1/13. myelolipoma of the adrenal gland diagnosis and management.myelolipoma of the adrenal gland is a rare benign tumor. It is diagnosed incidentally in most cases because of its non-functioning nature, unless it causes symptoms due to its size. It has specific sonographic and computed tomographic features. A case is presented, magnetic resonance findings are reported for the first time and a review of the literature is conducted.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/13. uterine rupture in second trimester abortion in a grand multiparous woman. A complication of misoprostol and oxytocin.Rupture of unscarred uterus during the second trimester is rare. There have been only 32 cases reported in the literature since 1968. A case of ruptured uterus in a grand multiparous woman is presented.To our knowledge, this might be the first reported case in the English literature of uterine rupture during second trimester termination of pregnancy using a prostaglandin E1 analogue (misoprostol) and oxytocin.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
3/13. Treatment of extrahepatic bile duct disease in infancy and early childhood.Extrahepatic bile duct disease is a rare finding in infancy and early childhood. However, there is an increasing number of patients operated at this age reported in the literature. This increase may have multifactorial reasons, e.g. real increase, better ability of detection as a result of better diagnostic techniques and knowledge of predisposing factors of extrahepatic bile duct disease in childhood, especially in early childhood and infancy. The following report describes three cases of extrahepatic bile duct disease in infancy and early childhood treated at the Department of Surgery of the University of technology in Aachen, germany. From 1986 to 1998 28 patients below 18 years were operated at our Department of Surgery. There was a recognizable increase of patients in 1996, 1997 and 1998. Whereas from 1986 to 1995 an average of 1.5 Cholecystectomies in pediatric patients were done, the years from 1996 to 1998 show an average of 5,33 patients operated per year. Every patient obtained a cholecystectomy -- 15 conventional open Cholecystectomies and 13 Laparoscopies, which were primarily performed in children in our clinic in 1991. Besides cholecystectomy in one case a Hepaticoenterostomy was necessary and in another case surgical treatment of the Papilla of Vater and the common bile duct was performed. In 22 patients symptomatic cholelithiasis was the indication for a cholecystectomy. Another Patient had a gallbladder polyp consisting of heterotopic Duodenal glands, two patients showed a shock gallbladder following trauma and cardiac operation and three patients had chronic cholecystitis without gallstones. Clinical data was collected and retrospectively reviewed. Additionally, we created a personal questionnaire to carry through a follow-up. Three patients were less than 3 1/2 years old. The youngest patient was only 5 months old and presented with cholelithiasis and choledocholithiasis. Another male patient, aged 2 years received a cholecystectomy and a Hepaticoenterostomy because of a choledochal cyst Type Ib (Todani-classification). And a 3-year-old-girl had a shock gallbladder caused by thromboembolism following cardiac operation nine days before.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
4/13. Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief.OBJECTIVE: The purpose of this study was to report the effect of radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for locally advanced cancer of the pancreatic body on intractable abdominal and/or back pain and to explore the histopathologic mechanism of this pain. patients: Five patients with pancreatic body cancer involving the celiac and/or common hepatic artery underwent this radical surgery intended to cure the cancer. DESIGN: A retrospective analysis was performed. MAIN OUTCOME MEASURES: Surgical magnitude, postoperative pain control, postoperative outcome, and histopathologic findings were studied. RESULTS: Arterial reconstruction, gastrointestinal reconstruction, and blood transfusions were unnecessary. The organ deficit was limited to the distal pancreas, spleen and left adrenal gland. There was no postoperative mortality. postoperative complications occurred in four patients, who were successfully managed with medical treatment. This led to prolonged hospital stays. The intractable preoperative abdominal and/or back pain was completely relieved immediately after surgery in all patients. Perfect pain control has been maintained from surgery to the last follow-up. Histopathologic examination of the surgical specimens revealed cancer invasion of the celiac plexus in all patients. CONCLUSIONS: This operation offers not only disease radicality but also perfect pain relief. The survival benefit has not yet been fully defined.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
5/13. Bilateral giant adrenal myelolipomas: a case report.myelolipoma is a relatively rare benign tumor composed of fatty tissue and bone marrow elements. It is frequently associated with the adrenal glands but may exist as a solitary mass elsewhere. Adrenal myelolipomas are typically nonfunctioning and asymptomatic. They may be associated with an endocrine disorder such as Cushing's disease, Addison's disease, or hyperaldosteronism; however they are most often discovered incidentally. Their size is usually less than 5 cm and they are managed nonoperatively. We report a case of bilateral giant adrenal myelolipoma producing abdominal pain in a 54-year-old man, who presented to his primary care physician with complaints of right shoulder pain with vague abdominal discomfort. Imaging studies identified bilateral suprarenal masses measuring 12 x 14 cm on the right and 8 x 10 cm on the left. These masses were consistent with fatty tissue radiographically. In addition a focal 5 x 4-cm mass was identified in the transverse colon. Because the patient was symptomatic and a diagnosis of liposarcoma could not be excluded he was taken to the operating room for exploratory laparotomy with excision of the masses and a transverse colectomy. Final histologic analysis identified bilateral adrenal myelolipomas and a solitary lipoma of the transverse colon. His postoperative course was uneventful with relief of the pain. Despite its benign nature and rare growth beyond 5 cm myelolipoma of the adrenal gland is best managed with excision in the symptomatic patient. Preservation of adrenal tissue is vital so as not to commit patients to a lifetime of steroid replacement.- - - - - - - - - - ranking = 0.4keywords = gland (Clic here for more details about this article) |
