Alcoholics, heroin addicts and normal controls were asked for their degree of preference for the two lateral (left, right) sides during their performance of unilateral activities involving one of the four paired organs, hand, foot, eye and ear. Side-bias was assessed by a questionnaire, with 22 items for hand preference, and five items each for foot, eye and ear preference. Group difference was assessed with a mixed-factorial design (Group x Side) for each form of side-bias. Unlike heroin addicts and normal controls, alcoholics exhibited a significant reduction in right side-bias for all four measures, which suggests an anomalous pattern of lateralization.
Lipomas are one of the most common benign mesenchymal tumors in the body. Usually asymptomatic, they rarely warrant treatment unless they attain enormous size causing cosmetic deformity or pressure effects. Head and neck region is an uncommon site, retropharyngeal space being one of the rarest. Lipomas in this region can produce pressure symptoms demanding surgical excision. This is a case report of retropharyngeal lipoma, extending from skull base to the clavicle. Though tumor was present for 20 yrs it exhibited rapid growth over a period of 2-3 yrs causing respiratory obstruction, dysphagia & dysphonia. Clinically the entire laryngopharynx, trachea and carotid sheath were pushed anteriorly. On imaging, it showed classical features of a lipomatous mass. Patient underwent complete excision which presented a surgical challenge to surgeon and the anaesthetist from intubation to extubation. Keywords Lipoma . Retropharyngeal Patients and methodsA 65-yr-old male presented to Manipal Hospital Bangalore with a left sided neck mass since 20 yrs, exhibiting rapid progression for past 2-3 yrs. Progressive dysphagia, dysphonia and respiratory obstruction were presenting features. Clinical examination revealed a large soft fl uctuant swelling occupying the entire left lateral neck, grossly shifting the laryngopharynx and the trachea to the opposite side. The medial border of the swelling was merging behind the larynx (Fig. 1). There was a smooth bulge in the post.pharyngeal and left lateral pharyngeal wall intraorally. Left vocal cord was immobile. Routine biochemical and hematological examinations were normal. The differential diagnosis considered in this case was lymphangioma. CT scan of the neck revealed a well encapsulated low density IMAGES IN SURGERY
Hemothorax is most commonly caused by trauma, but can also result from iatrogenic injury, rupture of pleural adhesions, neoplasm, complication of anticoagulation, aneurysmal rupture, rupture of pulmonary vascular malformations, endometriosis, and exostoses. A recurrent right-sided hemothorax, with a temporal relation to menses, in a young female distinguishes thoracic endometriosis from other etiologies. Video assisted thoracoscopic Surgery (VATS) is thought of as the definitive diagnostic procedure for the diagnosis of thoracic endometriosis. We present a case of a young female with a recurrent right sided hemothorax, whose diagnosis was obscured by two negative pleural biopsies obtained via VATS. CASE PRESENTATION:A 36-year-old female with a history of pulmonary embolism s/p anticoagulation, presented with recurrent dyspnea on exertion, pleuritic chest pain, and a bleeding umbilical mass, worsened by menses. She had a history of three years of recurrent right-sided hemorrhagic pleural effusions of unknown etiology. She had undergone right pleurectomy via VATS two years prior. The biopsy showed pleural tissue with mesothelial cell hyperplasia and chronic inflammation. A repeat VATS was performed one year later, with conversion to open thoracotomy, and biopsy of a nodule demonstrated a foreign body reaction, most likely to talc. No endometrial tissue was found. Patient underwent thoracoscopic decortication at this time. During her work up, the patient had been trialed on Depo Provera, without improvement. Biopsy of her umbilical mass demonstrated endometriosis and the presumptive diagnosis of thoracic endometriosis syndrome was made, with plans to start the patient on GnRH antagonist therapy.DISCUSSION: Catamenial hemothorax can result from ectopic endometrial tissue implantation directly in the pleural cavity or from abdominal implantations that bleed into the pleural cavity in a retrograde manner. In both cases, disease manifestation fluctuates temporally with menses. For this reason, VATS biopsies may have limited ability to rule out thoracic endometriosis in the workup of hemothorax. McCann et al. further elaborate on the limitations of VATS in diagnosis of catamenial hemothorax by identifying a decrease in diagnostic yield when a biopsy is performed outside of menstruation which they attribute to degradation and autolysis of the proliferative tissues approximately 48 hours after menstruation.CONCLUSIONS: This case illustrates the use VATS biopsy can be misleading in diagnosing catamenial hemothorax due to the various implantation sites and the temporal fluctuations of ectopic endometrial tissue.
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