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1/6. Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection.

    We report ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast after injection through a thoracic paravertebral catheter that was placed at the right T8-9 spinal level for pain management in a patient with multiple fractured ribs. We review the literature and describe the subendothoracic fascial communication between the thoracic paravertebral space and the retroperitoneal lumbar paravertebral region, which we propose, is the anatomical basis for ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast in our patient.
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2/6. Bilateral pleural effusions: unexpected complication after left internal jugular venous catheterization for total parenteral nutrition.

    Bilateral pleural effusions occurred after total parenteral nutrition was administered via a left internal jugular venous line. The most likely explanation for the fluid passage into both pleural cavities was migration of the tip of the catheter from within the vein into the mediastinum. Fluid can pass into both pleural cavities via anatomical communications, yet to be described, which exist between the two pleural cavities.
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3/6. synovial cyst of the pulp of the little finger--origin from the wrist joint.

    Synovial cysts of the pulp of the little finger in three elderly patients were shown by arthrography to arise from leakage of synovial fluid from the wrist joint into the ulnar bursa and thence into the flexor synovial sheath in the digit. Distant as well as local sources of the contents of synovial cysts should be considered when the local anatomy permits communication between a degenerate joint and an adjacent tendon sheath.
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4/6. Spontaneous nonfistulous barium reflux into the biliary tract: association with duodenal ulcer disease. A report of four cases.

    Reflux of barium into the bile duct system during a barium study of the upper gastrointestinal tract is rare in the absence of spontaneous or postoperative fistula. We report four patients, three men and one woman, who had such reflux, associated with active duodenal ulcer disease, shown at radiologic and endoscopic investigation. Reflux of gastrointestinal contents into the biliary tract can result from peptic ulcer disease with duodenal involvement. The finding does not necessarily imply fistulous communication, ulcer perforation, or surgical emergency.
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5/6. Case report: topical DMSO for mitomycin-C-induced skin ulceration.

    mitomycin-C is a commonly used anticancer drug for patients with advanced anal, breast, colorectal, gastric, lung, or pancreatic cancers. mitomycin-C can cause severe necrosis and ulceration when extravasated inadvertently into skin and soft tissues following IV drug administration. Local applications of heat, ice, and common antidotes such as glucocorticosteroids and hyaluronidase or sodium thiosulfate have failed to reduce the experimental toxicity of these vesicant reactions in mice. Plastic surgery with split-thickness skin grafting may be required to palliate local pain symptoms and loss of function, although some extravasations heal without any local treatment. This brief communication summarizes two case reports of the treatment of severe mitomycin-C venous extravasations using topical applications of dimethylsulfoxide (DMSO). Although the authors' experience represents the results of DMSO interventions in only two patients, the response to treatment in both patients was so pronounced that others may find this useful in their practice.
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6/6. LAD-right ventricular fistula complicating PTCA: another case.

    Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract.
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