Cases reported "Calcinosis"

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1/233. Integrated approach for revascularization in multivessel coronary artery disease and porcelain aorta.

    We report two cases in which combined beating heart revascularization of the left anterior descending artery (LAD) and percutaneous angioplasty of the non-LAD target arteries were adopted after the intraoperative detection of porcelain aorta and impossibility to complete surgical revascularization. This type of strategy preserves the benefits of surgical LAD grafting and complete revascularization and results in a simple and low-risk technical procedure in an otherwise challenging setting.
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2/233. Pseudocholelithiasis in an elderly man with calcified hydatid cysts.

    A 69 year old man with intrabiliary rupture of a calcified echinococcal cyst mimicking acute cholelithiasis is discussed. This case is of interest because the correct diagnosis was not recognized preoperatively despite the fact that certain aspects of the illness were classic features of this complication of hydatid disease. Although this is a common complication of hydatid disease, which is well recognized in other countries, only seven cases have been reported in the American literature. Treatment of our patient included successful use of a Roux-en-Y drainage procedure which, to the best of our knowledge, has not previously been employed in treating this disease.
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3/233. Calcification in mucinous cholangiocellular carcinoma.

    Calcification is rarely seen in cholangiocellular carcinoma. We herein report the case of a 53 year-old man with calcification in a cholangiocellular carcinoma. Because imaging studies had revealed coarse calcified foci, hepatolithiasis was suspected pre-operatively. The patient underwent a laparotomy in which intra-operative cholangioscopy revealed no gallstones but did reveal an unsuspected tumor with abundant mucin. A left hepatic lobectomy with resection of the extrahepatic bile duct was performed. The tumor histology was mucinous adenocarcinoma with calcification. In the English language literature, we found 9 cases of cholangiocellular carcinoma with macroscopic calcification. Six of these cases were mucinous adenocarcinomas. Roentgenologic examination revealed coarse calcification in 7 cases and fine calcification in 2 cases. Clinicians should note that cholangiocellular carcinoma, especially the mucinous variant, may be accompanied by coarse calcification.
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4/233. Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients.

    Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French west indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.
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5/233. hypoparathyroidism, intracranial calcification, and seizures 61 years after thyroid surgery.

    Though hypocalcemic symptoms from hypoparathyroidism following thyroidectomy most often occur in the immediate postoperative period, hypoparathyroidism can present itself many years after the thyroid surgery with nonspecific symptoms. We present herein the case of a 74-year-old woman with previously undiagnosed hypoparathyroidism who had tonic-clonic seizures and intracranial calcification 61 years after her thyroidectomy. This case is unusual because of the long latency between thyroidectomy and clinical presentation.
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6/233. Ruptured retroperitoneal mucinous cystadenocarcinoma with synchronous gastric carcinoma and a long postoperative survival: case report.

    We describe an 86-year-old woman with a long survival following surgey for a massive retroperitoneal mucinous cystadenocarcinoma and a synchronous gastric carcinoma. Computed tomography showed a huge tumor with septation and calcification. Upper gastrointestinal radiography showed the additional gastric lesion. At operation, the 23 x 20 x 12-cm retroperitoneal tumor had ruptured. Tumor resection and distal gastrectomy including regional lymph nodes were performed. Mucinous peritoneal implants were removed as completely as possible. Histologically, the mucinous tumor showed limited invasion, whereas the poorly differentiated gastric adenocarcinoma showed no serosal invasion. Among 18 retroperitoneal mucinous cystadenocarcinomas reported in the English literature since 1965, only ours was associated with gastric carcinoma. Despite peritoneal implants, our patient has survived for 6 years without clinical recurrence. As at other sites, retroperitoneal mucinous cystadenocarcinoma often grows slowly. Total removal, even after peritoneal dissemination, can result in long survival.
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7/233. Aortic dissection complicating cardiac surgery in a patient with calcified ascending aorta.

    Aortic dissection is a rare but devastating complication of cardiac surgery. Adequate and early diagnosis of intraoperative aortic dissection and quick therapeutic decision making are the keys for saving patients in such cases. We describe the case of a 68-year-old man referred for CABG and mitral valve replacement with severe calcification of the ascending aorta. Intra-operative transesophageal echocardiography was useful for diagnosis of intra-operative aortic dissection and malperfusion of the true lumen. Immediate switching of the arterial perfusion site established flow in the true lumen with prompt subsidence of the expanded false lumen. CABG, mitral valve replacement and graft replacement of the ascending aorta could be simultaneously performed in this patient.
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8/233. Infantile cerebral aneurysms with visual pathway compression.

    Intracranial aneurysms are rare in infancy. The commonest presentation is intracranial hemorrhage, but signs of mass effect are more frequent than in adults. We report 2 infants with cerebral aneurysms, one presenting with macrocephaly and another with strabismus. Both had visual loss and optic disc pallor; MRI revealed a suprasellar mass and anterior visual pathway compression. In both cases, the preoperative diagnosis was craniopharyngioma. It is essential to recognize that, although exceedingly uncommon, cerebral aneurysms do occur in infants and have features that differ from those in adults.
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9/233. Symptomatic calcified subdural hematomas.

    Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.
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10/233. Coconut atrium: transmural calcification of the entire left atrium.

    Massive calcification of the left atrium usually spares the interatrial septum, which provides a cleavage plane for surgical access to the mitral valve. Endoatriectomy with mitral valve replacement is the currently accepted corrective procedure because it affords maximum exposure while decreasing the risk of embolization and intraoperative hemorrhage. We describe a case in which the entire left atrium, including the septum, was thickly calcified and resembled a coconut shell. This condition prevented surgical correction of severe mitral stenosis. To our knowledge, this is the most severe case of left atrial calcification yet reported in the literature. Although it is not possible to establish preoperatively that the atrium is completely calcified and impossible to incise, when predisposing factors and evidence of complete transmural calcification are present, the surgeon should be aware of this possibility and should weigh carefully the decision to operate.
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