The frequent occurrence of hematuria in children necessitates diagnostic evaluation. Hematuria may occur with either renal or lower urinary tract disease. Clarification of the etiology of hematuria, whether microscopic or gross, is facilited by localizing the site of bleeding to the kidney (glomerular) or the lower urinary tract (non-glomerular). The mean cellular volume (MCV) of urinary red blood cells (RBCs) of pediatric patients with glomerular (group I; n=77) and non-glomerular (group II; n=34) hematuria was determined using Coulter Counter Model S plus IV. We found that re blood cells of glomerular origin had a smaller volume than non-glomerular cells(73.79 9.75 m3 vs 83.55 3.77 m3, p<0.001). If an urinary MCV equal to 80.56 m3 was taken as the cut-off value between glomerular and non-glomerular hematuria, a correct assessment of the site of bleeding was made in 89 (80%) of the 111 patients studied (sensitivity 76%, specificity 88%). The ratio of the urinary erythrocyte MCV to that in blood(Umcv/Bmcv) was compared with the diagnosis. If an Umcv/Bmcv ratio equal to 0.95 was taken as the cut-off value between glomerular and non-glomerular hematuria, a correct assessment of the site of bleeding was made in 93 (83%) of the 111 patients studied (sensitivity 79.6%, specificity 94%). Coulter counter analysis of urine provides a simple noninvasive and objective aid to the diagnosis of hematurai. This test, when used early in the management of pediatric patients with hematuria, may help to avoid invasive investigations.
Blood Cells ; Child ; Diagnosis ; Erythrocytes* ; Hematuria* ; Hemorrhage ; Humans ; Kidney ; Sensitivity and Specificity ; Urinary Tract ; Urologic Diseases

NO abstract available.
Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Lymphocytes* ; RNA, Messenger* ; Transforming Growth Factor beta

Pigmented villonodular synovitis is a benign proliferative disorder affecting the synovium. In 1941, Jaffe assembled under the common term of pigmented villonodular synovitis dissimilar lesions described by different names, that issuch as giant cell tumors of synovial tendon sheaths, actual pigmented villonodular synovitis, and villonodular bursitis. (Giant cell tumors of tendon sheaths, which may be localized, most often occurring in fingers, flexor tendons or interphalangeal joints, or diffuse, usually arising in the vicinity of large joints.) Involvement of the temporomandibular joint is very rare. (We report a rare case of pigmented villonodular synovitis of the temporomandibular joint that invaded the mandibular condyle. A 34-year-old man had a large left preauricular (parotid) mass for two years that he had focal facial nerve paralysis, temporal and zygomatic branches. The clinical appearance suggested a parotid tumor. At surgical exploration, a tumor was found to be severely adhered sion to the facial nerve and involving the temporomandibular joint. Histologically, Tthe resected specimen histologically was a proliferative lesion composed of epithelioid histiocytes, spindle cells, and multinucleated giant cells.) The appearance was typical of the family of lesions that includes pigmented villonodular synovitis, bursitis, and tenosynovitis . rewritten as follows: (Giant cell tumors of tendon sheaths, which may be localized, most often occurring in fingers, flexor tendons or interphalangeal joints, and spread to other parts after arising in the vicinity of large joints.) rewritten as follows: (A 34-year-old man had a large left preauricular (parotid) mass for two years and showed focal facial nerve paralysis in the temporal and zygomatic branches. The clinical appearance suggested a parotid tumor. Surgical exploration revealed a tumor that was severely connected to the facial nerve involving the temporomandibular joint. Histologically, the resected specimen was a proliferative lesion composed of epithelioid histiocytes, spindle cells, and multinucleated giant cells.)
Adult ; Bursitis ; Facial Nerve ; Fingers ; Giant Cell Tumors ; Histiocytes ; Humans ; Joints ; Mandibular Condyle ; Paralysis ; Synovial Membrane ; Synovitis, Pigmented Villonodular* ; Temporomandibular Joint* ; Tendons ; Tenosynovitis

Actinomycosis is a chronic and suppurative infection caused by an endogenous Gram-positive bacterium. The usual sites of infection are the head and neck, thorax, and abdomen. Primary cutaneous actinomycosis is very rare and usually associated with external trauma and local ischemia. We report on the case of a primary cutaneous actinomycosis of the nasolabial fold in a 70-year-old woman. The patient had a well-defined subcutaneous nodule on the nasolabial fold without any other lesion. The patient was treated successfully with surgical resection and combined antibiotic therapy. There has been no recurrence during the 3 months period of follow-up.
Abdomen ; Actinomycosis* ; Aged ; Female ; Follow-Up Studies ; Head ; Humans ; Ischemia ; Nasolabial Fold* ; Neck ; Recurrence ; Thorax

