ABSTRACT
El Tumor Desmoide, es un tumor raro de origen mesenquimal con una incidencia aproximada de 0.3% (1) que, si bien es considerado un tumor benigno por no presentar metástasis a distancia, se considera un tumor localmente agresivo con altas tasas de recidiva tras la extirpación quirúrgica de entre el 19 a 28% (2). Se presenta el caso clínico de una mujer de 21 años de edad, gestante de 7 semanas, que acudió a consulta a la Unidad de Mastología del Hospital de Clínicas por percatarse de nódulo en cuadrante superoexterno de mama derecha, que aumenta de tamaño. Se realizó exéresis tumoral con márgenes, cuyo diagnóstico fue un Tumor Desmoide y, posterior resección de márgenes para ampliación. El Tumor Desmoide es poco frecuente de localización mamaria, que fue tratada con cirugía con buena evolución en una mujer gestante, por lo que debe considerarse esta patología en pacientes jóvenes gestantes, como diagnóstico diferencial en nódulos mamarios.
Desmoid tumor is a rare tumor of mesenchymal origin with an approximate incidence of 0.3% (1). Although it is considered a benign tumor because it does not present distant metastases, it is considered a locally aggressive tumor with high rates of recurrence after surgical removal of between 19 to 28% (2). We present the clinical case of a 21-year-old woman, 7 weeks pregnant, who attended the Mastology Unit of the Hospital de Clínicas, after noticing a nodule in the upper outer quadrant of the right breast, which was increasing in size. Tumor excision with margins was performed, whose diagnosis was a Desmoid Tumor, and subsequent resection of margins for amplifying The Desmoid Tumor is rare in the breast and was treated with surgery with a good evolution in a pregnant woman, so this pathology should be considered in young pregnant patients, as a differential diagnosis in breast nodules.
Subject(s)
Breast Neoplasms , Fibromatosis, Aggressive , Neoplasms , Breast , Pregnant WomenABSTRACT
A mucocele is a mucus-filled, variable-sized, cavity that can appear as a nodule in the oral mucosa. It's a very common exophytic lesion resulting from a salivary accumulation, due to an alteration of the minor salivary gland.They can be categorized according to their etiology: they may occur from extravasation or retention of the secretion.The main one is the extravasation mucocele caused by traumatic rupture of the gland's epithelium spilling out the mucus in the extra-glandular space. The mechanical trauma can be caused by lip biting habits or by a cutting tooth in constant contact with the lip. [1] The collection then triggers an immune reaction in the mucosa with swelling, leading to the formation of granulation tissue with inflammatory cells. At this point, there is a pseudo capsule with no epithelialized lining defining a pseudocyst. [2] However, the retention cyst is a true cyst due to an epithelial proliferation of the exit ducts that generates an obstruction of the salivary flow. [2] Treatment options for mucoceles involve surgical resection, marsupialization, cryosurgery, steroid injection. The surgical excision remains the gold standard therapy for this lesion, but relapse might happen (8.8% on the labial/buccal mucosa). [3]
Subject(s)
Humans , Therapeutics , Mucocele , Salivary Glands, Minor , Lipodystrophy, Familial PartialABSTRACT
Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.
