RESUMO
Carcinoids are a rare and slow growing tumor, having a propensity to affect all organs but most commonly involve the gastrointestinal tract, followed by lungs. Carcinoid tumors secrete a variety of peptides and neuroamines. Though clinical presentation is varied and depends on the involved organ along with produced neuroactive amines, common symptoms include flushing, explosive watery diarrhoea and bronchospasm. Estimation of 5-HIAA in 24-hour urine is highly specific. Serum chromogranin is highly sensitive even in non-secretory carcinoids. Octreoscan along with MIBG is a better diagnostic modality as compared to computed tomography or magnetic resonance imaging alone. Treatment involves a multidisciplinary approach, including resection of primary tumor and debulking, embolisation of liver carcinoids, somatostatin analogues and chemotherapy. Molecular target therapy with Sunitinib and Bevacizumab have been shown to have a promising role in treatment, with higher response rate and slower progression.
RESUMO
INTRODUCTION: Giant urinary bladder calculus in an adult is an uncommon entity. The number of patients with giant bladder calculi has decreased over recent years owing to wider availability of healthcare and better diagnostic modalities. CASE REPORT: We present a case of a young adult without any history of recurrent urinary tract infections or bladder outlet obstruction with giant vesical calculus who presented to the emergency department with gross hematuria, abdominal pain, and dysuria. Investigations revealed a large calculus in the urinary bladder, and suprapubic cystolithotomy was performed. A large stone of 6.5×6×5.5 centimeters, weighing 125 grams, was removed. On follow-up, the patient was free of any symptoms and cystoscopy was normal. CONCLUSION: Urinary outflow obstruction must be ruled out in all patients with giant vesical calculus. Patients without any predisposing condition should be treated as a separate entity and evaluated accordingly. Multiple surgical treatment modalities are available for bladder calculus patients. Treatment is personalised as per size of stone, number of stones, and associated comorbidities.
RESUMO
Background: Gastrointestinal perforations constitute a major cause of patients with acute abdomen pain coming to the surgery emergency room. Incidence, site of perforation, and age is different in the developing world and is showing new trends. The etiological spectrum in the developing world is different from the western world. This study was conducted to find out the latest trends in perforation peritonitis in India. Methods: This study was conducted in a single surgical unit of Darbhanga Medical College and Hospital, India. A total of 350 consecutive patients with perforation peritonitis were studied in terms of age, sex, seasonal variation, biochemical parameters, clinical presentation, radiological and intraoperative findings, surgical intervention, and postoperative outcome. Results: The most common cause of perforation peritonitis in our study was a duodenal ulcer (~50%) followed by typhoid (20%), traumatic (14.5%), appendicular (7.4%), and tubercular (3.1%) cases. Males were three times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life. Peptic ulcer perforations were common in autumn and winter and typhoid perforations were common during the summer and rainy seasons. Conclusion: Spectrum of perforation peritonitis cases in this part of world is different from developed western countries. It is different in respect of younger age at presentation, site of perforation, and etiological factors. Infective pathology makes up to a quarter of total cases in the developing world. The developing world has more perforation peritonitis cases involving the upper gastrointestinal tract, while the western world has a predominance of lower gastrointestinal tract perforations.