RESUMO
An 85-year-old lady presented with a large midline neck mass. After 8 years of steady growth, the previously asymptomatic mass began to cause stridor and dysphagia. The patient's comorbidities included a previous partial glossectomy for haemangioma of the tongue, chronic obstructive pulmonary disease, congestive cardiac failure and obesity (body mass index >30). CT neck revealed the midline mass was cystic in nature, most likely a thyroglossal duct cyst. This mass was closely related to an angiomatous malformation involving the tongue, floor of mouth and left parotid. Fine needle aspiration cytology was consistent with a colloid goitre characterised as Thy-1. Due to her extensive comorbidities, surgical resection of the midline mass was deemed to be a high-risk procedure. A Sistrunk's procedure was performed. Dissection proved difficult due to the intimately related base of tongue haemangioma. Histopathology confirmed it to be a benign thyroglossal duct cyst. She made an uncomplicated postoperative recovery.
Assuntos
Hemangioma/complicações , Cisto Tireoglosso/complicações , Neoplasias da Língua/complicações , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
OBJECTIVE: to determine whether intraoperative dexamethasone is a risk factor for secondary posttonsillectomy bleeding. DESIGN: retrospective chart review. SETTING: tertiary care referral centres in Scotland. METHOD AND PATIENTS: the charts of 530 pediatric patients undergoing tonsillectomy were reviewed over a 3-year period (January 2004 to December 2006), and data were collected regarding the use of dexamethasone intraoperatively. Data were analyzed using the SPSS for Windows statistical package (SPSS Inc, Chicago, IL). MAIN OUTCOME MEASURES: incidence of secondary posttonsillectomy bleeding. The relative risk of posttonsillectomy bleeding was measured in those receiving dexamethasone. Logistic regression analysis was performed. RESULTS: Thirty-seven episodes of secondary hemorrhage were encountered in 36 children: 9 of 253 (3.6%; 95% CI 1.6-6.7) patients receiving intraoperative dexamethasone compared to 28 of 277 (10.1%; 95% CI 6.8-14.3) not receiving dexamethasone. Six patients had to undergo an emergency reoperation to arrest bleeding, only one of whom had received dexamethasone. When added to a stepwise logistic regression model with age, gender, indication for surgery, surgeon grade, and operative technique, dexamethasone and the presence of obstructive symptoms were the only significant factors influencing the risk of bleeding. The odds ratio indicates that patients with obstructive symptoms (OR 0.16; 95% CI 0.04-0.70) and those receiving dexamethasone were less likely to develop secondary bleeding (OR 0.44; 95% CI 0.20-0.96). CONCLUSION: based on our study data, the use of intraoperative dexamethasone does not appear to increase the risk of posttonsillectomy bleeding.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Dexametasona/efeitos adversos , Glucocorticoides/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Tonsilectomia/efeitos adversos , Tonsilite/cirurgia , Criança , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Período Intraoperatório , Modelos Logísticos , Masculino , Hemorragia Pós-Operatória/etiologia , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
Kidney transplantation and the associated immune suppression are associated with a significantly increased risk of developing cancer during long-term follow-up. Thyroid cancer has been recognised as a potential post-transplant risk but has not yet been subject of a focused review. We therefore performed a meta-analysis on data of 50,861 patients with a total follow-up of 198 595 patient-years and identified a 6.9-fold higher standardised incidence ratio (95% confidence interval 5.6-8.7, P<0.001) of thyroid cancer post renal transplantation as compared with a non-transplant group. All such cancers were of papillary type as far as histopathology was known. The mean time to discovery was 6.0 years post transplantation. This puts thyroid cancer into the group of high cancer risk following solid organ transplantation which already includes cervical cancer, non-melanoma skin cancer, oral and lip cancer and haematological malignancies. It is unclear what causes the increased cancer incidence. Inclusion of thyroid ultrasound in long-term post-transplant evaluation may help to ensure timely recognition of this condition.
Assuntos
Carcinoma Papilar, Variante Folicular/etiologia , Transplante de Rim/efeitos adversos , Neoplasias da Glândula Tireoide/etiologia , Adulto , Carcinoma Papilar, Variante Folicular/epidemiologia , Seguimentos , Humanos , Incidência , Transplante de Rim/fisiologia , Transplante de Rim/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias da Glândula Tireoide/epidemiologiaRESUMO
We describe a case of life-threatening small bowel haemorrhage in a 56 year old man, who was found to have partial midgut malrotation at laparotomy. An association between congenital malrotation and gastrointestinal haemorrhage has not previously been reported in this age group. We discuss the association between gut malrotation and small intestinal pathology and describe the principles of management in these patients.