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Introduction: Colloid cysts are one of the benign intracranial tumors most commonly occurring in the rostral part of the thirdventricle. These may present with varied spectrum of clinical features that poses challenges in clinical diagnosis. The presentationmay range from being asymptomatic to simple headaches, seizures, and even sudden death. Most of the symptoms can beattributed to the development of obstructive hydrocephalus. Chemical or aseptic meningitis is unusual complication posingcomplicating differential diagnosis. We describe eight such cases with wide variety of symptoms.Materials and Methods: We present a case series of eight cases of the third ventricle colloid cysts presented at our institute.Age of the patients ranged from 15 to 55 and five of them were females. All the clinical features were recorded from eachone of them. Computed tomography and magnetic resonance imaging were used to diagnose the condition. Four of themunderwent excision of the cyst in single stage either by open or endoscopic approach. Two patients underwent preliminaryventriculoperitoneal shunt done in the view of poor neurological status and craniotomy and excision was done in later stage. Inone patient bedside external ventricular drain was inserted for emergency decompression of ventricles. One patient is underserial radiological follow-up.Results: Eight cases that we observed had wide variety of symptoms. Six patients had chronic headache with progressiveseverity, and four of them had nausea with vomiting, three patients had seizures. The cysts in two patients were discoveredaccidentally, during the evaluation of seizures in one patient and others in evaluation of traumatic head injury. One elderly patienthad presented with psychiatric symptoms, drop attacks along with the features of normal pressure hydrocephalus. One teenagepatient presented with sudden deterioration and went into cardiac arrest even after emergency decompression of ventriclesdone. Seven of them underwent surgery and one of them succumbed. The surgery improved health in all other seven patients.Conclusion: Colloid cysts may present with a wide range and beyond expected neurological manifestations. The severity orrapid clinical deterioration does not exactly correlate with depending on the site, size of the cyst. Leaking cysts with chemicalmeningitis may further complicate the diagnosis. Hence, early diagnosis and surgery with complete removal of cysts offer betterclinical outcomes in those patients.
ABSTRACT
Malignant peripheral nerve sheath tumor (MPNST) is a rare pathologic lesion in a patient with solitary neurofibroma. A 32-year-old man presented with a firm and slightly tender mass in the right infratemporal region involving the right preauricular and temporomandibular joint area. The patient has a history of removal of a solitary neurofibroma 22 years back in the same region. The lesion had enlarged rapidly over the past 3 months, and a spindle cell lesion was diagnosed through a superficial incisional biopsy. Surgical removal of the lesion using modified preauricular transzygomatic approach was done. Histopathologically, it was diagnosed as an MPNST.
ABSTRACT
A giant vesical calculus more than 100 gram is rare entity. Fewer than 30 cases are reported in English literature of vesical calculus more than 100 gm. Largest vesical calculus was of weight 6294 gm by Arthure et al. Available treatment options for vesical calculi include open surgical removal, extracorporeal fragmentation and endoscopic crushing followed by extraction of pieces. Recently, endosurgical mechanical cystolithotripsy followed by percutaneous extraction has been evolved for small or moderate-sized calculi. Our case report demonstrated vesical calculus of 400gms which is a rare finding in today urologic practice.
ABSTRACT
A 1-year-old girl with patent ductus arteriosus (PDA) was admitted for cardiac catheter examination which identified a 7.8 mm Krichenko D type PDA. An Amplatzer duct occluder (ADO) was used but fluoroscopy showed the device at an oblique angle and residual shunt. The girl underwent surgical removal of the device 2 days after deployment because of progression of residual PDA shunt and left pulmonary artery encroachment, suggesting device dislodgement. Median sternotomy was performed, cardiopulmonary bypass was established and dissection was carried out around the PDA. Marked protrusion of the PDA wall made by the ADO retention disc was noted. The main pulmonary artery was incised under cardioplegic arrest. The device was incarcerated in PDA and attempts to remove the device failed. Therefore delivery cable through sheath was reconnected to the device by its microscrew, and the pulmonary end of the device was recaptured into sheath. The incarceration was dissolved and the device was removed. PDA was ligated.
ABSTRACT
Se realizó un estudio descriptivo y transversal de 200 pacientes con leucoplasia bucal, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde septiembre del 2007 hasta igual mes del 2012, a fin de evaluar los efectos terapéuticos del nitrógeno líquido en el tratamiento de esta afección. Este refrigerante se empleó en la remoción quirúrgica de la citada enfermedad y propició una óptima regeneración de los tejidos bucales afectados en el menor tiempo posible. Para ello se aplicaron intervenciones repetidas de enfriamientos súbitos, así como deshielos lentos y espontáneos, con excelentes resultados en los integrantes de la casuística. Esta sustancia criogénica fue efectiva en el epitelio mucoso por sus propiedades, tales como: anestésica, antimicrobiana, antiinfecciosa, cicatrizante e inmunológica y permitió una curación rápida, menos dolorosa, sin riesgo ni complicación e inocua a los tejidos bucales, lo cual impidió la formación de cicatrices residuales.
