[Difficult diagnosis of a pancreatic paraganglioma]

INTRODUCTION

The paraganglioma is a rare tumour that can sometimes develop near to the pancreatic gland and can occasionally mimic an intra pancreatic mass. Invasive investigations with puncture or primary surgical resection must be avoided because of the risk of vital complications.

EXEGESIS

We report on the case of a 41 years old woman presenting with a mass apparently affecting the pancreatic gland. She also presented with malaises. Paraganglioma was suspected because of the malaises and the blood pressure crises. The diagnosis was permitted by the findings of high urinary metanephrine levels. So the tumour was resected without previous fine needle aspiration and with specific anaesthetic measures. No complication was observed.

CONCLUSION

When a patient presents with a pancreatic mass, physician must carefully take into account the possibility of a paraganglioma particularly when malaises are present.

[Oriental biliary lithiasis. Retrospective study of 690 patients treated surgically over 8 years at Hospital 108 in Hanoi (Vietnam)]

The purpose of this study was to review the unique features distinguishing Oriental from Western gallbladder disease based on a series of 690 patient who underwent surgical treatment at hospital 108 in Hanoi. Oriental cholangiohepatitis often affects in young patients with no gender predilection. The disease originates mainly in canaliculi and leads to blockage or obstruction of the main bile duct inside and outside the liver. Onset has been related to nutritional, infectious, and parasitic factors. Ascariasis may play a determinant role. Because of these unique features, surgical treatment is usually focused on the main bile duct and depends on the size, number, and effects of gallstones. The authors recall that excision of liver tissue may be unavoidable in some cases due to the severity and consequences of lithiasis.

[Kidney cancer in horseshoe kidney. A case report of an unexpected diagnosis]

The authors report a case of renal cell carcinoma in a horseshoe kidney and discuss diagnostic and therapeutical aspects arising from this combination. Renal carcinoid tumors and nephroblastoma seems to be more frequent in this malformation. Diagnosis of horseshoe kidney may be difficult and angiography examination is very useful to confirm renal anomaly, tumor situation, and to plan the surgical approach because vascularization vary case to case. Heminephrectomy adapted to neoplasic localisation remains the essential treatment.

[Value of the bilio-intestinal bypass in biliary disease in the Far East: retrospective study of 5 year experience at the Calmette Hospital of Phnom Penh (Cambodia)]

Gallstone disease in the Far East exhibits a number of special features regarding epidemiology and etiology as well as indications for and response to surgical treatment. Surgical bypass techniques seldom used for treatment of gallstone disease in the West can be highly effective in lowering complication and recurrence rates in oriental patients. The purpose of this retrospective report is to describe a 5-year experience with gallstone disease at the Calmette Hospital in Phnom Penh (Kingdom of Cambodia). After reviewing the main pathological features encountered, we describe the indications for the two bypass techniques used. Choledocoduodenostomy was used for frail, elderly patients while choledochojejunostomy was the treatment of choice and achieved excellent short, middle, and long-term results in younger patients.

[Unusual testicular tumor: an ectopic spleen]

The authors report a case of discontinuous splenogonadal fusion diagnosed after left orchidectomy. Ectopic spleen in the scrotum is a rare congential anomaly frequently associated with other anomalies, especially limb defects. The diagnosis is difficult. Preoperative isotope scanning and intraoperative pathological examination can be performed to avoid unnecessary orchidectomy.

A P-selectin/CD62P monoclonal antibody (LYP-20), in tandem with flow cytometry, detects in vivo activated circulating rat platelets in severe vascular trauma

P-selectin, also known as CD62P, GMP140 or PADGEM, is present in platelet alpha-granules and endothelial cell Weibel-Palade bodies and is very rapidly expressed on the surface of these cells on activation. In this study, an anti P-selectin monoclonal antibody (LYP20) was used, in tandem with flow cytometry, to identify activated platelets at the site of induced vascular trauma or in peripheral blood. Moreover, electron microscopy was performed to characterize sites of vascular trauma and quantify the number of adhering platelets. The same induced vascular trauma was observed to result into animals responding in 2 different ways (Group I, Group II) following the degree of platelet activation. Five rats, out of 14 with induced vascular trauma, had more than half of their circulating platelets expressing P-selectin when drawn at the site of the trauma (67.4% +/- 3.44) or in peripheral blood (78.5% +/- 2.5) (Group I). In the remaining 9 animals a much smaller proportion of circulating platelets expressed P-selectin when assayed from trauma sites (18% +/- 3.34) or in peripheral blood (18.0% +/- 4.30) (Group II). Enhanced P-selectin expression by circulating platelets in Group I, compared to Group II, appears to be linked to the degree of activated platelets adhering at sites of trauma (171 +/- 15 x 10(3) platelets versus 48 +/- 31 x 10(3) platelets per mm2). In the 5 control animals, that were not operated on, platelets expressing P-selectin when drawn at the site of a mock trauma (7.0% +/- 1.84) or in the peripheral blood (11.2% +/- 3.30) showed little activation.(ABSTRACT TRUNCATED AT 250 WORDS)