Unilateral adrenal hyperplasia: a rare cause of primary aldosteronism

A 73-year-old gentleman with a background history of long-standing hypertension and hyperlipidaemia presented with one-year history of persistent asymptomatic hypokalaemia associated with metabolic alkalosis. Within a few months, the hypertension worsened, needing increasing dose of anti-hypertensive agents. Biochemical test showed an elevated aldosterone-renin ratio but the computerized tomography (CT) scan of adrenal did not show any adrenal mass. Arterial stimulation venous sampling (ASVS) lateralized the lesion to the left side. A left retroperitoneal adrenalectomy was performed with immediate reversal of hypokalaemia and improvement of blood pressure control to only single anti-hypertensive agent

Colonic perforation in percutaneous nephrolithotomy: a case report

We aim to report a rare case of colonic perforation post percutaneous nephrolithotomy (PCNL) and its conservative management. We report a 63-year-old Malay, thalassemia carrier male who underwent an uncomplicated left PCNL for a left renal stone. On second postoperative day, clinically evidence of subcutaneous emphysema. Serial CXR imaging confirmed presence of air under diaphragm. Small colonic perforation was diagnosed which subsequently developed localized collection retroperitoenally. He was successfully treated with non-operative management including intravenous antibiotic, surgical drainage and good nutrional has successfully support healed the collection. Serial CT renal protocol showed a healed retroperitoneal collection and patient made a good clinical recovery. PCNL has promising stone clearance rate. However, it carries complications. A rare yet important complication; colonic perforation is a serious complication that if detected earlier, good clinical recovery can be achieved conservativel

Lymphocytic mastopathy: a great mimicry of carcinoma

Three elderly ladies presented with clinical suspicion of breast cancer. Lumpectomy was performed in all 3 cases and histopathological examination came back as lymphocytic mastopathy. Only one of them had a classical long history of diabetes to suggest diabetic mastopathy. The other two cases was non-diabetic and not associated with autoimmune disease. Clinicopathologic and imaging revisited. The disease posed a diagnostic challenges and management dilemma

Silicone breast implant rupture from pectoralis muscle contraction causing IGA Nephropathy: a case report

A 34-year-old woman who was diagnosed with a left breast carcinoma underwent breast conserving surgery and axillary dissection. This was followed with adjuvant breast irradiation and endocrine therapy. She had a local recurrence in the breast 7 years later. She underwent a left nipple sparing mastectomy and submuscular implant reconstruction. The silicone implant ruptured during an episode of strong pectoralis muscle contraction, 5 years postimplantation. MRI confirmed the rupture to be intracapsular and extracapsular. She declined implant replacement. She presented with painless hematuria 2.5 years after the rupture. A renal biopsy confirmed IgA nephropathy

The accuracy of surgeon-performed preoperative parathyroid ultrasound localization for Renal Hyperparathyroidism patient

INTRODUCTION: Parathyroid surgery for renal hyperparathyroidism (RHPT) is indicated when patients have a progressive disease despite optimal medical therapy. The success of total parathyroidectomy in RHPT lies in accurate localization and excision of all PTGs. Recently, surgeon-performed ultrasound (SPU) has been increasingly used for the preoperative localization of PTGs in the intent of focused approach and reduce morbidity. Thus, we conducted a prospective observational single-center study to determine the accuracy of SPU for PTG localization in RHPT and the factors affecting its accuracy. MATERIALS AND METHODS: This is a prospective, observational, single-center study conducted in University Kebangsaan Malaysia Medical Centre between March 2018 and March 2019. The patients’ preoperative demography, clinical data, and relevant blood laboratory results, including calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone, were recorded. Preoperative USG and surgery were performed by the same endocrine surgery consultant. RESULTS: SPU localization had an overall accuracy of 78.1%, sensitivity of 81.0%, and specificity of 30.0% with a positive predictive value of 94.8% and a negative predictive value of 10.5%. The SPU gland localization rate was significantly higher in patients without goiter (median=0.88, IQR=0.63–1.00) than in those with goiter (median=0.50, IQR=0.25–0.75) (p=0.028). CONCLUSIONS: SPU localization of the PTG in RHPT had an accuracy comparable with that in previous literature with the additional advantage of identifying concurrent unknown thyroid nodules. Considering the high prevalence of concomitant nodular thyroid disease in our RHPT population, we advocate the routine use of preoperative neck ultrasound for RHPT patients undergoing parathyroid surgery

The relationship between gut microbiome estrobolome and breast cancer: A systematic review of current evidences

Breast cancer is the most frequent kind of cancer and the second leading cause of mortality worldwide, behind heart disease. Next-generation sequencing technologies enables for unprecedented enumeration of human resident gut microorganisms, conferring novel insights into the role of the microbiota in health and individuals with breast cancer. A growing body of research on microbial dysbiosis seems to indicate an elevated risk of health complications including cancer. Although several dysbiosis indices have been proposed, their underlying methodology, as well as the cohorts and conditions of breast cancer patients are significantly different. To date, these indices have not yet been thoroughly reviewed especially when it comes to researching the estrogen-gut microbiota axis. Instead of providing a thorough rating of the most effective diversity measurements, the current work aims to be used to assess the relevance of each study's findings across the demographic data, different subtypes, and stages of breast cancer, and tie them to the estrobolome, which controls the amount of oestrogen that circulates through humans. This review will cover 11 studies which will go into a detailed discussion for the microbiome results of the mentioned studies, leaving to the user the final choice of the most suited indices as well as highlight the observed bacteria found to be related to the estrobolome in hopes of giving the reader a better understanding for the biological cross-talk between gut microbiome and breast cancer progression

Rectal neuroendocrine tumor: a case series

The gastrointestinal (GI) tract contains no fewer than 13 different types of neuroendocrine cells.( 1)Although the GI tract have the largest amount of neuroendocrine cell, the occurrence of GI NETs are rare and only constitute less than 2 % of all GI malignancies. Rectal NETs are the second most common GI NETs after small bowel. Most of the cases discovered incidentally during screening colonoscopy for other reasons. (2

Ovarian tumor: Rare presentation of breast cancer metastasis

Introduction: Ovarian metastasis is uncommon. Approximately, 10% breast carcinoma will have ovarian involvement1 . It involved bilateral ovaries in about 80% of cases 1 . Due to its low prevalence, ovarian metastasis from a lobular type of breast carcinoma is rare. Here, we presented a case of invasive lobular breast carcinoma metastasis to ovaries after 6 years of the first diagnosis Case Summary: This is a 39 years old Malay lady diagnosed as left breast invasive lobular carcinoma with initial clinical staging of T2 N1 M0 in 2008. Initially she had wide local excision with axillary clearance but due to involved deep surgical margin she underwent mastectomy. Progestrogen receptor is positive. Estrogen and HER2 receptor was negative. Subsequently, she completed FAC regimes and radiotherapy. She has been on Tamoxifen since 2010. In January 2014, she presented with painless abdominal distension of 4 months duration without bowel or urinary symptom or pain. CT scan showed bilateral ovarian masses, likely malignant. Exploratory laparotomy was carried out by the Gynaecology team. Intraoperatively, there was bilateral ovarian tumor with pelvic lymphadenopathy and ascites. Total abdominal hysterectomy bilateral salphingoophorectomy and omentectomy was done. Histopathological reports came back as metastatic ovarian invasive lobular carcinoma with positive pelvic lymphadenopathy but no omentum involvement. After oncologist consultation, we planned for second line of chemotherapy, Doxitacel for 6 cycles

Thyroidectomy for symptomatic goitre in a field hospital setting. a general surgeon’s experience in Malaysian field hospital, Cox’s Bazaar Bangladesh

Purpose: To describe the experience of thyroidectomy for symptomatic goitre in a Field Hospital setting. Methodology: All patients who underwent thyroidectomy for symptomatic goitre between 1st September 2018 to 20th February 2019 were included. Preoperative, intra-operative and post-operative data were taken.Thyroid function test (TFT) was done in a nearby NGO hospital and thyrotoxicosis was treated first prior to surgery. Prophylactic antibiotics was given with IV amoxycillin/clavulanate 1.2 g. Thyroidectomy was performed in a standard form using bipolar diathermy and sutures. Drain was inserted when indicated. Post operatively serum calcium and later TFT was measured. Results: A total of 19 patients had thyroidectomy. 7 patients had hemithyroidectomy and 12 patients had total thyroidectomy. 7 patients weretoxic goitres, 4 had huge goitre with retrosternal extension and 1 patient wasrhesus negative requiring autologous blood storage preoperatively. Decision for type of surgery was done on a case to case basis. All patients had compression symptoms. Cervical and chest X-rays were taken. Ultrasound was done by the Emergency Physician. Intraoperatively there were no complica-tions, mean blood loss was 20 ml, mean operating time was 104 minutes for total thyroidectomy and 56 minutes for hemithyroidectomy. Post-operatively 1 patient had transient hoarseness of voice for 2 months,3 patients had transient mild hypocalcemia and all patients had resolution of compression symptoms. Histopathological services was not available at that time. Conclusion: Thyroidectomy in a Field Hospital setting is a feasible option in areas of prolonged crisi