A descriptive and cross-sectional study was carried out in 200 patients with oral leukoplakia, attended in the stomatology department of the Polyclinic of Specialties in "Saturnino Lora Torres" Provincial Teaching Clinical Surgical Hospital of Santiago de Cuba, from September 2007 to the same month of 2012, in order to evaluate the therapeutic effects of liquid nitrogen in treating this condition. This coolant was used in the surgical removal of the lesion and contributed to a good regeneration of affected oral tissues in the shortest time possible. With this purpose repeated interventions of sudden cooling were applied, as well as slow and spontaneous thaws with excellent results in the members of the case material. This cryogenic substance was effective in the mucosal epithelium by its anesthetic, antimicrobial, anti-infective, healing and immunologic properties, allowing a quick and less painful cure, without risk or complication, and safe for oral tissues, which prevented the occurrence of residual scars.
ABSTRACT
The use of pulmonary artery catheter can be helpful in managing patients after cardiac surgery. Nevertheless, there is a risk of serious complications, such as knotting. A 61 year old man underwent tricuspid valve replacement under cardiopulmonary bypass (CPB). After implantation of a stented tissue valve in the tricuspid valve, repositioning of the catheter was performed. After weaning from CPB, an abnormal pattern of pulmonary artery pressure was suddenly observed on the monitor. Resistance was met when removing the catheter with the balloon deflated, at a 20 cm distance from the tip of the catheter. Chest radiography showed a knot in the catheter within the right brachiocephalic vein. Superior vena cava opened and the distal part of the catheter with the knot was successfully removed.
Subject(s)
Humans , Brachiocephalic Veins , Cardiopulmonary Bypass , Catheters , Organothiophosphorus Compounds , Pulmonary Artery , Stents , Thoracic Surgery , Thorax , Tricuspid Valve , Vena Cava, Superior , WeaningABSTRACT
A 51-yr-old man underwent mitral valve replacement and tricuspid valve repair due to mitral and tricuspid regurgitation under cardiopulmonary bypass. The pulmonary artery (PA) catheter was inserted easily via right internal jugular vein and functioned well until the end of surgery. The surgery was uneventful and patient's hemodynamics were stable both in the operating room and intensive care unit. All PA catheter functions were normal, but the balloon rupture was suspected because it was unable to obtain pulmonary capillary wedge pressure. On attempted removal of the PA catheter at the next day, considerable resistance was encountered and pulmonary artery tracing was dampened. A followed-up chest X-ray revealed the catheter to be in the right pulmonary artery without evidence of knotting. Suture related entrapment was suspected, and on reoperation, PA catheter was found to be sutured at the left atriotomy site. The PA catheter was removed under cardiopulmonary bypass and revealed a hole between proximal port and thermal filament.
Subject(s)
Cardiopulmonary Bypass , Catheters , Hemodynamics , Intensive Care Units , Jugular Veins , Mitral Valve , Operating Rooms , Pulmonary Artery , Pulmonary Wedge Pressure , Reoperation , Rupture , Sutures , Thorax , Tricuspid Valve , Tricuspid Valve InsufficiencyABSTRACT
OBJECTIVE: In the present study, we evaluate visual outcomes after surgical removal of craniopharyngiomas and analyze the factors that are considered to affect visual outcomes. METHODS: This study includes 30 patients with craniopharyngioma, who underwent surgery in this clinic during the last 10 years. The changes of visual function (visual acuity and field) of the patients were assessed preoperatively and postoperatively, and paired data of this change were compared. Also, the factors that influence on this change were analysed. RESULTS: Among the 21 patients complaining of decreased vision before the operation, 8 patients were improved (38.0%), and 7 patients were worse (33.3%). However, Four out of 9 patients without any preoperative visual symptoms developed worse vision after the operation (44.4%). The average duration of symptom was 17.2 months in the improved group and 23.6 months in the aggravated group. The tumors recurred in only 5 patients after the gross total resection: Four of them showed the aggravation of visual function after surgical removal and 1 had improvement. CONCLUSION: After removal of craniopharyngiomas, the overall rate of vision improvement, no change and aggravation are 26.6%, 36.7% and 36.7%, respectively. Aggravation of postoperative visual function is higher in males, children and patients with a longer duration of symptom and the tumor recurres more frequently in patients who complained of worsened vision after surgical removal.
