1/6. Iatrogenic Creutzfeldt-Jakob disease following human growth hormone therapy: case report.We report the case of a 41-year-old man with iatrogenic Creutzfeldt-Jakob disease (CJD) acquired after the use of growth hormone (GH) obtained from a number of pituitary glands sourced from autopsy material. The incubation period of the disease (from the midpoint of treatment to the onset of clinical symptoms) was rather long (28 years). Besides the remarkable cerebellar and mental signs, the patient exhibited sleep disturbance (excessive somnolence) from the onset of the symptoms, with striking alteration of the sleep architecture documented by polysomnography. 14-3-3 protein was detected in the CSF, and MRI revealed increased signal intensity bilaterally in the striatum, being most evident in diffusion-weighted (DW-MRI) sequences. This is the second case of iatrogenic CJD associated with the use of GH reported in brazil.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/6. diagnosis and therapeutic management of iatrogenic parotid sialocele.Salivary gland sialoceles are relatively common and may be a complication of trauma with a penetrating salivary gland injury or may be a complication of salivary gland surgery. The development of new diagnostic tools such as magnetic resonance sialography and endoscopic techniques has led to further improvements in the clinical and diagnostic assessment of this condition, and botulinum toxin therapy has recently been described in the management of parotid sialoceles. We here report the case of a 41-year-old patient with an unusually complicated parotid sialocele following an unsuccessful attempt to remove a stone located in the distal third of Stensen's duct. Magnetic resonance sialography and sialoendoscopy were used in order to obtain an adequate diagnostic assessment. The patient underwent extracorporeal lithotripsy that led to partial symptom regression. After the development of a parotid abscess, he received antibiotics and a botulinum toxin type A injection that induced spontaneous drainage and disappearance of the symptoms. Magnetic resonance sialography and sialoendoscopy are promising new diagnostic techniques for better noninvasive management of iatrogenic sialoceles.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
3/6. Disappearance of a virilizing adrenal tumor following therapy with cyproterone acetate.A 57-year-old woman presented with an apparently obvious diagnosis of iatrogenic virilization. At the age of 51, she began a 4-year treatment with prednisone or cyclosporine, which are known to promote hair growth, for Behcet disease. At the age of 56, osteoporosis was overtreated with the anabolic steroid nandrolone. Insignificant inhibition by dexamethasone of the extremely high serum concentrations of testosterone and less high concentrations of weak androgens prompted us to search for a virilizing tumor. Computed tomography showed a 2.3 x 1.5 cm nodule in the right adrenal gland. As the patient refused surgery, virilization was treated with the antiandrogen cyproterone acetate (CPA), but for only 4 months because clinical and hormone abnormalities reversed and the tumor was no longer visible. The patient remains symptom-free. This first report of a curative effect of CPA on a purely virilizing adrenal tumor opens new avenues in the management of such tumors.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/6. Iatrogenic peritoneal adenomyoma after laparoscopic subtotal hysterectomy and uterine morcellation.Five years after laparoscopic subtotal hysterectomy and morcellation, pelvic magnetic resonance imaging demonstrated the presence of an irregular and heterogeneous pelvic mass measuring 40 x 40 x 30 mm. Histologic examination confirmed smooth muscle hyperplasia infiltrated by numerous endometrial glands (adenomyosis).- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/6. Prostatic gland damage: a possible complication of bladder neck Y-V-plasty.A case of primary ejaculatory failure due to prostatic damage in a 23-year-old patient is presented. This occurred secondary to Y-V operation of the bladder neck which was performed 19 years earlier. To our knowledge, this complication has not been described previously.- - - - - - - - - - ranking = 4keywords = gland (Clic here for more details about this article) |
6/6. Iatrogenic supralevator fistula.This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |