RESUMO
Male factor infertility (MFI) is a growing health issue in society. The vitamin D receptor gene (VDR) is expressed in many tissues and modulates expression of several other genes. The purpose of this study was to investigate the association between MetSyn, VDR gene (FokI, rs-2228570; C > T) polymorphisms and MFI in Indian adults. Fifty cases and fifty-four controls, fulfilling inclusion and exclusion criteria, were included with their informed consent. Fasting plasma glucose, triglyceride, HDL-C were estimated by clinical chemistry analyzer (Beckmam Coulter DXC 800, USA). Serum insulin was measured by electrochemiluminescence immunoassay and VDR gene polymorphism by RFLP-PCR. Statistical analysis was done using SPSS 20.0. MetSyn was more frequent in MFI cases than controls. There was significant difference between waist circumference, fasting plasma glucose, triglycerides in MFI cases and controls. There was significant difference in HOMA-IR between MFI cases and controls (p value < 0.05) and serum insulin was significantly raised in MFI cases (p value < 0.05). VDR gene polymorphism was found to be associated with MFI cases as compared to controls and the serum level of vitamin D was also decreased in MFI cases than in controls (p value < 0.05). This study provides evidence that insulin resistance is more in MFI cases than in controls and occurrence of MetSyn and its components is higher in MFI cases than in controls. Our findings provide evidence that VDR gene (FokI, rs-2228570; C > T) polymorphism increases the risk of male factor infertility.
RESUMO
SNNL is a rare, benign lesion which may arise from trauma, a sclerosing haemangioma or it may represent a burned out phase of various conditions like parasitic infections, or chronic infections like tuberculosis. Histopathology provides the definite diagnosis, which thus helps clinicians in allaying unnecessary anxiety of the patient and in planning proper management.We are reporting two cases here, which had solitary necrotic nodules of liver (SNNL), with emphasis on the aetiology and morphology of the lesions. SNNL was incidentally detected during cholecystectomy done in both young female patients. The lesion was solitary in one case and it was multiple in the other. The suspected aetiology in one of the cases was parasitic, whereas it was tuberculosis in the other. The clinical features in both cases were suggestive of neoplasms.
RESUMO
Pheochromocytoma in pregnancy is rare (1 in 50,000 full term pregnancies). Recognition of the condition is central to improving outcome (maternal and foetal mortality is reduced from 58% and 56%, respectively to 2% and 11-15%, respectively). An antenatal patient in third trimester diagnosed as pheochromocytoma has been described. Diagnosis of pheochromocytoma was confirmed by urinary VMA levels and demonstration of right adrenal mass on ultrasound. A multidisciplinary approach was used and the patient received antihypertensives for 10 days. Vaginal delivery was conducted under epidural analgesia and the patient was kept under close surveillance. She delivered a healthy baby girl weighing 2.5 kg. The intrapartum and the postpartum period were uneventful. Adrenalectomy was done at 6 weeks postpartum. Using multidisciplinary approach and individualised management decreases both maternal and foetal morbidity and mortality. Selected multigravidae cases and those with previous history of short uncomplicated labour, may be considered for vaginal delivery under epidural analgesia and with back up facilities available to manage hypertensive crisis.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Adrenalectomia/métodos , Parto Obstétrico/métodos , Feocromocitoma/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Feocromocitoma/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Resultado da GravidezRESUMO
Retained surgical sponge or glossypiboma is a relatively common occurrence; however, surgeons may not report these events for fear of litigation and adverse publicity. We report postoperative complications in three cases due to retained surgical sponges. The first case, a 26-year-old woman, presented with gastric outlet obstruction due to the sponge obstructing the pyloric canal three weeks following cholecystectomy, which was completely relieved following endoscopical removal of the sponge. The second case, a 32-year-old woman, presented with repeated attacks of intestinal obstruction following cholecystectomy and tubal ligation and was treated with surgical removal of the sponge. The third patient, a 40-year-old woman, presented with features of colonic obstruction following hysterectomy. Colonoscopy revealed a partial migration of the sponge through the colonic wall and on laparotomy, she was found to have multiple internal fistulae between the small and large intestines, all occurring around the inflammation caused by the retained sponge.
