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61.
Melanomas located anywhere below the knee can drain to the popliteal fossa. Sentinel nodes in the popliteal fossa are found in 1-9.6% of cases. The positivity rate in these nodes is 12.5-30%, which is comparable to rates in conventional nodal basins. Formal dissection of the popliteal fossa for a positive sentinel node is indicated. Inguinal dissection based only on the presence of involved popliteal lymph nodes is not warranted. 相似文献
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64.
A secondary perineal hernia is a type of incisional hernia of the pelvic floor, occurring after pelvic surgery such as abdominoperineal
excision of the rectum and pelvic exenteration. Our aim is to review the available literature on the subject. This report
reviews a recently repaired case, followed by a review of the available literature on the presenting condition, concentrating
on approaches and methods of repair. Perineal hernias are uncommon, and not many surgeons face them. It is not known if and
how these hernias could be prevented. The method and approach of repair should probably be individualized, but we believe
that the use of a mesh is important in the repair of such hernias because of the significant tissue defect prevailing in most
of the cases, in addition to the unhealthy tissues related to the use of radiotherapy. The laparoscopic approach has been
recently utilized and its use is expected to increase. 相似文献
65.
Hyposplenism is not a rare condition and can complicate a remarkable number of illnesses. The two most time-honored diseases associated with the development of hyposplenism are sickle cell anemia and celiac disease. Hyposplenism is relatively easy to recognize by typical changes observed on the peripheral blood smear; including Howell-Jolly bodies, monocytosis, lymphocytosis, and increased platelet counts. Diagnosis can be confirmed by pitted RBC counts or 99Tc-labelled radiocolloid scan of the spleen; wherever available. Diagnosis needs to be made promptly to institute pneumococcal vaccination in a timely fashion and to recognize and treat bacterial infections promptly and aggressively because of the tendency of hyposplenic subject to develop fatal invasive disease. Overwhelming pneumococcal sepsis accounts for the major mortality cases in hyposplenic subjects; however severe infections with other encapsulated bacteria and protozoa have been reported. Hyposplenic individuals may also be at a higher risk for vascular, autoimmune and thrombotic diseases and they may have a higher risk of developing solid tumors. The commonly used pneumococcal polysaccharide vaccine is ineffective in asplenic subjects, because it requires the presence of IgM memory B cells, and should be given before splenectomy. In splenectomized, and functionally hyposplenic subjects, the pneumococcal conjugate vaccine is more effective, because it utilizes a T cell dependent mechanism, and should be the preferred vaccine in these circumstances. 相似文献
66.
The authors present a case of an infant boy, otherwise healthy, who presented with acute irritability and obtundation. A head computed tomography scan revealed massive intracerebral hemorrhage. Investigations of the etiology revealed abnormal clotting times and reduced activity of all vitamin K-dependent factors. All etiologies of vitamin K deficiency were ruled out except malabsorption. The diagnosis of cystic fibrosis was confirmed by sweat chloride and genetic testing. Cystic fibrosis could present with cerebral bleed and should be considered in its differential diagnosis when other etiologies are not clear, as the other manifestations of vitamin K deficiency could be very subtle and unnoticed. Screening and early diagnosis of cystic fibrosis may prevent serious complications. 相似文献
67.
Iyad AL-Ammouri William Shomali Moaath M. Alsmady Mahmoud Abu Abeeleh Khader Mustafa Islam Massad Basem Bustami Suhayl Saleh 《Pediatric cardiology》2010,31(6):912-914
This report describes a case involving anomalous drainage of inferior vena cava (IVC) to the left atrium diagnosed when the
patient was 32 years old. The tricuspid valve and the right ventricle were small. Successful surgical repair was performed,
with significant improvement of the patient’s clinical status. The use of exercise testing with pulse oxymetry monitoring
aided in the decision of timing for closure of the iatrogenically created atrial septal defect. 相似文献
68.
Basem Abdelmalak Nicholas Marcanthony Joseph Abdelmalak Michael S. Machuzak Thomas R. Gildea D. John Doyle 《Journal of anesthesia》2010,24(4):607-610
Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management
of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who
presented with a 10 × 9 × 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome.
He had severe obstruction of the right mainstem bronchus, distal trachea with tumor compression, and endobronchial tumor invasion.
Our second case was a 62-year-old man with tracheal and bronchial obstruction secondary to a recurrent non-small-cell lung
cancer mediastinal mass. Both patients were scheduled for laser tumor debulking and treatment of the tracheal compression
with a Y-stent placed through a rigid bronchoscope. Both patients were fiberoptically intubated awake under sedation using
a dexmedetomidine infusion, followed by general anesthesia (mainly using higher doses of dexmedetomidine), thus maintaining
spontaneous ventilation and avoiding muscle relaxation during a very stimulating procedure. The amnestic and analgesic properties
of dexmedetomidine were particularly helpful. Maintaining spontaneous ventilation with dexmedetomidine as almost the sole
anesthetic could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management
of AMMs. 相似文献
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Basem B Morcos Bilal Baker Sameh A Hashem 《Annals of the Royal College of Surgeons of England》2010,92(6):e29-e30
A patient with phyllodes tumour of the breast is discussed. During follow-up, she presented with intestinal obstruction caused by ileocaecal intussusception. The cause of the intussusception was metastatic phyllodes tumour, which is a unique presentation. 相似文献