scholarly journals Clinical Characteristics and Treatment Outcome of 485 Patients with Nonfunctioning Pituitary Macroadenomas

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Guadalupe Vargas ◽  
Baldomero Gonzalez ◽  
Claudia Ramirez ◽  
Aldo Ferreira ◽  
Etual Espinosa ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Evidence ◽  
Clinical Presentation ◽  
Imaging Diagnosis ◽  
Benign Lesions ◽  
Central Hypothyroidism ◽  
Median Volume ◽  
Tumor Persistence ◽  
Design And Methods ◽  
Pituitary Macroadenomas

Background. Nonfunctioning pituitary adenomas (NFPAs) are the most common benign lesions of the pituitary gland.Objective. To describe our experience with the management of NFPA.Study Design and Methods. Retrospective evaluation of NFPA patients managed between 2008 and 2013. We analyzed data regarding clinical presentation, imaging diagnosis, hormonal status, surgical, radiotherapeutic, and pharmacological treatment, and outcome.Results. 485 patients (54% men, mean age53±14years) were followed for a median of 6.5 years. Visual field abnormalities and headaches were the presenting complaints in 87% and 66%, respectively. The diagnosis of NFPA was made incidentally in 6.2%, and 8% presented with clinical evidence of apoplexy. All patients harbored macroadenomas, with a median volume of 10306 mm3; 57.9% had supra- or parasellar invasion and 19.6% had tumors larger than 4 cm. Central hypothyroidism, hypogonadism, and hypocortisolism were present in 47.2%, 35.9%, and 27.4%, respectively. Surgical resection was performed at least once in 85.7%. Tumor persistence was documented in 27% and was related to the size and invasiveness of the lesion. In selected cases, radiotherapy proved to be effective in controlling or preventing tumor growth.Conclusions. The diagnosis and treatment of NFPA are complex and require a multidisciplinary approach.

Clinical presentation of 209 surgically operated non-functioning pituitary macroadenomas

2021 ◽  
Author(s):  
Mared Edwards ◽  
Caroline Hayhurst ◽  
Amr Mohamed ◽  
J Steve Davies ◽  
D Aled Rees ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Pituitary Macroadenomas

scholarly journals Complex-Compound Odontoma: A Rare Clinical Presentation

2018 ◽  
pp. 39-44
Author(s):  
Damla Torul DDS, PhD ◽  
Metehan Keskin DDS ◽  
Seda Gun DDS, PhD ◽  
Didem Odabasi DDS, PhD
Keyword(s):  
Early Detection ◽  
Complex Compound ◽  
Rare Case ◽  
Multidisciplinary Approach ◽  
Clinical Presentation ◽  
Odontogenic Tumor ◽  
Compound Odontoma

Odontomas can be detected as complex or compound variants and they rarely show the histologic characteristics of both types together. The tumor commonly associated with malocclusion, eruption disturbances and pathological anomalies, but they seldom cause bony expansion. Early detection and management of odontoma with multidisciplinary approach pose an important role to prevent disturbances associated with this common odontogenic tumor. Here we report a rare case of an odontoma which show the features of both complex and compound types and also cause bony expansion, eruption failure in an 8-year-old boy.

scholarly journals Prevalence of non-infectious dermatoses in patients attending a tertiary care center in Rajasthan

2019 ◽  
Vol 5 (1) ◽  
pp. 192
Author(s):  
Bhagirath Singh ◽  
Indira Subhadarshini Paul
Keyword(s):  
Clinical Evidence ◽  
Clinical Presentation ◽  
Skin Diseases ◽  
Genetic Disorders ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Pigmentary Disorders ◽  
Protozoal Infection

