Diagnosis and treatment of carotid body tumors

ABSTRACT Objective: Carotid body tumors (CBTs), especially familial paragangliomas, are rare benign neoplasm, accounting for <0.5% of all tumors; and they are the most common extra-adrenal paraganglioma. Because of peripheral vascular and neural invasion or compression of tumors, early diagnosis and treatments are very important, whereas this kind of tumors have got slow progression and low malignity potential. The aim of this study was to review an institutional experience in the management of paragangliomas. Methodology: In this study, CBTs were clinically suspected in 33 patients but diagnosed by histopathology in between 1999 and 2011 at our department. Three of these patients presented with bilateral tumors. All but one was operated upon. The ages of the 48.3 surgically treated patients ranged 32-58 years. A mass in the neck was the common symptom in all patients. The patients were classified according to the Shamblin classification. There were 17 patients (11 women 6 men) in the first group, 13 patients (9 women, 4 men) in the second group, and 3 patients (2 women 1 man) in the third group. Results: All of these 33 surgically treated patients had confirmed CBT by histopathology. CBTs were resected without a shunt procedure. No mortality occurred, however one patient experienced Horner syndrome post operatively. In the follow up period, no recurrences were observed. Three of the patients was had hoarseness, but improved after six months. No stroke occurred in the patients. Conclusion: CBTs are infrequent neoplasm; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions

Successful Retrieval of the Detached Porous Metallic Tip of a Mechanical Aspiration Catheter during Thrombectomy in a Case with May-Thurner Syndrome: A Case Report

Modern, minimally invasive techniques used to treat deep venous thrombosis, such as percutaneous mechanical thrombectomy (PMT) and catheter-directed thrombolysis, have gained worldwide acceptance. PMT has the advantage of speed and is also associated with improved outcomes, shortened hospital stays, and low complication rates. The main complications associated with PMT have been primarily due to iatrogenic vascular damage resulting in perforation, embolic occlusion, and arteriovenous fistula formation; to date, there has been no publication in the literature describing complications resulting from device failure. We present an unusual complication of PMT resulting from detachment of the catheter tip during thrombectomy and bailout technique employed

Acoustic Radiation Force Impulse (ARFI) elastography quantification of muscle stiffness over a course of gradual isometric contractions: a preliminary study.

Aims: To evaluate the feasibility of quantitative analysis of muscle stiffness by Acoustic Radiation Forced Impulse (ARFI) elastography over a course of graduate isometric voluntary contractions. Material and methods: The stiffness of the bilateral biceps muscle of 13 healthy volunteers was measured in real time by ARFI elastography, while the forearm was in neutral-extended position, 90 degree self-flexed positions and 90 degree self-flexed position, with altered weights ranging from 1 to 8 kg placed on flattened palmar surfaces consecutively. The determined increases in biceps muscle stiffness were measured for both arms and correlated with the loadings weights adopted at progressive trial stages. Results: The mean shear wave velocity (SWV) values of biceps muscles in a neutral position, in 90 degree flex position and 90 degree flex position with 1 to 8 kg weights on palmar surfaces were 2.162 +/- 0.302 m/sec, 3.382 +/- 0.581 m/sec, and 3.897 +/- 0.585 to 5.562 +/- 0.587 m/sec, respectively. Significant correlations between the muscle SWV values and related palmar weights and between the SWV values of right and left sides at different trial stages were identified (r=0.951 and r=0.954, respectively). A mutual propagation path of deep regions to entire areas was described to account for the distribution of increase in stiffness with increases in palmar weights. The confidence of method regarding inter-observer difference was confirmed by the correlation analyses of the results (r=0.998). Conclusions: ARFI elastography is a feasible imaging modality for quantifying the stiffness of isometrically voluntarily contracting muscles

A case of xanthogranulomatous pyelonephritis mimicking Wilms tumor

Xanthogranulomatous pyelonephritis (XGPN) is a very rare, unusual variant of pyelonephritis characterized by destruction of renal parenchyma. It usually occurs in adults with a history of recurrent urinary tract infections. The condition is rare in children and the disease can imitate renal tumors. Here, we describe a 12-year-old boy who presented with abdominal pain. He did not have any history of urinary tract infection. Computed tomography and magnetic resonance imaging showed a cystic lesion in the left upper kidney. The patient underwent radical nephrectomy with a provisional diagnosis of Wilms tumor however histopathological examination of specimen revealed XGPN. Xanthogranulomatous pyelonephritis should be kept in mind in the differential diagnosis of renal lesions in childhood, during surgery if any suspicion from the diagnosis, a frozen biopsy should have been taken

Perforation of Meckel's diverticulum by foreign body

Meckel's diverticulum (MD) is a congenital disorder of the gastrointestinal tract that is usually asymptomatic. Perforation of an MD by foreign bodies is an extremely rare cause of acute abdomen in children. We present a rare case of perforation of an MD in a child after eating melon seeds. The patient was treated successfully with segmental resection and primary anastomosis and had an uneventful postoperative recovery

Operative and non-operative management of children with abdominal gunshot injuries

BACKGROUND: Non-operative management (NOM) is a standard treatment method for solid organ injuries worldwide. There is no consensus on the management of gunshot wounds (GSW) because of the higher frequency of hollow viscus injuries (HVI) and the unpredictable depth of tissue damage produced by kinetic energy transfer during retardation of the bullet. Here we aimed to reevaluate indications for surgery and NOM based on our pediatric patients with abdominal GSW

Traumatic diaphragmatic rupture in children

Background: The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group

The Adrenal Gland: An Organ Neglected in Pediatric Trauma Cases

Purpose: Adrenal gland injury (AGI) caused by trauma may cause bleeding and life-threatening problems in children. The objective of this study was to analyze the prevalence of AGI in final diagnoses of trauma