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Angiosarcoma is an infrequent tumor among sarcomas, especially presenting as a primary tumor within the central nervous system, which can lead to a rapid neurological deterioration and death in few months. We present a 41-year old man with a right frontal enhancing hemorrhagic lesion. Surgery was performed with histopathological findings suggesting a primary central nervous system angiosarcoma. He was discharged uneventfully and received adjuvant chemotherapy and radiotherapy. At 5 months, the follow-up MRI showed two lesions with an acute subdural hematoma, suggesting a relapse. Surgery was again conducted finding tumoral membranes attached to the internal layer of the duramater around the right hemisphere. The patient died a few days later due to the recurrence of the subdural hematoma. This case report illustrates a rare and lethal complication of an unusual tumor. The literature reviewed shows that gross-total resection with adjuvant radiotherapy seems to be the best treatment of choice.

Background A primary central nervous system lymphoma (PCNSL) presenting with massive hemorrhage is a rare occurrence that is difficult to distinguish from a high-grade glioblastoma. Comprehensive descriptions of the imaging characteristics of such tumors have not yet been reported. Herein, we reported a case of a PCNSL with massive hemorrhage by presenting the imaging features of computed tomography (CT) imaging and structural and perfusion magnetic resonance imaging (MRI). Case summary A 48-year-old man presented with headache lasting for 10 d. CT of the brain showed a round, heterogeneous, high-density lesion with surrounding edema in the right temporal lobe. For further diagnosis, a series of MRI examinations of the brain were subsequently performed, and a hemorrhagic lesion with ring-like enhancement was determined. The whole lesion was relatively hypoperfused on arterial spin labeling images. Surgical resection of the lesion and histopathological examination confirmed that the lesion was a diffuse large B-cell lymphoma with massive hemorrhage. Conclusion PCNSLs with hemorrhage occur very rarely, and structural and perfusion MRI examinations are requested exceedingly rarely. This case provided insight into some characteristics of a hemorrhagic lymphoma on CT and MRI examinations. Perfusion MRI examination may be useful for the differential diagnosis of PCNSLs and other brain tumors.

Intracranial Masson tumor (intravascular papillary endothelial hyperplasia, IPEH) is a benign lesion that is thought to originate from a reactionary process in response to compromised blood flow. IPEH may be classified into one of three subtypes based on etiology as it may result from the excessive proliferation of endothelial cells within a normal vessel (primary), vascular malformation (type II), or organized hematoma (type III). We report the case of a 79-year-old woman who presented with confusion, gait instability, and urinary incontinence. Neuroimaging revealed a hemorrhagic lesion within the right lateral ventricle, which was successfully resected. To our knowledge, this is the first reported case of an intraventricular IPEH and 33rd case of primary intracranial IPEH. We further performed a systematic review of the literature on all prior type I intracranial IPEH cases and discuss the importance of long-term follow-up in intracranial IPEH.

Background Hemorrhage progression following traumatic brain injury (TBI) is not fully understood, and preventing it would be a potential therapeutic opportunity in TBI management. The aim of this study was to determine how non-operated hemorrhagic lesions progress following TBI, and how this affects outcome. Methods This was a retrospective observational cohort study of adult patients (≥ 15 years) with moderate-to-severe TBI. Hemorrhage volumes were calculated from computed tomography (CT) scans using semi-automated volumetric segmentation. Results In total, 643 patients were included, with a median Glasgow Coma Scale of 7. Contusions were the most common form of traumatic intracranial hemorrhage. The mean total lesion volume on the first CT scan was 4.29 ml, and the mean lesion progression volume (LPV), i.e. the increase in volume from first CT scan until the lesion had stopped progressing, was 3.85 ml. Contusions showed a significantly larger LPV than SDH and EDH (p

Objective When performing burr hole endoscopic neurosurgery, it is necessary to get enough surgical corridor. We have used various instruments to extend burr hole size, but it was cumbersome to use so many tools. Methods In this report, we describe a novel instrument—a dilator attachment with a cordless handle to make it simple and safe to extend a burr hole. We developed this burr hole dilator attachment with blades on the side and an arc form on the bottom to prevent dural damage. It can be used to drill safely and efficiently. We describe some experiences of using this device. Results It is important to balance the maximization of the operation range and surgical invasiveness for endoscopic neurosurgery. This new dilator for extending a burr hole is a safe, useful device to get enough surgical view and easily perform a surgical procedure in endoscopic surgery. Conclusions Our dilator for expanding a burr hole improves the work of endoscopic surgery on intracranial hemorrhagic lesions.

Encephalic Vascular Accident (EVA) is one of the cerebrovascular diseases that causes great impact on the worldhealth and generates enormous social and economic costs (CONTIN, 2011). The EVA has a therapeutic window of 3 h forthe treatment, period in which it is possible to intervene in the ischemic or hemorrhagic lesion to diminish the damages(RAFFIN, 2002). Early and accurate diagnosis is fundamental because it is a medical emergency and only clinical evaluationof patients with suspected stroke is insufficient and incapable of differentiating whether the lesion is hemorrhagic or ischemic(SILVA, OLIVEIRA, 2017). The accepted imaging methods to initially evaluate are computed tomography (CT) and MagneticResonance (MRI) for examination of the skull. Computed tomography and magnetic resonance imaging are important in thecharacterization, identification, diagnostic confirmation of stroke and the removal of hypotheses from other causes,facilitating the rapid decision making regarding the use or not of thrombolytic therapy. Diagnosis by CT and MRI in EVAreliably helps to identify differences between irreversibly affected brain tissue and reversible tissue that may benefit fromearly treatment such as reperfusion, preventing cell death and reestablishing normal function (Silva, 2017). Each techniquehas advantages and disadvantages, being suggestive more studies that can compare through measures of greater precisionthe point efficiency among the techniques.

The purpose of this study was to ascertain change in structure of mucosa of small intestine, if any, in small intestine of Swiss albino mice as an effect of chronic use of nonsteroidal anti-inflammatory drugs-Ibuprofen. Longitudinal study conducted on 46 adult Swiss albino mice, 23 as experimental and 23 as control. Ibuprofen was given at a dose of 40 µg/g body weight per day for 6 weeks by intragastric route in experimental group of mice while control group of mice received same volume of distilled water. Mice of both the groups were sacrificed and desired segments of small intestines were dissected out and tissues were subjected to histological processing. Histomorphometry was performed and relevant photomicrographs were obtained. Student's unpaired t test by GraphPad Prism 6 software. Height of villi was not significantly altered but there was significant reduction of the number of goblet and non-goblet cells (enterocytes and other columnar cells) in mucosal lining of the small intestine of experimental group of mice. Percent distribution of the goblet and non-goblet cells was not altered in villi of two groups. Chronic exposure of Ibuprofen in therapeutic dosage caused reduction of the functional cell mass in lining epithelium of villi of middle segment of small intestine. However, there was no evidence of ulcerative or hemorrhagic lesion.

SUMMARY: Broiler meat is a high-quality food for humans, and is worldwide consumed. Brazil plays an important role in the poultry industry and in its South region is situated the most important producer. Recently, alterations on the meat aspect have aroused the interest of researchers to clarify their causes. The objective of this investigation was to evaluate the relationship between environmental conditions and seasons on the prevalence of Dorsal Cranial Myopathy (DCM) and also, to generate a DCM classification in scores, for griller-type broilers. Carcasses were picked out from several stages of industrial processing from a slaughterhouse located in South Brazil. The prevalence of DCM was measured using the database of partial condemnations of the Official Inspection Service during 19 months. Meteorological data were obtained from the National Institute of Meteorology (in Portuguese Instituto Nacional de Meteorologia- INMET), of the Ministry of Agriculture, Livestock and Supply. In addition, microorganisms with public health importance were measured on samples taken from the muscles with DCM. The prevalence of DCM was compared among seasons using Analysis of Variance (ANOVA). The relation with other environmental conditions was accessed using a principal component analysis. Partial condemnations by DCM were higher (P < 0.001) during autumn (0.529%) and winter (0.547%). In the other extreme, summer presented the lowest percentage of condemned carcass (0.199%). The prevalence of DCM appeared to be inversely related to the temperatures. The association between relative humidity and the prevalence of DCM seemed to move in the same direction. No differences were observed in the qualitative and quantitative microbiological analysis between carcasses affected by DCM and the control group (P > 0.05). Visually, it could be noted that the hemorrhagic lesion of the Anterior latissimus dorsi (ALD) muscle diminished during the processing line, making the DCM imperceptible, even in those carcasses with severe DCM score at the beginning of the process. In conclusion, the climate features approached here could be correlated to this emerging myopathy. However, this lesion does not represent a food security issue for the consumers regarding evaluated microorganisms, as this kind of lesion tends to disappear in the final sellable product.

