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Biomedical subjects

M DaSilva

Publications and source records attributed to M DaSilva.

7 recordsLinked to original sources
PubMed2004

Simultaneous bilateral laparoscopic adrenalectomy: a surgical option for multiple endocrine neoplasia (MEN 2) patients with bilateral pheochromocytomas.

Multiple endocrine neoplasia (MEN 2) is a rare disorder. Of this group, 42% develop a pheochromocytoma of which 60% will have bilateral involvement. Although the benefits of unilateral laparoscopic adrenalectomy have been well documented, fewer cases of simultaneous bilateral laparoscopic adrenalectomy have been reported. We present the cases of three patients with MEN 2 who underwent successful simultaneous bilateral laparoscopic adrenalectomy after their initial presentation with bilateral pheochromocytoma. Although the management of bilateral pheochromocytomas has traditionally been approached via open laparotomy or bilateral posterior incisions, the bilateral laparoscopic approach should be considered a viable alternative for patients requiring surgical intervention. Clinical outcomes and complications are similar to open laparotomy. Simultaneous bilateral laparoscopic adrenalectomy is a safe and effective procedure that results in a more rapid recovery and a shorter hospital stay for patients with bilateral pheochromocytomas originating from MEN 2.

Adrenal Gland Neoplasms↗
PubMed1999

"Histiocytic markers" in melanoma.

BACKGROUND: Tumor cells of malignant melanoma, the "great imitator," may morphologically mimic almost any cell, including histiocytes. Immunohistochemical stains for histiocytes are often used to distinguish histiocytic lesions that resemble melanomas, but we have noted and others have reported that these markers may be immunoreactive in melanomas. METHODS: We evaluated 43 primary and metastatic melanomas with traditional markers for melanomas (S100, HMB45, and NKI-C3) and common markers used for histiocytes (alpha-1-antitrypsin or AAT, CD68/KP1, HAM56, Mac387, and Muramidase). The extent (<5%, 5 to 30%, 30 to 60%, 60 to 90%, >90%) and intensity (1+ to 4+) of staining were recorded semi-quantitatively. RESULTS: Melanoma immunoreactivity (>5% of tumor cells) was as follows: S100, 100%; HMB45, 91%; NKI, 91%; AAT, 95%; CD68, 86%; HAM56, 26%; Mac387, 7%; and Muramidase, 30%. Among the histiocytic markers, staining by AAT and CD68 was typically diffuse but weak. Staining by HAM56, Mac387, and Muramidase was usually focal. In contrast, the traditional melanoma markers showed diffuse and strong staining. Interpretation of the histiocytic markers was complicated by scattered atypical histiocytes and pigmented tumor cells. CONCLUSION: Melanomas are commonly immunoreactive for histiocytic markers. AAT and CD68 immunostains are diffusely positive almost as frequently as traditional melanoma markers, although with weaker intensity. HAM56, Mac387, and Muramidase are less commonly positive and exhibit focal staining. Therefore, depending on the context, histiocytic markers may not be helpful in differentiating histiocytes and histiocytic tumors from melanomas.

Adult↗
PubMed1997

Bilateral femoral neck stress fractures in an amenorrheic athlete.

Stress fractures in athletes rarely involve the femoral neck. This report described the diagnosis and treatment of bilateral femoral neck stress fractures in a 30-year-old amenorrheic triathlete who is lactose intolerant and has a low caloric intake. The possibility of fatigue fracture should be considered in patients who have pain in the lower extremities that is exacerbated by activity, especially if they have hormonal or nutritional disorders.

Adult↗
PubMed1991

Cerebrospinal fluid flow dynamics in children with external ventricular drains.

Fifty-five children had 64 external ventricular drains (EVDs) placed predominantly (95%) for cerebrospinal fluid (CSF) shunt infections. In 9 children, a computer monitoring system measured the CSF output each second continuously for up to 24 hours. The monitoring was repeated daily for up to 9 days. The state of arousal of the patients was recorded simultaneously. In all children, daily EVD outputs were related to age, sex, weight, method of establishing the EVD, height of the drip chamber, time since insertion, and type of infecting organism. Computer monitoring revealed wide fluctuations in flow rate, with peak rates frequently greater than 20 ml/h and periods of flow arrest. These changes were usually associated with increased arousal, but also occurred with sleep. The mean EVD flow rate for all children was 6.3 ml/h. EVD output increased with age and weight. EVD output decreased with Gram-negative or multiple-organism infections and with elevation of the drip chamber. Resolution of the infection, sex of the patient, and method of establishing the EVD had no effect on output. These results predict that CSF production increases with brain growth in humans: that CSF production is depressed by Gram-negative and multiple-organism infections: that implanted CSF shunts with standard valves flow at equivalent rates to an EVD in the supine position; and that the CSF drainage requirements in this group are approximately equal to their EVD outputs.

Adolescent↗
PubMed1989

The histopathologic diagnosis of head and neck tumors by special stains.

Various histochemical and immunocytochemical stains were useful in the diagnosis of six unusual head and neck neoplasms that included spindle-cell squamous carcinoma, synovial sarcoma, mucoepidermoid carcinoma, melanoma, T-cell lymphoma, and B-cell lymphoma. Close cooperation with a pathologist ensured rapid diagnosis and the initiation of appropriate therapy. Three cases required special histochemical stains to make a diagnosis or determined tumor differentiation. The three other cases would have been identified as poorly-differentiated tumors of unknown origin without the use of special immunocytochemical stains. These latter findings influenced our final therapeutic strategy, which emphasizes the uses of special stains and studies to accurately identify tumors of the head and neck.

Adolescent↗