1/23. Pseudocyst formation after abdominoplasty--extravasations of Morel-Lavallee.A soft tissue injury can lead to the formation of a pseudocyst in the subcutaneous adipose tissue, due to a seroma, haematoma or fat necrosis. These cysts were first described in 1853 by the French physician Morel-Lavallee. He observed the phenomenon in the lower limb in women after a tangential trauma with separation of the fatty layers. A similar condition can occur following surgery of the abdomen, when performing liposuction and subcutaneous dissection with a large dead space. In this report we present two cases with large pseudocysts in the abdominal wall, which were seen in long term follow-up after an abdominoplasty performed elsewhere. The pathogenesis, the treatment and the literature are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/23. Common head and neck manifestations of AIDS.head and neck manifestations of acquired immunodeficiency syndrome (AIDS) can involve the skin, ear, upper aerodigestive tract, and neck. Several head and neck manifestations of AIDS may be the only initial sign of this disease process and therefore primary-care physicians and otolaryngologists must be able to recognize and understand the management of these lesions. Cystic enlargement of the parotid gland and Kaposi's sarcoma are increasingly being encountered in the head and neck exam of HIV-infected patients. An example of each of these disease processes is presented with full discussion about the various treatment methods.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/23. milk of calcium in the inferior calyx of a hydronephrotic kidney in a tetraplegic patient - a diagnosis to be made before scheduling for extracorporeal shock wave lithotripsy.STUDY DESIGN: A Case Report of renal milk of calcium in a tetraplegic subject. OBJECTIVES: To increase the awareness of renal milk of calcium in spinal cord injury (SCI) physicians. Renal milk of calcium contains a colloidal suspension of calcium crystals. Since upright views of the kidneys are not performed in tetraplegic subjects, the renal milk of calcium may be misinterpreted as renal lithiasis by routine radiography taken in supine position. SETTING: Regional spinal injuries Centre, Southport, england. METHOD: In a 41-year-old male with traumatic tetraplegia, X-ray of abdomen in supine position showed multiple opacities in the region of the left kidney. These radio opaque shadows were interpreted as renal calculi. Subsequently, computed tomography (CT) of the kidneys was performed. RESULTS: CT confirmed the presence of calculi in the mid-polar calyx. However, the density situated in the inferior calyx of the hydronephrotic left kidney exhibited a horizontal upper edge. This specific radiological finding as observed in the CT of kidneys, provided the clue to the presence of milk of calcium in the inferior calyx of the hydronephrotic left kidney. CONCLUSION: As plain film of the abdomen in standing position is not performed in SCI patients, physicians caring for SCI patients should have a high index of suspicion for renal milk of calcium. Prompt diagnosis of renal milk of calcium will help to avoid unnecessary surgery, or extracorporeal shock wave lithotripsy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/23. Differentiating hiv-1 parotid cysts from papillary cystadenoma lymphomatosum.BACKGROUND: patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION: PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS: As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/23. Mediastinal parathyroid cyst with tracheal constriction.A 63-year-old man visiting a physician for slight dyspnea, attributed to a lump on his neck, was found in ultrasonography and computed tomography to have a cyst extending from the left lobe of the thyroid gland to the superior mediastinum. radiography showed right deviation of the trachea. The cyst disappeared after fine-needle aspiration, but cyst fluid subsequently reaccumulated and he was admitted to our hospital. No abnormalities were detected in tests of thyroid and parathyroid function or blood chemical analysis. The cyst was surgically removed and diagnosed as a nonfunctioning parathyroid cyst, based on the high-intact parathyroid hormone in cyst fluid. The patient recovered fully and has shown no recurrence in the 11 months to data since surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/23. Angle-closure glaucoma in teenagers.OBJECTIVE: To report the occurrence of angle-closure glaucoma in 2 teenagers. DESIGN: Observational case reports, review of literature. methods: review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. MAIN OUTCOME MEASURES: intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy. RESULTS: The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. CONCLUSION: Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/23. Inferior vena cava thrombosis: an unusual complication of a large simple non-parasitic liver cyst requiring an integrated approach.Most of the simple hepatic cysts are asymptomatic and have a benign course. However, some exceptional life-threatening complications