Assuntos
Colecistectomia/efeitos adversos , Migração de Corpo Estranho/complicações , Histerectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Tampões de Gaze Cirúrgicos/efeitos adversos , Adulto , Doenças do Colo/etiologia , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , Humanos , Obstrução Intestinal/etiologia , Erros Médicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , UltrassonografiaAssuntos
Colelitíase/complicações , Gastropatias/etiologia , Dor Abdominal/etiologia , Adulto , Feminino , HumanosAssuntos
Humanos , Feminino , Adulto , Colelitíase/complicações , Gastropatias/etiologia , Dor Abdominal/etiologiaRESUMO
A case of an isolated submandibular gland metastasis from a clinically occult papillary thyroid carcinoma is described in a 46-year old lady. Initial surgery was done based on the fine needle aspiration cytology (FNAC) report of adenocarcinoma of the submandibular gland. Histopathologic examination of the specimen suggested a metastatic papillary carcinoma. Occult papillary carcinoma in the thyroid was found by multiple blind FNACs. Subsequently to near-total thyroidectomy, no other site of metastasis was found on radio-iodine scanning.
Assuntos
Carcinoma Papilar/secundário , Neoplasias da Glândula Submandibular/secundário , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Glândula Submandibular/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaAssuntos
Antibioticoprofilaxia/métodos , Infecção Hospitalar/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Incidência , Injeções Intramusculares , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
Sex cord tumor with annular tubules (SCTAT) is a rare tumor seen in the ovary usually associated with Peutz-Jeghers syndrome. Testicular SCTAT are more infrequent and only four such cases have been reported in the literature. A 28-year-male presented with infertiliy. He had a history of orchiopexy 10 years back for right-sided inguinal testes. A right testicular biopsy done to investigate the cause of infertility revealed testicular atrophy with a focus suspicious of SCTAT. The right-sided orchiectomy revealed two firm nodules of 0.5 and 0.2 cms of SCTAT and sertoli cell nodule (SCN) respectively on microscopy. He did not have any features of Peutz-Jeghers or any other dysgenetic syndrome. He is asymptomatic after follow up of 26 months. This is the fifth case of testicular SCTAT and the first with SCN.
Assuntos
Criptorquidismo/complicações , Infertilidade Masculina/etiologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/complicações , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/patologia , Adulto , Humanos , MasculinoRESUMO
PURPOSE: The objective of this prospective pilot study was to estimate serum C3 levels and complement activation within 12 hours of injury and to correlate them with abbreviated injury score (AIS) so as to predict the outcome of injury in terms of mortality or sepsis. METHODS: The test group (n=30) of patients with < 12 hours of injury were assessed by the AIS-80 and compared with a control group (n=10). Serum C3 levels were estimated by the single radial immunodiffusion technique and complement activation by both two-dimensional and counter immuno-electrophoresis. Statistical analysis was performed using the correlation regression analysis and the minimum discrimination information statistics (MDIS) analysis. RESULTS: Serum C3 levels were not reduced in patients with injury severity score (ISS) < 12 (n=7). There was a statistically significant difference of serum C3 levels in patients with ISS between 12 and 29 (n=15) and in patients with ISS more than 29 (n=9). Complement activation also correlated well with ISS (p < 0.05). Complement activation and serum C3 levels were found to influence subsequent development of septic complications in the post injury period, being significantly lower in patients who developed septic complications. Complement alterations in trauma patients were a direct result of the trauma since they were not seen in patients undergoing surgery. CONCLUSIONS: ISS is a good prognosticator of outcome of trauma and serum C3 levels and complement activation are good predictors for mortality and development of septic complications in recently injured patients. These may prove to be effective parameters in the management of the patients with injury.
