Unexpected Cause Research Articles

Intraplacental choriocarcinoma as an unexpected cause of intrauterine death at term

Intraplacental choriocarcinoma is rare. It can cause fetal death at term by fetomaternal hemorrhage. We present a case of intraplacental choriocarcinoma. After a hydatidiform mole with persistence of throphoblastic disease, the patient delivered a stillborn baby at term. Massive fetomaternal hemorrhage was the unexpected cause of death. Choriocarcinoma was only diagnosed after pathologic revision of the placenta because of persistent high levels of serum hCG (human chorionic gonadotropin). Massive fetomaternal hemorrhage should alert the obstetrician and the pathologist to the possibility of choriocarcinoma arising from the placenta.

An unexpected cause of Small Intestinal Obstruction in Crohn's Disease

An unexpected cause of Small Intestinal Obstruction in Crohn's Disease

Urinothorax: an unexpected cause of severe dyspnea

Dear Editor: Recently, Tortora et al. [1] reported on a case of urinothorax with severe dyspnea. This description is of interest because urinothorax is rarely recognized. To date, less than 60 cases have been reported [2, 3]. However, to diagnose urinothorax is very important; in a patient with obstructive uropathy and pleural effusion, if the effusion is a urinothorax, no further diagnostic tests are necessary because it disappears after the resolution of the obstruction. To consider this possible diagnosis is of interest especially in patients whose obstruction is caused by a malignant disease. Due to this importance, we consider it to be of interest to present some clinical, radiological, and biochemical data that could help in its diagnosis. Reviewing the literature, we have found two groups of urinothorax: those associated with bilateral obstruction (prostate disease or bladder cancer, for instance) and those associated with a traumatic cause (including surgical injury or blunt trauma) [3]. In most cases, urinothorax do not produce respiratory symptoms, but cases with severe dyspnea have been described [1, 2]. In cases of unilateral lesion, the effusion tends to be ipsilateral to this side. Urinothorax resolves without treatment after the resolution of a urinary problem. Therefore, establishing the diagnosis is necessary to perform a thoracocentesis. The fluid looks and smells like urine and it is a transudate with a creatinine concentration higher in pleural fluid than in serum, as in the case reported by Tortora et al. [1]. Probably, urinothorax is more frequent than is recognized, but the scarcity of reported cases might be due to the low index of suspicion (it would not always be suspected) and because it occurs in a clinical scenario where urological problem predominates and rapidly resolves. The publication by Tortora et al. [1] demonstrates the contribution of emergency radiologists in the suspicion and the detection of this rare entity.

Urinothorax: An unexpected cause of pleural effusion

Urinothorax is an unexpected cause of transudative pleural effusion associated with obstructive uropathy. We present a case of urinothorax in a patient with congestive heart failure who had undergone percutaneous nephrolithotomy. The diagnosis was made after an unexpected enlargement of the pleural effusion after treatment with diuretics.

Urinothorax: an unexpected cause of severe dyspnea

We report an unusual cause of the pleural effusion due to extravasation of urine from the retroperitoneal space into the thoracic cavity. In our case, the urinoma occurred owing to obstructing urinary tract lesion due to opaque stone. Although rare, urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma.

An unexpected cause of abdominal pain in a peritoneal dialysis patient

Sirs, In the recent issue of the journal, pelvic inflammatory disease in a pediatric peritoneal dialysis patient was presented by Ozcakar et al. as an unexpected cause of abdominal pain during continuous ambulatory peritoneal dialysis (CAPD). Although peritonitis is a main cause of abdominal pain in CAPD patients, other primary abdominal events occasionally develop and surgery is frequently considered in such cases. We herein report a CAPD patient who presented with abrupt abdominal pain and was finally diagnosed with intussusception of the jejunum associated with a juvenile polyp. This is, to the best of our knowledge, the first report of a case of intussusception as a complication in a CAPD patient. A 16-year-old boy was admitted to our hospital because of severe abrupt abdominal pain and recurrent vomiting. He had been undergoing CAPD since he was 13 years of age because of a chemotherapyinduced nephropathy for acute lymphocytic leukemia which had developed when he was 3 years of age. He was oliguric and needed five cycles of peritoneal dialysis a day to keep his blood pressure normal. On admission, he had severe pain and tenderness in his epigastric region. Laboratory studies showed the following: WBC 7,500/μl, hematocrit 36.1%, platelets 208,000/μl, serum total protein 7.1 g/dl, albumin 4.1 g/dl, blood urea nitrogen 62 mg/dl, creatinine 12.8 mg/dl, sodium 144 mEq/l, potassium 4.0 mEq/l, chloride 97 mEq/l, amylase 114 IU/l (normal range: 35–133 IU/l), and C-reactive protein 0.1 mg/dl. The dialysate was clear and not bloody. On abdominal Xray examination, neither air-fluid level nor free air was noted. However, a segmental dilation of the small intestine with edematous thickening of the intestinal wall was noted on computed tomography and on ultrasonography, suggesting a possibility of adhesionrelated strangulation of the intestine. A laparotomy was performed on the following day and the operative findings, however, showed an intussusception of the jejunum that was about 20 cm in length at the portion of 80 cm from the ligament of Treitz. After closed reduction of the intussusception, because a polyp was tangible at the lead point of the intussusception from outside of the intestinal wall, the bowel was removed about 40 cm in length including the polyp. The polyp was identified as a juvenile polyp in the jejunum that was about 2 cm in length. After the operation, his symptoms disappeared and he could carry on peritoneal dialysis after a short period of transition to hemodialysis. Although the association of his intussusception with the implementation of CAPD is unclear, this case indicates that intussusception should also be included as one of the unexpected causes of abdominal pain in patients undergoing peritoneal dialysis.

Pathological Calcification: Crystallization, Infection, or Cell Transdifferentiation

It is becoming increasingly clear that the pathophysiology of calcification within diseased human tissues is complex. Inflammation appears to be associated with many calcific processes, including advanced atherosclerosis, nephrolithiasis, and calciphylaxis of end-stage renal disease. In all three instances characteristic cellular responses could potentially either mediate or ameliorate the calcific response. Increasingly, microorganisms are being identified as an unexpected cause of disease, with a recent well-known example being the association of H. pylori and peptic ulcer. The possibility that microorganisms contribute to pathologic calcification and the associated inflammation is, however, controversial. This symposium will examine evidence for three possible but not mutually exclusive mechanisms of pathologic calcification: (1) processes that drive and influence inorganic crystallization; (2) the mechanisms by which cells mediate crystallization, including cell transdifferentiation; and (3) evidence for the presence of calcifying microorganisms within diseased human kidneys and arteries. The program will conclude with a panel discussion led by a moderator who will comment on divergent points from the perspective of a pathologist.

Unexpected cause of raised benzene absorption in coke oven by-product workers

Urinary biological monitoring for benzene (by measuring benzene metabolites) in coke oven by-product workers produced the unexpected result that 2 out of 10 employees had significantly raised urinary S-phenylmercapturic acid (S-PMA). However, simultaneous personal air sampling showed no excessive airborne exposure. Possible causes for this finding were investigated having excluded inhalation as the route of uptake. It was suspected that skin absorption via contaminated overalls was the possible mechanism and a standard frequency for overall change was introduced. Changing overalls after every four shifts reduced uptake levels to less than the equivalent of 1 ppm inhaled dose for all employees. Skin absorption of benzene in coke oven by-product workers from contaminated overalls can be significant and therefore overalls should be changed on a regular and frequent basis.

Ureteral Stenosis Secondary to Granulomatous Vasculitis

Vasculitic syndromes are a group of disorders characterized by inflammation of the blood vessels. They include polyarteritis nodosa (PAN), Churg-Strauss syndrome (CS), and Wegener granulomatosis (WG) that differ on type, size, and location of the involved vessels. We report a rare case of granulomatous vasculitis leading to ureteral stenosis in the absence of other systemic manifestations of the disease. The patient was a 56-year-old woman who began to complain of left lumbar pain, nocturia, and dysuria. Computed tomography scan demonstrated a large abdominal mass with ureteral compression. A tissue specimen obtained by laparotomy revealed the presence of a chronic inflammatory process with fibrosis, granulomatous reaction, extravascular eosinophilia, and prominent vasculitis. She was put on corticosteroids and azathioprine with a decrease of the tumoral mass. This incompletely classified vasculitis was an unexpected cause of the abdominal mass.

An unexpected cause of angina detected by ECG-gated cardiac computed tomography

Until recently anomalous coronary artery anatomy was only identified either by coronary angiography, at autopsy, or during cardiac surgery. With recent developments in the area of cardiac imaging, ECG-gated cardiac computed tomography (CT) has emerged as a minimally invasive modality to delineate both coronary anatomy and pathology. We present a case of an anomalous right coronary artery origin from the ascending aorta detected by ECG-gated cardiac CT in a 47 year-old male who presented to the emergency department complaining of acute chest pain after intense exercise. Given its relatively non invasive nature, ECG-gated cardiac CT may assist in the diagnosis and management of patients with atypical chest pain in which more invasive diagnostic examinations (i.e. coronary angiography) are not warranted.

Crisis management during anaesthesia: obstruction of the natural airway

Background: Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences...

Carboxyhemoglobin formation as an unexpected side effect of inhaled nitric oxide therapy in severe acute respiratory distress syndrome

To report an unexpected cause of carboxyhemoglobinemia associated with inhaled nitric oxide therapy in severe acute respiratory distress syndrome. Case report. Medical critical care unit at Lausanne University Hospital. One female patient with acute respiratory distress syndrome treated with inhaled nitric oxide, who developed a simultaneous increase in blood methemoglobin and carboxyhemoglobin. Potential pathophysiologic mechanisms linking acute respiratory distress syndrome, inhaled nitric oxide, methemoglobin, and carboxyhemoglobin are discussed. Since carboxyhemoglobin has a negative influence on oxygen-carrying capacity, this effect may potentially offset the beneficial influence (if any) of inhaled nitric oxide on arterial PO2. This observation does not support the use of inhaled nitric oxide in the treatment of acute respiratory distress syndrome.

