An unusual case of triple location (skull, patella and thigh) Cryptococcus neoformans is described. The peculiarity of the case is based on the probability of direct post-traumatic bone inoculation, subsequent seeding from skull to patella, thigh and cerebral spinal fluid (CSF), patella involvement, lack of evidence of lung involvement and lack of predisposing underlying disease. The response to surgery and a combination of amphotericin B and 5-flucytosine administration was favorable without relapse at follow-up after 7-year discontinuation of therapy.
An awareness of the surgical anatomy and the possible dispositions of the recurrent laryngeal nerve (RLN) is helpful in avoiding its injury during thyroidectom y.The relationship of the RLN to the trachea and its course relative to the tracheoesophageal plane were studied in 151 patients undergoing thyroidectomy. One hundred sixty-six (166) nerves were identified, 95 on the right and 71 on the left.Most nerves, both on the right (59%) as well as the left (53.5%), ran posterior to the tracheoesophageal plane. Most right nerves (84.2%) had an oblique course in the frontal plane as related to the tracheal axis or midline (deviation); on the left, most nerves (57.8%) showed no significant deviation. The nerves were found to course from posterior to anterior in the sagittal plane as they ascended the neck in 52.5% of cases on the right (type I1 obliquity), whereas on the left, 50.7% of the nerves ran in this direction. Approximately 37.2% of the nerves on the right, and 40.8%, on the left, had no obliquity in the sagittal plane paralleling the tracheal axis.
Collecting duct carcinoma, also known as Bellini duct carcinoma is a rare renal tumour of high malignancy. Though generally symptomatic, the aggressive nature of most of these tumours is such that more than 50% of patients have metastatic disease at the time of initial diagnosis. We describe the case of a 59-year-old man who presented to our hospital with a periodical pain in the left lumbar region. Grey-scale sonography of the left kidney showed an ill-defined tumour, almost isoechoic to renal cortex. The tumour was centrally located, with extension to the cortex and did not cause bulging of the renal outline. On contrastenhanced ultrasonography (U/S) and on contrastenhanced magnetic resonance imaging (MRI), the tumour was inhomogeneously hypoenhancing. The patient underwent a left radical nephrectomy. Histological diagnosis indicated collecting duct carcinoma of the kidney. The differential diagnosis between conventional or papillary renal carcinoma may be difficult and in these cases the molecular genetic findings are important, since all tumours have shown monosomies for chromosomes 1,6,14,15 and 22 and have lacked the changes seen in either conventional or papillary renal carcinoma. The prognosis is poor and about two thirds of patients die of their disease within two years of diagnosis.
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