RESUMO
A retrospective analysis of 215 differentiated thyroid cancers was undertaken to identify the various prognostic variables. There were 132 papillary and 83 follicular cancers; both histologic types occurred at an earlier age, with a male to female ratio of 1: 1.1 (signifies near parity in both sexes, in contrast to marked female preponderance in most of the reports and amongst benign thyroid disorders). There was a significant difference in the size of the primary tumours; 60/132 (45%) of papillary and 30/83 (36%) of follicular cancers were early T0-1 lesions and 20 (15%) papillary and 24 (29%) follicular cancers were advanced T3 lesions. Age did not affect the size of the primary tumour. Regional lymph node and pulmonary metastases were common in both types of cancer while distant metastases occurred more frequently in follicular cancers (p < 0.005). Following surgery, contralateral lobe recurrence in the remaining lobe was more common in the follicular cancer group, while loco-regional recurrence after near-total thyroidectomy was more frequent in the papillary cancer group (p > 0.05). Mortality in 26/132 (20%) papillary and 28/83 (34%) follicular cancer patients was high in both groups, but significantly higher in the follicular cancer group (p < 0.05). Although mortality among patients with papillary cancer was higher in patients older than 40 years of age (p < 0.05), age did not affect survival in patients with follicular cancer. Gender did not affect survival in either group. The extent of the disease at presentation was the most important determinant of survival, with mortality significantly higher among patients with T3N3M1 lesions (p < 0.001).
Assuntos
Adenocarcinoma Folicular/diagnóstico , Carcinoma Papilar/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/mortalidade , Adenocarcinoma Folicular/cirurgia , Adulto , Idade de Início , Carcinoma Papilar/mortalidade , Carcinoma Papilar/cirurgia , Feminino , Bócio Endêmico/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
A rare case of papillary carcinoma of the thyroid producing hyperthyroidism is presented. A young patients presented seven years after a thyroid operation with metastatic disease in the cervical lymph nodes and a history of deteriorating vision in the left eye. He also had a lesion in the base of the skull which could not be established to be metastasis from the thyroid cancer. There was clinical and biochemical evidence of hyperthyroidism. Radionuclide scan revealed uptake in the residual thyroid tissue and patchy uptake by the cervical lymph nodes. The patient underwent a complete thyroidectomy and radical neck dissection of the left side and 'berry-picking' of the lymph nodes on the right side. Although the patient became euthyroid post-operatively, his general condition deteriorated and he rapidly lost vision in both eyes before any ablative therapy could be instituted for the tumour in the base of the skull. The patient was lost to follow-up.
Assuntos
Carcinoma Papilar/complicações , Hipertireoidismo/etiologia , Neoplasias da Glândula Tireoide/complicações , Adulto , Cegueira/etiologia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Humanos , Hipertireoidismo/diagnóstico por imagem , Hipertireoidismo/terapia , Metástase Linfática/patologia , Masculino , Esvaziamento Cervical , Neoplasias Primárias Múltiplas , Cintilografia , Neoplasias da Base do Crânio/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
A case of an amebic liver abscess with unusual clinical manifestations is presented. A middle-aged male with an abscess in both lobes of the liver presented with obstructive jaundice due to pressure on the porta hepatis with stasis of the bile in the intrahepatic biliary radicals. The patient did not respond to repeated needle aspirations and thus required open drainage. Subsequently, the patient developed a biliary leak through the drainage sites, and an injection of contrast dye into the cavity revealed a communication between the abscess cavities and the biliary tree. The biliary leak stopped spontaneously, and the large cavities also closed completely during the followup period.
Assuntos
Icterícia/etiologia , Abscesso Hepático Amebiano/complicações , Sistema Biliar/anatomia & histologia , Sistema Biliar/patologia , Feminino , Humanos , Fígado/anatomia & histologia , Fígado/patologia , Abscesso Hepático Amebiano/patologia , Pessoa de Meia-IdadeRESUMO
An analysis of management of 546 cases of solitary thyroid nodules in an endemic area is presented. None of the evaluating procedures could effectively isolate benign from malignant disease. Of 508 cases considered clinically to be benign, 42 harboured malignancy on histological examination whereas of the 38 cases suspected clinically to be malignant, 21 were histologically benign. 131I-Thyroid scanning also lacked sensitivity in identifying malignant nodules since the prevalence of malignancy in cases which were 'cold' (44/316) was not significantly different from that amongst the 'uniform' cases (15/142). Fine-needle aspiration cytology, although the most sensitive and specific evaluating modality, did not decrease the number of operations for solitary thyroid nodules nor did it increase the incidence of malignancy amongst the operated cases, because of its limitations in differentiating benign from malignant follicular neoplasms. The conditions under which surgery was advocated are described.