6/13. Multiple granulomatous inflammation in the minor salivary glands: a proposed new entity, allergic granulomatous sialadenitis.We report a patient who presented with multiple small submucosal nodules with granulomatous inflammation in the minor salivary glands of the oral cavity. A 43-year-old woman presented with a 1-week history of multiple small submucosal nodules in her oral cavity after having taken medicine for abdominal pain. The patient did not have a history of fever, rectal bleeding, skin lesions or arthritis, but did have a history of drug allergy and bronchial asthma. Histopathological examination of the submucosal nodules showed sialadenitis with marked infiltration of lymphocytes, eosinophilic cells, macrophages and Langhans-type or foreign-body-type multinucleate giant cells. The macrophages tended to be aggregated and appeared to have caused immature granuloma formation without caseous necrosis. Degranulated eosinophilic cells were numerous. sarcoidosis, Crohn's disease, tuberculosis and atypical mycobacterial infection were not identified by medical examination. Three weeks after discontinuing the medication the patient was seen again at a follow-up visit. Multiple submucosal small nodules and other symptoms were not evident at that time. This case report may represent a new entity of salivary gland disease that we tentatively refer to as 'allergic granulomatous sialadenitis'.- - - - - - - - - - ranking = 1.2keywords = gland (Clic here for more details about this article) |
7/13. Adrenal myelolipoma in a child.A case of adrenal myelolipoma is reported in a 14-year-old girl. Abdominal ultrasound examination revealed a left-sided ovarian cyst 13 cm in diameter and an 8 x 8-cm hyperechoic heterogenous solid mass localized in the right adrenal gland. The ovarian cyst and adrenal mass were removed surgically. Histological examination of the adrenal mass revealed a proliferation of mature adipose tissue with bone marrow-like hematopoietic elements. The ovarian cyst was a simple serous cyst.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
8/13. Hepatic adenocarcinoma expressing inhibin in a young patient on oral contraceptives.A case of primary hepatic carcinoma is reported, which occurred in a 24-year-old woman with a 10-year history of oral contraceptive use, and demonstrated unique morphologic and immunohistochemical features. The tumor was located in the left hepatic lobe, measured 14 cm at its widest, and showed histologic heterogeneity. The neoplastic cells were mostly arranged in trabecular and pseudoglandular growth patterns simulating hepatocellular carcinoma; however, in focal areas, small cystic, organoid and tubular patterns predominated. Immunohistochemical stains showed a phenotype consistent with biliary differentiation (positive staining for cytokeratin 7, cytokeratin 19, carcinoembryonic antigen and CA 19-9 antigen). The tumor cells were negative for markers that would be suggestive of hepatocytic or neuroendocrine differentiation. Interestingly, they were positive for inhibin, a protein that is known to be expressed in sex cord-stromal tumors of the ovary, trophoblastic neoplasms and adrenal cortical tumors, but not in hepatic tumors. However, no definite evidence of gonadal stromal, trophoblastic, or adrenocortical differentiation was identified on extensive immunohistochemical work-up. In conclusion, this unique case may represent a rare variant of cholangiocarcinoma expressing inhibin.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
9/13. Recurrent cholangitis associated with biliary sludge and Phrygian cap anomaly diagnosed by magnetic resonance imaging and magnetic resonance cholangiopancreatography despite normal ultrasound and computed tomography.A 31-year-old woman presented with a one and half years' history of intermittent right upper quadrant (RUQ) pain, high fever and severely painful, warm and reddish swollen skin lesions on the fingers. Acute attack resolution occurred within 2 weeks after treatment with non-specific antibiotics. Low-grade fever (around 37.5 degrees C) and less painful swellings continued for 6 months after each attack. Abdominal ultrasound and computed tomography (CT) scans did not show any abnormality during the attacks. biopsy of the skin lesions after the second attack revealed lymphocytic vasculitis. All laboratory studies including rheumatologic serology panel were normal. One month after the complete resolution of the second attack, the patient was observed to have high fever, the same skin lesions on the fingers as at the initial stage, nausea and marked abdominal pain in the RUQ. Routine laboratory studies including complete blood count, liver function tests and serum amylase and lipase levels were normal. An abdominal CT scan revealed a slight thickening of the gallbladder wall (3.9 mm). Two weeks later, abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were performed because of persistent abdominal pain. They revealed both biliary tract and pancreatic gland alterations consistent with past cholangitis and pancreatitis with coexisting Phrygian cap anomaly and biliary sludge on the neck of the gallbladder.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
10/13. Elevated amylase in childhood.A 3-year-old boy was referred to a regional centre with an acute abdomen. On admission, his abdomen was clinically benign but an extremely high serum amylase titre noted. The patient was treated with simple observation and over the following period he was found to have an inflamed parotid gland.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
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