Cases reported "Dilatation, Pathologic"

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1/15. Mucin-producing tumor of the pancreas associated with pyothorax: report of a case.

    We report herein the case of a 76-year-old man for whom an invasive mucin-producing tumor of the pancreas (MPTP) was successfully treated by surgery. A cystic lesion of the pancreas had been found by computed tomography (CT) 9 years earlier, 2 years following which suction drainage for left pyothorax had been carried out. A pancreatic cyst fistula to the thorax had subsequently been found during decortication for recurrent pyothorax 2 years later. methicillin-resistant staphylococcus aureus was detected in the pleural discharge after the thoracotomy, and thoracic fenestration was performed. A CT scan done 4 years later showed enlargement of the pancreatic cysts and a cystography revealed communication to the duodenum via the main pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed dilatation of the main pancreatic duct. The pancreatic cyst fistulated to the stomach and to the fenestrated thorax. Since MPTP was suspected from this clinical course, a distal pancreatectomy, partial gastrectomy, and omentopexy to the thorax were performed. The pathological diagnosis was intraductal papillary-mucinous tumor of the pancreas with a megacyst. While MPTP is recognized as a low-grade malignancy, some cases of invasive disease have been reported. To the best of our knowledge, this is the first case of MPTP associated with pyothorax due to fistula formation.
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2/15. Aortico-left ventricular tunnel: two new cases with a long-term follow-up.

    Aortico-left ventricular tunnel is a rare congenital communication between the ascending aorta and the left ventricle. Its hemodynamic effect is severe aortic incompetence. Surgery is the only treatment and should be performed before aortic incompetence or ventricular dilation develops. Two neonates with aortico-left ventricular tunnel were operated on at our institution, with closure of the aortic end of the tunnel with a Gore-Tex patch. The 2 patients were discharged in good conditions, and at 112 and 42-month follow-up respectively they are in good health, without medication and with a normal echocardiographic pattern. Aortico-left ventricular tunnel should be treated surgically as soon as possible in order to prevent any damage to the aortic valve and the left ventricle. The operative risk is not low, but results are very encouraging.
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3/15. Idiopathic localized dilatation of the ileum: CT findings.

    We report computed tomographic and pathologic findings of an adult case of idiopathic localized dilatation of the ileum presenting as hematochezia and bowel perforation. If a cyst-like structure that has narrow communications with proximal and distal bowel loops and a layered enhancement pattern similar to those of adjacent bowels on the computed tomogram of a patient with gastrointestinal bleeding, idiopathic localized dilatation of the ileum should be suspected.
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4/15. Laryngeal chondroma presenting as a laryngopyocele.

    The abnormal dilatation of saccules in direct communication with the laryngeal lumen is termed laryngocele. A simple laryngocele is an air-filled dilatation of the saccule and is mostly asymptomatic. When the neck of the laryngocele is obstructed, the laryngocele becomes filled with mucus. If a mucus-filled laryngocele is infected, it is called a laryngopyocele. The etiology of laryngoceles is not well understood. However, there is an association between laryngoceles and carcinoma of the supraglottic larynx. The main reasons are probably obstruction and mucosal retention of the saccule, increasing intralaryngeal pressure due to airway obstruction or abnormal contraction of the involved laryngeal muscles due to tumoral spreading. We present a patient with laryngopyocele that arose because of a laryngeal chondroma.
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5/15. Successful surgical treatment of rupture of coronary arteriovenous fistula with unconsciousness after chest and back pain.

    A 65 year-old woman was admitted to our hospital, because of unconsciousness after chest and back pain. echocardiography showed pericardial effusion. She suffered from pre-shock due to cardiac tamponade. Although a cause of cardiac tamponade was unclear, we performed emergency surgical treatment without coronary angiography. In operation, we found a rupture of coronary arteriovenous fistula and repaired it. The patient recovered from the surgery uneventfully. Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major vessel. It is the most common congenital anomalies of the coronary arteries. Many patients with these anomalies remain asymptomatic, but some patients develop symptoms of congestive heart failure, infective endocarditis, myocardial ischemia, arrhythmia, or rupture of an aneurismal fistula. Usually, the dilatation of fistula is common, and although 19% of this may become aneurysmal, the rupture of the aneurysm is very rare. We report a case of ruptured coronary arteriovenous fistula who underwent successful emergent surgery.
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6/15. Right-to-left interatrial shunt despite normal pulmonary artery pressure. Anatomical implications.

    Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea induced by the upright position and relieved by supine position and an arterial deoxygenation increased by the upright position which improves during recumbency. In many cases, this syndrome has been associated with patent foramen ovale and right-to-left shunt. Several anatomical factors that can alter the atrial anatomy and facilitate shunting through an interatrial communication have been related with this syndrome. We present a case in which an enlarged aortic root was the main anatomical factor that contributed to transient right-to-left shunting induced by postural changes.
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7/15. Hydromyelic hydrocephalus. Correlation of hydromyelia with various stages of hydrocephalus in postshunt isolated compartments.

    The clinical features and pathophysiology of specific forms of hydromyelia are analyzed in this report together with the chronological changes of associated hydrocephalus. Nine patients were studied; all had hydromyelia with varying degrees of associated hydrocephalus. Clinically applicable classification systems were used to evaluate the progression of hydrocephalus (Stages I to IV) and to define the compartment isolated after shunting in the previously communicating cerebral ventricles (Types I to IV). Four patients had Stage IV disease (holoneural canal dilatation); one had Stage II and four had Stage I disease (both Stages I and II with supratentorial hydrocephalus). All patients were initially treated by ventriculoperitoneal shunting at an average age of 9.9 years. Five patients had progressive spinal symptoms before or after treatment of their hydrocephalus. Two patients had Type III isolation (an isolated rhombencephalic ventricle) with a functioning ventricular shunt; ventriculography confirmed a communication between the fourth ventricle and the hydromyelia, and both patients improved after placement of a shunt in the fourth ventricle. The remaining patients had Type IV isolation (isolated central canal dilatation) with a functioning ventricular shunt. This study indicates that in some cases the pathophysiology of hydromyelia is closely related to associated hydrocephalus. A new concept of the development of an isolated compartment after shunting is proposed to explain the progression of hydromyelia in these cases.
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8/15. Massive gastric distention in the intubated patient. A marker for a defective airway.

    Tracheal intubation is a commonly performed procedure generally associated with a low complication rate. A clinical sign that could lead to early detection of complications could improve management of mechanically ventilated patients. We present two instances of potentially lethal complications that were heralded by the presence of massive gastric distention. This finding should alert physicians that an abnormal communication may exist between the endotracheal tube and the gastrointestinal tract.
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9/15. Systolic expansion of the aortic root: an echocardiographic and angiographic sign of aortic composite graft dehiscence.

    Precise diagnosis of aortic composite graft dehiscence may be difficult. We present a case illustrating this problem and its resolution. Two-dimensional echocardiography and contrast ventriculography revealed a space adjacent to the aortic valve conduit that demonstrated marked systolic expansion. The dynamic variation of this space was secondary to communication with the left ventricular cavity caused by disruption of the composite graft valve ring. Thus, systolic expansion of the aortic root is a useful echocardiographic and angiographic sign of composite graft dehiscence.
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10/15. Central retinal vein occlusion in a case of arteriovenous communication of the retina.

    A case of isolated arteriovenous communication of the retina (AVCR) decompensated to central retinal vein occlusion and visual loss resulted. This decompensation is not rare. Therefore, photocoagulation of the shunting vessels has to be the preferred treatment.
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