We report a case of a healthy 78 -year- old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS – guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS – guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

While there is an ethical obligation to improve clinical outcomes by developing better therapies, surgical innovation has largely progressed without the strict regulations required of novel pharmaceutical products. We explore the reasons why new surgical techniques are frequently introduced without the benefit of randomised controlled trials, and present an approach to the ethical evaluation of novel surgical procedures.
Biomedical Research ; ethics ; Clinical Competence ; Diffusion of Innovation ; Ethics, Medical ; General Surgery ; ethics ; methods ; standards ; Humans ; Informed Consent ; Medical Audit ; Medicine ; Singapore ; Specialty Boards

A 26 year-old Malay man presented with first attack of left eye optic neuritis that recovered fully with intravenous methylprednisolone after 3 weeks. He developed a second attack of optic neuritis in the right eye the following week. Lhermitte sign as well as Uthoff phenomenon were also positive. On day-3, he developed bilateral paraplegia and sensory loss at T8 level, which progressively worsen and became bedridden on day-5. MRI showed bilateral enhance-ment of the optic nerve with the presence of long multisegmental demyelinating plaque in the thoracic to lumbar spinal cord and the brainstem, sparing the brain hemisphere. He was promptly given high dose intravenous methylprednisolone followed by oral predni-solone. He was also assigned on intensive neuro-phy-siotherapy. He recovered after 3 months and was able to walk with walking aids. He recovered completely after 7 months and resumed working as site contactor. There was no relapse during the last 1 year follow-up. His final visual acuity improved to 6/9 in the right eye and 6/6 in the left eye. The visual field of the right eye showed per-sistent mild cecocentral scotoma. And diffuse depression.