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Nasopharyngeal branchial cleft cysts (NBC) are generally single, unilateral, and asymptomatic. They may get infected or produce obstructive symptoms as it enlarges. The definitive diagnosis is usually confirmed by Magnetic resonance imaging (MRI) and histopathology. A 54-year-old male patient presented with progressive bilateral nasal obstruction, more on the right side, associated with hyponasal voice and postnasal discharge of 2 years' duration. A cystic mass was found by nasal endoscopy on the lateral right side of the nasopharynx, extending to the oropharynx, and was confirmed with MRI findings. Uneventful total surgical excision and marsupialization were done with follow up of nasopharyngeal endoscopic examination on each visit. The pathological features and the site of the cyst were compatible with a second branchial cleft cyst. Although rare, NBC should be considered one of the differential diagnoses of nasopharyngeal tumors. Surgical excision and marsupialization are the main treatment with low complication and recurrence rates.
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Microcystic adnexal carcinoma (MAC) is an infiltrative rare cutaneous neoplasm for which there are no consensus management guidelines because of the paucity of evidence-based practice; hence, the utility of their management is based only on previously published case reports. We report a case of a scalp lesion that was successfully treated using a combination of surgical resection, chemotherapy, and radiotherapy.
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BACKGROUND AND AIMS: Obesity is still a major health issue worldwide and bariatric surgeries are now considered one of the most effective ways to manage morbid obesity. Women who are obese in their reproductive age appear to be representing the majority of the patients seeking bariatric surgeries, accounting for (80%). The aim of this study is to assess women's awareness level of obstetric and gynecological impact of bariatric surgery on their health. SETTINGS AND DESIGN: A cross-sectional study was conducted using an online survey. METHODS: Online survey was used to collect data which was distributed through social media. Questions regarding the level of knowledge were included along with sociodemographic characteristics of the population. STATISTICAL ANALYSIS USED: The Statistical Package for Social Sciences (SPSS) software was used to conduct the statistics analysis. RESULTS: The survey elicited a total of (457) valid responses that were analyzed. The majority of responses were from married women (66.3%). Most common age group where those from (15 to 24) years. However, nearly about three-quarters of participants were found to have poor knowledge (73.1%) and only small percentage had a good level of knowledge (3.3%) and the rest of the participants were in the moderate group. Further analysis showed that good knowledge was among those who have consulted a physician, underwent bariatric surgery, whom source of information was the internet, and whom had more than one source. CONCLUSION: The level of knowledge regarding the obstetric and gynecological impact among females was found to be poor in the eastern region of Saudi Arabia.
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[This corrects the article DOI: 10.1186/s13017-017-0141-6.].
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Retained foreign bodies after surgery is a rare condition which can have medico-legal consequences. Foreign bodies forgotten in the abdomen include towels, artery forceps, pieces of broken instruments or irrigation sets, and rubber tubes. The most common surgically retained foreign body is the laparotomy sponge. Such materials cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. We report a case of 41-year-old female admitted with features of intestinal obstruction and had a previous history of hysterectomy performed 2 months back at another hospital. Pathologists must be aware of this entity and its proper reporting as the cases are liable to go to court. Surgeons must recognize the risk factors that lead to a gossypiboma and take measures to prevent it.
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BACKGROUND AND AIMS: We carried out this study in order to know the epidemiology and management strategies for breast cancer patients in our patient population. SETTINGS AND DESIGN: The epidemiological data pertaining to demography and risk factors for carcinoma breast were analyzed retrospectively in patients admitted to a tertiary care hospital of North India. MATERIALS AND METHODS: Hospital records of 304 patients admitted for over a period of five years (January 1998 to December 2002) were used for data analysis. STATISTICAL ANALYSIS USED: Paired T-test. RESULTS: Mean age of our female breast cancer patients was found to be lower compared to the western world, with an average difference of one decade. A majority of the patients were from a rural background and had a longer duration of symptoms compared to urban patients. Lump in the breast was a dominant symptom. Familial breast cancer was uncommon. Left sided breast cancer was slightly preponderant. Screening by mammography and staging procedures such as bone scan, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI) were sparsely used. The most common histology was infiltrating duct carcinoma. CONCLUSION: Modified radical mastectomy was found to be a safe operative procedure. Breast conservative surgery, although considered the gold standard in early breast cancer, was found unsuitable for our patients, due to the social background and lack of intensive radiotherapy and chemotherapy backup. Infiltrating duct carcinoma was more commonly associated with positive lymph nodes compared to other histopathologies. Cases operated by surgical oncologists had better axillary clearance. Neoadjuvant chemotherapy was used mainly by surgical oncologists suggesting a more rational approach toward the management of breast carcinoma.