Both intrathyroidal parathyroid adenoma and acute pancreatitis from hyperparathyroidism are rare disorders. We report a case of acute pancreatitis from hyperfunctioning intrathyroidal parathyroid adenoma in a 40-year-old man with severe abdominal pain. Serum chemistry values show-ed high amylase, lipase, calcium and intact parathyroid hormone level, and abdominal CT revealed acute pancreatitis. A 7 mm lesion was detected inside the left upper pole of thyroid on neck ultrasonography and confirmed to be a parathyroid lesion based on fine needle aspiration cytology. After exploratory parathyroidectomy, symptoms subsided. In patients who present with acute pancreatitis, hyperparathyroidism should also be considered if risk factors such as alcohol ingestion, gallstone, previous endoscopic retrograde cholangiopancreatography, and abdominal trauma do not exist. Exploratory parathyroidectomy should be performed in a case of acute pancreatitis from primary hyperparathyroidism.
Abdominal Pain ; Adult ; Amylases ; Biopsy, Fine-Needle ; Calcium ; Chemistry ; Cholangiopancreatography, Endoscopic Retrograde ; Eating ; Gallstones ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Lipase ; Neck ; Pancreatitis* ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy ; Risk Factors ; Thyroid Gland ; Tomography, X-Ray Computed ; Ultrasonography

Synovial sarcomas is a mesenchymal tumor that usually occurs in the extremities. Fewer than 100 cases of synovial sarcoma have been reported in the head and neck lesion. We experienced 2 cases of synovial sarcoma of neck, and so reported with a review of literature.
Extremities ; Head ; Neck* ; Sarcoma, Synovial*

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.
Clavicle ; Female ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Osteitis Fibrosa Cystica ; Parathyroid Glands ; Parathyroid Neoplasms* ; Pelvic Bones ; Rare Diseases ; Ribs

Multiple endocrine neoplasia type 1 (MEN 1) is characterized by the coexistence of primary hyperparathyroidism, enteropancreatic tumors, and anterior pituitary adenoma. Also adrenal adenoma, lipoma, carcinoid tumors could exist simultaneously on the atypical clinical course of MEN 1. Among these diseases, primary hyperparathyroidism is the most common manisfestation of MEN 1 syndrome. However, it sometimes presents no clinical symptoms and is incidentally detected on medical checkup. A 48-year-old woman, while undergoing a regular medical check-up, was diagnosed with primary hyperparathyroidism. Further studies showed concurrence of pancreatic tumor and adrenal tumor, but there was no pituitary lesion. The patient underwent parathyroidectomy with auto-implantation of parathyroid tissue, pylorus preserving pancreatico-duodenectomy and partial adrenalectomy. The pathological test confirmed it to be parathyroid hyperplasia, well-differentiated pancreatic endocrine carcinoma and adrenal cortical adenoma. We report this atypical and asymptomatic case of MEN 1 with a review of the relevant literature.
Adenoma ; Adrenalectomy ; Adrenocortical Adenoma ; Carcinoid Tumor ; Female ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperplasia ; Lipoma ; Mass Screening ; Middle Aged ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Parathyroidectomy ; Pituitary Neoplasms ; Pylorus

Damages on the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the recurrent laryngeal nerve and meticulous surgical techniques can significantly decrease the incidence of this complication. The nonrecurrent inferior laryngeal nerve is an exceedingly rare anomaly of the recurrent laryngeal nerve. The nonrecurrent inferior laryngeal nerve is associated with abnormal development of the aortic arch, where the innominate (brachiorephalic) artery is not found and the right common carotid artery rises directly from the aortic arch. The aberrant right subclavian artery can always be felt against the vertebral column behind the esophagus. Surgeons need to be aware of the positions of these arteries to avoid damaging them. We experienced a case of nonrecurrent inferior laryngeal nerve in the right side with the aberrant right subclavian artery. The patient received a total thyroidectomy with neck dissection for thyroid carcinoma with nodal metastasis. Incidentally, we also found nonrecurrent inferior laryngeal nerve, and also found an aberrant right subclavian artery by the computed tomography scan. The patient presented transient vocal cord paralysis but gained complete recovery of vocal cord mobility after one and a half month later.
Aorta, Thoracic ; Arteries ; Carotid Artery, Common ; Esophagus ; Humans ; Incidence ; Neck Dissection ; Neoplasm Metastasis ; Recurrent Laryngeal Nerve* ; Spine ; Subclavian Artery ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND AND OBJECTIVES: The nonrecurrent inferior laryngeal nerve (NRILN) is a rare anomaly of the recurrent inferior laryngeal nerve (RILN), associated with abnormal development of the aortic arch that can be associated with an increased risk of vocal fold paralysis. This study will describe preoperative diagnosis and intraoperative findings. SUBJECTS AND METHOD: We describe 10 cases (0.53%) of the NRILN observed during 1890 surgical procedure between January 2006 and December 2008. RESULTS: The NRILN was observed on the right side in all cases. Although the NRILN was preserved, immediately after the surgery, vocal fold paralysis was present in one patient who completely recovered one month later. CONCLUSION: Injury due to RILN that results in vocal fold paralysis is one of the serious complications in thyroid and parathyroid surgery. If the RILN is not found in the classic position during surgery, this can be a possibility of the presence of the NRILN
Aorta, Thoracic ; Humans ; Paralysis ; Recurrent Laryngeal Nerve ; Subclavian Artery ; Thyroid Gland ; Thyroidectomy ; Vocal Cords