Subject(s)
Child , Humans , Male , CraniopharyngiomaABSTRACT
Subject(s)
Alveolar Process , Deglutition Disorders , Denture, Complete , Eating , Edema , Hematoma , Immunocompromised Host , Incisor , Mandible , Mastication , Molar , Mouth Floor , Mucous Membrane , Seroma , Sutures , Tongue , Ulcer , Wounds and InjuriesABSTRACT
Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Subject(s)
Child , Humans , Infant, Newborn , Male , Abscess , Antifungal Agents , Aspergillosis , Aspergillus , Azotemia , Brain Abscess , Central Nervous System , Dehydration , Drug Therapy , Fever , Granulomatous Disease, Chronic , Hematologic Neoplasms , Immunocompromised Host , Seizures , SurvivorsABSTRACT
Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Subject(s)
Child , Humans , Infant, Newborn , Male , Abscess , Antifungal Agents , Aspergillosis , Aspergillus , Azotemia , Brain Abscess , Central Nervous System , Dehydration , Drug Therapy , Fever , Granulomatous Disease, Chronic , Hematologic Neoplasms , Immunocompromised Host , Seizures , SurvivorsABSTRACT
Desmoplastic small round cell tumor (DSRCT) is a distinct clinicopathologic entity that has only recently been described. This aggressive malignant small cell neoplasm tends to occur in adolescents and young adults, who may present with vague abdominal discomfort or distention. We report a case of DSRCT in a 13 year-old girl who presented with intermittent abdominal pain and bulky intra-abdominal mass, accompanied by an increased serum level of a tumor marker CA125. Clinical, pathological, immunohistochemical and radiologic features were compatible with DSRCT. She is under aggressive combination chemotherapy after surgical resection.
Subject(s)
Adolescent , Female , Humans , Young Adult , Abdominal Pain , Desmoplastic Small Round Cell Tumor , Drug Therapy , Drug Therapy, CombinationABSTRACT
Primary leptomeningeal malignant melanoma is rare entity. We present a case of primary leptomeningeal malignant melanoma of 66-year-old male, who had suffered severe headache, confusion, and right hemiparesis. The brain computed tomography and magnetic resonance image revealed a well enhancing mass with hemorrhage in the left fronto-parietal region. Total surgical removal of the lesion was performed without neurological deficit. He died at home 6 months after operation. Probably, it seems that the cause of death was poor general condition due to obtunded mentality or brain herniation due to increased intracranial pressure. The literature on this subject is briefly reviewed.
Subject(s)
Aged , Humans , Male , Brain , Cause of Death , Headache , Hemorrhage , Intracranial Pressure , Melanoma , ParesisABSTRACT
OBJECTIVE: This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. METHODS: We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. RESULTS: 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th and 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. CONCLUSION: Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.