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Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama Masculina/diagnóstico , Neoplasias da Mama Masculina/epidemiologia , Neoplasias da Mama Masculina/terapia , Terapia Combinada , Feminino , Cirurgia Geral/estatística & dados numéricos , Hospitais , Humanos , Índia/epidemiologia , Masculino , Mastectomia , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Fatores de RiscoRESUMO
BACKGROUND: We address the prognostic and predictive value of KRAS, PIK3CA and BRAF mutations for clinical outcomes in response to active agents in the treatment of metastatic colorectal cancer (mCRC). METHODS: We determined KRAS, BRAF and PIK3CA mutations in tumours from 168 patients treated for mCRC at two institutions. All patients received 5-FU-based first-line chemotherapy and treatment outcome was analysed retrospectively. RESULTS: KRAS, BRAF and PIK3CA mutations were present in 62 (37%), 13 (8%) and 26 (15%) cases, respectively. Multivariate analysis uncovered BRAF mutation as an independent prognostic factor for decreased survival (hazard ratio (HR) 4.0, 95% confidence interval (CI) 2.1-7.6). In addition, patients with BRAF-mutant tumours had significantly lower progression-free survival (PFS: HR 4.0, 95% CI 2.2-7.4) than those whose tumors that carried wild-type BRAF. Among 92 patients treated using chemotherapy and cetuximab as salvage therapy, KRAS mutation was associated with lack of response (P=0.002) and shorter PFS (P=0.09). BRAF (P=0.0005) and PIK3CA (P=0.01) mutations also predicted reduced PFS in response to cetuximab salvage therapy. CONCLUSIONS: These results underscore the potential of mutational profiling to identify CRCs with different natural histories or treatment responses. The adverse significance of BRAF mutation should inform patient selection and stratification in clinical trials.
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Neoplasias Colorretais/genética , Mutação , Fosfatidilinositol 3-Quinases/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas/genética , Proteínas ras/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Cetuximab , Classe I de Fosfatidilinositol 3-Quinases , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Valor Preditivo dos Testes , Prognóstico , Proteínas Proto-Oncogênicas p21(ras) , Terapia de SalvaçãoRESUMO
Primary intraosseous meningioma of the skull is an uncommon lesion often confused preoperatively with a primary bone tumor of the skull. We report this rare tumor in a 19-year-old male who was radiographically diagnosed as osteoid osteoma.
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Neoplasias Meníngeas/patologia , Meningioma/diagnóstico , Neoplasias Cranianas/patologia , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Radiografia , Neoplasias Cranianas/diagnóstico por imagemRESUMO
Homozygous sickle cell disease (SCD) is characterised by increased soluble P-selectin (sP-selectin), suggesting increased platelet activation, and high non-transferrin-bound iron (NTBI), reflecting iron overload, possibly due to blood transfusion. Hypothesising a relationship between these processes, we measured both markers in 40 SCD patients and 40 age/gender/race-matched controls, finding increased levels of each marker in the patients (both P<0.001), but more pertinently a significant NTBI/sP-selectin correlation (r=0.52, P<0.001). Both indices were increased in the blood of 15 recently-transfused patients compared with 25 three-month transfusion-free patients (P<0.001), but only sP-selectin was higher in present sickle crisis (P<0.001). We suggest that increased NTBI associated with blood transfusion iron overload in SCD may promote platelet activation.