Aims: To report a patient with unrecognized small macular melanoma, who gradually developed neovascular glaucoma that was treated with an Ahmed valve. We presume that tumor cells gained access to the orbit through this aqueous drainage device. Methods: The medical records pertaining to 5 different centers, the results of imaging studies, the clinical course of the patient and histopathological findings were retrospectively reviewed. Results: A 61-year-old man presented with a blind and painful proptotic right eye. Retinal hemorrhage had been suspected 3 years earlier and followed accordingly thereafter. Yearly performed MRI studies demonstrated the steady growth of the hemorrhagic lesion/tumor. Meanwhile, he developed neovascular glaucoma first treated unsuccessfully with cyclocryotherapy then with implantation of an Ahmed valve. Right proptosis became evident within a year, and a final MRI study revealed a large retrobulbar mass. Orbital exenteration was performed and histopathological examination showed intraocular and orbital epithelioid cell melanoma. Tumor cells were also found within the reservoir of the Ahmed valve. The patient died of widespread metastases 1 year later. Conclusions: Ahmed valve implantation in an eye with unsuspected macular choroidal melanoma may ultimately be associated with extraocular extension and orbital tumor formation.

Tranexamic acid might be beneficial for cerebral hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on cerebral hemorrhage. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of tranexamic acid on cerebral hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model. Seven RCTs involving 1702 patients were included in the meta-analysis. Overall, compared with control intervention in cerebral hemorrhage, tranexamic acid could significantly reduce growth of hemorrhagic mass (RR = 0.78; 95% CI = 0.61–0.99; P = 0.04) and unfavorable outcome (RR = 0.75; 95% CI = 0.61–0.93; P = 0.008), but demonstrated no substantial influence on volume of hemorrhagic lesion (Std. MD = −0.10; 95% CI = −0.27 to 0.08; P = 0.28), neurologic deterioration (RR = 1.25; 95% CI = 0.60–2.60; P = 0.56), rebleeding (RR = 0.62; 95% CI = 0.35–1.09; P = 0.10), surgery requirement (RR = 0.78; 95% CI = 0.40–1.51; P = 0.46), and mortality (RR = 0.86; 95% CI = 0.69–1.05; P = 0.14). Compared to control intervention in cerebral hemorrhage, tranexamic acid was found to significantly decrease growth of hemorrhagic mass and unfavorable outcome, but showed no notable impact on volume of hemorrhagic lesion, neurologic deterioration, rebleeding, surgery requirement and mortality.

Organized hematoma of the maxillary sinus is an uncommon, benign, heterogeneous, non-neoplastic, and hemorrhagic lesion characterized by mucosal swelling and bone destruction that can be locally aggressive in the unilateral maxillary sinus. The clinical, radiographical, and pathological characteristics of a 2-year-old patient with an organized hematoma in the maxillary sinus were studied with preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans and histopathological examination with hematoxylin and eosin (HE and lymphatic factors, such as D2-40; and proliferation factors, such as Ki-67 and bcl-2. A total of 17 articles of similar pathology have been reported in the English-language literature under the name of an organized hematoma in the maxillary sinus. We reviewed these retrospective studies of 60 patients who were treated surgically within the past 17 years and found no consensus on the diagnostic criteria of this disease or surgical approaches. Patient age ranged from 11 to 78 years, and the average age was 42.8 years. The ratio of male to female was approximately 2:1, no cases in pediatric patients were found. We report the first case of organized hematoma in the pediatric maxillary sinus with its clinico-radio-pathologic characteristics. Preoperative imaging was essential for the accurate diagnosis of this disease, and sublabial approach combined with endonasal endoscopic confirmation can be also recommended in the pediatric patient.

