Biomedical subjects
M Keohane
Publications and source records attributed to M Keohane.
Myocarditis and pericarditis with tamponade associated with disseminated tuberculosis.
Tuberculous involvement of the myocardium is relatively rare. Tuberculous pericarditis with tamponade and myocarditis in a young woman with no evidence of immunosuppression and disseminated tuberculosis is described. Three distinct forms of myocardial involvement are recognized: nodular tubercles (tuberculomas) of the myocardium; miliary tubercles of the myocardium; and an uncommon diffuse infiltrative type. The myocardium is involved by a hematogenous route, by lymphatic spread or contiguously from the pericardium. The diagnosis can be made by endomyocardial biopsy if clinical suspicion is strong and echocardiographic findings are suggestive. Antituberculosis drugs may be curative. With an increasing prevalence of tuberculosis, the possibility of potentially lethal myocardial tuberculosis is important to consider.
Differential lung physiotherapy using a double lumen tube in flail chest and refractory lung atelectasis.
The management of refractory lung atelectasis in a patient with flail chest can be difficult. Treatment of lung atelectasis is complicated by practical problems with the application of chest physiotherapy, postural drainage and incentive spirometry. Although double lumen endotracheal tubes have been used in such cases for the purpose of differential lung ventilation, the use of differential lung physiotherapy has not been reported before. This report describes the successful application of this technique in a patient with flail chest and refractory lung atelectasis.
Persistent atrial fibrillation following central venous cannulation.
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Left atrial myxoma presenting with embolism to the aorta.
We present a patient with left atrial myxoma embolizing to the ascending aorta. The features have not been reported previously and were diagnosed with transesophageal echocardiography.
Patient comfort: spinal versus epidural anesthesia for cesarean section.
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Peripheral nerve blocks for paediatric day-stay surgery: one year's experience in a district general hospital.
Two hundred children underwent day-care surgery using peripheral nerve blockade as an adjunct to general anaesthesia during a twelve month period. Total post-operative analgesia was achieved in 86%, simple oral analgesia was needed in 9% and the remaining 5% of patients required systemic opiate administration for pain.
A split laryngeal mask as an aid to training in fibreoptic tracheal intubation. A comparison with the Berman II intubating airway.
Thirty patients were randomly allocated to one of two groups in order to compare the use of a split laryngeal mask airway with the Berman II airway as aids to training in fibreoptic laryngoscopy. In both groups anaesthesia was induced with propofol and maintained with isoflurane in N2O/O2 (FIO2 = 0.5). The fibreoptic laryngoscope was guided towards the larynx using the split laryngeal mask airway in group 1 and the Berman airway in group 2. The tracheas of all patients were successfully intubated at the first attempt and no patient's peripheral oxygen saturation decreased below 92%. Two min after intubation mean heart rate was significantly greater in group 1 (101 beat.min-1) than in group 2 (84 beat.min-1) (P < 0.05). The split laryngeal mask is a useful aid to training in fibreoptic intubation and may allow better airway control than the Berman II intubating airway.
Small bowel carcinoma in Crohn's disease. Distinguishing features and risk factors.
An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion. The increasing number of case reports of adenocarcinoma arising at the site of long-standing Crohn's disease, many with dysplasia within areas of diseased bowel, is further evidence that Crohn's disease is a precancerous condition. Physicians must continue to search for methods of earlier diagnosis to improve the prognosis of small bowel carcinoma in Crohn's disease.
Pituitary-containing benign cystic teratoma arising from the uterosacral ligament.
We report on the incidental finding of pituitary tissue in a mature teratoma on the uterosacral ligament of a 56-year-old woman who underwent exploratory laparotomy for ovarian masses. While the occurrence of pituitary tissue has been reported rarely in benign cystic teratoma of the ovary, and while pituitary adenomas can occur in ectopic sites, we have found only one report in the literature of benign cystic teratoma of extragonadal origin composed of mature adenohypophyseal and neurohypophyseal elements.
Improved local control of thoracic disease in small cell lung cancer with higher dose thoracic irradiation and cyclic chemotherapy.
Over the past decade, improvement in survival has developed for patients with small cell lung carcinoma (SCLC) due to treatment strategies that include: cyclic combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation. In this study, we assess the outcome of treatment with initial cyclic combination chemotherapy including: cyclophosphamide, VP 16-123 and methotrexate combined with radiotherapy (RT), 6000 cGY [corrected] to the thorax for patients with limited disease and 3000 cGy [corrected] for patients with extensive disease. Forty-six patients are evaluated: 26 patients with limited disease and 20 with extensive disease. In patients who received 6000 cGy [corrected], to thoracic lesions, in combination with chemotherapy, administered for 3 courses prior to and following RT, the rate of clinically detected failure in the thorax was 3.8%. Morbidity was considered acceptable, although the occurrence of encephalopathy in 6 of 19 cases who received cranial irradiation, 3000 cGy [corrected], and concomitant chemotherapy was a serious consequence. Control of the primary tumor achieved by the use of higher dose RT is shown to be superior to that observed at lower doses of RT. This suggests that for the small cohort of patients whose disease is truly limited at the time of diagnosis, therapeutic regimens, which include higher dose RT, could increase the number of long term survivors of SCLC.
Infantile hemangioendothelioma of heterotopic intrathoracic liver associated with diaphragmatic hernia.
An autopsy of a six-hour-old term neonate, who died during surgery for repair of a left diaphragmatic hernia, revealed an infantile hemangioendothelioma type I arising in a heterotopic lobe of liver in the left thorax. The upper pole of the tumor was attached by fibrovascular tissue to the lower lobe of the left hypoplastic lung. A pedicle attached to the lower pole of the heterotopic liver pierced through the diaphragm to the left lobe of the normal liver. This case is an example of an unusual association of congenital malformation and putative neoplasm.
Oat cell carcinoma metastatic to ureter.
A rare and perhaps unique case of oat cell carcinoma metastatic to the ureter is presented.
Edema of the lower extremities secondary to obstructive sarcoidosis.
Lower extremity edema is an unusual presentation of sarcoid. In this patient the diagnosis was established via lymphangiography and operative biopsy. Like the other manifestations of the disease, leg edema seems to respond to steroid therapy.
Upper abdominal calcification in a young man.
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Renal vascular abnormalities in acute pancreatitis.
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Slow infusion intravenous cholangiography.
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Cystic papillary adenocarcinoma of the submandibular gland in a child.
A 12-year-old boy reported that a mass in his left jaw had been growing slowly for 8 months. Axial and coronal contrast-enhanced spiral CT showed a 5-cm cystic mass within an enhancing, mildly enlarged submandibular gland. Excisional biopsy revealed a cystic papillary adenocarcinoma of the left submandibular gland, very rare in children.