LUMBOCOSTOVERTEBRAL SYNDROME (LCVS) - A RARE ENTITY

Full term female neonate, weighing 2.7 kg, was born to 37- year-old mother with an uneventful antenatal course. On examination, child was active and anthropometric parameters were normal. Head to toe examination revealed a globular swelling below left costal margin lateral to dorsolumbar spine measuring approximately 6 cm X 6 cm. It was soft, nontender, reducible and used to become prominent on crying. Rest of general and systemic examination was th th normal. X-ray of chest and spine showed dysplastic 9 , 10 , th th th 11 , 12 thoracic vertebrae (Fig 1 red arrow) with absent left 9 , th, th th 10 11 , 12 ribs (Fig 1 blue arrow) and left lumbar hernia (Fig 1 yellow arrow). Ultrasonography abdomen showed a hernial defect in left lumbar region measuring 5 cm X 5 cm containing small bowel loops. Ultrasonography spine showed spina bida occulta. Echocardiography was normal. Lumbar hernia was repaired by pediatric surgeons, operative ndings showed 5 cm X 4 cm hernial sac containing small bowel loops. Child had uneventful post-operative course and discharged successfully. Baby was advised regular follow up.

A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia

Introduction: Splenomegaly and pancytopenia are rare complications of Graves' disease with few reports in the literature about this association. The pathogenesis is unknown and immunological mechanisms seem to be involved. The possibility of hyperthyroidsm should always considered in patients with pancytopenia. Objective: Describe clinical case of association between Grave's disease, splenomegaly and pancytopenia. Method: This is a case report, obtained through data from medical records of a reference hospital located in the city of Juazeiro do Norte, Ceara, Brazil. Case report: Patient, 46 years old, female, sought treatment at a reference hospital with abdominal pain that started two days earlier, prevalent in mesogastric region and left hypochondrium very intense and recurrent, associated with significant consuptive syndrome ( loss of 10 Kg in 4 months), asthenia, dyspnea on minimum exertion, irritability and fine tremor in extremitie. SHe denied fever, palpitations, heat intolerance, skin ou eye changes. A diffuse thyroid enlargement with the presence of thrill and murmur, digital clubbing, fixed and bright look, light exophthalmos and splenomegaly about 6 cm below the left costal margin were abserved after physical examination. Ultrasound examination (USG) of the abdomen and CT scan showed moderate splenomegaly. Laboratory tests showed normocytic and normochromic anemia, leukocytosis and mild thrombocytopenia. Thyroid USG showed characteristic features of Graves' disease, a bone marrow biopsy revealed maturation preserved in all strains and lack of fibrosis and megakaryocytes present in normal number without atypia. treatment was set with propylthiouracil 300 mg a day and after the first revaluation after hospital discharge three weeks later a regression of splenomegaly has been observed. Conclusion: This case ilustrates the rare association between hyperthyroidism and splenomegaly with pancytopenia.

Transperitoneal Subcostal Access for Urologic Laparoscopy: Experience of a Large Chinese Center

Objective. To present our experience of using transperitoneal subcostal access, Palmer’s point (3 cm below the left costal margin in the midclavicular line), and its right corresponding site, in urologic laparoscopy. Methods. We used Palmer’s point and the right corresponding site for initial access in 302 urologic surgeries (62 cases with prior surgeries). The record of these cases was reviewed. Results. Success rate of initial access is 99.4%, and complication rate of puncturing is only 3.4% with no serious complication. In the cases with prior surgeries, there were only two cases with access complication on the right side (minor laceration of liver). For people with BMI more than 30 kg/m2 (12, 3.9%), the success rate was also 100 percent. Conclusions. Palmer’s point and the corresponding right location are feasible, effective, and safe for initial access in urologic laparoscopic surgeries. This entry technique should be used routinely in urologic laparoscopic surgeries.

Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

A 55-year-old man presented with splenomegaly (10 cm below left costal margin) and leucocytosis (145 × 109/L). Differential showed neutrophilia with increased basophils (2%), eosinophils (1.5%), and left shift including myeloblasts (3%). A diagnosis of chronic myeloid leukemia in chronic phase was established after marrow cytogenetics demonstrated the Philadelphia chromosome. Molecular studies showed a BCR-ABL1 qPCR result of 65% on the International Scale. Imatinib therapy at 400 mg daily was initiated due to patient preference, with achievement of complete hematological response after 4 weeks of therapy. BCR-ABL1 at 1 and 3 months after starting therapy was 37% and 13%, respectively (all reported on International Scale). Is this considered an adequate molecular response?

Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements

PART I Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements. I. Autoantibody on Erythrocytes in Acute Hemolytic Anemia, by Tonietti et al. Page 179—Methods and Material: The top 6 lines on page 180 should be transposed to page 179 starting as the 3rd line under Source of Erythrocytes, and the section properly reading as follows: Source of Erythrocytes The patient (L.S.), a seven year old male, was studied at the Centro Nazionale Transfusione Sangue, C.R.I., in March 1967. His history of anemia dated back to May 1964. Physical examination showed a deeply jaundiced boy. On palpation of the abdomen, the liver was felt 2 cm. below the right costal margin and the spleen 3 cm. below the left costal margin. The superficial lymph nodes were minimally but definitely enlarged. Examination of the blood revealed a red cell count of 1.8 million, a total white count of 3,600 and a platelet count of 180,000 per cu. mm. Bilirubin was 4.9 mg./100 ml. and the osmotic fragility of the red blood cells was normal. The blood group was O CCDee. Etc. Antiglobulin Tests Direct agglutination tests performed with the patient’s erythrocytes and antiserum to human globulin and antiserum to human IgG were positive. Absorption of the antihuman globulin with pure IgG rendered the serum incapable of agglutinating the erythrocytes of the patient,6 thus showing that the antibody coating the erythrocytes was of the IgG class.

CLINICAL CONFERENCE

Dr. Silverman: I shall present the history of an infant who was admitted to our premature nursery on May 9, 1956. This Puerto Rican male infant was born during the thirty-sixth week of an uneventful pregnancy. An antenatal serologic test for syphilis was negative. Delivery was spontaneous. Birth weight was 1070 gm. Physical examination on admission to the nursery revealed the liver to be 1 cm below the right costal margin and the spleen was firm, 1 cm below the left costal margin. Nothing else worthy of comment was noted and the infant was managed in a routine manner. The immediate newborn period was entirely uneventful, specifically neither petechiae nor unusual degree of icterus were noted. The ocular fundi were examined, as a matter of routine, during the third and fifth weeks of life and they were described as normal. During the sixth week of life, when the infant weighed 2080 gm, it was suddenly noted that the abdomen was quite distended. Examination at this time disclosed marked hepatosplenomegaly, both organs were firm. Again neither icterus nor petechiae were noted. There appeared to be some difficulty in swallowing. Roentgenograms of the chest at this time were normal and of the skull revealed intracranial calcification which was displayed in a pattern that seemed to outline dilated lateral ventricles. Lumbar puncture yielded cerebrospinal fluid which was negative except for protein of 198 mg/100 ml. The urine and cerebrospinal fluid were examined for the cells characteristic of cytomegalic inclusion disease and none were found. Funduscopic examination at this time disclosed an area of chorioretinitis in the right eye. It was presumed at this time that the infant had toxoplasmosis.