MANAGEMENT OF A PHAEOCHROMOCYTOMA IN A CHILD

The management of a case of phaeochromocytoma in a child usingalpha and beta receptor blocking drugs is described. This reportconfirms that estimations of plasma catecholamine concentrationsand direct measurement of arterial pressure are of considerablevalue. Methoxyflurane would appear to be a most suitable anaestheticfor patients with this condition.     

A Rare Manifestation of Herpes Zoster: A Case Report

Herpes zoster has an incidence of 350,000 cases per year in the United States. The involvement of the foot and ankle is rare. Most surgeons are not aware of this disease as a cause of extremity pain, its manifestation, and the treatment options. Post-herpetic neuralgia is a common sequela of herpes zoster and can be prevented with prompt treatment. In this article, we present a case of a 53-year-old female with right heel pain secondary to herpes zoster.     

A new case of pseudotumoral renal tuberculosis

The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.     

A sensitive immunoradiometric assay for serum thyroid-stimulating hormone. A first-line investigation for thyroid function

The value of a highly sensitive immunoradiometric assay for thyroid-stimulating hormone (TSH) in distinguishing between hyperthyroid patients and normal controls is discussed. The assay has a sensitivity of 0.3 microU/ml and correctly categorised all patients in this study as either hyperthyroid or euthyroid. An approach to thyroid function testing using this sensitive TSH assay as a first-line investigation is presented.     

精索神经鞘瘤一例报告

回顾性分析我院收治的1例精索神经鞘瘤患者的临床资料。本例患者行精索肿物切除术,术后恢复良好。术后病理确诊为精索神经鞘瘤。精索神经鞘瘤属于罕见病例,最佳治疗方式是手术切除,术后应严密随访。     

A MICROPROCESSOR-CONTROLLED GAS MIXING DEVICE

This paper describes the use of solenoid valves for the productionof binary gas mixtures. The system is controlled by a microprocessorand is capable of delivering accurate flows and concen-trationsof gases over the ranges commonly used in anaesthesia. Sincethe flow produced by the valves is pulsatile, a system for mixingthe gases and smoothing the pulses is described. A back pressureregulator is fitted downstream of each of two mixing/dampingchambers and a method of using this as a flow transducer isdescribed. The advantages of this system over conventional rotametersare discussed.     

Amedicus: A new iatrogenic syndrome

This iatrogenic syndrome is found in patients in general hospitals and in a variety of medical clinics, to a degree assuming almost epidemic proportions. It is characterized by one or all of these clinical manifestations: confusion, anxiety, insomnia, hostility, depression, suspiciousness, hopelessness, indecisiveness. distrust, withdrawal and the feeling of abandonment. The patient's organic pathology is not sufficient to account for these manifestations and they often appear in patients with no previous psychiatric history. The common denominator in this condition is the patient's communication that he feels he is operating without a physician who is directly responsible for his care. This comes about as a direct consequence of the proliferation of group medical practices and the increasing mechanization and specialization in medical practice over the last one or two decades. The result is often a lack of communication between the many different physicians by whom the patient is seen. Consequent to this, the patient is faced with contradictory information from a variety of physicians who fail to coordinate the diagnostic workup and treatment approach. The direct cause is the absence of a single physician who would coordinate the patient's care and orchestrate the harmonious functioning of the health care team. The clinical manifestations of this syndrome rapidly clear when the liaison psychiatrist or some other member of the health care team can fulfill this function. This article on the ‘amedicus syndrome’ addresses itself to the clinical picture of this syndrome, possible etiology, dynamics and treatment. Supportive case vignettes are presented.     

A technique for reduction mammoplasty

The author presents a technique for reduction mammoplasty in which the amount of skin removed is limited to a small area in the middle part of the breast. The glandular tissue is resected laterally and medially at the caudal part of the circumference of the breast, along with a midline wedge. With this technique and with the retraction of the skin and the sutures that pull this skin to the midline, the final result is a very short horizontal scar.Presented at the VIIIth International Congress of Plastic Surgery, Montreal, 1983     

A Tudor medical group portrait

The famous painting by Hans Holbein, celebrating the 1540 union of the Barbers and the Surgeons to form the Company of Barber-Surgeons, is well known. The work commemorates a milestone in the history of English surgery, but it is also important in another context. Group portraits of professionals were virtually unknown in England at this time, in contrast to portrayals of royalty or aristocratic families. This seems to be the earliest depiction of a group of eminent medical men with the King; the Holbein painting is unique in this respect.     

Parotid haemangioma. A case report

The presentation of a rare cavernous haemangioma of the parotid in a 17-year-old male is the twenty-first case in the English literature, and the first report in a black adult patient. The aetiology of this lesion is unknown and differs from that of the infantile capillary type. The pathognomonic signs of fluctuating size, discoloration and bruit are rare; the diagnostic hallmark in this case was spontaneous tumour regression. Doppler studies and arteriography may be valuable in diagnosis and management, in which surgical excision is the treatment of choice.     