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Anemia Falciforme/sangue , Plaquetas/patologia , Sobrecarga de Ferro/sangue , Selectina-P/análise , Transferrina/análise , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Ferro/metabolismo , Masculino , Selectina-P/sangue , Estatística como Assunto , Transferrina/metabolismoRESUMO
BACKGROUND AND OBJECTIVES: Non-transferrin bound iron (NTBI) is associated with increased morbidity in a number of transfusion-dependent disease states such as the severe haemoglobinopathies. We hypothesized that this may be related to excess NTBI present in plasma-depleted red blood cell units that are free of clear haemolysis. MATERIALS AND METHODS: The level of NTBI was determined using the bleomycin assay in samples from 20 stored plasma-depleted red cell units, at approximate 5-day intervals up to day 33 after donation. Forty units of fresh-frozen plasma (FFP) and 40 units of platelet concentrates were used as negative controls, and samples from 12 units of FFP were also serially assessed. RESULTS: Median [interquartile range (IQR)] NTBI was 0 microm (0-0.35) in samples taken from units 3-10 days after donation. Thereafter, the levels of NTBI increased, becoming significant (median 3.05; IQR: 0.05-6.7 microm) 17-22 days after donation. After 30 days, NTBI was detectable in all red cell units. NTBI was undetectable in platelet concentrates and FFP. CONCLUSIONS: Increased levels of NTBI become detectable 17-22 days after donation and increase further with storage time. This excess NTBI may promote bacterial infection in iron-loaded individuals.
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Transfusão de Eritrócitos , Sobrecarga de Ferro/etiologia , Substitutos do Plasma/química , Infecções Bacterianas , Preservação de Sangue/métodos , Eritrócitos , Humanos , Sobrecarga de Ferro/complicações , Fatores de Tempo , Transferrina/fisiologiaRESUMO
Decreased serum vitamin E levels are found in homozygous sickle cell disease (SCD). Excessive transfusions may lead high non-transferrin-bound iron (NTBI). Hypothesizing a relationship between the two, vitamin E (measured using high performance liquid chromatography) was significantly lower in 30 SCD patients than in 30 age-/sex-matched controls (P < 0.001), but NTBI (bleomycin assay) was higher (P < 0.001). Vitamin E was lower in 10 transfused patients than in 20 non-transfused patients (P < 0.001) with a significant inverse correlation between the NTBI and vitamin E (r = -0.58, P < 0.001). NTBI associated with iron overload in SCD may increase the potential for oxidative damage and low vitamin E activity may compound this effect.
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Anemia Falciforme/sangue , Antioxidantes/análise , Ferro/sangue , Vitamina E/sangue , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , Estudos de Casos e Controles , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Transferrina/análiseRESUMO
Post-term choriocarcinoma is an infrequent event with poor prognosis. The diagnosis is usually delayed due to failure to recognise the mode of presentation of this disease. Being a rare occurrence, limited data is available regarding its clinical features. The choriocarcinoma in our patient presented as an isolated huge pedunculated growth over the uterine serosa without intrauterine involvement and distant metastasis.
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Coriocarcinoma/diagnóstico , Neoplasias Pélvicas/diagnóstico , Período Pós-Parto , Neoplasias Uterinas/diagnóstico , Adulto , Coriocarcinoma/diagnóstico por imagem , Coriocarcinoma/patologia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/patologia , Gravidez , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologiaAssuntos
Doenças Parotídeas/diagnóstico , Tuberculose Bucal/diagnóstico , Abscesso/microbiologia , Adolescente , Antituberculosos/uso terapêutico , Biópsia , Quimioterapia Adjuvante , Humanos , Masculino , Doenças Parotídeas/complicações , Doenças Parotídeas/cirurgia , Tuberculose Bucal/complicações , Tuberculose Bucal/cirurgiaRESUMO
An 8-year-old male presented with an acute abdomen. Exploration revealed bilious ascites, oedematous pancreatitis with areas of necrosis, and omentum showing patches of fat necrosis. The common bile duct and almost all of the common hepatic duct were gangrenous and had sloughed, with bile leaking from the junctional stump of the right and left hepatic ducts. The patient was managed successfully by Roux-en-Y hepaticojejunostomy. This is a rare case showing necrosis and sloughing of the extrahepatic bile ducts in acute pancreatitis.
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Ducto Colédoco/patologia , Ducto Hepático Comum/patologia , Pancreatite/complicações , Doença Aguda , Anastomose em-Y de Roux , Criança , Necrose Gordurosa , Humanos , Masculino , Necrose , Omento/patologia , Compostos Radiofarmacêuticos , Disofenina Tecnécio Tc 99mRESUMO
A case of hydatid disease of lung and liver is described. The patient was investigated because of a circumscribed shadow in the right lung on chest skiagram. Another cystic shadow was picked up in the right lobe of liver on ultrasound examination. Both the cysts in right lung and liver were removed simultaneously through a right thoracophrenotomy. Emphasis is being laid on the utilization of single stage thoracotomy as an operative procedure of choice for hydatid cysts of right lung and liver.
