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Journal of Comparative Pathology 2016A 1 cm diameter mass was detected in the caudal superotemporal area of the left eye of a 6-year-old neutered male ferret (Mustela putorius furo). The mass and the left...
A 1 cm diameter mass was detected in the caudal superotemporal area of the left eye of a 6-year-old neutered male ferret (Mustela putorius furo). The mass and the left eye were removed surgically. Microscopical examination revealed a tumour of the adnexal gland of the eye that had invaded the surrounding ocular muscle. The tumour was composed of basal-type epithelial cells arranged in a solid, or occasionally tubular, pattern. Immunohistochemically, the tumour cells expressed cytokeratin and p63, but not smooth muscle actin. Based on these findings, the tumour was diagnosed as a basal cell adenocarcinoma of the lachrymal gland. In addition to the tumour, the retina of the left eye was detached and folded at the centre of the globe. This is the first report of a non-human case of basal cell adenocarcinoma of the lachrymal gland.
Topics: Adenocarcinoma; Animals; Eye Neoplasms; Ferrets; Male
PubMed: 27388784
DOI: 10.1016/j.jcpa.2016.05.015 -
Asian Pacific Journal of Cancer... 2016The purpose of this study was to evaluate the prevalence and predictors of post-Loop Electrosurgical Excision Procedure (LEEP) complications in Srinagarind Hospital,...
The purpose of this study was to evaluate the prevalence and predictors of post-Loop Electrosurgical Excision Procedure (LEEP) complications in Srinagarind Hospital, Khon Kaen, Thailand. Retrospective chart review was performed for 200 patients undergoing LEEP during January 2012 to February 2013. Their mean age was 45 years-old. Fifty-three (26.5%) were menopausal. The three most common preceding abnormal cervical cytology were high-grade squamous intraepithelial lesion (HSIL; 50%), atypical squamous cell cannot exclude HSIL (ASC-H; 10.5%), and low-grade squamous intraepithelial lesion (LSIL; 10%). The overall complications prevalence rate was 16.5% (95%CI, 11.4-21.6). Complications included bleeding (11%; 95%CI, 6.66-15.3), offensive discharge (4%; 95%CI, 1.28-6.72), and pelvic inflammatory disease (1.5%; 95%CI, 0.18-3.18). Only mode of delivery was an independent predictor of post-LEEP complications. Women with previous caesarean sections carried an increased risk of complications by 3.9 times (95%CI, 1.21-12.56) compared with vaginal delivery. In conclusion, LEEP is generally safe with an acceptable complication rate. Previous caesarean section was the only independent predictor for post-LEEP complications. However, this predictor still needs prudent evaluation as no clear cause-effect relationship was identified.
Topics: Adult; Atypical Squamous Cells of the Cervix; Colposcopy; Electrosurgery; Female; Follow-Up Studies; Humans; Middle Aged; Neoplasm Staging; Papanicolaou Test; Postoperative Complications; Pregnancy; Prognosis; Retrospective Studies; Squamous Intraepithelial Lesions of the Cervix; Thailand; Uterine Cervical Neoplasms; Vaginal Smears; Uterine Cervical Dysplasia
PubMed: 27221920
DOI: 10.7314/apjcp.2016.17.4.2211 -
European Journal of Obstetrics,... Mar 2016
Topics: Adnexal Diseases; Adult; Cysts; Female; Hip Dislocation, Congenital; Humans; Magnetic Resonance Imaging; Pregnancy
PubMed: 26748970
DOI: 10.1016/j.ejogrb.2015.11.027 -
World Journal of Gastroenterology Aug 2015Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) is the operation of choice for medically refractory ulcerative colitis (UC), for UC with dysplasia,... (Review)
Review
Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) is the operation of choice for medically refractory ulcerative colitis (UC), for UC with dysplasia, and for familial adenomatous polyposis (FAP). IPAA can be a treatment option for selected patients with Crohn's colitis without perianal and/or small bowel disease. The term "pouchitis" refers to nonspecific inflammation of the pouch and is a common complication in patients with IPAA; it occurs more often in UC patients than in FAP patients. This suggests that the pathogenetic background of UC may contribute significantly to the development of pouchitis. The symptoms of pouchitis are many, and can include increased bowel frequency, urgency, tenesmus, incontinence, nocturnal seepage, rectal bleeding, abdominal cramps, and pelvic discomfort. The diagnosis of pouchitis is based on the presence of symptoms together with endoscopic and histological evidence of inflammation of the pouch. However, "pouchitis" is a general term representing a wide spectrum of diseases and conditions, which can emerge in the pouch. Based on the etiology we can sub-divide pouchitis into 2 groups: idiopathic and secondary. In idiopathic pouchitis the etiology and pathogenesis are still unclear, while in secondary pouchitis there is an association with a specific causative or pathogenetic factor. Secondary pouchitis can occur in up to 30% of cases and can be classified as infectious, ischemic, non-steroidal anti-inflammatory drugs-induced, collagenous, autoimmune-associated, or Crohn's disease. Sometimes, cuffitis or irritable pouch syndrome can be misdiagnosed as pouchitis. Furthermore, idiopathic pouchitis itself can be sub-classified into types based on the clinical pattern, presentation, and responsiveness to antibiotic treatment. Treatment differs among the various forms of pouchitis. Therefore, it is important to establish the correct diagnosis in order to select the appropriate treatment and further management. In this editorial, we present the spectrum of pouchitis and the specific features related to the diagnosis and treatment of the various forms.
Topics: Humans; Pouchitis; Predictive Value of Tests; Proctocolectomy, Restorative; Prognosis; Risk Factors; Terminology as Topic
PubMed: 26269664
DOI: 10.3748/wjg.v21.i29.8739 -
American Journal of Obstetrics and... Nov 2015Despite recommendation for ovarian conservation in low-risk, premenopausal women, bilateral oophorectomy is often performed. The purpose of this study was to investigate...
OBJECTIVE
Despite recommendation for ovarian conservation in low-risk, premenopausal women, bilateral oophorectomy is often performed. The purpose of this study was to investigate factors associated with removal of normal ovaries at the time of hysterectomy for benign indication in women age <51 years.
STUDY DESIGN
Demographics, indication for surgery, adnexal pathology, and surgical approach were analyzed for hysterectomies from a voluntary, statewide surgical quality collaborative. Cases were excluded if the surgical indication was cancer, pelvic mass, or obstetric, or if age was >50 years. Cases were categorized according to pathology of the adnexal specimen as cancer, benign findings, normal ovary, or no ovarian specimen. Variables including demographics, medical comorbidities, and surgical characteristics were analyzed to identify characteristics associated with oophorectomy at the time of hysterectomy. A logistic regression model was then developed to identify factors independently associated with removal of normal ovaries.
RESULTS
A total of 6789 subjects were included. Oophorectomy was performed in 44.2% of women (n = 3002). In all, 23.1% (n = 1565) had normal ovaries on pathology. Incidental ovarian cancer was found in 0.2% (n = 12), and benign pathology was found in 21% (n = 1425). Removal of normal ovaries was less likely when the surgical approach was vaginal (18%) as opposed to laparoscopic (23.1%) or abdominal (26.0%). With adjustment, abdominal (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.43-2.09]) and laparoscopic (OR, 1.27; 95% CI, 1.08-1.50) approach showed significantly higher odds of normal ovary removal compared to vaginal hysterectomy. Age 46-50 years was also significantly associated (OR, 1.78; 95% CI, 1.53-2.07). Surgical indications associated with increased oophorectomy with normal resultant pathology were family history of cancer (OR, 3.09; 95% CI, 1.94-4.94), endometrial hyperplasia (OR, 2.36; 95% CI, 1.38-4.01), endometriosis (OR, 2.01; 95% CI, 1.30-3.09), and cervical dysplasia (OR, 1.91; 95% CI, 1.12-3.28).