A practical guide to meta-analysis

The wealth of medical research published on a yearly basis demands methods to summarize the literature. Narrative or expert reviews were the traditional method to provide this summary; however, biases associated with narrative reviews raise questions regarding whether this process provides sufficient evidence to guide practice. Meta-analysis is becoming increasingly popular because it can combine results from similar studies to calculate an overall estimate of a treatment effect. Although meta-analysis has its limitations, a thoughtful and well-planned analysis is a valuable tool in providing a high level of evidence. We discuss the steps needed to perform a meta-analysis as a guideline for those interested in pursuing this type of research.     

A SAFE,NEW APPROACH TO ESTABLISHING A PNEUMOPERITONEUM AT LAPAROSCOPY

The traditional method of establishing a pneumoperitoneum before laparoscopic surgery is via a Verres needle inserted in the midline below the umbilicus while tenting the abdominal wall with the hand. A new approach is described in which preliminary surgical exposure and tenting of the linea alba immediately above the umbilicus is achieved before needle insertion through the superior margin of the umbilical ring. The advantages of this new technique over the conventional method are discussed. Further technical features important in the safe formation of the pneumoperitoneum are emphasized.     

A torted pelvic spleen

An unusual case of an acute abdomen due to a torted wandering spleen in the pelvis is presented. As is usual for the few cases reported, the diagnosis was unsuspected pre-operatively. The treatment is splenectomy and a quick and complete recovery followed this. Literature on the subject is reviewed.     

A case of bladder pheochromocytoma

The clinical picture of bladder pheochromocytoma is usually typical; however, the diagnosis is occasionally delayed because of the rarity of this neoplasm. We report a case of unsuspected bladder pheochromocytoma in which the patient had a hypertensive episode during transurethral resection. A 67-year-old male presented with the chief complaint of painless macrohematuria. Cystoscopy revealed a submucosal tumor on the right lateral wall of the bladder. The tumor was operated on transurethrally, followed by partial cystectomy. The pathological diagnosis was pheochromocytoma, primarily occurring in the bladder. Treatment of this lesion requires a high degree of clinical suspicion based on the patient's symptom complex in order to enable adequate preparation prior to surgical manipulation.     

A patient with Pfeifer-Weber-Christian Disease - Successful Therapy with Cyclosporin A: case report

Background  

Pfeifer-Weber-Christian disease (PWCD) is a rare inflammatory disorder of the subcutaneous fatty tissue. The diagnosis and therapy of this rare type of panniculitis is still controversial and will be discussed in this article.     

CHOOSING A PULMONARY VENTILATOR

The author presents an approach to the selection of an automaticpulmonary ventilator. The indications for automatic ventilatorsare set out and a guide to choice is then suggested on physiologicaland practical considerations. Many features of machines arediscussed briefly and a rather high standard is put forward.The underlying emphasis throughout is that the clinician shouldbe fully aware of his requirements and the limitations of apparatus,and that he makes his selection in this frame of mind.     

Developmental facial paralysis: A review

The purpose of this study is to clarify the confusing nomenclature and pathogenesis of Developmental Facial Paralysis, and how it can be differentiated from other causes of facial paralysis present at birth.Differentiating developmental from traumatic facial paralysis noted at birth is important for determining prognosis, but also for medicolegal reasons.Given the dramatic presentation of this condition, accurate and reliable guidelines are necessary in order to facilitate early diagnosis and initiate appropriate therapy, while providing support and counselling to the family.The 30 years experience of our center in the management of developmental facial paralysis is dependent upon a thorough understanding of facial nerve embryology, anatomy, nerve physiology, and an appreciation of well-recognized mishaps during fetal development.It is hoped that a better understanding of this condition will in the future lead to early targeted screening, accurate diagnosis and prompt treatment in this population of facially disfigured patients, which will facilitate their emotional and social rehabilitation, and their reintegration among their peers.     

ASPIRATION OF STOMACH CONTENT IN A CONSCIOUS PATIENT: A Case Report

A case of aspiration of vomitus in a conscious patient is described.This resulted in severe bronchospasm, dyspnoea, cyanosis andperipheral circulatory failure. The patient recovered followingtreatment by tracheobronchial lavage, antispasmodics, antibioticsand hydrocortisone. The similarity to Mendelson's syndrome isnoted. A plea is made for wider recognition of the possibilityof this condition arising.     

A new concept in blepharoplasty

Apart from what may be considered complications, the intervention of any aesthetic surgery can have undesired effects (scar sequelae, normal regional dynamic disorders, edema, iatrogenic acceleration of the aging process in the area). The orbital region is particularly sensitive to these undesirable effects due to its situation and the importance of the eyelids in facial sign language. The sum of these undesirable effects and not infrequent complications often place the plastic surgeon in a compromising situation. It is for this reason that in recent years we have made a special effort to analyze causes, to design new techniques, and to evaluate the combination of different techniques in an attempt to minimize these undesirable effects, so as to be able to offer patients more natural and safer results. It is with this intention that this paper records some anatomical and functional details of the eyelids, analyzes the physiology of the aging process, and examines some classic and modern techniques.