Subject(s)
Female , Humans , Male , Astrocytoma , Biopsy , Ependymoma , Hematoma , Incidence , Infarction , Magnetic Resonance Imaging , Meningioma , Myelography , Neurilemmoma , Pneumonia , Postoperative Complications , Prognosis , Pulmonary Edema , Radiculopathy , Spinal Cord Neoplasms , Spinal CordABSTRACT
BACKGROUND: Accessory axillary breast tissue is present in approximately 2% to 6% of women, but receives little attention in the surgical literature. Furthermore, a carcinoma, as well as other pathologic changes, can arise within accessory axillary breast tissue. METHODS: Between January 1990 and December 1997 at our clinic, 83 patients underwent surgical removal of accessory axillary breast tissue. All the patients were female, and the ages ranged from 14 to 57 years, with a median of 33.8. The clinical characteristics, indications, and techniques of surgical removal, pathologic findings, and postoperative results were analyzed. RESULTS: The major clinical manifestations were axillary mass (95.2%), pain and/or tenderness (41%), and cyclic change of size (21.7%). In most patients, these symptoms appeared first during puberty (25.3%) and pregnancy (43.4%). On examination, the mass was in the right axilla in 35 patients (42.2%), the left axilla in 19 patients (22.9%) and both axillae in 29 patients (34.9%), and 3 patients had rudimentary accessory nipples. Surgical removal was performed for cosmetic problems (61.5%), clinical symptoms (21.7%), and suspicion of pathologic lesions (9.6%). The excised breast tissue varied in size from 2.5 cm to 14 cm with a median of 6.2 cm. The pathological findings demonstrated ductal dilatation in 21 patients (25.3%), chronic inflammation in 4 patients (4.8%), fibrocystic changes in 3 patients (3.6%) and lactating adenosis in 2 patients (2.4%). Postoperative complications developed in 8 patients (8.3%), and seroma was the most common. In our study, none of the patients experienced recurrence of disease, and 96.4% of the patients enjoyed cosmetically satisfying outcomes. CONCLUSIONS: In conclusion, from our experience, the treatment of choice for accessory axillary breast tissue is surgical removal, which eliminates the clinical symptoms and the aesthetical deformity and provides tissue to rule out any pathologic changes including malignancy. For cosmetically satisfying outcomes, a scar hidden from sight and balanced shapes of both axillae should be kept in mind during the operation.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Axilla , Breast , Cicatrix , Congenital Abnormalities , Dilatation , Inflammation , Nipples , Postoperative Complications , Puberty , Recurrence , SeromaABSTRACT
Currently, laser phtocoagulation is the only recognized therapy for submacular neovascularization. Because of high persistence and recurrence rate and dissatisfying result following laser photocoagulation, other treatment modali-ties have been attempted and one of which is surgical management of neovascular membrane. We investigated the surgical results of 13 eyes of 13 patients who had submacular neovascularization under the fovea which was not amenable to laser photocoagulation.Patients have undergone pars plana vitrectomy and removal of subretinal neovascular membrane.Preoperative and postoperative vision and fluorescein angiogram were investigated.Five patients (38%) had improved vision,five patients (38%) decreased and three (23%) had same vision. Mean follow up duration was 10.8 months (ranging 6 month to 57 month) and 1 case of recurrence was noted but others had stable postoperative vision and ophthalmoscopic finding. Considering poor natural history and dissatisfying result of laser photocoagulation, surgical management can be considered as another option.
Subject(s)
Humans , Fluorescein , Follow-Up Studies , Light Coagulation , Membranes , Natural History , Recurrence , VitrectomyABSTRACT
One of the complication during or after subclavian vein cannulation is intravascular catheter or wire embolization. Although some studies have reported safety of retaining foreign body embolization, and even death. The intravascular foreign body can be removed surgically or non-surgically. With improvement in instrument technology and technique, percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. Commonly used methods to remove intravascular foreign bodies are loop snare and basket technique. Sometimes biopy forcep can be used. We have experienced 2 cases of non-surgical removal of intravascular foreign bodies. One of the foreign bodies was 7cm wire fragment in right atrium(RA), the other was a 50cm guide wire. We used the standard loop snare technique for removal of 7cm wire fragment in RA and stone removal basket and 3.0mm ACS PTCA balloon to remove the 50cm short guide wire.