Huge adrenal haemangioma

Adrenal tumours are either functioning or non-functioning. Non-functioning adrenal tumours are generally asymptomatic and usually of enormous proportions at the time of presentation. A case is presented here of a patient with a huge right adrenal haemangioma which was successfully treated surgically. This unusual tumour was 25 cm in diameter, was well encapsulated and weighed 4 kg. The literature pertaining to this interesting case is reviewed.     

Ethical Issues in the Management of Geriatric Cardiac Patients

Ethical Issue: The patient's pneumonia required assisted ventilation. After weaning, a second intubation is necessary. The patient's "living will" asks for no artificial life support     

Does the surgical approach in cochlear implantation influence the occurrence of postoperative vertigo?

OBJECTIVE: To investigate the impact of different cochleostomy techniques on vestibular receptor integrity and vertigo after cochlear implantation. STUDY DESIGN: Retrospective cohort study. SUBJECTS: A total of 62 patients (17 to 84 years of age) underwent implantation via an anterior or round window insertion approach. METHODS: Two groups of cochlear implant patients were compared with respect to their pre- and postoperative vestibular function and the occurrence of postoperative vertigo. The data were related to the different cochleostomy techniques. The patients were tested by a questionnaire (dizziness handicap inventory, DIH), caloric irrigation (vestibulo-ocular reflex, VOR) for the function of the lateral SCC and by vestibular evoked myogenic potential (VEMP) recordings for saccular function. RESULTS: Significant differences of postoperative VEMP responses (50% vs 13%) and electromystagmography (ENG) results (42.9% vs 9.4%) were found with respect to the 2 different insertion techniques. The number of patients with vertigo after the surgery as evidenced by DHI (23% vs 12.5%) was significantly different. CONCLUSION: The used round window approach for electrode insertion should be preferred to decrease the risk of loss of vestibular function and the occurrence of vertigo.     

吡柔比星(THP)膀胱灌注预防腺性膀胱炎术后复发的疗效观察

目的 评价吡柔比星(THP)膀胱灌注预防腺性膀胱炎术后复发的疗效。方法 对30例腺性膀胱炎患者行经尿道汽化电切术,术后定期应用THP(40mg/50ml)膀胱内灌注化疗。结果 30例患者随访5～20个月,平均14.5个月,3例复发(10％)。未见有全身性药物不良反应,仅2例血白细胞降至3000个/ml。结论THP膀胱灌注预防腺性膀胱炎术后复发疗效满意,病人耐受性好,副作用小。     

Potential increased risk of virus transmission due to exclusion of older donors because of concern over Creutzfeldt-Jakob disease. The National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study

BACKGROUND: Concern over the theoretical possibility of disease transmission via blood from donors who develop Creutzfeldt-Jakob disease has led to proposals to exclude older individuals from donating plasma for further manufacture into pooled plasma donations. The impact of extending this age-deferral policy to blood donors was examined with respect to the risk for known transmissible viruses. STUDY DESIGN AND METHODS: Demographic characteristics and confirmed prevalence rates (/10(5) first-time donations) and incidence rates (/10(5) person-years for repeat donors) for viral markers were compared for donors < 50 years old (n = 1,259,805 [85%]) and > or = 50 years old (n = 219,856 [15%]) and for donors < 60 years old (n = 1,409,176 [95%]) and > or = 60 years old (n = 70,485 [5%]). Incidence rates were combined with infectious window-period estimates for each virus, to calculate the risk of virus transmission per 10(6) donations. RESULTS: Unadjusted prevalence rates were significantly greater for younger than for older donor groups for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) (p < or = 0.05). Incidence rates (and transmission risk estimates) for HBsAg were significantly higher in the < 50 donor group than in the > or = 50 group (p < or = 0.05), and those for HIV, human T-lymphotropic virus, and HCV were not significantly higher (p > 0.05). Blanket removal of donors over the age of 50 would potentially lead to the following significant increases in the risk of infected units: HIV, 12 percent; HCV, 21 percent; and hepatitis B virus (HBsAg), 22 percent. CONCLUSION: Removal of donors over the age of 60 would not significantly affect the risk of infected units. Deferral of donors > or = 50 years of age from whole-blood donations for unfounded concerns about Creutzfeldt-Jakob disease could have adverse effects on both blood availability and safety.     

Detection of Undiagnosed Coeliac Disease with Atypical Features Using Antireticulin and Antigliadin Antibodies

Eighteen patients with a variety of non-gastrointestinal symptomswere incidentally found to have circulating antireticulin antibodyand on subsequent testing were also positive for antigliadinantibody. They prospectively underwent jejunal biopsy to determinewhether or not they had coeliac disease. Their age range was21–79 years (mean 42 years). Enteropathy was present in13 (72 per cent) and was always associated with circulatingIgA antigliadin antibody. Enteropathy was not present in thefive cases who had only IgG antibody. Clinical improvement occurredin eight of 11 patients who complied with a gluten-free dietand was paralleled by an improvement in the mucosal histologyin seven of eight who were re-biopsied. The most remarkablecases were two patients who presented with severe debility andno apparent haematological or biochemical abnormalities, andwho subsequently made a dramatic recovery on a gluten-free diet.It is concluded that antireticulin antibody detected by routineautoantibody screening and confirmed to have IgA antigliadinantibody specificity is a useful indicator of an otherwise undiagnosedenteropathy. This serves to emphasize that the condition cansometimes be associated with atypical features and significantmorbidity.