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A malleable endoscopic suction instrument: technical note.

Flexible endoscopes are being employed for a variety of neurosurgical procedures. These instruments have drawbacks, especially in their ability to evacuate clotted blood. We have attempted to rethink the design of these instruments and have developed a malleable endoscopic suction instrument. This has proved to be helpful in a variety of intracranial and intraspinal procedures.

Endoscopes↗

[Sonographic appearance of renal fibrolipomatosis].

Diagnostic ultrasound studies were performed in 104 patients with renal fibrolipomatosis. The lesions were echo-poor in 94 of 104 cases and echogenic in the remaining 10 patients. The echo-poor lesions presented multiple echo-poor zones, a single echo-poor region of a finger-shaped configuration. The latter pattern resembled hydronephrosis. Differentiation between the two lesions was possible on the basis blurred contours, absence of increased transmission and lower echo intensity in fibrolipomatosis than in urinary tract obstruction. Cases of echogenic fibrolipomatosis are characterized by a high proportion of collagen fibres. Differential diagnosis of these lesions including tumours of the renal parenchyma and pelvis are discussed.

Humans↗

Excessive nodular hyperplasia of Brunner glands associated with gastric hypersecretion and lipomatous atrophy of the pancreas.

The case of a 34-year-old woman complaining of diarrhoea and abdominal pain is presented. Contrast radiography and endoscopy showed multiple polypoid tumours in the second part of the duodenum. Moreover, a severe fatty infiltration of the pancreas was shown by magnetic resonance and computed tomography scans. Due to pain, pancreatoduodenectomy (Whipple operation) was performed, and subsequent histopathologic examinations showed excessive Brunner gland hyperplasia of the duodenum and severe lipomatous atrophy of the pancreas. The occurrence of these two rare conditions in one patient has not been described previously, and it is conceivable that the lipomatous atrophy and exocrine insufficiency of the pancreas may have caused a compensatory stimulation of the submucosal structures of the duodenum.

Adult↗

Macrocephaly with multiple soft tissue and visceral hamartomas ("Bannayan-Zonana" syndrome). Case report.

Since its first description few cases of the rare association of macrocephaly with multiple soft tissue and visceral hamartomas (Bannayan-Zonana syndrome) have been reported. In this paper we report a case of a 7 year old child in whom lipomas of the abdomen and right flank have been treated with liposuction. We could find no previous evidence that this surgical technique has been used in the treatment of this syndrome.

Cephalometry↗

Topical capsaicin for the treatment of acute lipodermatosclerosis and lobular panniculitis.

Topical capsaicin is well known to reduce nociceptive pain and neurogenic inflammation by depleting substance P. Its fibrinolytic and antithrombotic effects are less well known. We report two cases of acute lipodermatosclerosis which did not respond to several conventional treatment regimens and one case of acute lobular panniculitis in a pregnant woman with venous insufficiency, who were successfully treated within a short period of 3 weeks with topical 0.075% capsaicin cream.

Acute Disease↗

Aesthetic considerations in the cervicofacial management of Madelung syndrome.

The most common concern in patients with Madelung syndrome who are seeking cosmetic improvement is the deposition of fat in the cervicofacial region. Surgical experience in a series of 15 patients was summarised to provide guidelines for a rational approach to a better aesthetic outcome. The records and clinical photographs of these patients were reviewed. Outcome was assessed in terms of adequacy of debulking, final overall symmetry, smoothness of contour, prominence of scar, and necessity for multiple sessions. Open excision was the preferred primary treatment. A long mid-neck, transverse skin crease incision provided good exposure and was superior to multiple local incisions. Other surgical details worth noting include subplatysmal dissection, thick skin flaps, dissection around instead of into lipomas, appropriate removal of redundant skin, adequate reduction of tumour size instead of total excision, haemostasis, suction drainage, and layered skin closure. Liposuction was a useful adjunct for contouring the sides of the jaws in selected patients.

Adult↗

Tamponade caused by cardiac lipomatous hypertrophy.

Cardiac lipomatous hypertrophy is an unusual disorder that typically affects the interatrial septum. We report a case in which large subpericardial deposits of fat were initially mistaken for a pericardial effusion and the subsequent clinical picture resembled tamponade. The patient improved following a pericardiectomy.

Aged↗