Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Colestasis/etiología , Perforación Intestinal/etiología , Enfermedades del Sigmoide/etiología , Stents/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatocolangiografía por Resonancia Magnética/métodos , Colecistectomía Laparoscópica/métodos , Colestasis/diagnóstico por imagen , Colestasis/cirugía , Conducto Colédoco/diagnóstico por imagen , Conducto Colédoco/cirugía , Remoción de Dispositivos/métodos , Femenino , Estudios de Seguimiento , Humanos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Laparotomía/métodos , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/terapia , Reoperación , Medición de Riesgo , Enfermedades del Sigmoide/diagnóstico por imagen , Enfermedades del Sigmoide/cirugíaRESUMEN
Hereditary nonpolyposis colorectal cancer is the most common form of hereditary colorectal cancer. Occasionally, the presentation of colorectal cancer may be at an early age when parents may be unidentified obligate carriers. The risk of colorectal cancer increases with increasing age, even in inherited disease. Therefore, it is important to screen parents of patients presenting at a young age and to obtain a complete pedigree to identify and screen those who are at risk. Two such families where the index case presented at a young age were encountered in our practice and both their mothers were found to have colorectal cancer on surveillance colonoscopy. We recommend that parents of the index cases should be screened and more detailed family pedigree obtained when patients present at a young age with colorectal cancer.
Asunto(s)
Adenocarcinoma/genética , Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Adenocarcinoma/diagnóstico , Adulto , Anciano , Colonoscopía , Neoplasias Colorrectales Hereditarias sin Poliposis/diagnóstico , Femenino , Heterocigoto , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Padres , Linaje , Pronóstico , Medición de Riesgo , Muestreo , Adulto JovenRESUMEN
OBJECTIVES: To quantify the risk of venous thromboembolism (VTE) following air travel and assess methods of prevention. DESIGN: Review of literature. METHODS: We reviewed Pubmed, Medline, Embase and Cochrane Databases for studies that have assessed the risk of VTE associated with air travel. RESULTS: There is an association of VTE with air travel with pooled odds ratio of 1.59 (confidence interval 1.04-2.43) from three case control studies and relative risk of 2.93 (confidence interval 1.5-5.58) from two controlled cohort studies. The incidence of symptomatic pulmonary embolism (PE) is extremely low but there is substantial increase when the distance travelled is more than 5,000 miles (1.5 PE per million passengers) or time of flight is more than 8h duration (2.57 PE per million passengers). The quantitative risk of lower limb venous thrombosis in high-risk subjects is 5% per flight and 1.6% per flight for low risk subjects following long haul flights. All six randomised trials to test the below knee compression stockings with ankle pressures of 14-30 mmHg have shown reduction in lower limb venous thrombosis. CONCLUSION: VTE is more common in those with additional risk factors when the risk is about 5% per air travel for long haul flights. Class I or II below knee compression stockings are effective in the prevention of lower limb venous thrombosis.
Asunto(s)
Aeronaves , Embolia Pulmonar/etiología , Viaje , Trombosis de la Vena/etiología , Medicina Aeroespacial , Humanos , Medición de Riesgo , Factores de RiesgoRESUMEN
The key to diagnosis for deformed or scaling nipple is cytology or histology. While scrape cytology and punch biopsy do not provide underlying breast tissue for histology wedge excision requires more time and resource. We present the technique of nipple core biopsy (NCB) in 40 patients with deformed or scaling nipple done as a part of triple assessment yielding both skin and breast tissue for histological examination. Histological diagnosis confirmed eczema in 24, Paget's disease of nipple in 9 and chronic inflammation in 2. Among 5 remaining patients with normal skin histology, underlying breast invasive ductal carcinoma was seen in 3, ductal carcinoma in situ (DCIS) in 1 and adenoma in 1. NCB identified 5(55%) significant breast pathologies in Paget's disease and detected a further 2 invasive cancers in the absence of a palpable mass. The technique also provides additional information in the form of oestrogen receptor, which can have direct impact on patient management.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Eccema/diagnóstico , Pezones/patología , Enfermedad de Paget Mamaria/diagnóstico , Anciano , Biopsia con Aguja/métodos , Femenino , Humanos , Receptores de Estrógenos/análisisRESUMEN
Although aneurysmal subarachnoid haemorrhage appears to be fairly common in the developing countries, the data on the results of management appear to be relatively sparse. This is a retrospective study of 40 patients with 44 intracranial aneurysms operated upon at the National Neurosurgical Referral Centre in Kathmandu, Nepal from 1991 to 1999. The female male ratio was 1.5:1. Age ranged from 16 to 69 years with a mean of 43.2. In location, 18 (41%) were anterior communicating, 10 (23%) posterior communicating, nine (20%) middle cerebral, five (11%) internal carotid other than posterior communicating, two (5%) distal anterior cerebral and one (2%) posterior circulation. Multiple aneurysms were present in four (10%) and giant in three (8%). The timing of surgery ranged from 3 days to 3 months from the day of bleeding. Microsurgical clipping was possible in 37 (93%) and wrapping had to be done in three (7%). Overall mortality was four (10%), two (5%) had a surgery-related death and a further two (5%) died later due to pulmonary embolism. The remaining (90%) made a good recovery. The results compare favourably with that of the International Cooperative Study. Further reduction in mortality will have to await the introduction of endovascular techniques.