BackgroundIntussusception is invagination of a proximal segment of bowel into the distal segment in telescopic manner. Although intussusception is common among children, intussusception secondary to terminal ileal endometriosis in an adult is a very rare encounter. We present such a case of intussusception in a Sri Lankan female.Case presentationA 43 year old Sri Lankan female presented to the surgical casualty unit with features of a subacute intestinal obstruction. Her past surgical and medical histories were unremarkable. On examination she was haemodynamically stable with distended abdomen and there was generalized tenderness. There was no guarding or rigidity. No masses were palpable. Bowel sounds were increased. Her urine was negative for Human Chorionic Gonadotrophin hormone. Full blood count revealed an increased white blood cell count with predominant number of neutrophils. Plain abdominal X-ray film showed dilated small bowel loops with empty rectum and distal colon. Patient underwent emergency exploratory laparotomy. An annular growth at terminal ileum was noted. Proximal bowel loops were distended. There was no free fluid in the abdomen. Ileo caecal tuberculosis was suspected and right hemicolectomy was performed. Uterus and bilateral ovaries appeared normal. Post surgical recovery was uneventful. The pathologist has noted endometriosis of terminal ileum contributing to the stricture formation and intussusception at the site. Following recovery patient was referred to a Gynaecologist for management of endometriosis.ConclusionThough terminal ileal endometriosis is a very rare cause of intussusception it is important to consider the possibility of it, especially when a female patient of reproductive age presents with symptoms and signs of intestinal obstruction.
Avulsion injuries of the apophysis in adolescents are found most commonly in the pelvis and proximal femur. Among them avulsion fracture of the lesser trochanter apophysis is relatively an uncommon injury. We report a 15 year old patient with an avulsion fracture of the lesser trochanter apophysis on left side who sustained it with a forceful extension of the left hip. Conservative management has been the most popular treatment modality, and we decided to proceed with non-surgical management of the injury since the displacement was not significant. Surgical fixation is indicted when there is a significant displacement or if the patient has higher functional demands.
Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.
Metastasis to breast from an extra mammary primary malignancy is extremely rare. We came across a female with metastasis of monomorphic synovial sarcoma (spindle cell tumor) of right thigh to the breast. She presented to us with a rapidly growing monomorphic synovial sarcoma in her right thigh. Patient had to undergo several episodes of wide local excision due to local recurrence of the tumour. One year after her initial presentation she developed a metastatic lesion in the right breast.
Introduction Thyroid diseases are common disorders with a great geographical variation worldwide. Underlying pathology of a thyroid swelling can be variable, with thyroid cancer being the most sinister pathology of all. Fine Needle Aspiration Cytology (FNAC) is a widely accepted, simple and minimally invasive investigation in the assessment of nodular thyroid disease. Objective This study was conducted to evaluate the reliability of FNAC in diagnosing malignant thyroid conditions. Material and methods Retrospective analysis of patients who underwent thyroidectomies in a teaching hospital during a ten month period was considered in the study. Their preoperative FNAC diagnosis was compared with the post operative histopathological diagnosis. Results and conclusion Data from 94 patients who underwent FNAC and subsequent histological examination were collected. Eight patients were excluded due to inadequate information given for a conclusive diagnosis. Out of the remaining 86 patients 44 had colloid nodules 16 had thyroiditis 24 had papillary carcinomas and 2 had follicular neoplasms. The FNAC reliability in diagnosing thyroid malignancy was concluded as sensitivity 73%, specificity 85%, positive predictive value 67.8% and negative predictive value of 87.9%. This is consistent with the recent reports in the literature that suggest sensitivity, specificity, positive and negative predictive values of FNAC in detecting thyroid diseases ranging from 84-98%, 67-100%, 34-92%, and 65-94% respectively.
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