Plasmodium falciparum infection as an unexpected cause of anemia in a healthy parturient

Plasmodium falciparum infection as an unexpected cause of anemia in a healthy parturient

GH- deficiency as an unexpected cause of erectile dysfunction (ED)

Objectives: Experimental data suggest a direct involvement of the GH/IGF-1 axis in the regulation of penile erection by dose dependant stimulation of endothelial nitric oxid formation. Moreover, in healthy men systemic GH serum levels significantly increased during penile tumescence. The present study was designed to better evaluate a potential involvement of GH deficiency (GHD) in a subgroup of patients with ED. Material and Methods: Serum IGF-1 was measured in 100 unselected patients with a diagnosis of ED for more than six months.Patients with severe organogenetic or psychogenetic causes of ED were excluded. If IGF-1 serum levels were below the age- adjusted 10th percentile dynamic testing of the GH axis was performed (insulin- tolerance- test, combined arginine/GHRH- test). Patients with a peak GH response of 33kg/m2. 15 subjects showed no exclusion criteria and were tested by the ITT. 4 of them showed a partial GHD and 2 a severe GHD in both tests. Control of other pituitary axes and a neuroradiological control by MRT showed no signs of any other pituitary disease. Conclusions: Our results suggest that ED is associated with unexpected failure of GH secretion in adults in an unexpected high proportion. Despite the good experimental evidence of a link between GHD and ED direct testing by GH substitution is warranted to evaluate a causal link between both conditions.

GH- Deficiency as an unexpected cause of erectile dysfunction (ED)

GH- Deficiency as an unexpected cause of erectile dysfunction (ED)

Plasmodium falciparum infection as an unexpected cause of anemia in a healthy parturient

Plasmodium falciparum infection as an unexpected cause of anemia in a healthy parturient

Estimated Radiation Dose from a Mox Fuel Shipping Package that is Hypothetically Submerged in the Sea

The sea transport of fresh MOX fuel from Europe to Japan is under consideration. For the structure and equipment of transport ships for fresh MOX fuels, there is a special safety standard called the INF Code of the IMO. For transport of radioactive materials, there is a safety standard stipulated in the Regulations for the Safe Transport of Radioactive Material issued by the IAEA. Under these, code and standard, fresh MOX fuel will be transported safely by sea. However, a dose assessment has been made by assuming that a fresh MOX fuel package might be sunk from some unexpected cause. In both cases, for a package sunk in the coastal region and for one sunk in the open sea, the evaluated results of the dose equivalent by radiation exposure of the public are far below the dose equivalent limit of the ICRP recommendation (1 mSv.y−1).

Unexpected findings in the investigation of an airplane crash

We report on the discovery at autopsy of an unexpected cause of a crash during landing of a small sports plane with four people on board. Surprisingly, an intact bullet and fragments of the casing were found in the body of the pilot. As expected, autopsy of the other passengers predominantly revealed signs of polytraumatization. In addition, one passenger had a tunnel wound to the left hand and another, a soft tissue tear between the thumb and forefinger of the right hand. These wounds were considered to be associated with a shooting incident in the cabin. The autopsy findings and additional gunpowder trace investigations suggested that the pilot had been incapacitated by a shot from behind, resulting in the plane crash. The present findings underscore the importance of conducting autopsies on all air crash victims.

Post-mortem examination after cardiac surgery.

Following a recent enquiry into surgery at a paediatric cardiac centre in England, there will be substantial changes in the way that the success and failure of surgical procedures will be monitored and investigated. Post-mortem examinations on patients dying after cardiac surgery are likely to be performed and reported in more detail. This review describes the protocol that we have developed and summarizes recent clinical and pathological studies that have increased our understanding of postoperative pathophysiology. Close attention should be paid to the history, particularly the operation note. Cardiac failure is the commonest cause of death. We believe this is a clinicopathological diagnosis and provide definitions of preoperative and perioperative cardiac failure. Haemorrhage, stroke, pulmonary emboli and infection are other important causes of death. Methods of dissection are suggested for bypass grafts and valve replacements. Two recent studies show that the post-mortem examination provides answers to most clinical questions and reveals an unexpected cause of death in 10-15% of patients. There are limitations however: an incomplete or indeterminate cause of death is found in 14-25% of patients, most commonly sudden clinically unexplained death or clinically unexplained cardiac failure soon after surgery.

An unexpected cause for combined deficiency of coagulation factors V and VIII

Clinical GeneticsVolume 54, Issue 1 p. 22-23 An unexpected cause for combined deficiency of coagulation factors V and VIII First published: 23 April 2008 https://doi.org/10.1111/j.1399-0004.1998.tb03687.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume54, Issue1July 1998Pages 22-23 RelatedInformation