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Lanitis S Filippakis G Sidhu V Al Mufti R Lee TH Hadjiminas DJ 《Annals of the Royal College of Surgeons of England》2008,90(4):338-339
INTRODUCTION
We present an unusual case of severe anaphylaxis to Patent Blue dye with atypical clinical features during sentinel lymph node biopsy (SLNB). The medical personnel involved with sentinel node biopsies should be alert, and familiar with this unusual entity. We also present current data from the literature.CASE REPORT
During a wide local excision for primary breast cancer and SLNB, and early during the operation, the patient became severely tachycardic and hypotensive without any signs of urticaria, rash, oedema, or bronchospasm. Resuscitation required the addition of noradrenaline infusion followed by an overnight admission to the intensive care unit. Raised serum tryptase levels supported the diagnosis of anaphylactic shock while skin tests showed a severe reaction to Patent Blue dye.CONCLUSIONS
Severe, life-threatening anaphylaxis to Patent Blue dye may present without obvious previous exposure to the dye and without the cardinal signs of oedema, urticaria and bronchospasm making the diagnosis and management of such cases challenging. Correct diagnosis and identification of the causative factor is important and requires a specific set of laboratory tests that are not commonly requested in every-day medical practice. It is not clear from the literature whether the condition is common enough to justify pre-operative prophylactic or diagnostic measures. 相似文献3.
Sophocles Lanitis Sivahamy Sivakumar Nabeela Zaman Olwen Westerland Ragheed Al Mufti Dimitri J Hadjiminas 《Annals of the Royal College of Surgeons of England》2010,92(2):e29-e31
IntroductionWe highlight the pitfalls in delaying the diagnosis of primary hyperparathyroidism (pHPT) in patients with acute pancreatitis as the sole clinical presentation. Primary hyperparathyroidism is a recognised, but rare, cause of acute pancreatitis. Hypercalcaemia caused by undiagnosed pHPT may be the only causative factor of recurrent acute pancreatitis.Patients and methodsThree patients with multiple admissions for acute pancreatitis were diagnosed having pHPT during the work-up to identify possible causative factors. None of the patients had any other common predisposing factor for acute pancreatitis as revealed by clinical examination, blood tests and imaging. In retrospect, all had abnormally elevated calcium during previous admissions which was not further assessed.ResultsAfter diagnosis of pPTH, patients underwent bilateral neck exploration and parathyroidectomy. Histology confirmed parathyroid adenomas. The blood calcium level returned to normal and the patients remain well and asymptomatic after operation.ConclusionsThe role of pHPT as a causative factor is underestimated when managing patients with acute pancreatitis, and frequently the underlying disease remains undiagnosed for a long time. Proper early diagnosis and management prevent unnecessary morbidity. 相似文献
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Al-Dulaimi Ragheed Duong Phuong-Anh Chan Brian Y. Fuller Matthew J. Ross Andrew B. Dunn Dell P. 《Emergency radiology》2022,29(1):125-132
Emergency Radiology - To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of... 相似文献
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Rogers Douglas Al-Dulaimi Ragheed Rezvani Maryam Shaaban Akram 《Abdominal imaging》2019,44(2):697-704
Abdominal Radiology - To distinguish the corpus luteum with adjacent ovarian stromal edema as an entity associated with pelvic pain, with confounding ultrasound features that may lead to... 相似文献
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Diagnosis and Management of Male Breast Cancer 总被引:3,自引:0,他引:3
Lanitis S Rice AJ Vaughan A Cathcart P Filippakis G Al Mufti R Hadjiminas DJ 《World journal of surgery》2008,32(11):2471-2476
Background Male breast cancer (MBC) is rare with an incidence of 1% of all breast cancers. The evidence about the treatment is derived
from the data on the management of the female breast cancer because conduction of randomized, controlled trials is impossible
due to the rarity of the disease. In this study, we review the special features, overall management, diagnosis, and treatment
of patients with MBC managed under our care with a brief review of the current literature.
Methods During the period 1998 to 2006, we managed 1103 new patients with breast cancer in St Mary’s Hospital. Among these, 14 patients
were men. We retrospectively reviewed the case notes, histology, and follow-up notes of all the newly diagnosed patients with
MBC.
Results In this series, 28.6% had only in situ disease. Moreover, in 78.6% there was an in situ component present. One patient was
found to have a cancer on the microdochectomy specimen after an operation for single duct nipple discharge, and in a second
patient the cancer was found in the gynecomastia operation specimen. All ten invasive tumors were estrogen receptor positive
(ER +ve), whereas eight were progesterone receptor positive (PgR +ve). With a median follow-up of 35 months, there was one
locoregional recurrence and one disease-associated death.
Conclusions In situ cancer may not be as rare as previously reported among patients with MBC. Increased patient awareness and early assessment
by a specialist is a key to early diagnosis and improved outcomes. 相似文献