RESUMEN
The occurrence of urinary bladder paragangliomas is rare. A 12-year-old Chinese girl who presented with history of blurring of vision was found to have grade IV hypertensive retinopathy. Investigations revealed a phaeochromocytoma on the posterior wall of the urinary bladder. A partial cystectomy with right ureter reimplantation was undertaken and her hypertension was promptly controlled. The diagnosis and management of this rare tumour is discussed.
Asunto(s)
Feocromocitoma/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Feocromocitoma/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnósticoRESUMEN
The aim of the study was: to obtain the profile of patients (with regards to age and family history of breast cancer) with a palpable breast mass. To determine the validity of ultrasound in the assessment of the palpable breast mass by determining the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound in distinguishing a malignant mass. To determine the most discriminating ultrasound characteristics for differentiating benign and malignant masses. Seventy patients who had fine needle aspiration cytology of a palpable breast mass were subjected to an ultrasound assessment of the mass. The ultrasound findings were classified as benign, indeterminate or malignant. These findings were then compared with either the cytology or histology results in cases that eventually had surgical excision. The age of the patients ranged from 15 to 66 years old The majority was in the third and fourth decades with an average age of 25 years. The 8 patients with a proven malignant breast mass were aged between 39 and 66 years old. They did not have any family history of breast cancer. Only 4 patients had a family history of breast carcinoma and all proved to have a benign breast lesion. Ultrasound had a sensitivity of 100%, specificity of 85.7%, positive predictive value of 50%, negative predictive value of 100% and accuracy of 87.5% for distinguishing a malignant mass. For benign masses: 93.7% had well-defined margins, 81.3% had homogenous internal echoes, 91.7% had depth-width ratio of less than 1.0 and 89% were compressible. For malignant masses: 87.5% had either ill-defined or irregular margins, 87.5% had inhomogenous internal echoes and mixed posterior echoes, and 100% were incompressible. The majority of patients with a palpable breast mass were aged below 40 years old. Most of the patients with a malignant breast mass were aged 40 years and older. Neither a positive nor a negative family history of breast cancer had any significance on outcome. Ultrasound had high sensitivity, specificity and accuracy in distinguishing a malignant mass. The most discriminating benign ultrasound characteristic was compressibility. The most discriminating malignant ultrasound characteristic was ill-defined and irregular margins.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Adolescente , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Palpación , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
Schwannomas are rare tumours arising from peripheral nerve linings. A case of a schwannoma arising from cervical sympathetic chain is presented. The clinical presentation was that of a right solitary thyroid nodule. Intra-operatively, a 3 x 3 cm encapsulated lesion was seen arising posterior to the vagas nerve and attached to the cervical sympathetic trunk. The lesion was excised together with part of the nerve. Post-operatively, the patient developed Horner's syndrome that persisted. Unitil 2000, less that 50 cased of cervical sympathetic schwannoma have been described in the Englidh literature. A brief description of the pathology, presentation, diagnosis and treatment of this condition is presented.
Asunto(s)
Neurilemoma , Nódulo Tiroideo , Neoplasias de Cabeza y Cuello , Síndrome de Horner , Humanos , Neurilemoma/diagnóstico , Sistema Nervioso SimpáticoRESUMEN
Fifteen cases of insulinoma were managed at HUKM over a period of 20 years. Although all patients presented with neurological symptoms, the diagnosis was delayed in all. Fasting hypoglycaemia and the measurement of C-peptide levels eventually made the diagnosis. Pre-operative localization investigations were not particularly useful. Intraoperative ultrasound (IOUS) detected 72% of the insulinomas, while 93% of the insulinomas were identified intraoperatively by palpation. All the insulinomas were detected intraoperatively with the combination of the two techniques. Twelve of 15 patients had benign adenomas including one patient with MEN-1 syndrome. Two patients had malignant insulinomas. One patient refused surgery. Nine patients underwent pancreatic resections and the remaining 5 patients had the adenomas enucleated.
Asunto(s)
Insulinoma , Enfermedades Pancreáticas/fisiopatología , Adulto , Anciano , Femenino , Humanos , Insulinoma/diagnóstico , Insulinoma/fisiopatología , Insulinoma/cirugía , Malasia , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía , Adulto JovenRESUMEN
Acute suppurative thyroiditis in a 62 year old lady with enteric fever is reported. Plain radiography of the neck showed a distinct localised abscess cavity with air fluid level. A rare causative agent Salmonella typhi was isolated. Needle aspiration and antibiotics resulted in complete recovery.
Asunto(s)
Tiroiditis Supurativa/etiología , Fiebre Tifoidea/complicaciones , Enfermedad Aguda , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Solitary thyroid nodules are commonly seen in surgical outpatient clinics. A detailed history and a careful physical examination are essential. In the management of the solitary thyroid nodule, fine needle aspiration cytology has become the cornerstone investigation. Ultrasound cannot differentiate between benign and malignant nodules, however is useful in the follow-up period to identify any further nodular growth. As thyroid malignancy occurs in both hot and cold nodules, radionuclide scans are not useful in the management of solitary thyroid nodules. We have attempted to outline the process of managing the solitary thyroid nodule and discuss the options available.
Asunto(s)
Nódulo Tiroideo/cirugía , Adenoma/cirugía , Biopsia con Aguja , Carcinoma Medular/cirugía , Carcinoma Papilar/cirugía , Quistes/cirugía , Humanos , Pediatría/métodos , Nódulo Tiroideo/patologíaRESUMEN
Between January 1978 to December 1993, 130 cases of adrenal diseases were diagnosed and surgically treated at the National University of Malaysia. They were 58 cases (44.6%) of Conn's syndrome, 40 cases (30.7%) of Cushing's syndrome, 20 cases (15.3%) of phaeochromocytoma and 12 cases (9.2%) of adrenocortical carcinoma (ACC). The commonest cause of Conn's syndrome was an adenoma (96.5%) which affected the left gland four times more than the right gland. Cushing's syndrome was caused by adrenocortical adenoma (32.5%), diffuse bilateral adrenal hyperplasia (40.0%), pigmented macronodular hyperplasia (20.0%) and adrenal carcinoma (7.5%). Twenty-five percent of the phaeochromocytomas were extraadrenal in origin arising mainly from the abdominal sympathetic chain. More than 50% of ACCs were non-functioning tumours. Fifty percent of the patients with ACC had inoperable tumours. The prognosis was poor even with adjuvant chemoradiotherapy. The main surgical approach was the anterior transabdominal route. There was no operative mortality or morbidity in all operated cases.
Asunto(s)
Síndrome de Cushing/cirugía , Hiperaldosteronismo/cirugía , Feocromocitoma/cirugía , Complicaciones Posoperatorias/fisiopatología , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/epidemiología , Enfermedades de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Adulto , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/epidemiología , Femenino , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiología , Incidencia , Masculino , Feocromocitoma/diagnóstico , Feocromocitoma/epidemiología , Distribución por Sexo , Singapur/epidemiología , Resultado del TratamientoRESUMEN
A patient with carcinoma of the right breast and coincidental primary hyperparathyroidism is presented. The distinction between hypercalcemia of malignant and hyperparathyroid origins is based on biochemical analysis and localisation of parathyroid adenoma on a computer tomogram of the neck.
Asunto(s)
Neoplasias de la Mama/complicaciones , Carcinoma Ductal de Mama/complicaciones , Hipercalcemia/etiología , Hiperparatiroidismo/complicaciones , Adenoma/patología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/patologíaRESUMEN
Continent pouch ileostomy is fashioned for patients who need a proctocolectomy. It is usually indicated for cases of ulcerative colitis and familial adenomatous polyposis where the anal sphincter can no longer maintain normal function or has to be removed. A case of familial adenomatous polyposis with features of Gardner's syndrome is reported. The patient presented with carcinoma of the rectum. Abdominoperineal resection followed by completion pancolectomy was performed. A continent pouch ileostomy was fashioned for him. He resumed work as a labourer within six months. The pouch was troublefree, needed to emptied four to six times a day and was fully continent of fluid, flatus and faeces until his demise three years later from liver secondaries. Continent pouch ileostomy is a better alternative than permanent end ileostomy. All care should be taken to rule out the existence of Crohn's disease. It is proposed that continent pouch ileostomy should be offered to patients needing permanent ileostomy if the expertise is available.
Asunto(s)
Adenocarcinoma/cirugía , Poliposis Adenomatosa del Colon/cirugía , Proctocolectomía Restauradora , Neoplasias del Recto/cirugía , Adenocarcinoma/patología , Poliposis Adenomatosa del Colon/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Recto/patología , ReoperaciónRESUMEN
Radiologically guided localization procedures are indicated pre-operatively when breast lesions are nonpalpable. The results of 42 percutaneous hookwire localizations over a period of 3 years are described. Of the total, 7 (17%) were found to be malignant. Biopsy was indicated by mammographically detected mass in 48%, by microcalcifications in 40% and by microcalcifications with an associated mass in 12%.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Mama/patología , Adulto , Anciano , Biopsia , Femenino , Humanos , Mamografía , Persona de Mediana EdadRESUMEN
Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Adolescente , Adulto , Anciano , Niño , Várices Esofágicas y Gástricas/epidemiología , Femenino , Hemorragia Gastrointestinal/epidemiología , Humanos , Malasia/epidemiología , Masculino , Persona de Mediana Edad , Embarazo , Recurrencia , Estudios Retrospectivos , Escleroterapia/métodosRESUMEN
Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.