<p class="abstract"><strong>Background:</strong> Pediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment and prognosis. There is very little epidemiological study available on non-infectious childhood dermatoses in India. The aims of the study were to find the prevalence, clinical profile and various etiological factors associated with childhood non-infectious dermatoses and to determine the prevalence of most common non-infectious childhood dermatoses.</p><p class="abstract"><strong>Methods:</strong> This cross-sectional observational study conducted at tertiary care centre in Rajasthan, India. Children with age 13 years and below with clinical evidence of cutaneous disorders were studied. Parents who have not given consent for the study, acutely ill children, Children having infectious dermatoses (bacterial, fungal, viral, arthropods, parasitic and protozoal infection) were excluded from the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 232 cases were studied which showed a female preponderance of 55.60%. Most of the skin diseases were seen in the 5 to 13 years (school children) age group. The most common dermatoses was eczematous (36.63%), among eczema atopic diathesis was the commonest (17;20%) followed by hypersensitivity dermatoses (21.12%), genetic disorders (13.36%), disorders of genetic disorders (7.4%), sweat gland disorders (8.18%), pigmentary disorders (4.31%), papulo squamous disorders (4.74%), Nevi (6.46%).</p><p class="abstract"><strong>Conclusions:</strong> Eczematous dermatoses were the most commonly noted in the study, followed by hypersensitivity dermatoses. Atopic diathesis was the commonest endogenous eczemas. Acne, insect bite reaction and miliaria were the other common dermatoses. There was no significant association of various dermatoses with systemic diseases in the study.</p>

scholarly journals Orofacial manifestations of mucocutaneous leishmaniasis: a case series from Brazil

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 756
Author(s):  
Gleicy Gabriela Vitória Spinola Carneiro Falcão ◽  
Liliane Lins-Kusterer ◽  
Patricia Miranda Leite-Ribeiro ◽  
Viviane Almeida Sarmento
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Presentation ◽  
Case Series ◽  
Treatment Delay ◽  
Great Variability ◽  
Psychological Consequences ◽  
Facial Deformity ◽  
Mucocutaneous Leishmaniasis ◽  
Risk Of Disease ◽  
Delays In Diagnosis

Dentists play a fundamental role in the early diagnosis of oral leishmaniasis. Although these lesions are rare at oral mucosa, this is one of the manifestations sites of the disease This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had leishmaniasis diagnosis confirmed by laboratory tests, with orofacial involvement. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dentist. In two reported cases, there were unspecific biopsy results. This series of cases highlights the importance of a multidisciplinary approach in the diagnosis and treatment of oral and perioral leishmaniasis. Patients with atypical lesions, originating from or living in endemic regions, should be investigated for leishmaniasis. These procedures could avoid delays in diagnosis and decrease the risk of disease dissemination.

An unusual presentation of synchronous bladder metastases from an oesophageal adenocarcinoma

2021 ◽  
Vol 103 (7) ◽  
pp. e227-e230
Author(s):  
D Wignall ◽  
R Sawant ◽  
A Gkentzis ◽  
L Lee
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Evidence ◽  
Oesophageal Carcinoma ◽  
Oesophageal Adenocarcinoma ◽  
Gastrointestinal Malignancy ◽  
Direct Invasion ◽  
Bladder Abnormalities ◽  
Upper Gastrointestinal ◽  
Progressive Dysphagia

Adenocarcinoma of the bladder is a rare form of malignancy accounting for fewer than 2% of bladder tumours. It is most commonly a result of direct invasion from prostatic, rectal or gynaecological primaries and less commonly presents from distant haematological or lymphatic metastasis. We report a rare case of oesophageal carcinoma metastasising to the bladder. It involves a 71-year-old man with progressive dysphagia and diagnostic computerised tomography findings of thickening in the oesophagus, bladder and common bile duct. Subsequent endoscopic biopsies of the oesophageal and bladder abnormalities showed immunohistochemical features consistent with upper gastrointestinal malignancy. This report aims to add to current clinical evidence of this route of metastasis and also highlight some of the key markers used by pathologists in interpretation of specimens. It also emphasises the essential role of a multidisciplinary approach for the diagnosis of such rare conditions.

Abstract WMP9: Impact of Collateral Blood Flow on Clinical Presentation, Diffusion and Perfusion Imaging, Infarct Growth and Clinical Outcome in the DEFUSE 2 Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Michael P Marks ◽  
Maarten G Lansberg ◽  
Michael Mlynash ◽  
John-Marc Olivot ◽  
Matus Straka ◽  
...  
Keyword(s):  
Perfusion Imaging ◽  
Clinical Presentation ◽  
Stroke Severity ◽  
Collateral Flow ◽  
Collateral Blood Flow ◽  
Point Scale ◽  
Median Volume ◽  
And Diffusion ◽  
Blinded Reader ◽  
Good Flow

Objective: To determine the relationships between angiographic collaterals and diffusion/perfusion imaging, subsequent infarct growth and clinical outcomes in DEFUSE 2 study patients. Methods: Patients undergoing endovascular therapy within 12 hours of stroke onset were prospectively enrolled. Only patients with a TICI score of 0, 1 and ICA/M1 occlusion at baseline were included in this analysis. A blinded reader assigned a collateral score using a previously described 5 point scale, from 0 (no collateral flow) to 4 (complete/rapid collaterals to entire ischemic territory). Analysis was dichotomized to poor flow (0-2) versus good flow (3-4). Collateral score was correlated with baseline NIHSS, DWI volume, PWI volume (Tmax > 6), TICI reperfusion, infarct growth and mRS at day 90. Results: Sixty patients had TICI 0, 1 ICA/M1 occlusions and adequate angiographic images to evaluate collaterals. Baseline NIHSS correlated with collateral score (p=0.002). Median NIHSS for patients with poor collateral flow (0-2) was 18 (IQR, 13-22) versus 14 (10-17) for those with good flow (3-4), p=0.025. Baseline T max > 6 volume correlated with collateral score (p=0.002). Median volume of tissue at risk (T max > 6) in those with poor collateral flow was 115 ml (IQR, 74-136) versus 82 (51-109) with good flow, p=0.012. Collateral score did not correlate with baseline DWI volume. TICI reperfusion (0-3) correlated with collateral score (p=0.027). Patients with poor collateral flow had 29% TICI 2b-3 reperfusion versus 65.5% with good flow, p=0.009. Those with poor reperfusion (TICI 0-2a) showed a trend to more infarct growth with poor collaterals, 92 ml (52-194) [mean (IQR)] versus 36 ml (14-106) with good collaterals, p=0.06. Patients with poor collaterals who reperfused (TICI 2b-3) were still likely to have a mRS 0-2 at 90 days compared to those without reperfusion; OR 12 (95% CI, 1.6-98). Conclusion: Collaterals correlate with baseline clinical stroke severity and the PWI volume. In addition, good collaterals correlate with higher rates of reperfusion (TICI 2b-3). When patients do not reperfuse, good collaterals appear to limit infarct growth.

Trends and outcomes of ruptured ovarian cysts

2021 ◽  
pp. postgradmedj-2020-138833
Author(s):  
Wei How Lim ◽  
Nikki Woods ◽  
Vincent P Lamaro
Keyword(s):  
Emergency Department ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Ovarian Cysts ◽  
Free Fluid ◽  
Vaginal Intercourse ◽  
Imaging Diagnosis ◽  
Retrospective Audit ◽  
Common Clinical Presentation ◽  
Health Institutions

BackgroundRuptured ovarian cysts are common gynaecological presentation to health institutions with abdominal pain. While this phenomenon is generally self-limiting, surgery may be necessary in cases of haemodynamic compromise or association with torsion. The aim of this audit is to identify the trend of hospital presentations, as well as the review the management of modern gynaecology practice.MethodsA retrospective audit of all women who presented to the emergency department with an imaging diagnosis of ruptured ovarian cysts was conducted over a 5-year period at St Vincent’s Hospital, Sydney.ResultsDuring the study period, 408 women were identified. There was a trend towards conservative management, as observed in 84.7% of women, while the remaining 15.4% underwent surgery. Haemorrhagic or ruptured corpus luteum was the most common diagnoses. As expected, women who had surgical intervention were more likely to have larger cysts (20 vs 50%; p<0.05), and larger free fluid findings on imaging (1.4 vs 23.8%; p<0.05) compared with those managed conservatively. There were no statistically significant differences in location of ovarian cysts (right or left) or antecedent to hospital presentation (vaginal intercourse or trauma).ConclusionRuptured ovarian cysts of both functional and non-functional types remained a common clinical presentation of acute pain for women to the emergency department. Majority of women were managed conservatively in our cohort, and indications for surgery were large ovarian cysts and large free fluid seen on imaging findings. Surgery was largely feasible with minimal complications.