In this study, we investigated the gastroprotective effect of an isopropanol extract from the aerial parts of Artemisia princeps (IPAP) and developed a gastroretentive floating tablet of IPAP (IPAP-FR) for maximized local gastroprotective effects. Pre-treatment with IPAP ameliorated the gastric mucosal hemorrhagic lesions in ethanol/HCl- or indomethacin- treated rats. IPAP decreased mucosal hemorrhage of gastric ulcers induced by ethanol or indomethacin plus pyloric ligation in rats. The optimized floating tablet, IPAP-FR, floated on medium surface with more sustained eupatilin release compared to the non-floating control tablet. X-ray photographs in beagle dogs showed that IPAPFR was retained for > 2 h in the stomach. In the ethanol-induced gastric ulcer rat model, the gastric hemorrhagic lesion was improved more substantially with IPAP-FR compared to the non-floating control tablet. Based on these data, our data suggest that IPAP-FR has an improved therapeutic potential for the treatment of gastric ulcer.

Higher plasma copeptin levels correlate with poor clinical outcomes after traumatic brain injury. Nevertheless, their links with acute traumatic coagulopathy and progressive hemorrhagic injury are unknown. Therefore, we aimed to investigate the relationship between plasma copeptin levels, acute traumatic coagulopathy and progressive hemorrhagic injury in patients with severe traumatic brain injury. We prospectively studied 100 consecutive patients presenting within 6 h from head trauma. Progressive hemorrhagic injury was present when the follow-up computerized tomography scan reported any increase in size or number of the hemorrhagic lesion, including newly developed ones. Acute traumatic coagulopathy was defined as an activated partial thromboplastic time greater than 40 s and/or international normalized ratio greater than 1.2 and/or a platelet count less than 120 × 109/L. We measured plasma copeptin levels on admission using an enzyme-linked immunosorbent assay in a blinded fashion. In multivariate logistic regression analysis, plasma copeptin level emerged as an independent predictor of progressive hemorrhagic injury and acute traumatic coagulopathy. Using receiver operating characteristic curves, we calculated areas under the curve for progressive hemorrhagic injury and acute traumatic coagulopathy. The predictive performance of copeptin was similar to that of Glasgow Coma Scale score. However, copeptin did not obviously improve the predictive value of Glasgow Coma Scale score. Thus, copeptin may help in the prediction of progressive hemorrhagic injury and acute traumatic coagulopathy after traumatic brain injury.

Introduction. Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. Material and Methods: A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, inlcuding the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. Results. The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the rightsided ones to present its symptoms although the average hematoma diameter value was almost the same. Conclusion. The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.

Pretreating a pig kidney with 500 low-energy shock waves (SWs) before delivering a clinical dose of SWs (2000 SWs, 24 kV, 120 SWs/min) has been shown to significantly reduce the size of the hemorrhagic lesion produced in that treated kidney, compared with a protocol without pretreatment. However, since the time available for patient care is limited, we wanted to determine if fewer pretreatment SWs could be used in this protocol. As such, we tested if pretreating with 300 SWs can initiate the same reduction in renal lesion size as has been observed with 500 SWs.Fifteen female farm pigs were placed in an unmodified Dornier HM-3 lithotripter, where the left kidney of each animal was targeted for lithotripsy treatment. The kidneys received 300 SWs at 12 kV (120 SWs/min) followed immediately by 2000 SWs at 24 kV (120 SWs/min) focused on the lower pole. These kidneys were compared with kidneys given a clinical dose of SWs with 500 SW pretreatment, and without pretreatment. Renal function was measured both before and after SW exposure, and lesion size analysis was performed to assess the volume of hemorrhagic tissue injury (% functional renal volume, FRV) created by the 300 SW pretreatment regimen.Glomerular filtration rate fell significantly in the 300 SW pretreatment group by 1 hour after lithotripsy treatment. For most animals, low-energy pretreatment with 300 SWs significantly reduced the size of the hemorrhagic injury (to 0.8% ± 0.4%FRV) compared with the injury produced by a typical clinical dose of SWs.The results suggest that 300 pretreatment SWs in a voltage ramping treatment regimen can initiate a protective response in the majority of treated kidneys and significantly reduce tissue injury in our model of lithotripsy injury.

