Tumoral calcinosis in secondary hyperparathyroidism

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To  report  a  case  of  tumoral  calcinosis  from  secondary hyperparathyroidism  and  to describe its surgical management.<br /><strong>METHODS:</strong><br /><strong> Design:</strong> Case Report<br /> <strong>Setting:</strong> Tertiary Public University Hospital<br /> <strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal  parathyroidectomy,  right  thyroid  lobectomy  with  isthmusectomy,  and  transcervical thymectomy.    Follow-up  revealed  marked  decrease  in  parathyroid  hormone,  and  progressive resolution of the tumoral calcinosis.<br /><strong>CONCLUSION:</strong> Subtotal  parathyroidectomy  and  transcervical  thymectomy  have  a  role  in  the management  of  tumoral  calcinosis,  and  in  this  case  led  to  excellent  post-operative  results. The rare  presentation  of  secondary  hyperparathyroidism  and  intervention  in  this  patient  may  have potential lessons for future management of similar cases.</p>

Incidental diagnosis of rectal cancer in a patient with papillary thyroid cancer

BACKGROUND: Differentiated thyroid cancer is a common endocrine malignancy with an indolent course and high overall survival rate. With more cases diagnosed early, survivors of this cancer live longer and hence are at risk of second primary cancers. In patients with known primary malignancy, work-up often focuses on the primary disease, so that coexistence of another primary malignant lesion can be missed.CASE PRESENTATION: We report a case of a 78 year-old Filipino male diagnosed to have papillary thyroid cancer with nodal metastases presenting with an incidental rectosigmoid cancer on pre-operative workup.TREATMENT AND OUTCOME: Patient eventually underwent complete surgical removal of both malignancies. He is currently on levothyroxine suppression therapy with no evidence of tumor recurrence for both malignancy and is on close follow-up for cancer recurrence surveillance.CONCLUSION: Clinical vigilance for cancer screening and surveillance is mandatory for patients diagnosed with any type of primary malignancy to reduce the rate of missing secondary primary malignancy simultaneously present in the same patient , Early cancer detection might improve cancer patient's overall prognosis and eventually proved to be life-saving.

Validation of salivary cortisol among Filipino adults suspected with Cushing's syndrome

BACKGROUND: Cushing's syndrome is a state of hypercortisolism manifesting non-specific clinical; features where its diagnosis entails biochemical confirmation of cortisol excess. this study aims to validate the efficacy of midnight salivary cortisol as a screening test for Filipino suspected with Cushing's syndrome and determine the cut-off value applicable in the local setting. METHODS: This is a cross-sectional study of Filipinos suspected with endogenous Cushing's syndrome seen at a tertiary hospital. Modification of plasma cortisol measured by RIA was used to measure salivary cortisol. The sensitivity, specificity, positive predictive curve, negative predictive curve and area under the screening tests were estimated and compared using 48 hour low dose dexamethasone suppression test (LDDST) as the reference standard. RESULTS: The determine cut-off value (? 7.0 nmol/L) for salivary cortisol showed a relatively high sensitivity (91.3%) and specificity (89.5%) in detecting cases suspected of Cushing's syndrome. One milligram (1mg) dexamethasone suppression test had the highest sensitivity (100%) but had the lowest specificity (68.4%) as a screening test. The area under the curve of the three diagnostic test appeared to be similar when compared with the low dose dexamethasone suppression test. CONCLUSIONS: Using a cut-off value of 7nmol/L, local utility if late-night salivary cortisol has a high sensitivity and specificity in detecting Cushing's syndrome. It has a similar efficiency with 24-hour urine free cortisol and 1mg dexamethasone suppression test as a screening test for Cushing's syndrome. Salivary cortisol may be considered as a valid initial screening test for Filipinos suspected of cushing's syndrome.

Splenic actinomycosis mimicking malignant lymphoma - A rare case of abdominal actinomycosis

BACKGROUND: Splenic Actinomycosis is a rare entity which usually presents as a difficult diagnostic case. It is a chronic granulomatous infectious disease, caused by Actinomyces which is commonly associated with history of abdominal surgery and manipulation. Majority of cases would present as an enlarging abdominal mass often mimicking malignant tumors.CASE PRESENTATION: This paper presents a rare case of splenic actinomycosis in a 24-year-old Filipino female presenting as multiple splenic abscesses leading to gradual progressive ascites initially thought to be due to a malignant lymphoma. On physical examination, massive ascites and splenomegaly were the only abnormality appreciated. Initial radiologic imaging (x-ray, ultrasound, CT scan) revealed presence of multiple splenic nodules associated with extensive mediastinal and retroperitoneal lymphadenopathy as well as peritoneal extension/carcinomatosis (Figure 1 and 2). Splenic biopsy revealed presence of actinomyces (Figure 3).TREATMENT AND OUTCOME: Patient was started on amoxicillin 2.0 g per day for 24 months which led to a significant resolution of her massive ascites. Subsequent abdominal ultrasound showed gradual reduction in the hepatic and splenic size with resolution of splenic foci. Patient is currently on frequent follow-up.CONCLUSION: Splenic actinomycosis although extremely rare should be included as a differential diagnosis when presented with an unusual splenic mass or abscess on CT scan. Majority would mimic different forms of malignancy hence early histologic biopsy is usually needed to prevent unnecessary extensive and invasive surgical procedures. Radiologic and biochemical test are usually non-specific and not helpful with the establishment of the diagnosis. Although surgery remains to be the cornerstone for its management, prolonged antibiotic therapy might show promising results due to intensive closer follow up and accessibility to monitoring modalities for treatment response.

A survey of knowledge, attitudes and practices of sedation and analgesia among medical residents and pulmonary fellows-in-training at the University of the Philippines-Philippine General Hospital

BACKGROUND: Providing sedation and analgesia for patients especially in the intensive care units remains difficult and controversial for clinicians and many institutions.OBJECTIVE: The purpose of this study is to describe the knowledge, attitudes and practices on sedation and analgesia among medical residents and pulmonary fellows-in-training in a tertiary care hospital.METHODS: The research design is a prospective descriptive survey of 67 participants.RESULTS: Midazolam is the preferred sedative agent for continuous infusion. The top two reasons why sedation is used according to the knowledge of the study participants were agitation and patient comfort. Monitoring neurologic status is the primary reason why sedation is not used. Majority of the medical residents said that 50% of the mechanically ventilated patients require continuous intravenous sedation. On the other hand, pulmonary fellows-in-training said that 50-75% of mechanically ventilated patients require continuous intravenous sedation. Twenty three participants (34.32%) have used a sedation scale, of which majority uses Ramsay Sedation Scale. Morphine is the preferred analgesic agents of the study participants. Unavailability of analgesic agents is the top reason why analgesia is not used.CONCLUSION AND RECOMMENDATION: The medical residents and pulmonary fellows-in-training showed differences inknowledge, attitudes and practices with regard to use of sedation and analgesia. To increase their knowledge and improve their practice, they should be given medical education and training in sedation and analgesia.