1/6. Perianal mucinous adenocarcinoma: unusual case presentations and review of the literature.Perianal mucinous adenocarcinoma is a rare cancer constituting 3 to 11 per cent of all anal carcinomas. It may arise de novo or from a fistula or abscess cavity. We present two cases of this disease process. Case One is a 52-year-old man with a chronic history of perianal abscesses who presented to the emergency room with a large bowel obstruction. He required diversion and wide local excision with lateral internal sphincterotomy for relief of the obstruction. pathology from the excised material revealed the unexpected diagnosis of invasive mucinous adenocarcinoma of the anus. Case Two is a 59-year-old man with a chronic history of complex fistulas and abscesses who presented to our office with a horseshoe fistula and deep postanal space abscess. Because of the nonhealing nature of the wound, biopsies from the abscess crater, fistulous tract, and the perianal skin opening were taken. The pathology department identified the specimens as invasive mucinous adenocarcinoma of the anal canal. This is an aggressive cancer often misdiagnosed clinically as benign pathology. A high index of suspicion and biopsy of fistulous tracts and abscesses are the keys to early diagnosis and treatment. With combination chemotherapy and radiation therapy in conjunction with aggressive surgical resection long-term survival might be obtained.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. Genitourinary anomaly in congenital varicella syndrome: case report and review.We describe a 1-year-old boy with congenital varicella syndrome who had vesicoureteral reflux (VUR) and neurogenic bladder. His mother had varicella during the 3rd month of pregnancy. At birth the patient presented with right microphthalmia, right microcornea, and persistent hyperplastic primary vitreous of the right eye. He had chronic constipation from 3 months of age. He had urinary tract infection at 1 year of age. Urological investigation revealed left grade V VUR and neurogenic bladder. His varicella zoster virus IgG titer measured by ELISA was 39.4 antibody index (normal <0.1). He had repeated episodes of urinary tract infection despite antibiotic prophylaxis and clean intermittent catheterization, and underwent a uretero-vesiconeostomy at 2 years of age. Maternal infection during early pregnancy and the serological evidence of varicella zoster IgG antibodies without a history of varicella after birth led to the diagnosis of congenital varicella syndrome. Urogenital anomalies have previously been described in 14 cases of congenital varicella syndrome. Most of these patients had neurogenic bladder, the pathophysiology of which could be explained by the known neurotropic nature of the virus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/6. neostigmine: an alternative treatment for constipation.constipation is a common complication of amyotrophic lateral sclerosis (ALS), especially as the disease progresses. While ALS patients may experience disturbed gastrointestinal motility due to the nature of the disease and decreased physical activity, the constipation is not usually caused by mechanical obstruction. Acute colonic pseudo-obstruction (ACPO) is a syndrome characterized by massive dilation of the colon without mechanical obstruction. Recent studies have shown neostigmine may be an effective treatment for ACPO. Through a case study, the author discusses the use of neostigmine and its nursing implications on a patient with ALS.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/6. Metastatic uterine serous carcinoma originating in an endometrial polyp: a report of 2 cases.BACKGROUND: Endometrial carcinoma is the most common cancer of the female genital tract. Two histologic variants have been described: an estrogen-dependent form and a more aggressive, non-estrogen-dependent form, which includes uterine serous carcinoma. CASES: Two cases of uterine serous carcinoma were confined to an endometrial polyp without myometrial invasion and were widely metastatic. One patient presented with abdominal pain and constipation, while the other patient was asymptomatic. Both patients had elevated CA-125 levels. At the time of surgery, these patients were found to have extensive carcinomatosis and underwent surgical staging procedures that required bowel resections. pathology showed metastatic disease originating in a small focus of serous adenocarcinoma at the tip of an endometrial polyp. Combination chemotherapy was planned; but 1 of the patients died prior to its initiation. CONCLUSION: These cases emphasize the aggressive nature of uterine serous carcinoma despite insignificant myometrial invasion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/6. cauda equina syndrome secondary to constipation: an uncommon occurrence.Suspected spinal cord or cauda equina pathology is an emergency that must be dealt with swiftly, with appropriate referral and investigations. constipation is a clinical diagnosis of exclusion, but should not be forgotten as a cause of major morbidity when severe in nature. It can mimic an acute abdomen, sepsis and even spinal cord pathology. We describe a case of cauda equina syndrome in a young man. The pathology responsible was found to be constipation with faecal impaction, once nerve and bony pathology were excluded. When treated, there was almost immediate resolution of the neurologic signs and urinary retention.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/6. "Like mother, like son:" hereditary anterior sacral meningocele. Case report and review of the literature.Anterior sacral meningocele (ASM) is a relatively rare, congenital disorder. Usually it presents sporadically, but there are case reports of hereditary ASMs and evidence of a dominant mode of inheritance. In this article the authors describe a case illustrating the hereditary nature of ASM and present available literature on the disease. The authors present the case of a 19-month-old boy in whom an ASM was diagnosed during a workup for constipation. The child's 31-year-old mother had been treated for the same condition 20 years earlier, when she had presented with back pain. These cases are discussed in the context of previous reports of similar cases. There are several case reports in the literature in which an ASM occurred as a familial, isolated disorder (in the absence of other caudal abnormalities or syndromes). The condition is reported more commonly in women, but it is unclear whether this is a true difference in prevalence or a diagnosis or reporting bias. A review of the literature indicates an autosomal-dominant inheritance with variable penetrance and presentation. Anterior sacral meningoceles can be hereditary. Given the potential complications of the disease if left untreated and the simplicity of screening--obtaining an abdominal radiograph and the patient's clinical history--we recommend screening of immediate family members of affected individuals. Surgical treatment is recommended if an ASM is discovered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |