Papillary microcarcinomas are a specific subgroup of papillary thyroid cancer. They have the same histological features as papillary thyroid cancer but are 1.0 cm or less in diameter. These tumours are a common incidental finding at autopsy and in thyroid glands excised for other pathology. This tumour can metastasize to regional lymph nodes but its ability to cause significant morbidity and mortality has been questioned. As papillary microcarcinomas can represent up to 30 per cent of all papillary cancers seen in a thyroid surgeon's practice, they are an important group. The aim of this review article is to outline the natural history of papillary microcarcinoma and to offer therapeutic management strategies.
Clinical assessment of 134 patients with hidradenitis suppurativa revealed clinical evidence supporting an androgen-based endocrine disorder underlying the condition. Such features included postpubertal onset maximal during the third decade; female preponderance (13:5); premenstrual flare in 57 per cent of women; absence of this flare associated with irregular or anovulatory menstrual cycles; and an increased incidence of obesity and acne. Detailed hormone profiles in 36 female patients and 14 controls showed evidence of relative androgen excess and decreased progesterone levels in those patients without a premenstrual flare. Obesity and enhanced peripheral androgen conversion by apocrine tissue are possible explanations for normal serum androgen profiles in patients with a flare. Precise elucidation of the hormonal abnormality is a prerequisite for effective medical treatment of early disease.
SummaryEpidural abscess is a well-recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter-related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.Keywords Anaesthetic techniques, regional; epidural, caudal. Complications; epidural abscess, paraplegia, diabetes. ...................................................................................... Correspondence to: Dr M. G. A. Palazzo Accepted: 21 January 1997 Case historyA 53-year-old man, with noninsulin-dependent diabetes mellitus, was referred for specialist opinion by his general practitioner because of right buttock pain radiating into the posterolateral thigh and calf.Examination revealed straight leg raising limited to 75Њ on the left and 55Њ on the right. Knee reflexes were present and equal but ankle reflexes were absent. The plantar responses were equivocal and power was normal in both legs. A clinical diagnosis was made of lumbosacral nerve root compression due to intervertebral disc pathology and a caudal epidural injection was performed.A mixture of procaine hydrochloride and triamcinolone acetonide (unlicensed for epidural use) was drawn up from new sterile vials, the tops of which had been swabbed with 0.5% chlorhexidine in 70% spirit and allowed to dry. The skin was cleaned with 0.5% chlorhexidine in 70% spirit and allowed to dry. A new sterile 2'' 21G needle was introduced through the sacral hiatus using a no-touch technique (without the use of gloves, gown or mask). A total of 22 ml of 0.5% procaine hydrochloride with 80 mg of triamcinolone acetonide was slowly injected into the epidural space. After an initial administration of 10 ml, continued injection produced bilateral leg pain. However, within minutes of completing the procedure re-examination revealed that straight leg raising was full and painfree at 85Њ. On review 3 weeks later the patient reported significant coccygeal pain which had made sitting difficult. In addition he had experienced 4 days of bilateral leg pain, radiating into the posterior thighs and calves which had necessitated bed rest. Examination revealed pain-free spinal movements and straight leg raising was pain-free at 80Њ. His neurological status was unremarkable except for absent ankle reflexes. A further caudal injection was performed in an identical way to the first, including drug volume and dosage. However, bilateral leg pain was provoked after 5 ml had been injected.The following day he felt feverish and had a headache. He developed rigors and was admitted to hospital 3 days after the second epidural injection. On examination he was afebrile, had a stiff neck but no focal neurological signs. His bladder was distended. Haematological investigation showed a white blood cell count of 24.6 × 10 9 .l ᮊ 1997 Blackwell Science LtdAn L 4/5 and L 5 /S 1 bilateral foraminal and nerve root...
From six to 89 months after surgery 82 patients who had been treated by radical surgery (118 excisions) for intractable hidradenitis suppurativa were reviewed. Local recurrence rates varied greatly with the disease site, being low after axillary (3%) and perianal surgery (0%) and high after inguinoperineal (37%) and submammary (50%) excision. Recurrence results from inadequate excision or an unusually wide distribution ofapocrine glands, but physical factors such as obesity, local pressure, and skin maceration played a part in a few patients. Recurrence due to inadequate surgery tended to be the most troublesome. At follow up 75 (91%) ofthe patients were pleased with the results of their operation. A quarter of the patients developed disease at a new anatomical site after operation.Radical surgery gives good symptomatic control of severe hidradenitis suppurative of the axilla, inguinoperineal, and perianal regions but is less satisfactory for submammary disease.
From six to 89 months after surgery 82 patients who had been treated by radical surgery (118 excisions) for intractable hidradenitis suppurativa were reviewed. Local recurrence rates varied greatly with the disease site, being low after axillary (3%) and perianal surgery (0%) and high after inguinoperineal (37%) and submammary (50%) excision. Recurrence results from inadequate excision or an unusually wide distribution ofapocrine glands, but physical factors such as obesity, local pressure, and skin maceration played a part in a few patients. Recurrence due to inadequate surgery tended to be the most troublesome. At follow up 75 (91%) ofthe patients were pleased with the results of their operation. A quarter of the patients developed disease at a new anatomical site after operation.Radical surgery gives good symptomatic control of severe hidradenitis suppurative of the axilla, inguinoperineal, and perianal regions but is less satisfactory for submammary disease.
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