Focal nodular hyperplasia presenting as acute abdomen

Focal nodular hyperplasia (FNH) is a benign liver tumour with an asymptomatic course, rarely causing complications. When the diagnosis is certain, only watchful observation is necessary. We highlight an interesting case of a 42-year-old woman with a FNH that ruptured and became haemorrhagic, thus presenting as an acute surgical abdomen. The diagnosis was only established after surgical resection with histopathological confirmation. Although haemorrhage of hepatic FNH is extremely rare, this case highlights the small risk of rupture in large lesions.     

Congenital syphilis presenting as swelling of fingers and toes

Congenital syphilis has varied manifestations in first two years of life. A case of 4-month-old child who was presented with painless swelling of finger and toes is reported. Family history was suggestive of syphilis in parents and one sibling. VDRL test in serum was positive in 1:128 dilution. Treponema pallidum haemagglutination test was positive. The child was treated with crystalline penicillin and responded favourably.     

Relapsed Hodgkin's disease presenting as a right knee swelling

A 49 year-old Indian housewife was diagnosed with Hodgkin's disease in 1995. She was given combination chemotherapy comprising Chlorambucil, Vincristine, Procarbazine and Prednisolone. Unfortunately she defaulted after two courses of chemotherapy. One year later, she developed progressive right knee swelling and pain, associated with loss of appetite, loss of weight, intermittent fever, night sweats and pruritus. The right knee swelling measured 15 cm x 20 cm and was warm and tender. A plain radiograph of the right knee revealed osteolytic lesions at the distal end of the right femur and the proximal ends of the right tibia and fibula, associated with gross periosteal reaction and soft tissue swelling. Apart from left cervical lymphoadenopathy, examination of other systems was unremarkable. Pelvic bone marrow biopsy was inconclusive. An open biopsy of the lower end of the right femur was consistent with Hodgkin's disease. She was given salvage combination therapy comprising Chlorambucil, Vincristine, Procarbazine, Prednisolone, Doxorubicin, Bleomycin and Vinblastine. She tolerated the treatment well and responded with significant reduction in the swelling and pain of the right knee. Unfortunately, she again defaulted treatment after 2 courses of chemotherapy. This case illustrates an unusual presentation of Hodgkin's disease in relapse.     

Carcinoma of the sigmoid colon presenting as a scrotal swelling.

A case of adenocarcinoma of the sigmoid colon, presenting as a testicular mass, is described. At sigmoid colectomy widespread metastases were found and only palliative care could be offered thereafter. The incidence and age of such a presentation and manner of spread of the occult primary are discussed.     

Diffuse nodular hyperplasia of Brunner's gland presenting as upper gastrointestinal haemorrhage

Brunner's gland adenoma is a very unusual cause of upper gastrointestinal bleeding. We report a 16-year-old boy who presented with upper gastrointestinal haemorrhage from diffuse nodular hyperplasia of Brunner's gland without involvement of the first part of the duodenum. The patient was managed conservatively during his hospital stay, and was doing well without any recurrence after nine months of follow-up.     

耳后带血管蒂软骨皮瓣重建耳廓部分缺损

目的探讨耳后带血管蒂软骨皮瓣在耳廓部分缺损修复中的应用价值。方法自2004年11月～2006年1月之间采用耳后带血管蒂软骨皮辩修复两例耳廓部分缺损的病例。术前以超声多普勒确定耳廓后动脉,术中切取带耳廓后动脉为蒂的耳甲软骨皮瓣,转位重建修复耳廓缺损。结果两例均取得满意效果,术后软骨皮辩无坏死,色泽及形态满意。随访2～4年,修复结构未见萎缩及变形。结论耳后带血管蒂软骨皮瓣由于具有与耳廓缺损区域接近的皮肤色泽,纹理以及厚度,靠近修复区域,而且耳廓后动脉可以提供充分的血液供应,避免术后的缺血萎缩,是一种较好的修复耳廓局部缺损的方法。     