Xanthogranulomatous pyelonephritis: an overview and management guide for clinicians

2021 ◽  
Vol 82 (2) ◽  
pp. 1-8
Author(s):  
Patrick Jones ◽  
Darko Lazic ◽  
Bhaskar K Somani ◽  
Amr Hawary
Keyword(s):  
Kidney Stone ◽  
Associated Factors ◽  
Multidisciplinary Approach ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Female Gender ◽  
Stone Disease ◽  
Flank Pain ◽  
Xanthogranulomatous Pyelonephritis ◽  
Neoplastic Process

Xanthogranulomatous pyelonephritis is a rare and chronic form of pyelonephritis. Patients can present with an array of signs and symptoms including flank pain, fever and weight loss. The insidious nature of its clinical presentation means that it can mimic a neoplastic process. Kidney stone disease, diabetes and female gender are the most common associated factors. Early diagnosis can be difficult, but is vital to avoid sequelae such as abscess formation and involvement of surrounding structures. Management requires a multidisciplinary approach. Definitive resolution can only be achieved through nephrectomy. This article provides an overview and guide to diagnosis, investigation and management.

Self-Mutilation in Children with Obstetric Brachial Plexus Palsy

1999 ◽  
Vol 24 (5) ◽  
pp. 547-549 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Clinical Evidence ◽  
Clinical Presentation ◽  
Presentation Of Self ◽  
Abnormal Behaviour ◽  
Obstetric Brachial Plexus Palsy ◽  
Erb’S Palsy ◽  
Self Mutilation ◽  
Obstetric Brachial Plexus ◽  
A Prospective Study

In a prospective study, the incidence and clinical presentation of self-mutilation was documented in 127 consecutive cases of obstetric brachial plexus injury. Six out of the 127 cases (4.7%) had clinical evidence of self-mutilation. The incidence of self-mutilation was much higher among children with total palsy (4/37) than Erb’s palsy (2/90). All affected children were able to bring the mutilated hand or forearm to the mouth without assistance from the contralateral normal limb. Mutilation in patients with total palsy was generally severe and usually involved biting the tips of the digits. However, mutilation in patients with upper (Erb’s) palsy was mild in degree and tended to involve the dorsum of the hand. Similarity between human self-mutilation and animal autotomy following denervation are discussed along with the different theories explaining the mechanism of this abnormal behaviour.

scholarly journals Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team

2018 ◽  
Vol 35 (02) ◽  
pp. 116-121 ◽  
Author(s):  
Tamir Friedman ◽  
Keith Quencer ◽  
David Madoff ◽  
Ronald Winokur
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Presentation ◽  
Treatment Guidelines ◽  
The United States ◽  
Imaging Diagnosis ◽  
Patient Assessment ◽  
Timely Manner ◽  
Response Team ◽  
Hospital Deaths

AbstractPulmonary embolism (PE) is currently the third leading cause of death and moreover is likely underdiagnosed. PE remains the most common preventable cause of hospital deaths in the United States, which may be attributable to its diagnostic challenges. Although difficult to diagnose, patient mortality rates are time-dependent, and thus, the suspicion and diagnosis of PE in a timely manner is imperative. Diagnosis based on several criteria which may dictate imaging workup as well as laboratory tests and clinical parameters are discussed. The evolution of treatment guidelines via various clinical trials and recommendations is outlined, setting the stage for the use of fibrinolytics, whether systemic or catheter directed. Treatment, including fibrinolytics, is predicated on patient triage into three large categories—massive, submassive, or low-risk PE. Additionally, a relatively new concept of a multidisciplinary team composed of several subspecialty experts known as the PE response team (PERT) is discussed. PERT's timely and unified recommendations have been shown to optimize care and decrease mortality while tailoring treatment to each individual afflicted by PE.

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