International audience; We report our methodological developments to investigate, in a multi-center study using mean diffusivity, the tissue damage caused by a severe traumatic brain injury (GSC

One of the areas of fetal and neonatal neurology where MR has provided significant improvement in knowledge is focal cerebral ischemia on both arterial and venous basis [1, 2]. In the detection of acute lesions or chronic sequelae, MR has shown a high sensitivity and specificity. The use of diffusion-weighted imaging (DWI) has increased the MRI sensitivity in acute conditions in both fetal and neonatal period [3, 4]. On the other side, the accurate assessment of lesion extension has facilitated the prediction of neurological outcome.

The magnitude of damage to cerebral tissues following head trauma is determined by the primary injury, caused by the kinetic energy delivered at the time of impact, plus numerous secondary injury responses that almost inevitably worsen the primary injury. When head trauma results in a cerebral contusion, the hemorrhagic lesion often progresses during the first several hours after impact, either expanding or developing new, non-contiguous hemorrhagic lesions, a phenomenon termed hemorrhagic progression of a contusion (HPC). Because a hemorrhagic contusion marks tissues with essentially total unrecoverable loss of function, and because blood is one of the most toxic substances to which the brain can be exposed, HPC is one of the most severe types of secondary injury encountered following traumatic brain injury (TBI). Historically, HPC has been attributed to continued bleeding of microvessels fractured at the time of primary injury. This concept has given rise to the notion that continued bleeding might be due to overt or latent coagulopathy, prompting attempts to normalize coagulation with agents such as recombinant factor VIIa. Recently, a novel mechanism was postulated to account for HPC that involves delayed, progressive microvascular failure initiated by the impact. Here we review the topic of HPC, we examine data relevant to the concept of a coagulopathy, and we detail emerging data elucidating the mechanism of progressive microvascular failure that predisposes to HPC after head trauma.

Susceptibility weighted imaging (SWI) combines magnitude and phase information from a high-resolution, fully velocity compensated, three-dimensional (3D) gradient echo sequence. We report on the use of this MRI technique in a young patient with acute lymphocytic leukemia (ALL) and demonstrate a higher detection rate of hemorrhagic lesion in comparison with other T2*-weighted sequences.

Bites from brown recluse spiders (Loxosceles reclusa) result in several clinical manifestations, causing painful, disfiguring necrotic ulcers and, uncommonly, severe systemic effects. We report two cases reports with necrotic arachnidism from Turkey. A 21-year-old man was admitted to our clinic with the complaints of pruritis, redness on his neck. He had a history of spider bite one day ago. A 52-year-old woman had a cellulitis with hemorrhagic lesion and superficial necrosis on her arm and had a history of spider bite one day ago. Based on these clinical and epidemiological findings, a diagnosis of necrotic arachnidism was suspected, and the diagnosis of necrotic arachnidism was confirmed with these typical skin lesions and spiders bites in histories of patients. The outcome of our patients were good after antihistaminic, antibiotic, analgesic and anti-inflammatory treatments. The brown recluse spider is notorious for its necrosis-inducing bite. Its venom contains a rare toxin, sphingomyelinase D, which activates the vascular endothelium and initiates a cascade of activation of neutrophils and granulocyte macrophage colony-stimulating factor, resulting in tissue destruction. In many cases, diagnosis of spider bite is very difficult. Therefore, clinical and epidemiological findings, as well as a detailed history, may establish the diagnosis.

内視鏡的止血術を施行した大腸出血症例の臨床的特徴を明らかにする目的で、最近5年8ヵ月間に大腸出血と診断し内視鏡的止血術を施行した64例を抽出して、その臨床像と内視鏡像を遡及的に検討した。平均年齢は72.0歳で男性42例(65.6%)、女性22例(34.4%)であった。入院時に使用されていた薬剤を検討すると、64例中38例(59.4%)で低用量アスピリンを含むNSAIDもしくは抗血栓剤が使用されており、NSAIDは計25例(39.1%)に、抗血栓剤は計20例(31.3%)に使用されていた。出血原因は、大腸憩室出血が26例(40.6%)と最も多く、次いで出血性直腸潰瘍18例(28.1%)、大腸angiodysplasia 15例(23.4%)の順であった。止血法は、憩室出血と直腸潰瘍ではクリップ法が、angiodysplasiaではHSE局注およびAPC法が高頻度に選択されていた。止血成績は概して良好であったが、止血不能死亡例を1例に認めた。(著者抄録)

The aim of this study was to examine the optimum time of rehabilitation initiation after stroke in terms of disabilities, mobility and fall risk assessment. Data were collected prospectively at seven tertiary level health care centers in Bangladesh during the 36 months period from 2013 to 2016. All respondents were divided into four groups based on the initiation of rehabilitation as: a) 0-24 hours, b) 25-72 hours, c) 4-7 days and d) 8-60 days. Results show that significant improvement on stroke recovery, disabilities reduction, improvement in mobility restriction and reduction of fall risks in all the four groups but more improvement was observed in 0-24 hour’s group during follow-up after 3 and 12 weeks. On multinomial logistic regression analysis, the independent factors shows the mobility restriction and fall risk were more in the younger patients, male gender, married, hemorrhagic lesion and bilateral stroke.

We report a primary hepatic carcinoid tumor occurring in a 47-year-old man. The patient consulted our hospital complaining of epigastralgia. Abdominal ultrasonography, computed tomography scanning, and magnetic resonance imaging showed a large mass in the right lobe of the liver. FDG-PET revealed 18F-FDG uptake by the right hepatic lobe. The tumor was a solid mass with cystic components, approximately 15 cm in diameter. We conducted an extended right lobectomy of the liver. The resected specimen was a solid tumor with cystic components and hemorrhagic lesion. Microscopic findings showed that the tumor cells had round nuclei and formed trabecular patterns. Immunohistologically, tumor cells were stained positive for chromogranin A, neuron specific enolase, CD56, and S-100. Careful examinations before and after the operation revealed no other possible origin of the tumor. Based on these findings, the tumor was diagnosed as a primary hepatic carcinoid. This is a report of a rare case of a primary hepatic carcinoid tumor with a discussion of several other relevant reports.

症例は49才女性．右背部痛にて当院受診し，腹部超音波，単純CTにて，多発する肝嚢胞を認め，そのうち肝前上区域（S8）の嚢胞内に充実性部分が見られたが，造影効果なく，出血を伴った肝嚢胞と診断され経過観察となった．4カ月後に変化を認めなかったが，10カ月後に嚢胞径ならびに充実性部分の増大と内部性状の変化がみられた．各種造影検査で充実性部分に造影効果を認めたため，肝嚢胞腺癌を疑い肝前区域切除を施行した．組織学的に充実性部分は内部出血を伴った凝血塊と壊死組織で，血管腫様の不規則に拡張した血管腔の増生を伴っていた．

Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH.Methods. Three cases of maxillary sinus OH and a literature review are presented.Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion.Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment.

Background The association of a hemorrhagic tumor with secondary superficial siderosis (SS) is a relatively rare although well described phenomenon. Case description We present the case report of a 35-year-old male with a history of drowsiness, hypoacusia, drop attacks, and multidirectional nystagmus during the last 2 months, who presented with acute obstructive hydrocephalus caused by a fourth ventricle mass displaying radiological signs of repeated intra and extratumoral hemorrhage with SS. He underwent gross surgical removal of the solid component of the tumor. Microscopic examination revealed an ependymoma with atypical features, including prominent angiomatous formations and internal chronic hemorrhages with hemosiderin deposits, resembling a cavernoma. The scarce tumoral component, which extended around these cavernous vessels, lacked the gross typical features of fibrillary stroma or perivascular pseudorosettes. Conclusion To our knowledge, including the present case, there are 45 published reports of tumors associating secondary SS. Besides ependymoma, no other hemorrhagic lesion, tumoral or vascular, has been previously published associating a fourth ventricle location with secondary SS. The present case represents the fifth with this finding, and we strongly suggest ependymoma as a presumptive diagnosis when this rare association is encountered. In addition, this appears to be the first case reported in the scientific literature of a hemorrhagic fourth ventricle ependymoma mimicking both, radiologically and histologically, a cavernous malformation.

大腸の出血性病変に対する内視鏡は出血源の検索のみならず, 病変や出血の性状によっては, 同時に内視鏡的止血法も可能である.内視鏡的止血法の適応となる出血のなかで, 露出血管のように点状の出血には, クリップ法, 面状の出血にはヒータープローブ法や局注法が選択される場合が多い.内視鏡的止血法の適応となる病変のなかで, 高頻度であるのは大腸腫瘍の内視鏡的摘除後出血である.内視鏡的摘除後出血に対する止血法は組織侵襲が少ないクリップ法が選択される場合が多く, 止血効果も良好である.大腸憩室からの出血に対しては, クリップ法による憩室開口部の縫縮が止血に有用であった, 大腸の出血性病変に内視鏡的止血を行う際には, 病変や出血の性状によって最適な止血法を選択することが重要であるが, 単独の止血法のみに固執せず, いくつかの止血法を組み合わせて用いることが効果的な場合もある.

Numerous cases of self-inflicted foreign bodies in the male urethra have been reported. A case of a self-inflicted urethral injury or hemangioma in an adolescent that presented a dilemma is described here. An adolescent male of 14 years presented with a complaint of intermittent urethral bleeding for a week. He attributed this to blunt trauma sustained while playing in school. On examination, there was no sign suggestive of any trauma or any abnormal lesion on the genitalia or surrounding area. On cystourethroscopy, there was a solitary hemorrhagic lesion of 0.5 cm with a bluish base on the ventral surface of the pendular urethra, 1 cm proximal to the fossa navicularis, which was ablated using Ho:YAG laser fiber (365 μm) through a working channel mounted in an OIU (optical internal urethrotomy) sheath. The absence of any sign of external trauma or presentation after 1 week of the incident suggests an element of falseness in the history. It may be due to embarrassment or fear, which contributes to self-insertion of foreign bodies into the urethra as the primary cause, especially in adolescent males. However, the trauma can be coincidental, with the bleeding of the urethra caused by a urethral lesion like a hemangioma and might present after a long gap of 1 week due to a lack of understanding or lack of severe symptoms. Most patients of self-inflicted injuries are too ashamed to admit that they inserted any object. A psychiatric evaluation is recommended for all these adolescents, with appropriate medical therapy when indicated.

Introduction: Neuroenteric cysts are a rare type of spinal tumors that result of anomalies during embryonic development. A case with a rare haemorrhagic presentation is reported. Case report: 42 years old male that shows an initial clinical picture consisting of cervical pain. Cervical Magnetic Resonance (MR) reveals a lesion intradural-extramedullar at level C2-C3. Findings are in correlation with hemorrhagic lesion in reabsorption phase. A surgical procedure is performed. Through a bilateral C2-C3 and partial C1 laminectomy the cyst was emptied. The rest of membranes are removed. The patient shows a progressively improvement. The hystopathological analyses find match neuroenteric cyst type A. Discussion: 58 cases of neuroenteric spinal cysts reported in literature are analyzed. Total excision was performed in about 34%. There was any finding about hemorrhagic presentation in neuroenteric cyst in these cases.

A 49-year-old man presented with sudden of change of consciousness and left hemiplegia. He had the history of diabetes mellitus, hypertension and hyperlipidemia; however, he did not receive regular medical treatment. Computed tomography (CT) of brain disclosed a 7.1 × 3.9 cm hemorrhagic lesion (CT number: 70 Hounsfield unit (HU)) in right basal ganglion with suspicious fatty density (CT number: −4 …

The proliferative nodule is a lesion that develops within a congenital nevus. It is usually small (less than 5 mm), sometimes multiple, with a slow growth rate, and has a black or dark brown, smooth, shiny surface. It usually involutes spontaneously. We report a newborn infant who, at birth, had a giant congenital nevus with a nodular, ulcerative, hemorrhagic lesion within it. Physical and neurologic examinations were normal. Radiologic studies at birth and subsequently were normal. A fragment of the lesion was biopsied and histologic findings were compatible with a diagnosis of proliferative nodule in a giant congenital nevus. The rest of the nodule regressed spontaneously after 4 months.