Recurrent Pleomorphic Adenoma

This chapter discusses the etiology, clinical presentation, assessment, and treatment of recurrent pleomorphic adenoma. Recurrent tumor following surgery (or any other treatment) usually presents as a recurrent swelling at the primary site, with or without local symptoms. The incidence of recurrence following surgery varies depending on surgical technique, surgeon's experience, duration of follow-up, and clinical integrity. A recurrence rate of less than 1% is generally considered acceptable. The best policy to prevent recurrence of pleopmorphic adenoma is excisional biopsy of the tumor with maximal safe margin and functional neurological preservation. Treatment is determined by the age and physical health of the patient, number of pervious operations, and anatomical extent of the recurrence. Treatment options include observation, local excision, superficial parotidectomy, total conservative parotidectomy, total parotidectomy with resection of the involved nerve and immediate nerve graft (any procedure is followed by radiotherapy), and radiotherapy alone.

Larygeotrache oseophageal cleft: a rare entity

<p>Larygeotrache oseophageal cleft is a rare anomaly in a newborn presenting with respiratory distress and choking with feeding symptoms identical with oesophageal atresia with or without tracheo-oesophageal fistula .It is an abnormal communication of the larynx and the trachea with the oesophagus occurring during fifth to seventh week of gestation as a result of circoid cartilage failing to fuse dorsally. LTOC varies greatly in anatomical extent and clinical severity; more severe forms in which the some or all of the tracheal cartilaginous rings are incomplete are fatal unless corrected surgically. LTOC occurs in less than 1/10,000 to 1/20,000 live births with slightly male predilection and has a autosomal dominant mode of inheritance. Routine chest X-rays and barium oesophagogram are usually not conclusive but bronchoscopy will delineate anatomy of cleft clearly. We present detailed case report of neonate with respiratory distress and choking on feeding and illustrating maneuvers at endoscopy and subsequent individualized surgical management of child.</p>

Guidelines and Practical Considerations for Mapping Epileptiform Activity and Network Connectivity with Magnetoencephalography

Since its adoption in clinical practice, analysis and interpretation of magnetoencephalography (MEG) recordings in patients with epilepsy have evolved as a result of multidisciplinary input, with the aim of developing formalized criteria that can yield reliable results and that are complementary to other modalities used for diagnostic assessment in this cohort. The purpose of this chapter is to familiarize the interested practitioner with the process of analyzing interictal MEG recordings, using examples from clinical cases to illustrate the utility of this modality and acknowledging some of its limitations. To achieve this, the reader will first be presented with consideration of basic quality assessment measures when interpreting clinical MEG recordings. Subsequently, a description will be provided on a clinically valid approach that is standard of practice for performing source localization of epileptiform transients. Specifically, the latter is discussed in the broader context of identifying various interictal epileptiform transients in MEG recordings and determining their anatomical extent in order to better characterize the irritative zone. Finally, a review is provided for emerging methods in MEG connectivity analysis and their potential utility in clinical practice for elucidating epileptogenic networks.

Retroperitoneal lymphangiectasia: a great clinical masquerade

Retroperitoneal lymphangiectasia is a very rare lymphatic disorder characterized by abnormal proliferation of lymphatics. We present series of 3 cases of retroperitoneal lymphangiectasia which are diagnosed in our institute with the help of Ultrasonography (USG), Computed Tomography (CT) and Magnetic resonance imaging (MRI) of abdomen and pelvis with unusual clinical presentation. We include clinical features and imaging findings of this disorder with its pathogenesis and diagnosis. Two of the cases were clinically masquerading as hernia and one case was mimicking varicocele. Thorough clinical examination and USG, colour Doppler, CT and MRI are extremely helpful imaging investigation that aid in differentiating these lesions from hernia/ varicocele and the cross sectional imaging like CT and MRI can depict the anatomical extent of the disease.

Breast cancer

Breast cancer is the commonest female cancer, with a lifetime risk of approximately 1 in 9. There are approximately 40 000 new cases and 11 000 deaths from the disease in England and Wales each year. Breast cancer is an adenocarcinoma which arises from the glandular tissue of the breast. Its etiology is complex, with hormonal, genetic, and modifiable lifestyle factors all involved in developing the disease. Prognosis is related to the anatomical extent of the cancer, and other factors. This chapter discusses the definition and etiology of breast cancer, as well as its typical symptoms, less common symptoms, demographics, natural history, complications, diagnosis, treatment, and prognosis.

Direct Oral Anticoagulants for Pulmonary Embolism: Importance of Anatomical Extent

Pulmonary embolism (PE) studies used direct oral anticoagulants (DOACs) with or without initial heparin. We aimed to (1) evaluate if PE patients benefit from initial heparin; (2) describe patient characteristics in the DOAC studies; and (3) investigate whether the anatomical extent of PE correlates with N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, cause of PE, and recurrence rate. Our methods were (1) an indirect meta-analysis comparing the recurrence risk in DOAC-treated patients with or without initial heparin to those patients given heparin/vitamin K antagonist (VKA). (2) To compare the PE studies, information was extracted on baseline characteristics including anatomical extent. (3) The Hokusai-VTE study was used to correlate anatomical extent of PE with NT-proBNP levels, causes of PE, and recurrent venous thromboembolism (VTE). The meta-analysis included 11,539 PE patients. The relative risk of recurrent VTE with DOACs versus heparin/VKAs was 0.8 (95% confidence interval [CI]: 0.6–1.1) with heparin lead-in and 1.1 (95% CI: 0.8–1.5) without heparin. In the DOAC studies, the proportion of patients with extensive PE varied from 24 to 47%. In Hokusai-VTE, NT-proBNP was elevated in 4% of patients with limited and in over 60% of patients with extensive disease. Cause of PE and anatomical extent were not related. Recurrence rates increased from 1.6% with limited to 3.2% with extensive disease in heparin/edoxaban-treated patients, and from 2.4 to 3.9% in heparin/warfarin recipients. In conclusion, indirect evidence suggests a heparin lead-in before DOACs may be advantageous in PE. Anatomical extent was related to elevated NT-proBNP and outcome, but not to PE cause.