CONCLUSION
Removal of histologically normal ovaries is performed in nearly 1 of every 4 women age <51 years undergoing hysterectomy for benign indications. Factors associated include age closer to menopause, surgical approach, and certain indications for hysterectomy. Reducing the rate of elective oophorectomy in low-risk, premenopausal women may be a target for quality improvement efforts. Future work should continue to evaluate this practice, associated factors, physician counseling, and patient decision-making.
Topics: Adult; Female; Humans; Hysterectomy; Incidental Findings; Logistic Models; Middle Aged; Ovarian Neoplasms; Ovariectomy; Uterine Neoplasms
PubMed: 26032038
DOI: 10.1016/j.ajog.2015.05.062 -
The Clinical Teacher Jun 2015The objectives of this curricular innovation project were to implement a flipped classroom curriculum for the gynaecologic oncology topics of the obstetrics and...
BACKGROUND
The objectives of this curricular innovation project were to implement a flipped classroom curriculum for the gynaecologic oncology topics of the obstetrics and gynaecology medical student clerkship, and to evaluate student satisfaction with the change.
METHODS
Four short online videos on the topics of endometrial hyperplasia, cervical dysplasia, evaluation of an adnexal mass, and ovarian cancer were created, and students were instructed to view them prior to a class-time active learning session. The Learning Activity Management System (lams) open-source online platform was used to create an active learning class-time activity that consisted of a coached discussion of cases. Student satisfaction with the two aspects of the flipped curriculum was obtained. In addition, lecture assessment for the gynaecologic oncology topics and aggregate student performance on the gynaecological oncology questions of the US National Board of Medical Examiners (NBME) Subject Examination were compared before and after implementation of the curriculum.
RESULTS
Eighty-nine students rotated on the clerkship during the pilot period of analysis. Seventy-one students (80%) viewed the videos prior to the class session, and 84 (94%) attended the session. Student satisfaction was very high for both parts of the curriculum. There was no significant difference in aggregate student performance on the gynaecological oncology questions of the NBME Subject Examination. The flipped classroom curriculum demonstrates a promising platform for using technology to make better use of students' time
DISCUSSION
Our implementation of the flipped classroom curriculum for the gynaecologic oncology topics successfully demonstrates a promising platform for using technology to make better use of our students' time, and for increasing their satisfaction with the necessary didactic learning of the clerkship.
Topics: Clinical Clerkship; Consumer Behavior; Curriculum; Gynecology; Humans; Medical Oncology; Problem-Based Learning; Students, Medical; Teaching
PubMed: 26009948
DOI: 10.1111/tct.12328 -
The American Journal of Case Reports Mar 2015Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic, degenerative vascular disease that most frequently affects renal and carotid arteries in women...
BACKGROUND
Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic, degenerative vascular disease that most frequently affects renal and carotid arteries in women aged 30-50 years, and rarely complicating arteries of the lower limbs.
CASE REPORT
A 60-year-old woman was admitted with intermittent claudication of both legs. We performed pelvic and bilateral lower-extremities angiography, which revealed that the bilateral external iliac arteries (EIAs) had the 'string of beads' appearance with a diagnosis of FMD. Endovascular therapy (EVT) was performed for the bilateral EIAs. Optical coherence tomography (OCT) images showed thickening and thinning of the middle layer, while three-dimensional OCT images showed a 'haustra coli'-like appearance. After successful balloon angioplasty, claudication completely disappeared.
CONCLUSIONS
We report a rare case of EVT successfully performed for FMD of the bilateral EIAs. Our findings suggest that OCT may provide unique diagnostic clues in FMD patients.
