scholarly journals Symptomatic prostatic utricle: various approaches for treatment

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Manjiri S. ◽  
Kush Luthra ◽  
Padmalatha S. K. ◽  
Jeevak Shetty ◽  
Neehar Patil
Keyword(s):  
Cystic Mass ◽  
Surgical Approaches ◽  
Appropriate Treatment ◽  
Clinical Presentations ◽  
Prostatic Utricle ◽  
Micturating Cystourethrogram ◽  
Definitive Repair ◽  
One Year ◽  
High Index Of Suspicion ◽  
Laparoscopic Assisted

Abstract Background Pediatric presentations of a prostatic utricle have received only little attention. The incidence of symptomatic prostatic utricle has been reported but most cases are asymptomatic. The purpose of this study is to highlight the various clinical presentations and surgical approaches to treat a symptomatic prostatic utricle. Results This study includes a series of 7 cases over a period of 5 years. The diagnosis of prostatic was made on the basis of clinical presentations, ultrasonography, micturating cystourethrogram, and cystoscopy. Of the 7 patients, the newborn patient had antenatally detected abdominal cystic mass which presented with postnatal urinary retention, 5 patients had various urinary complaints, and 1 older child with disorder of sexual differentiation (DSD) had urinary incontinence. Depending upon the grade of prostatic utricle, treatment was done in the form of laparoscopic-assisted excision in 1, laparotomy and excision in 1, perineal excision in 2, and cystoscopic fulguration in 3 patients. Postoperative period was uneventful. All the patients were followed for a period of 1–2 years. Most of them were asymptomatic except one child who had recurrent episodes of epidydimo orchitis which was treated conservatively, and he was also asymptomatic at the end of 1 year. Five patients who had associated hypospadias were observed for one year for any urinary complaints before they underwent definitive repair for hypospadias. Conclusion Prostatic utricle is a vestigial remnant of müllerian duct most commonly associated with posterior hypospadias. High index of suspicion for prostatic utricle in cases with recurrent urinary complaints helps in timely detection and appropriate treatment can prevent further complications. Cystoscopy and micturating cytourethrogram remains the gold standard for diagnosis.

scholarly journals A Review on Medical Child Abuse and Child Protection

2021 ◽  
Vol 63 (3) ◽  
Author(s):  
Mustafa Hussein Ajlan Al-Jarshawi ◽  
Ahmed Al-Imam
Keyword(s):  
Child Abuse ◽  
Child Protection ◽  
Clinical Findings ◽  
Clinical Presentations ◽  
Medical Child Abuse ◽  
Three Stages ◽  
The Mean ◽  
One Year ◽  
The Uk ◽  
High Index Of Suspicion

Background Medical child abuse describes a child receiving unnecessary, harmful, or potentially harmful medical care at the caretaker's instigation. Objectives To focus on medical child abuse as an entity and emphasize its epidemiology, clinical presentations, prevention, and management. Results In the UK, the annual incidence of medical child abuse in children below one year increased to 3:100,000, while its prevalence in Arabs, including Iraq, is ambiguous due to lack of evidence and improper clinician's awareness. The mean age at diagnosis is 14 months to 2.7 years. Female caregivers are the most common offenders. Clinically, medical child abuse could fit into three stages; falsification of illness story, falsification of illness story and physical signs' fabrication, or induction of illness in children. A successful diagnosis mandates a comprehensive review of medical records to identify discrepancies between caregivers' stories versus clinical findings or investigations. Management requires recognizing abuse, halting it, securing the child's safety, maintaining the family's integrity when possible, and aborting unnecessary lateral referrals within the healthcare system. Conclusion Reported cases of medical child abuse are increasing steadily, while less severe ones go unrecognized. No diagnostic tool can help other than the physician's high index of suspicion. The management follows the same principles applied for other forms of child abuse, while good medical practice ensures its prevention.

Cerebral venous thrombosis

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Arterial Disease ◽  
Venous Occlusion ◽  
Neurological Complications ◽  
Appropriate Treatment ◽  
Clinical Presentations ◽  
Neurological Conditions ◽  
High Index Of Suspicion ◽  
Better Than

Most stroke results from arterial disease but venous occlusion can also cause stroke, and other neurological complications. This condition is uncommon and needs a high index of suspicion if it is not to be missed. The clinical presentations are varied and can mimic other neurological conditions. The diagnosis is important because with appropriate treatment the prognosis can be much better than for arterial infarction.

scholarly journals Neonatal screening and genotype-phenotype correlation of hyperphenylalaninemia in the Chinese population

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xin Wang ◽  
Yanyun Wang ◽  
Dingyuan Ma ◽  
Zhilei Zhang ◽  
Yahong Li ◽  
...  
Keyword(s):  
Neonatal Screening ◽  
Phenylalanine Hydroxylase ◽  
Laboratory Data ◽  
Molecular Characteristics ◽  
Phenotype Correlation ◽  
Common Amino Acid ◽  
Appropriate Treatment ◽  
Clinical Presentations ◽  
Average Current