Assuntos
Bócio Endêmico/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adenoma/diagnóstico , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Bócio Endêmico/cirurgia , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgiaRESUMO
Although serum thyroglobulin (STg) is a useful tumour marker to detect the recurrence of tumour in well differentiated thyroid carcinoma, it has as yet not been reported to be of value in predicting the behaviour of thyroid cancer. In the present study of 20 patients, the measurement of preoperative Stg/thyroid mass has been utilised to find out Tg synthesizing capacity of the tumour. This ratio was significantly higher in the patients with follicular variety than in papillary thyroid carcinoma. It was significantly higher in the metastasis group than in the group of patients without metastasis. The patients with functioning metastasis had a higher than average value of this 'ratio' than those with non functioning metastasis, though the difference was not statistically significant. Despite the limitation of a small number of patients included in this study, it is possible to highlight the possible utility of preoperative Stg estimation as a tumour marker in categorization of the patients of carcinoma of the thyroid gland.
Assuntos
Adenocarcinoma Folicular/sangue , Biomarcadores Tumorais/sangue , Carcinoma Papilar/sangue , Cuidados Pré-Operatórios , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Adenocarcinoma Folicular/cirurgia , Carcinoma Papilar/cirurgia , Seguimentos , Humanos , Reprodutibilidade dos Testes , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
A case report of isolated involvement of the mandible by non-Hodgkin lymphoma is presented. The patient presented with a non-healing ulcer following a tooth extraction. Biopsy revealed an undifferentiated cancer. Investigations failed to reveal any involvement of the organs. A hemimandibulectomy was performed followed by radiotherapy on receipt of the histopathological diagnosis of non-Hodgkin lymphoma. The patient is asymptomatic two and a half years after treatment.
Assuntos
Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma não Hodgkin/diagnóstico , Mandíbula/patologia , Biópsia por Agulha , Terapia Combinada , Feminino , Seguimentos , Humanos , Linfoma Difuso de Grandes Células B/radioterapia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma não Hodgkin/radioterapia , Linfoma não Hodgkin/cirurgia , Mandíbula/cirurgia , Pessoa de Meia-Idade , Fotomicrografia , Resultado do TratamentoRESUMO
A case of agenesis of gallbladder associated with Type IVa congenital choledochal cyst is reported. This combination is very rare and a review of literature revealed only three such cases. A brief discussion of gall bladder agenesis with particular reference to associated anomalies is presented. Difficulty in the management of Type IVa choledochal cyst where the extrahepatic and intrahepatic cysts are continuous at the porta, is highlighted.
Assuntos
Cisto do Colédoco/complicações , Vesícula Biliar/anormalidades , Adulto , Feminino , HumanosRESUMO
We present a case of visceral larva migrans which came as a complete histologic surprise. The patient was operated as a case of chronic cholecystitis and was found at operation to have multiple hepatic nodules. A cholecystectomy with a biopsy of the liver nodule was performed. Histopathologically a diagnosis of visceral larva migrans was made. To our knowledge this is the first case report of the disorder from India. A discussion based on the review of literature is presented.
Assuntos
Colecistite/patologia , Colelitíase/patologia , Larva Migrans Visceral/patologia , Hepatopatias Parasitárias/patologia , Biópsia , Colecistectomia , Colecistite/cirurgia , Colelitíase/cirurgia , Feminino , Vesícula Biliar/patologia , Humanos , Índia , Larva Migrans Visceral/cirurgia , Fígado/patologia , Hepatopatias Parasitárias/cirurgia , Pessoa de Meia-IdadeRESUMO
A case of primary hyperparathyroidism associated with osteitis fibrosa cystica presenting as paraplegia is described herein. The symptom complex of normocalcemic hyperparathyroidism with osteitis fibrosa cystica is a distinctly rare entity and to the best of our knowledge, this is the first case report of the normocalcemic variant of primary hyperparathyroidism presenting with paraplegia as a complication.