A six year-old presented with a 10-month history of vaginal discharge. On initial gynecologic evaluation, a vaginal mass was noted. A thorough investigation included pelvic sonogram, KUB sonogram, pelvic examination under anesthesia. A close team-up with a pediatrician and a urologist was established. Intra-operative findings revealed uterine didelphys and a blind hemivagina. This report discusses the approach to the investigation of vaginal discharge in association with a vaginal mass in a 6-year old.
HEMIVAGINA ; MULLERIAN DEFECT ; UTERINE DIDELPHYS

INTRODUCTIONIn a patient with hyperthyroidism, the detection of elevated thyroid hormone concentration with measurable thyroid-stimulating hormone (TSH) value poses considerable diagnostic difficulties.

CLINICAL PICTUREThis 38-year-old lady presented with clinical features of thyrotoxicosis. Her serum free thyroxine concentrations were unequivocally elevated [45 to 82 pmol/L (reference interval, 10 to 20 pmol/L)] but the serum TSH values were persistently within the reference interval [0.49 to 2.48 mIU/L (reference interval, 0.45 to 4.5 mIU/L)].

TREATMENTInvestigations excluded a TSH-secreting pituitary adenoma and a thyroid hormone resistance state and confirmed false elevation in serum TSH concentration due to assay interference from heterophile antibodies. The patient was treated with carbimazole for 18 months.

OUTCOMEThe heterophile antibody-mediated assay interference disappeared 10 months following the initiation of treatment with carbimazole, but returned when the patient relapsed. It disappeared again 2 months after the initiation of treatment.

CONCLUSIONSClinicians should be aware of the potential for interference in immunoassays, and suspect it whenever the test results seem inappropriate to the patient's clinical state. Misinterpretation of test values, arising as a result of assay interference, may lead to misdiagnosis, unnecessary and at times expensive investigations, delay in initiation of treatment and worst of all, the initiation of inappropriate treatment.

Adenoma ; diagnosis ; Adult ; Antibodies, Heterophile ; analysis ; immunology ; Diagnostic Errors ; Female ; Graves Disease ; diagnosis ; Humans ; Immunoassay ; Pituitary Neoplasms ; diagnosis ; Thyrotoxicosis ; blood ; diagnosis ; immunology ; Thyrotropin ; blood ; Thyroxine ; blood

Background: Axillary osmidrosis is a disease characterized by axillary malodor. The conventional treatment method of subdermal excision uses Metzenbaum scissors. Recently, subdermal excision using the Versajet system was introduced. However, it is an expensive surgical tool, and a recent study demonstrated a higher frequency of axillary skin necrosis with the Versajet. We propose a novel, cost-effective, and safe subdermal excision method that utilizes an electrosurgical tip cleaner (ETC). Methods: Our retrospective cohort study included 27 patients who underwent subdermal excision from June 2012 to November 2021. The patients were classified into three groups according to the surgical method: Metzenbaum scissors, Versajet, and ETC. The operation time, hospitalization cost, and postoperative complications were investigated. Results: The number of patients in the Metzenbaum scissors, Versajet, and ETC groups was seven, eleven, and nine, respectively. The mean operation time and hospitalization cost were significantly different among the three groups (P<0.05). The longest mean operation time was observed in the Metzenbaum scissors group (112.9±23.6 minutes), followed by the ETC and Versajet groups (76.4±27.1 and 64.2±24.8 minutes, respectively). The most expensive method was the Versajet ($2,346.1±517.7), followed by the ETC and Metzenbaum scissors ($1,391.8±317.7 and $1,279.6±287.5, respectively). No postoperative complications were observed. Conclusions The ETC is a novel method of subdermal excision, comparable to Metzenbaum scissors or Versajet. Therefore, it is recommended for situations where it is necessary to consider both the time and cost of surgery.

Background/Aims: Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes. Methods: In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression. Results: This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (P= 0.002), and test defensiveness score K (P= 0.001) and an increase of Hypochondriasis (P< 0.001) and Masculinity-Femininity scale (P= 0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group. Conclusions This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS.

Keloid scars are commonly found on the ears. Treatment modalities include compression, intralesional steroid injection, and surgical excision with or without radiotherapy, depending on the size and location of the keloid scar. Excision may be a curative solution, but it always requires the immediate reconstruction of the excised defect. Herein, we report the case of a keloid scar located at the helical base of the auriculotemporal sulcus that was treated by excision and a V-Y temporal advancement flap.
Cicatrix ; Ear ; Ear Auricle ; Keloid* ; Radiotherapy ; Surgical Flaps

Skeletal cavernous hemangiomas are rare, benign tumors that may involve the supraorbital rim and orbital roof. However, such involvement is extremely rare. We report a case of skeletal cavernous hemangioma of the frontal bone involving the orbital roof and rim. En bloc excision and reconstruction, using a calvarial bone graft for the orbital roof and rim defect, was performed. It is important not only to perform total excision of skeletal cavernous hemangiomas, but to properly reconstruct the defects after the total excision since several complications can arise from an orbital roof and rim defect.
Frontal Bone* ; Hemangioma, Cavernous* ; Orbit* ; Transplants

BACKGROUND: The donor site of abdominal flaps for breast reconstruction consists of a wide suprafascial cavity that poses a risk of seroma formation. The authors evaluated the efficacy of continuous progressive tension sutures (PTS) using unidirectional barbed absorbable sutures for decreasing the volume of fluid collection and the risk of seroma at the abdominal donor site. METHODS: Between March 2013 and February 2015, 37 consecutive patients underwent breast reconstruction using a deep inferior epigastric artery perforator flap. Two patients who underwent salvage operations were excluded. Ten patients underwent standard abdominal flap donor site closure without PTS. Seven received donor site closure with interrupted Vicryl PTS between the abdominal flap and abdominal muscle fascia. Eighteen patients underwent closure with continuous PTS using unilateral barbed absorbable sutures. Body mass index, the approximate flap area, the duration of drain maintenance, the total drained volume, and the incidence of seroma were compared across these 3 groups. The operative time and subjective difficulty perceived by the surgeon was compared between the 2 PTS groups. RESULTS: The total drained volume was lower and the duration of drain maintenance was shorter in both PTS groups than in the standard closure group. There were no cases of seroma in the PTS groups, and 2 that resolved with conservative care in the standard closure group. More time was required and the subjective difficulty score was significantly higher for interrupted PTS than for continuous PTS. CONCLUSIONS: Continuous PTS effectively reduced the duration of drain insertion, the total volume of drained fluid, and was swifter and easier to perform than interrupted PTS.
Abdominal Muscles ; Abdominoplasty ; Body Mass Index ; Breast ; Epigastric Arteries ; Fascia ; Female ; Free Tissue Flaps ; Humans ; Incidence ; Mammaplasty ; Operative Time ; Perforator Flap ; Polyglactin 910 ; Seroma ; Sutures ; Tissue Donors

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery
Adenoma, Pleomorphic ; Axons ; Biopsy ; Diagnosis ; Facial Muscles ; Facial Nerve ; Facial Paralysis ; Female ; Head ; Humans ; Immunohistochemistry ; Middle Aged ; Neck ; Neurilemmoma ; Parotid Gland ; Recurrence ; Schwann Cells

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.
Aged, 80 and over ; Cheek ; Eccrine Porocarcinoma ; Follow-Up Studies ; Head ; Humans ; Lower Extremity ; Male ; Neoplasm Metastasis ; Poroma ; Radiotherapy, Adjuvant ; Recurrence ; Sweat Gland Neoplasms ; Sweat Glands