Abstract Background Hyperphenylalaninemia (HPA) is the most common amino acid metabolic disease involving phenylalanine hydroxylase (PAH, OMIM*612,349) deficiency or coenzyme tetrahydrobiopterin (BH4) deficiency. Patients with severe HPA often have a difficult life. Early diagnosis of HPA before the development of symptoms is possible via neonatal screening, facilitating appropriate treatment and reducing mortality and disability rates. This study revealed the prevalence, mutational and phenotypic spectrum, and prognosis of HPA by neonatal screening from January 2001 to September 2020 in Nanjing, Jiangsu Province, China. Methods Through a retrospective analysis of the information available in the neonatal screening database, the clinical presentations, laboratory data, molecular characteristics and treatment follow-up data of HPA patients detected by neonatal screening were evaluated. Results We diagnosed 181 patients with HPA from 1 to 957 newborns, giving an incidence of 1:6873. Among these patients, 177 were identified as PAH deficient and four patients were BH4 deficient. The average current age of the patients was 6.38 years old. The most common mutations of PAH were c.728 C > A/ p.Arg243Gln (13.83 %), c.158G > A/ p.Arg53His (9.57 %), c.611 A > G/ p.Tyr204Cys (7.44 %), and c.721 C > T/ p.Arg241Cys (6.38 %). Conclusions This study revealed the prevalence, phenotype-genotype, and prognosis of HPA in China and contributes to the updating of PAHD data for China and worldwide. Our study not only expanded the spectrum of phenotypes and genotype but also provided a valuable tool for improved genetic counseling and management of future cases.

A Case of Incidentally Detected Bladder Lipoma and a Review of the Literature

2021 ◽  
Vol 17 ◽  
Author(s):  
Emre Emekli ◽  
Elif Gündoğdu
Keyword(s):  
Histopathological Examination ◽  
Adrenal Adenoma ◽  
Bladder Wall ◽  
Benign Tumors ◽  
Imaging Features ◽  
Multiplanar Reconstructions ◽  
Clinical Presentations ◽  
Pelvic Lipomatosis ◽  
One Year

Background: Lipomas are benign fatty tumors made of fat tissue. Bladder lipomas are extremely rare. For this reason, it is necessary to be aware of the imaging features when incidentally detected in imaging. Case Report: In the abdominal computed tomography (CT) performed as part of the follow-up examination of a 43-year-old patient, who had undergone surgery for adrenal adenoma five years earlier, a 14x9x8 mm smoothly marginated, ovoid-shaped, hypodense mass lesion with a homogeneous internal structure was detected in the anterior bladder wall. The pre-contrast density of the lesion was measured as -105 HU. The magnetic resonance imaging performed one year after the CT examination revealed a 14x9x8 intramural mass in the bladder wall, showing protrusion toward the lumen. The group was observed to be markedly hypointense on fat-suppressed T1 and T2-weighted images and considered consistent with a bladder lipoma. Discussion: Bladder lipomas are benign lesions that can vary in clinical presentations but usually cause hematuria. The differential diagnosis of bladder lipomas includes other mesenchymal rare benign tumors that can arise from the urinary bladder submucosal layer, including leiomyoma, hemangioma, plasmacytoma, fibroma, and neurofibroma, in imaging bladder lipomas present as homogeneous lesions containing macroscopic fat. Only the liposarcoma and pelvic lipomatosis could also show similar features. The less differentiated liposarcomas tend to present more heterogeneous enhancement, irregular-shaped margins, and infiltrative behavior. Also, appropriate multiplanar reconstructions may allow the radiologist to determine it is an extravesical pelvic lipomatosis. Conclusion: Using CT and MRI, these lesions rich in adipose tissue can be distinguished from other lesions, and their diagnosis can be made to a great extent. However, a histopathological examination is required for a definitive diagnosis.

Nodular melanoma presenting as an exophytic subungual mass

2018 ◽  
Vol 63 (1) ◽  
pp. 32-34 ◽  
Author(s):  
B Finlay ◽  
T Ramachandren ◽  
K Hussey ◽  
S Parkyn ◽  
K Meyer ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Interesting Case ◽  
High Index ◽  
Nodular Melanoma ◽  
Diagnostic Pitfall ◽  
One Year ◽  
High Index Of Suspicion ◽  
Subungual Melanoma

Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot.

scholarly journals A RARE CAUSE OF URETHRAL OBSTRUCTION IN AN INFANT - CONGENITAL POSTERIOR URETHRAL POLYP

2014 ◽  
Vol 04 (02) ◽  
pp. 147-148
Author(s):  
Sandeep B. Rai ◽  
Raghu Shankar
Keyword(s):  
Transurethral Resection ◽  
Voiding Dysfunction ◽  
Male Infant ◽  
Rare Finding ◽  
Benign Polyp ◽  
Micturating Cystourethrogram ◽  
Urethral Polyp ◽  
Rare Lesion ◽  
Almost All ◽  
High Index Of Suspicion