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Equinococose Hepática/diagnóstico , Equinococose Hepática/cirurgia , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/cirurgia , Toracotomia/métodos , Adulto , Equinococose Hepática/diagnóstico por imagem , Equinococose Pulmonar/diagnóstico por imagem , Feminino , Humanos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A rare case of primary vaginal calculus is presented. The case is unusual since it occurred after abdominoperineal resection for carcinoma rectum. The mechanism of stone formation in the patient has been discussed.
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Adenocarcinoma/cirurgia , Complicações Pós-Operatórias/diagnóstico , Neoplasias Retais/cirurgia , Cálculos Urinários/etiologia , Doenças Vaginais/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Cálculos Urinários/diagnóstico , Doenças Vaginais/diagnósticoRESUMO
AIMS: To determine whether nontransferrin bound iron is present in the serum of long term survivors of acute leukaemia and bone marrow transplantation who have liver dysfunction as indicated by consistently raised serum aspartate aminotransferase (AST) activities. METHODS: Thirty eight patients, who were at least three years from the end of treatment, were studied. Serum samples were analysed for hepatitis C, hepatitis B, AST, ferritin, and non-transferrin bound iron. A bleomycin based assay was used to detect non-transferrin bound iron. Patient and blood bank records were examined to determine the number of units of transfused blood received by each patient. RESULTS: Ten patients had consistently raised serum AST activities. Of these, two had evidence of hepatitis C infection, one had chronic hepatitis B infection and one had chronic graft versus host disease affecting the liver. None of these four patients had detectable non-transferrin bound iron. The remaining six patients had no obvious reason for raised AST activities, but four had non-transferrin bound iron detectable in their serum as compared with only two out of 28 patients with normal AST activities. Patients with abnormal AST activities had higher serum ferritin concentrations than those with normal AST, though serum ferritin was raised in 21 of 28 patients without liver dysfunction. CONCLUSION: Non-transferrin bound iron may be found in this group of patients, suggesting that iron overload is the cause of the observed liver dysfunction. Non-transferrin bound iron may also be a more specific indicator of iron overload than the serum ferritin concentrations.
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Transplante de Medula Óssea/efeitos adversos , Hemossiderose/etiologia , Ferro/metabolismo , Leucemia/terapia , Linfoma/terapia , Adulto , Idoso , Aspartato Aminotransferases/sangue , Feminino , Ferritinas/sangue , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/enzimologia , Doença Enxerto-Hospedeiro/metabolismo , Hemossiderose/enzimologia , Hemossiderose/metabolismo , Hepatite/complicações , Hepatite/enzimologia , Hepatite/metabolismo , Humanos , Ferro/sangue , Masculino , Pessoa de Meia-Idade , SobreviventesRESUMO
We report a case of fire during routine arthroscopy. This is an unusual but potentially disastrous complication. Recommendations are presented for preventing such an event.
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Artroscópios , Incêndios , Complicações Intraoperatórias/etiologia , Traumatismos do Joelho/cirurgia , Adulto , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Luz , MasculinoRESUMO
AIMS: To investigate and characterise the appearance of non-transferrin bound iron (NTBI) in the serum of patients after cytotoxic chemotherapy and to compare this with the onset and duration of neutropenia. METHOD: Non-transferrin bound iron was measured by a bleomycin assay in patients undergoing intensive chemotherapy for treatment of acute leukaemia or lymphoma. RESULTS: NTBI was detected after 26 of 27 courses of chemotherapy and lasted for a mean of 14.5 days. The presence of NTBI correlated with the serum iron binding saturation, but not with serum ferritin. Neutropenia occurred after all courses of chemotherapy and lasted for a mean of 20.0 days. NTBI and neutropenia occurred concurrently after 23 courses of chemotherapy, and had a mean joint duration of 9.5 days. CONCLUSIONS: NTBI is consistently present in the serum of patients after cytotoxic chemotherapy, often at the same time as the patient is neutropenic. This may be an additional risk factor for the development of infective episodes after chemotherapy.