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Thứ Bảy, 17 tháng 11, 2012

NHÂN CA U BÀNG QUANG XUẤT HUYẾT @ MEDIC

History
An 18-year-old man with an established history of neurofibromatosis type 1 (NF1) presented with weight loss and umbilical protrusion. He denied any pain, urinary symptoms, or gastrointestinal symptoms. An initial ultrasound (US) examination of the abdomen and pelvis demonstrated bilateral hydronephrosis and bladder wall thickening, which led to urologic consultation and, ultimately, cystoscopy. At cystoscopy, the bladder mucosa was noted to be irregular and compressed, but no focal intraluminal mass was appreciated. There was some apparent difficulty in identifying the ureteral orifices.
Further imaging with computed tomography (CT) and magnetic resonance (MR) imaging showed a large mass involving the bladder wall and causing the hydronephrosis. Bilateral nephrostomy tubes and ureteric stents were placed in an antegrade fashion, which succeeded in relieving the urinary obstruction.
 
 

Subsequently, the nephrostomy tubes were removed and the ureteric stents were left in place. The patient underwent a surgical biopsy, which demonstrated pathologic changes diagnostic of neurofibroma. The possibility of malignant degeneration was considered given the size of the mass, resulting in the referral of the patient to a tertiary-care center for radical cystectomy and urinary diversion.

 
Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen’s disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen’s patients.
 
 

Thứ Sáu, 9 tháng 11, 2012

KHÁNG SINH hoặc CẮT RUỘT THỪA ?




In her thesis, Jeanette Hansson discusses two major clinical studies of adult patients with acute appendicitis. In the first study she compares surgery with antibiotic therapy, while in the second patients with appendicitis were treated with antibiotics as first-line therapy.

Carried out at Sahlgrenska University Hospital and Kungälv Hospital, the studies showed that treatment with antibiotics was just as effective as surgery for the majority of patients.

"Some patients are so ill that the operation is absolutely necessary, but 80 percent of those who can be treated with antibiotics recover and return to full health," says Jeanette Hansson.

The thesis also shows that patients who are treated with antibiotics are at risk of fewer complications than those who undergo surgery.

The risk of recurrence within 12 months of treatment with antibiotics is around 10-15 percent. Jeanette Hansson and her colleagues hope to be able to document the risk of recurrence over the long term and also to study whether recurrences can also be treated with antibiotics.

Even though increased resistance to antibiotics could also affect the treatment, the conclusion is that antibiotics are a viable alternative to surgery in adult patients as things stand, provided that the patient accepts the risk of recurrence.

"It's important to note that our studies show that patients who need surgery because of recurrences, or because the antibiotics haven't worked, are not at risk of any additional complications relative to those operated on in the first place," says Jeanette Hansson.

The thesis: "Antibiotic therapy as single treatment of acute appendicitis" was publicly defended in May.