Abstract:Urethral polyp is a rare finding in young children. These are congenital fibroepithelial benign polyp in the prostatic urethra. They present with acute or intermittent urinary obstruction, hematuria or voiding dysfunction. Their diagnosis requires a high index of suspicion because of variability in presentation. Diagnosis can be made by ultrasonography or micturating cystourethrogram, however cystourethroscopy is confirmatory. Transurethral resection is possible in almost all the cases and recurrence is almost unknown. We report a case of this rare lesion in a male infant with a severe phimosis.

scholarly journals Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Galina Bogoslovskaya ◽  
Jose Zaldivar
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Extrapulmonary Tuberculosis ◽  
Young Female ◽  
Ca 125 ◽  
Test Results ◽  
Peritoneal Tuberculosis ◽  
Clinical Presentations ◽  
High Index Of Suspicion ◽  
Diagnostic Delays

Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy.Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject.

Delayed cytokine release syndrome after neoadjuvant nivolumab: a case report and literature review

Immunotherapy ◽  
2021 ◽  
Author(s):  
Aaron T Ciner ◽  
Howard S Hochster ◽  
David A August ◽  
Darren R Carpizo ◽  
Kristen R Spencer
Keyword(s):  
Adverse Event ◽  
Checkpoint Inhibitors ◽  
Corticosteroid Treatment ◽  
Hemodynamic Instability ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Related Adverse Event ◽  
Neoadjuvant Immunotherapy ◽  
Appropriate Treatment ◽  
High Index Of Suspicion

Aim: Cytokine release syndrome (CRS) is an infrequently described immune-related adverse event of checkpoint inhibitors (CPI). CPI-induced CRS typically presents with fevers, hemodynamic instability and organ dysfunction within 2 weeks of the last treatment cycle. Case study: We report an unusual case of delayed and severe CRS occurring postoperatively in a patient with hepatic-limited metastatic colorectal cancer who received neoadjuvant immunotherapy. After a negative workup for alternative causes, he received prolonged corticosteroid treatment with symptom resolution. Conclusion: CPI-induced CRS can mimic sepsis and clinicians should maintain a high-index of suspicion to diagnose this immune-related adverse event early and initiate appropriate treatment. As use of perioperative immunotherapy increases, the potential role of surgery to trigger CRS in this case warrants further investigation.

Early Gallbladder Carcinoma: A Single-Center Experience

2006 ◽  
Vol 92 (6) ◽  
pp. 487-490 ◽  
Author(s):  
Vincenzo Cangemi ◽  
Enrico Fiori ◽  
Cristina Picchi ◽  
Alessandro De Cesare ◽  
Roberto Cangemi ◽  
...  
Keyword(s):  
Gallbladder Carcinoma ◽  
Tnm Classification ◽  
Muscularis Propria ◽  
Surgical Approaches ◽  
Term Survival ◽  
Simple Cholecystectomy ◽  
Single Center Experience ◽  
Appropriate Treatment ◽  
Extended Cholecystectomy

Aims and background Controversy continues regarding the best surgical treatment for early gallbladder carcinoma defined as a tumor confined to the mucosa (pT1a) or to the muscularis propria (pT1 b) according to the TNM classification. This study evaluates the effectiveness of different surgical approaches in patients with early gallbladder carcinoma in terms of long-term survival. Materials and methods From 1980 to 2001, 175 patients with gallbladder carcinoma were admitted to our department. Fifteen of them underwent resections for early gallbladder carcinoma: 4 patients for pT1a tumors and 11 patients for pT1b tumors. All patients with pT1a tumors and 8 patients with pT1b tumors underwent simple cholecystectomy. The remaining 3 patients with pT1 b tumors underwent extended cholecystectomy. Results The 5-10 year cumulative survival rate was 100% for patients with pT1a tumors, 37.5% for patients with pT1b tumors who underwent simple cholecystectomy, and 100% for patients with pT1b tumors who underwent extended cholecystectomy. Conclusions Simple cholecystectomy is the appropriate treatment for patients with pT1a tumors, whereas patients with pT1b tumors require an extended cholecystectomy.

scholarly journals Outcomes from stereotactic surgery for essential tremor

2018 ◽  
Vol 90 (4) ◽  
pp. 474-482 ◽  
Author(s):  
Robert Francis Dallapiazza ◽  
Darrin J Lee ◽  
Philippe De Vloo ◽  
Anton Fomenko ◽  
Clement Hamani ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Neurological Complications ◽  
Treatment Modalities ◽  
Beneficial Effects ◽  
Appropriate Treatment ◽  
Long Term Follow Up ◽  
Added Benefit ◽  
One Year

There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.

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