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INTRODUCTION: Cutaneous metastasis from head and neck cancer is uncommon and it is seen from laryngeal cancer. Acrocutaneous metastasis from the base of tongue is relatively rare. CASE REPORT: We present a case of a 84-year-old male, previously diagnosed to have moderately differentiated squamous carcinoma of the base of tongue with lung and liver metastases and received palliative chemoradiation. He, now presented with ulcero-proliferative growth over the right 5th finger. In the present case, the patient initially presented with a nodule which later ulcerated and increased in size. There was associated discharge. There was clinical suspicion of underlying osteomyelitis. Hence right 5th finger amputation upto the middle phalanx was done. The histopathology report of the specimen was moderately differentiated squamous cell carcinoma. This is a case of skin metastasis from squamous carcinoma of the base of Tongue is rare at a short span of time following the completion of treatment. This case has highlighted the probable presence of occult skin metastasis at the time of diagnosis, which became apparent after the completion of treatment. CONCLUSION: Fine needle aspiration cytology should be done in cutaneous nodules associated with head and neck cancers to rule out malignancy, even if it clinically appears to be benign in nature.
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Hydrocoele of the canal of Nuck in an adult female is a rare entity and analogous to hydrocoele in males. Its usual presentation is in children, and its occurrence in adults is very uncommon, more so of the hour-glass variety. We report a case of a 38-year-old woman presenting with a right inguinal swelling of 3-month duration. On physical examination, the swelling was non-tender, cystic and irreducible. There was no cough impulse. Ultrasonography and contrast-enhanced CT revealed a cystic swelling with clear contents in the right inguinal region. Surgery was performed with excision of the cyst. The histopathology report suggested flat mesothelium cells, confirming the diagnosis.
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Quistes/cirugía , Conducto Inguinal/diagnóstico por imagen , Adulto , Medios de Contraste , Quistes/diagnóstico por imagen , Quistes/patología , Diagnóstico Diferencial , Edema/etiología , Femenino , Ingle/patología , Ingle/cirugía , Humanos , Conducto Inguinal/patología , Conducto Inguinal/cirugía , Enfermedades Peritoneales/patología , Enfermedades Peritoneales/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
To report the role of preoperative fine-needle aspiration cytology (FNAC) in patients with swellings in the parotid region at a tertiary care center. Prospective study of FNAC results compared with final histologic diagnosis as the standard criterion. An academic tertiary care center. A consecutive series of 51 patients who underwent FNAC of swellings in the parotid region between 2007 and 2009, of whom 41 had surgical resection. Predictive value, sensitivity, specificity, and accuracy. FNAC was performed in all the 51 patients who presented with a swelling in the parotid region in the out patient department in our hospital. Sixteen patients (31.4 %) were diagnosed to have malignancy, thirty patients (58.8 %) were diagnosed as benign condition. The FNAC was not satisfactory in 5 patients (9.8%) even after repeated aspiration. The FNAC diagnosis of malignant or suspicious lesion of the parotid region had positive and negative predictive values of 90 % and 96.66%, respectively. The diagnostic accuracy of FNAC is 95 %. We strongly recommend FNAC as a safe and accurate and less expensive method for preoperative diagnosis of the swellings in the parotid region.
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BACKGROUND: Laparoscopic appendicetomy had not gained importance against open appendicectomy and it remains controversial in Indian perspective. AIM: Compare the clinical outcome and cost effectiveness of Laparoscopic Appendicectomy (LA) versus Open Appendicectomy (OA). METHODS: A prospective study for a period of 21 months from Oct. 2005 to June 2007, 249 patients underwent appendicectomy and 200 patients were included in the study. 114 underwent Open appendicectomy and 86 underwent laparoscopic appendicectomy. Duration of surgery, postoperative complications, postoperative hospital stay, postoperative pain and requirement of analgesia, resumption of oral feeds, cost of hospital stay and return to normal activities was compared and noted. RESULT: Laparoscopic appendicectomy was better than open appendiectomy with respect to the wound infection rate, early resumption of oral feeds, postoperative pain, lesser use of analgesics, postoperative hospital stay (3.13 days after LA, 4.36 days after OA, P < 0.0001) and return to normal activities (LA group to OA group; 13.86 days to 19.44 days P< 0.0001). Although above mentioned advantages were at the cost of slightly increased duration of surgery (58.29 min in OA group to 74.13 min in LA group P < 0.0001HS) and cost of surgery {LA: OA Rs.4225.81: Rs.5560.92 (P <0.0001)}. CONCLUSION: Laparoscopic appendicectomy was better than open appendiectomy with respect to wound infection rate, early resumption of oral feeds, postoperative pain, lesser use of analgesics, postoperative hospital stay and return to normal activities. Although above mentioned advantages were at the cost of slightly increased duration of surgery and cost of surgery.
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There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.