord injury: an ultrasonographical evaluation.

INTRODUCTION: We used ultrasonography to detect the presence of biliary sludge or gallstones in Greek patients with complete high spinal cord injury (SCI) above the seventh thoracic segment (T7), within the first six months from injury onset, in order to evaluate the effects of neurological instability and dysfunction of the sympathetic nervous system (SNS) on the gallbladder function in the early post-SCI phase. METHODS: We evaluated 78 asymptomatic patients (57 males, 21 females; mean age 34.8 (range 19-56) years) with complete high SCI located above the T7 segment, and 78 healthy subjects (59 males, 19 females; mean age 35.2 (range 21-59) years) matched for age, gender and race, for a total period of 39 months. All the participants underwent ultrasonographical examination of the gallbladder and common bile duct within the first six months from the injury, in order to investigate the development of biliary sludge and gallstones. RESULTS: The incidence of biliary sludge was significantly higher in patients with SCI compared with the control group. The incidence of biliary sludge and gallstones was also significantly higher in patients with SCI patients in comparison with the healthy subjects. In male SCI patients, the incidence of biliary sludge was significantly increased in comparison with healthy subjects. No significant difference was revealed between the two groups in detection of gallstones. CONCLUSION: Our study indicates that the detection of gallbladder sludge and gallstones are significantly higher in Greek patients with complete high SCI above the T7 segment, as compared with healthy control subjects within the first six months of the injury onset. The complete disruption of the SNS and the neurological instability in the early post-SCI phase is probably responsible for the biliary sludge and gallstone formation. Our results suggest that ultrasonography should be performed in these patients at the first 3-6 months from the injury for the early diagnosis of the lithogenic bile.

Secondary involvement of breast with non-Hodgkin's lymphoma in a patient with HIV infection -- case report.

Secondary lymphoma of the breast is a rare entity in patients with non-Hodgkin's lymphoma (NHL). HIV infection is associated with an increased risk for developing NHL, however lymphomatous involvement of the breast in AIDS patients has rarely been reported. We present the case of a 33-year-old HIV-infected female patient with diffuse NHL who presented with a unilateral breast mass. Histologic examination of the biopsy specimen revealed a highly-malignant diffuse large B-cell lymphoma.

Clinical considerations and sonographic findings of a large nonpedunculated primary cervical leiomyoma complicated by heavy vaginal haemorrhage: a case report and review of the literature.

Leiomyomas of the uterine cervix are uncommon. Cervical leiomyomas in non-pregnant women rarely are of clinical significance and their complications include pressure effects on the bladder or urethra, degenerative phenomema and menorrhagia. We present a case of 46-year-old female, gravida 2, para 1 who was presented in the gynaecological emergency room with the chief complaint of profound vaginal bleeding over the previous three weeks with recent passage of clots. Pregnancy test was negative. She suffered from profound orthostatic hypotension and tachycardia. On examination, her abdomen was soft, non-tender, and without rebound, guarding or palpable masses. Bimanual examination was notable for the presence of a large firm mass fixed to the uterine cervix. The cervix was 8 cm dilated and the body of the uterus was felt separate from the mass. The sonographic findings were consistent with a large cervical leiomyoma. Subtotal hysterectomy with salpingo-oophorectomy was performed and the patient's postoperative course was uneventful. In conclusion, in the present case the cause of the heavy vaginal bleeding was a primary cervical fibroid as the uterus attempted to abort it.

Ruptured tubo-ovarian abscess as a complication of IVF treatment: clinical, ultrasonographic and histopathologic findings. A case report.

Tuboovarian abscess is a rare complication of IVF treatment, which can be lethal on rupture. Hereby, we present a case of a ruptured tubo-ovarian abscess, following transvaginal ultrasound-guided oocyte retrieval for IVF and transcervical embryo trasfer in a 38-year-old white female patient with five years of primary infertility who underwent aspiration of bilateral hydrosalpinges at the time of oocyte retrieval. This case suggests that the reactivation of latent pelvic infection due to a previous pelvic inflammatory disease (PID) was the possible route of infection after transvaginal ultrasound-directed follicle aspiration--transcervical embryo transfer. We conclude that physicians should consider the diagnosis of tubo-ovarian abscess in the differential diagnosis of abdominal pain, fever and leukocytosis after ovum retrieval and transcervical embryo transfer for IVF treatment. Preservation of the uterus and unaffected uterine adnexa should be attempted in such cases if future pregnancy is desired.

Primary ruptured ovarian pregnancy in a spontaneous conception cycle: a case report and review of the literature.

Ovarian pregnancy is an uncommon presentation of ectopic gestation, where the gestational sac is implanted within the ovary. Usually, it ends with rupture, which occurs before the end of the first trimester. Its presentation often is difficult to distinguish from that of tubal ectopic pregnancy and hemorrhagic ovarian cyst. We describe a case of primary ovarian pregnancy in a 31-year-old patient who presented to the emergency room with symptoms and signs of peritonism and positive urine hCG test. The gestation sac was demonstrated in the right ovary by transvaginal sonography. MSD (mean sac diameter) was 15 mm corresponding to the sixth gestational week. Free fluid was found in the Douglas pouch. Culdocentesis was positive for hemoperitoneum. Henceforth, emergency laparotomy and wedge resection of the ovary was perfomed. Aetiological, clinical and therapeutical aspects of this rare extrauterine pregnancy are described. Also, the problems of its differential diagnosis are discussed.

Liver lesion on computed tomography and ultrasonography in adult Niemann Pick disease related to sea blue histiocyte syndrome--a case report.

The case of a 42-year-old man with Niemann Pick disease and a liver lesion is presented. The lesion was hypodense on CT and had mixed echogenicity on US. Hepatosplenomegaly, interstitial infiltration of the lungs, an absence of neurological signs, family history, laboratory data, sea blue histiocytes in the bone marrow and Niemann Pick's cells in the liver suggested a subtype of Niemann Pick disease (Type B), with a focal lesion in the liver due to thus condition. We believe that this is the first case in the literature. Niemann Pick disease and its subtypes, as also the sea blue histiocyte syndrome are briefly discussed.