Topics: Angioplasty, Balloon; Female; Fibromuscular Dysplasia; Humans; Iliac Artery; Middle Aged; Tomography, Optical Coherence
PubMed: 25819398
DOI: 10.12659/AJCR.893167 -
La Revue Du Praticien Nov 2014The evolution of inflammatory bowel disease (IBD) is characterized by the occurrence of gastrointestinal complications. For Crohn's disease (CD), it is mainly... (Review)
Review
The evolution of inflammatory bowel disease (IBD) is characterized by the occurrence of gastrointestinal complications. For Crohn's disease (CD), it is mainly strictures, fistulas and abdominal or pelvic abscess in luminal forms and perianal lesions (ulcers, fissures, fistula/abscess) in the perineal forms. For ulcerative colitis (UC), main complications are severe flare up and dysplasia/cancer. In Crohn's disease, stenosis can be treated medically in first line (steroid-immunosupppresseurs or antiTNF) especially when the inflammatory component is predominant or in extensive lesions. In case of limited lesions (< 4 cm) and low inflammatory component, endoscopic dilatation can be propose before surgery, especially in patients previously operated on. Abdomino-pelvic abscess should be drained if the size is greater than 4-5 cm and treated with antibiotics. If obstructive signs are present after the resolution of the abscess, surgery is usually required. In some cases, an antiTNF therapy can be discussed (ongoing trial with the GETAID). Surgery during the MC should be performed laparoscopically, particularly in uncomplicated forms (first ileocecal resection) but also whenever possible for complicated diseases. Anoperineal abscess must be drained by non-tight setons. Medical treatment also involves antibiotics and antiTNF, usually in combotherapy. Biological glue is especially interesting in simple fistulas. Collagen plugs have not demonstrated efficacy in simple or complex perianal Crohn's disease fistulas and may have a deleterious effect. They are therefore not recommended. Severe UC flare up are still conventionally treated with corticosteroids IV for 3-5 days, followed in case of failure of a 2nd line treatment with infliximab or ciclosporin. The place of emergency colectomy had regressed due to the effectiveness of medical treatments.
Topics: Abdominal Abscess; Colorectal Neoplasms; Constriction, Pathologic; Crohn Disease; Humans; Inflammatory Bowel Diseases; Intestinal Fistula; Proctocolitis
PubMed: 25638864
DOI: No ID Found -
Archives of Pathology & Laboratory... Apr 2014Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant... (Review)
Review
CONTEXT
Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings.
OBJECTIVE
To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix.
CONCLUSIONS
Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.
Topics: Adenocarcinoma; Carcinoma, Endometrioid; Cervix Uteri; Diagnosis, Differential; Endometrial Neoplasms; Endometritis; Female; Humans; Immunohistochemistry; Metaplasia; Precancerous Conditions; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms
PubMed: 24678677
DOI: 10.5858/arpa.2012-0493-RA -
The Practitioner Jun 2013The hip and proximate tissues are implicated in a variety of childhood conditions, and in the differential diagnosis of many more. To a large extent the possible... (Review)
Review
The hip and proximate tissues are implicated in a variety of childhood conditions, and in the differential diagnosis of many more. To a large extent the possible diagnoses are limited by the child's age, an accurate history and thorough examination. Developmental dysplasia of the hip (DDH) is a spectrum disorder of joint development and/or instability. It is a major cause of morbidity in children and adults. It can be classified into three types: neuromuscular; teratological; and idiopathic (the most common type). Examination of the hips is carried out neonatally using Ortolani and Barlow manoeuvres to look for dislocation. These tests have high sensitivity but low specificity, and this is one reason why DDH is still picked up late. When a limping child presents it is important that the less common diagnoses, including infection, neoplasia and slipped femoral epiphysis are kept in mind and urgent referral made if necessary. In one study, where a diagnosis was made, the hip joint was the culprit in the majority of cases. Of these, 40% were diagnosed as irritable hip or transient synovitis. Other inflammatory arthritides/tendinoses accounted for 3.2%, Perthes' disease 2%, and infection 3.6%. Any age group is vulnerable to infection such as septic arthritis, osteomyelitis and pelvic pyomyositis. Early diagnosis and treatment, comprising antibiotics with or without surgery, is critical. In the limping child, fever with focal tenderness or restricted range of movement is indicative of infection unless investigations show otherwise.
Topics: Child; Diagnosis, Differential; Hip Joint; Humans; Joint Diseases; Physical Examination; Primary Health Care
PubMed: 23905285
DOI: No ID Found