may occur. We herein report the successful management of a case who suffered from a cystic compression of the inferior vena cava complicated by thrombosis of the inferior vena cava itself. To our knowledge this is the first report of such a complication and diagnostic and therapeutic aspects are discussed. This case is paradigmatic of the possible complexity of the diagnosis and treatment of cystic lesions of the liver and should induce physicians to consider a therapeutic approach if a clear tendency to enlarge can be recognized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/23. Intraoral extraction of cheek skin cyst.BACKGROUND: When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. OBJECTIVE: To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. METHOD: An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. RESULT: The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. CONCLUSION: A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/23. Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.BACKGROUND: amiodarone (Cordarone; Wyeth, Ayerst, new york) is a potassium channel blocking antiarrythmal medication indicated for recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia. Chemically, it is classified as an iodinated benzofuran derivate antiarrythmal drug not chemically related to any other available antiarrhythmic drug. Documented side effects of amiodarone include neurologic, gastrointestinal, dermatologic, cardiovascular, and ophthalmic. The ophthalmic abnormalities include optic neuropathy, optic neuritis, papilledema, corneal deposits, photosensitivity, lens opacities, and macular degeneration. Corneal microdeposits are seen in virtually all patients who receive amiodarone for more than 6 months. Corneal microdeposits result secondary to the secretion of amiodarone by the lacrimal gland with accumulation on, and absorption by, the corneal epithelium. Approximately 10% of these patients become symptomatic with glare and halos; however, that alone is usually not enough to precipitate intervention. CASE REPORT: A 69-year-old woman presented to our office with a 2-week history of halos and glare in both eyes (OU). Her ocular history was significant for occasional contact lens wear. Her systemic history was significant for atrial fibrillation, for which she was taking amiodarone daily for the last 6 years. Six weeks before the onset of her chief complaint, her daily amiodarone dosage was increased from 100 mg to 300 mg. Ophthalmic examination found decreased visual acuities OU, amiodarone keratopathy (subepithelial verticillata), and diffuse corneal epithelial edema with diffuse sodium fluorescein staining OU. The corneal compromise was treated in 2 ways: the source medication was discontinued, and the ocular signs were medicated with a prophylactic topical antibiotic along with supportive preparations (tears/lubricants) and monitored over 2 weeks until full elimination of the pathologic signs and their symptoms. Even after complete resolution of the acute keratitis, the infiltrative keratopathy persisted along with the initial complaints of halos and glare. The supportive treatments were maintained over the course of 2 months until full recovery. CONCLUSION: By exclusion, it was determined that the subepithelial depositions and cystic formations were secondary to an acute amiodarone dosage increase by a new practitioner. Prompt communication resulted in the physician discontinuing that medicine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/23. Laparoscopic liver surgery: Shifting the management of liver tumors.Laparoscopic liver surgery has evolved rapidly over the past 5 years in a select number of centers. The growing experience with these procedures has resulted in a shift in the diagnostic and therapeutic approach to common liver tumors. The fact that resection of benign and malignant hepatic masses can now be accomplished laparoscopically with relatively low morbidity has influenced the decision-making process for physicians involved in the diagnosis and management of these lesions. For example, should a gastroenterologist or hepatologist seeing a 32-year-old woman with an asymptomatic 4 cm hepatic lesion that is radiologically indeterminate for adenoma or focal nodular hyperplasia (FNH): (1) continue to observe with annual computed tomography/magnetic resonance imaging (CT/MRI) scans, (2) subject the patient to a liver biopsy, or (3) refer for laparoscopic resection? For a solitary malignant liver tumor in the left lateral segment, should laparoscopic resection be considered the new standard of care, assuming the surgeon can perform the operation safely? We present current data and representative case studies on the use of laparoscopic liver resection at 2 major medical centers in the united states. We propose that surgical engagement defined by the managing physician's decision to proceed with a surgical intervention is increasingly affected by the availability of, and experience with, laparoscopic liver resection.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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