耳后小切口矫正下颌角重度肥大的临床价值

目的探讨耳后微创纵形切口下颌角截骨术对矫正重度下颌角肥大的疗效。方法应用耳后微创纵形切口下颌角截骨术对26例重度下颌角肥大患者进行矫正,通过X线测量,比较术前术后数据变化及容貌改变来评价疗效。结果手术前后测量比较有明显差异,术后数据接近正常人群。本组26例中,非常满意者23例（88％）,满意3例（12％）。未出现下颌骨骨折,下齿槽神经损伤,出血感染等并发症。结论针对重度下颌角肥大患者采用耳后微创纵形切口下颌角截骨术,结合术前三维CT设计截骨线,可以有效矫正下颌角肥大,且效果良好。     

Neck swelling with renal stone

Since the advent of screening of calcium and imaging techniques (CT and MRI), hyperparathyroidism has been detected with increasing frequency. Although in the past, most patients present with severe bone and renal diseases, a large number of patients are asymptomatic. Number of parathyroid glands and their ectopic locations in individuals are the problem of its management. Parathyroid adenoma or hyperplasia may be a part of Multiple Endocrine neoplasia type II. This is the story of a boy of 18 years who had got admitted in the department of Otolaryngology, Mymensingh Medical College Hospital with the complaints of a neck swelling, abdominal discomfort, inability to walk, frequency of micturation for almost same duration of 1 year. After search, hypercalcaemia, bilateral renal stone, raised parathormone level and enlarged one parathyroid gland in lower pole of left thyroid lobe was identified. Clinically it was diagnosed as parathyroid adenoma which was proved histologically after surgical excision. Many controversies still exist regarding the treatment policy of parathyroid adenoma.     

Parathyroid hyperplasia associated with thymoma

The case of a 65 year old female with myasthenia gravis and hypercalcaemia is presented. Failure of medical control of the myasthenia necessitated thymectomy at which time parathyroid exploration was also carried out. This revealed parathyroid hyperplasia and a thymoma. This association has not been previously documented in the literature.     

耳后筋膜-骨膜瓣在乳突充填术中的应用

目的探讨经设计的各种不同类型的耳后筋膜-骨膜瓣在乳突填塞术中的应用,以达到提高手术效果及患者术后生活质量的目的。方法回顾性分析216例（耳）行耳后筋膜-骨膜瓣填塞乳突根治术腔的患者临床资料。结果术后随访1.5～4.0年,随访率92.6%。术后干耳率为100%,同期行鼓室成形术的126例术后半年平均语频气导、骨导听阈及气骨导差均较术前提高,1例胆脂瘤复发进行二次手术清除。结论经设计的各种不同类型的耳后筋膜－骨膜瓣,应用在乳突填塞术中对于缩小或消除乳突手术腔效果明显。     

Sarcoidosis presenting with severe hypocalcaemia

Disorders of calcium metabolism, especially hypercalcemia and hypercalceuria, are common in sarcoidosis. They are caused by extra renal unsuppressed production of 1,25 dihydroxy vitamin D at the level of the sarcoid granuloma. Hormonal changes during pregnancy have a physiological synergistic effect on this mechanism, which is primarily parathyroid hormone (PTH) dependant. However, the combination of primary hypoparathyroidism with hypocalcemia and sarcoidosis is rare. Di George syndrome, is a dysmorphic disorder characterised by aplasia/hypoplasia of thymus and parathyroid glands in addition to aortic arch anamolies and facial dysmorphia. After commencing appropriate treatment this lady made excellent recovary.     

Hereditary pancreatitis presenting with ascites

We report a case of an adolescent girl who presented with painless massive ascites secondary to chronic pancreatitis and a ductal fistula. The diagnosis was delayed and an unnecessary laparotomy was performed, as initial evaluation of ascites did not include measurement of serum and ascitic amylase. Evidence of pancreatic abnormalities in asymptomatic relatives suggested an underlying hereditary pancreatitis. Hereditary pancreatitis presenting as pancreatic ascites, to our knowledge, has not been described previously.