Heterotopic gastrointestinal cyst mimicking chronic cholecystitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Heterotopic gastric mucosa is described almost everywhere in the gastrointestinal tract, from the oral cavity to the rectum. The occurrence of heterotopic gastric tissue in the gallbladder is rare. A choristoma can be defined as a new growth developing from a displaced anlage not normally present in the anatomical site where it developed. We present an extremely uncommon case of a cyst (choristoma) attached to the gallbladder, which contained gastric and intestinal mucosa.</p> <p>Case presentation</p> <p>A 33-year-old woman was hospitalized with clinical symptoms of chronic cholecystitis. The laboratory findings were within the normal range. Abdominal ultrasonography revealed a thickened gallbladder wall and a stone in the cystic duct was suspected. In the course of laparoscopic cholecystectomy, a cyst was visualized in the vicinity of the duct and the gallbladder neck. Microscopic examination of the removed cyst revealed evidence of gastric, duodenal and small-intestinal mucosa. The immunohistochemical study revealed many endocrine cells, which were positive for several endocrine cell markers such as chromogranin, serotonin, gastrin and so on. It can be inferred that the observed cyst had arisen from the foregut early in the development of the gastrointestinal tract.</p> <p>Conclusion</p> <p>The presence of endocrine cells together with epithelial cells supports the hypothesis that these had developed simultaneously, and that the endocrine cells had probably supported the development of the epithelial cells by the release of hormones and growth factors. To the best of the authors' knowledge, this report is the first to report a gastrointestinal cyst choristoma with endocrine cells in the region of the cystic duct and gallbladder.</p

CARDIOLOGY IN THE YOUNG

Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood

Public Health Rep

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Non-invasive diagnosis and management of coronary arteriovenous fistula - A case report

Coronary arteriovenous fistulas are rare anomalies resulting in abnormal communication between the coronary artery and any chamber of the heart. An asymptomatic patient was referred for evaluation of her murmur. Two-dimensional and color Doppler echocardiographic evaluation revealed an enlarged left main coronary artery. A retrograde, eccentric smell jet was found within the right ventricular outflow tract at the pulmonary artery valvular level allowing us to detect the entrance she of the fistula. The diagnosis was confirmed by cardiac catheterization and angiocardiography. Although our case was asymptomatic, the decision to perform cardiac surgery was made because of the aneurysmatic appearance of the left coronary artery. In our opinion, visualization of coronary arteries by two-dimensional echocardiography, together with additional information obtained from the Doppler examination, provides an excellent technique for the noninvasive diagnosis of coronary artery fistula

Effects of high-dose intravenous methylprednisolone in children with acute rheumatic carditis

In order to measure the effects of high-dose intravenous methylprednisolone (HIVMP) and compare its efficiency with that of oral prednisolone (OP), 18 patients with active rheumatic carditis were studied. Ten patients received OF. while eight patients were treated with HIVMP. Clinical and laboratory responses to treatment were followed by sleeping pulse rate, systolic blood pressure, erythrocyte sedimentation rate (ESR), cardiothoracic ratio (CTR), PR interval on electrocardiogram. spectral and color flow imaging and Doppler echocardiographic findings: mitral and aortic regurgitant jet flow area, left atrial area, proximal width of mitral regurgitant jet area and regurgitation fractions

Transient right sided hypertrophic cardiomyopathy in an infant born to a diabetic mother

Hypertrophie cardiomyopathy (HCM) is a rare primary myocardial disease, characterized by hypertrophy of the left and/or right ventricle. Infants of diabetic mothers (IDM) are at risk for development of HCM, respiratory distress and persistent pulmonary hypertension. A case of severe right sided HCM in an infant born to a diabetic mother is presented. The patient's findings were complementary to the previous observations reporting HCM in IDM. The presence of disproportionate septal hypertrophy in the echocardiography of an infant born to a diabetic mother is highly suggestive of HCM in IDM. In our opinion, further cardiac evaluation is not indicated unless other cardiac abnormalities are suspected. © 1996 Dr. K C Chaudhuri Foundation

Transcatheter closure of congenital coronary arteriovenous fistula using detachable balloon technique [Konjenital koroner arteriyovenöz fistülün ayri{dotless}labilir balon teknigi ile transkateterizasyon yoldan kapati{dotless}lmasi{dotless}]

PubMed ID: 20929707[No abstract available

The urological manifestations of the tethered spinal cord.

The tethered cord is the fixation of the cord resulting in stretching as growth occurs. In this paper, three cases of tethered cord with symptoms related to the urinary tract were presented. In the first case, a 12-year-old girl presenting with abdominal pain and urinary incontinence had bilateral hydronephrosis and neurogenic bladder due to a tethered cord without having any other neuropathological manifestation. In the second case, an eight-year-old girl presented with enuresis and a mass in her back was found to have a lipomyomeningocele, hyperactive tendon reflexes in the lower limbs and pes cavus. Tethered cord associated with lipomyomeningocele caused a neurogenic bladder and bilateral hydronephrosis. In the third case, a seven-month-old girl presented with hydrocephalus as well as bilateral dilation of the renal pelvis, unilateral ureteral duplication and vesicoureteral reflux. A tethered cord was revealed in this patient, who had a meningomyelocele operation in the neonatal period. Renal function test in the first two cases were abnormal

Investigation of relationship between idiopathic hypercalciuria and urinary enzyme activities

In patients with uncomplicated idiopathic hypercalciuria renal function is normal except for increased renal calcium excretion. In this study, the level of fractional urinary enzyme excretion was assessed in relation to calciuria. Fourteen patients with a mean age of 5.8 ± 0.8 years who had daily urinary calcium excretion more than 4 mg/kg and with otherwise normal renal function tests were included in the study. None of the patients manifested either renal calculus or nephrocalcinosis. Fourteen normal children with a mean age of 5.4 ± 0.74 were included in the control group. The level of the urinary N-acetyl β-D glucosaminidase (NAG) to creatinine ratio, fractional aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) excretion were not significantly different compared to the control group (p > 0.05). The patients were subdivided according to the type of hypercalciuria. The levels of N'AG/creatinine ratio, fractional ALT, AST, ALP, LDH excretion were not significantly different in the absorptive type of caiciuria group compared to the control group (p > 0.05). In conclusion, hypercalciuria during childhood which is 6.46 ± 1.83 mg/kg/day is not related to the levels of NAG/creatinine ratio, fractional ALT, AST, ALP and LDH excretion in urine