Dizziness in a Tertiary Care Centre in Sikkim: Our Experience and Limitations

Abstract

Dizziness is a common symptom and though most of the causes are benign yet some may be potentially life threatening. Diagnosis can be a challenge sometimes due to lack of dedicated vestibular lab and injudicious use of vestibular suppressant medications. A 2 year retrospective study of the hospital records from September 2014 to August 2016 was done to study the causes of dizziness and the limitations and challenges in the diagnosis. 75 complete records of patients presenting with dizziness were accessed and analysed. 54.7% of the patients were males and most patients were young adults. Most of the cases were benign and Benign paroxysmal positional vertigo was the commonest diagnosed case (20%). Potentially life threatening cases diagnosed were cerebellar infarct and posterior fossa space occupying lesion (5.3%). Complete evaluation of a dizzy patient must be done to arrive at a causal diagnosis. Injudicious use of vestibular sedatives should be discouraged. Proper training and education to the primary care physician should be imparted so that they can adopt a practical approach for evaluation and management of a dizzy person.

http://ift.tt/2kAmon0

Intraoperative oliguria predicts acute kidney injury after major abdominal surgery

Abstract

Background

The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.

Methods

Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.

Results

The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg⁻¹ h⁻¹ was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77–3.97; P<0.001). The addition of oliguria <0.3 ml kg⁻¹ h⁻¹ to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval, 0.049–0.270; P=0.005).

Conclusions

Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3 ml kg⁻¹ h⁻¹ was significantly associated with increased risk of postoperative AKI.

http://ift.tt/2yaT5wl

Castleman’s disease: a rare presentation in a retroperitoneal accessory spleen, treated with a minimally invasive robotic approach

Abstract

Unicentric Castleman's disease (UCD) is a rare disorder of unknown etiology characterized by localized lymphoid tissue proliferation and interfollicular hypervascularity. A 33-year-old Caucasian female presented with vague abdominal discomfort and pain with pressure. Ultrasound and computed tomography detected a large peripancreatic mass. Robotic-assisted resection of the mass along with en bloc dissection of the encased left adrenal gland was done. Frozen section examination confirmed UCD hyaline vascular variant in a retroperitoneal accessory spleen. Preoperative diagnosis of UCD is difficult due to its lack of specific symptoms and its cytologic similarity to reactive lymphadenopathy and other lymphoproliferative disorders. Surgical resection is standard treatment and provides the pathological specimen required for diagnostic confirmation. Here, robotic-assisted laparoscopy allowed visualization, mobilization, precise resection and extraction of the mass from a difficult to access retroperitoneal region.

http://ift.tt/2y5NVQt

Dermatofibrosarcoma protuberans coexisting in a patient with a vascular malformation—a rare coincidence

Abstract

Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare soft tissue tumor with more aggressive behavior and it is not clear what causes this type of skin cancer. We describe the case of a 48-year-old woman who was born with a vascular malformation in the sternal region and presented suddenly with a soft tissue sarcoma (DFSP-FS) in the same territory. She was initially treated by embolization as the sarcoma was misdiagnosed but the tumor within 6 months seemed to be growing rapidly and reached a giant dimension with ulceration and required surgical intervention. The patient underwent a surgical removal of the mass but as the pathology report included a DFSP-FS with close margins,a second operation was required. A wide local excision was performed and reconstruction of defect by using bilateral pectoralis major muscle flaps and a full thickness skin graft from the abdominal wall. Post operatively the patient was treated with radiotherapy.

http://ift.tt/2y6NR32

Squamous cell carcinoma arising in familial gingival fibromatosis—a rare case report

Abstract

Familial gingival fibromatosis is a rare hereditary condition due to chromosomal abnormality which can occur as an isolated disease or as part of a syndrome and has an incidence of 1:350 000. This condition leads to esthetic, functional, psychological and masticatory disturbance of the oral cavity. Here, we present a case of 21-year-old female with severe enlargement of gums in maxilla and mandible. Deciduous teeth were erupted at normal age but the permanent teeth in the oral cavity were not erupted. Her grandmother, father and younger sister were also affected with the same condition. Incisional biopsy from the chronic ulcerated gingiva showed squamous cell carcinoma. Patient was referred to other cancer institution, where metastases to lung, bone and lymph node was detected on CT scan. The diagnosis was made based on clinical examination, family history and histopathological examination.

http://ift.tt/2y5NZ2F

Metastatic spread from squamous cell carcinoma of the hypopharynx to the totally implantable venous access port insertion site: Case report and review of literature

Abstract

Background

The totally implantable venous access port plays a crucial role in delivering chemotherapy in the outpatient setting. Here, we report the first case of a patient with hypopharyngeal tumor who developed chest wall metastasis over the totally implantable venous access port inserted in the internal jugular vein.

Methods

Our patient, a 58-year-old man with a hypopharyngeal tumor presented with a lump over the totally implantable venous access port site. The port was removed and the lump was biopsied. The CT studies showed that the tumor had spread along the catheter from the hypopharynx to the chest wall.

Results

The pathology from the biopsy showed squamous cell carcinoma (SCC). The patient had poor performance status and opted for hospice care.

Conclusion

We present a novel case of metastasis over the totally implantable venous access port implanted in a patient with a hypopharyngeal tumor. We also reviewed relevant literature comparing the data from percutaneous endoscopic gastrostomy (PEG) tube site metastasis with our patient and other similar case reports.

http://ift.tt/2y2tOVJ

Validation of the eighth edition American Joint Committee on Cancer staging system for human papillomavirus-associated oropharyngeal cancer

Abstract

Background

The eighth edition American Joint Committee on Cancer (AJCC) staging manual includes major changes in staging of oropharyngeal cancer (OPC). We evaluated the new staging system in order to validate this shift in classification.

Methods

We used the National Cancer Database (NCDB) to identify patients with human papillomavirus-associated (HPV-positive) OPC from 2010-2013. We restaged patients using the eighth edition guidelines and compared them with those from the seventh edition. We calculated stage-specific overall survival and concordance indices.

Results

We identified 15 116 patients with a median follow-up period of 29.1 months. Clinical and pathological staging changed for 93.9% and 91.7% of patients, respectively. Survival concordance indices for both clinical (0.621-0.656) and pathological (0.640-0.663) staging were improved in the eighth edition compared to the seventh edition.

Conclusion

The eighth edition guidelines have profoundly altered staging of HPV-positive OPC and seem to demonstrate improved survival discrimination.

http://ift.tt/2y4NGVY