There is a need for interventions to improve management and documentation in diabetes care in order to achieve early detection and prevention of complications. Developing a protocol for the clinic based on standard guidelines, and the use of flow sheets may be helpful in improving these intermediate indicators of quality of care.
Simple parathyroid cysts are rare; only about 200 cases have been reported in the literature. The diagnosis was facilitated recently by parathyroid hormone assay of the cyst fluid. Standard treatment consists of percutaneous aspiration of the cyst and surgical excision for recurrent lesions. Sclerotherapy of recurrent lesions was described in two cases and results were promising. The authors report a new case of recurrent nonfunctioning parathyroid cyst in a 34-year-old female, with complete resolution after ethanol sclerosis and no recurrence for 15 months of follow-up. Ethanol sclerotherapy is recommended as a simple and safe treatment for recurrent parathyroid cysts.
A 28-day-old baby boy presented with progressive jaundice and pallor of 3 weeks' duration. On examination he had moderate abdominal distension with a large rightsided firm immobile abdominal mass reaching the right iliac fossa. Laboratory studies showed severe anaemia (haemoglobin 52 mg/L), thrombocytopenia (platelet count 26 000/ µ L) and unconjugated hyperbilirubinaemia (total/direct bilirubin 193/7mg/L); Coombs test was negative. CT of the abdomen revealed a 10 × 7.5 × 5.5 cm heterogeneous mass arising from the right kidney, with areas of increased density suggestive of acute haemorrhage (Fig. 1). This large tumour was consistent with Wilms' tumour although mesoblastic nephroma was another possibility. The patient underwent emergency right nephrectomy. The kidney contained a 6.5 × 6.0 × 4.5 cm mass, the inner edge of which abutted the renal pelvis without invading it. The outer aspect of the mass compressed the surrounding renal cortex. The overlying renal capsule was focally ruptured and there was extensive haemorrhage into the perirenal fat. The cut surface of the mass was dark brown and friable, and the bulk of it appeared to be composed of clotted blood (Fig. 2). Microscopy of the mass revealed a cavernous haemangioma with extensive intratumoral and perirenal haemorrhage. Identifiable features of haemangioma were limited to a thin rim along the interface between the mass and normal renal tissue. They consisted of anastomosing vascular spaces separated by a scant connective tissue stroma, as well as large cystic spaces containing clotted blood (Fig. 3a). Entrapped normal tubules were occasionally seen within the stroma (Fig. 3b). The cells lining the vascular spaces were benign and expressed endothelial markers (factor VIII and CD34). Extensive sampling of the mass showed no evidence of malignancy. The patient had an uneventful postoperative course, and normal haematological and biochemical profiles upon discharge from hospital.
Acute gallstone pancreatitis in children may present as jaundice or abdominal pain. Recognition, early diagnosis and surgical intervention are the mainstay for a good outcome.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.