Wilms’ tumour in adults: a case report and review of the literature

Background  

Wilms’ tumour is a very rare adult malignancy representing 1% of adult renal tumours. It is however the most common renal tumour of childhood, and adult patients are treated in accordance with paediatric protocols.     

Steroid allergy? A case report and review of the literature

Does "steroid allergy" truly exist? If in fact it does, what would be the potential impact on our patients? Steroids are used extensively in the treatment of asthma, chronic obstructive pulmonary disease (COPD) and allergy-related conditions. COPD is the 5th leading cause of death in the United States. Asthma affects about 5% of adults and is the most common chronic illness of children, prompting about 1.5 million patients to seek care in the Emergency Department (ED) annually. Steroids themselves, however, have actually been shown to induce hypersensitivity reactions. This is a case report on a steroid allergy and a review of the literature. Several cases worldwide were reviewed demonstrating steroid allergies of various types. The literature shows a small population of patients who may be susceptible to an allergic reaction to corticosteroids ranging from a simple skin reaction to anaphylactic shock. Steroid allergy must be considered more frequently.     

Mesenteric cysts — A series of six cases with a review of the literature

Background  Symptomatic mesenteric cysts account for only 1 in 100,000 acute adult and 1 in 20,000 acute paediatric admissions. Acute symptoms are related to compression of intra-abdominal organs or stretching of the mesentery by rapid expansion. An abdominal mass, mobile in transverse but not longitudinal plane, is often the only physical finding. Method  We outline the presentation, management and histological findings of 6 cases that presented to this hospital from 1987–1997. Results  There were 5 adults aged 32–79 yr and an 8 yr old boy. The child presented acutely with a painful tender abdominal mass. Of the adults, 1 presented acutely, 2 with chronic symptoms and 2 were incidental findings. Mesenteric cysts were successfully resected in all cases. Conclusion  Surgical intervention is recommended and resection of adjacent bowel may be necessary for complete excision. Successful minimal access surgery via the laparoscope has been reported and may become more widely applicable.     

Pituitary involvement in Wegener’s granulomatosis: a case report and review of the literature

Wegener's Granulomatosis (WG)is a multi-system disorder characterized by necrotizing granulomas in the upper and/or lower respiratory tract, with or without focal     

Uncommon features of pulmonary Langerhans’ cell histiocytosis: analysis of 11 cases and a review of the literature

Pulmonary Langerhans＇ cell histiocytosis （PLCH） is an isolated form of Langerhans＇ cell histiocytosis thatusually develops in cigarette smokers.1＇2^ PLCH usually has typical light microscopic morphology with a spectrum of progressive changes.2-4^ It is characterized by peribronchiolar Langerhans＇ cell infiltrates mixed with macrophages, lymphocytes and eosinophils, that form stellate nodules. The nodular lesions are frequently cavitated and form thick- and thin-walled cysts, which are thought to represent enlarged airway lumina. PLCH lesions display temporal microscopic heterogeneity, with a progression from dense cellular nodules to cavitary nodules with increasing degrees of fibrosis that may extend along alveolar walls. In advanced cases,     

High dose progesterone therapy in lymphangioleiomyomatosis: a case report and review of literature.

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Synchronous granulocytic sarcoma of the breast and spine: a case report and review of the literature

Granulocytic sarcoma or chloroma is a rare tumour derived from myeloid cell precursors. It is generally seen before or after or together with the onset of myelocytic leukaemia. Immunohistochemical staining of myeloperoxidase is necessary for a definite diagnosis of granulocytic sarcoma. Recognition of this entity ensures an early aggressive chemotherapy that causes regression of the tumour.1-3 We present an unusual case of a 40-year-old woman who presented with back pain, numbness in the legs, and fatigue for 2 weeks. She was diagnosed as having synchronous granulocytic sarcomas of the breast and spine, confirmed surgically and histopathologically. After a subsequent systemic chemotherapy the patient was completely asymptomatic during a 20-month follow-up. We also reviewed the literature about the clinical manifestations, diagnosis, treatment, and prognosis of this condition.     

Bites to the hand: are they more than we can chew?

Animal bites to the hand caused by dogs, cats and humans are common conditions that general practitioners, emergency physicians and hand surgeons encounter in their practice. These bites are prone to infection and represent great cost to the patient in terms of time, money and disability, if not treated optimally from the outset. Other than lacerations to the skin, injuries to the tendons, nerves, bone and joints are commonplace given their proximity to the skin surface in the hand. Optimal treatment of acute animal bites to the hand should include clearance of contamination by surgical debridement, prophylactic antibiotics and tetanus toxoid, as well as staged reconstruction of all damaged tissue, including the skin, once the wound is deemed clean.     

A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating?

BackgroundUltrasonography-guided supraclavicular brachial plexus block has demonstrated safety as compared with landmark or nerve stimulation techniques. However, the minimum effective analgesic volume (MEAV) necessary for adequate blockade has not been determined. This study was undertaken to assess under fluoroscopy the postinjection spread of different drug volumes with clinical correlation. Secondary outcome measures included correlation of onset of block, block quality, and incidence of side effects.MethodsThis randomized, multiarm, cross-sectional, observational study was conducted at a single tertiary care center. A total of 549 patients were randomly allocated to 3 groups (20 ml, 30 ml, and 40 ml of drug mixture). A local anesthetic drug mixture with a radiopaque dye was administered under ultrasonographic guidance, and postinjection fluoroscopic drug spread was studied.ResultsSurgical anesthesia was achieved in 494 (89.98%) patients with 85.25%, 92.97%, and 91.71% in 20-, 30-, and 40-ml groups, respectively, being significantly low (p = 0.0317) in the 20-mL group. Cephalad and infraclavicular spread was higher in the 40-mL group than in other two groups (p = 0.103). Horner syndrome (HS) was seen in 51.18% of patients. First, ipsilateral superficial cervical plexus block was also observed in 40.22% of patients. Among patients who developed both, ∼60% of patients (99/167) belonged to the 40-mL group.ConclusionsOptimal MEAV appears between 20 and 30 mL. Higher drug volumes are associated with more cephalad spread and side effects. Drug spread can predict block efficacy as well. It is postulated that loss of sensation in the ipsilateral neck can be used to predict development of hemidiaphragmatic paresis similar to HS.     

Long-term management of venous thromboembolism: is there a role for low-intensity warfarin therapy?

The recently released PREVENT trial provides some answers.