January 23rd, 2010 by Bongi in Better Health Network, True Stories
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After having spoken about when you seem to know more than your consultant, I was reminded of another incident from my internship year where a colleague of mine taught me that sometimes it is best to do certain things under cover of darkness.
The patient (a sangoma) turned up at the surgery clinic one day. My colleague asked her what the problem was. Without uttering a word she lifted up her shirt to expose her breasts. The left one had a massive tumour that had fungated through the skin probably some time ago. There was a large stinking cauliflower-like mass with central ulceration that caused a fist sized cavity right up to the chest wall. The smell was also remarkable. Read more »
*This blog post was originally published at other things amanzi*
October 5th, 2009 by Medgadget in Better Health Network, News
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We have known for many years that melittin, an ingredient in bee venom, is a poison to tumor cells. Development of therapeutic uses of the substance has been stymied by the fact that melittin does damage to healthy cells as well. Now researchers from Washington University in St. Louis have developed nanoparticles called “nanobees” that can ferry the melittin directly to tumor cells with great specificity.
The Wall Street Journal reports: Read more »
*This blog post was originally published at Medgadget*
July 23rd, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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Earlier this month I received an e-mail asking for information. I have changed it slightly:
I have been pouring over the computer, searching for information on a tumor. I had removed last week from my left long finger (third finger). The pathology report came back as a myxoid tumor. I was told it was a tumor, not a cyst. Could you help me give me more information?
To begin, most digital myxoid or mucous tumors are cystic in nature. Very few are not. It is difficult to find much information in the literature, especially the current literature.
Digital mucous cysts (DMCs) are benign ganglion cysts. They most often are located at the most distal joint of the finger or in the nail fold. Physicians call this joint the distal interphalangeal (DIP) joints. The fingers are most commonly involved, but DMCs may occur on the toes. (photo credit)
The etiology of these cysts is not known. DMCs are also called myxomatous cutaneous cysts, periungual ganglions, mucous cysts, myxoid cysts, synovial cysts, dorsal cysts, nail cysts, cystic nodules, digital mucoid cysts, digital myxoid cysts, and digital mucinous pseudocysts.
The cyst often has a smooth shiny surface on exam. If located near the nail, there will often be a groove in the nail as in the photo above. The cyst’s size may vary.
If the cyst is asymptomatic, then treatment is not required. Recurrence is common regardless of which treatment is used.
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Aspiration of the contents (72% success rate with multiple aspirations, 2-5 treatments)
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Cyrotherapy (56% to 86% success rate)
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Steroid injection
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Surgical excision (88% to 100%)
Restriction of joint mobility, nail dystrophy, and changes to the contour of the proximal nail fold are potential drawbacks.
When considering a difference diagnosis keep in mind the following:
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Epidermoid cyst
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Heberden node or Rheumatic nodule
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Fibrokeratoma (DMCs may resemble this when they form between the proximal nail fold and the nail and protrude with a keratoticlike tip.)
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Giant-cell tendon sheath tumor
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Myxoid malignant fibrous histiocytoma
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Myxoid variant of liposarcoma (These are less likely to present as firm circumscribed masses and more likely to be deeply seated.)
REFERENCES
Digital Mucous or Myxoid Cyst
Digital mucous cyst – emedicine dermatology, the online textbook
Myxoid Cyst
Cystic Lesions of the Hands; Clinical Advisor, November 12, 2008; Noah S. Scheinfeld, MD, JD
Digital myxoid cysts: a review; Cutis; Feb 1986;37(2):89-94; Sonnex TS.
Myxoid Cysts; JAMA, Dec 1965; 194: 1239; Frederick A. J. Kingery
Ganglion of the Distal Interphalangeal Joint (Myxoid Cyst): Therapy by Identification and Repair of the Leak of Joint Fluid; ARCH DERMATOL/VOL 137, MAY 2001; David de Berker, MRCP; Clifford Lawrence, FRCP
Ray Amputation As A Treatment for Recurrent Myxohyaline Tumor of the Distal Extremity; Plastic and Reconstructive Surgery. 111(4):1573-1574, April 1, 2003; Mowlavi, Arian; Quinn, Brendon M.; Zook, Elvin G.; Milner, Stephen
Soft-Tissue Sarcomas of the Upper Extremity: Surgical Treatment and Outcome; Plastic and Reconstructive Surgery. 113(1):231-232, January 2004; Steinau, Hans-Ulrich; Kuhnen, Cornelius
Soft-Tissue Chondroma in the Thumb; Plastic and Reconstructive Surgery. 110(6):1599-1600, November 2002; Avc, Gülden; Aydogdu, Eser; Ydrm, Serkan; Aköz, Tayfun
*This blog post was originally published at Suture for a Living*
May 3rd, 2009 by EvanFalchukJD in Better Health Network, True Stories
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My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“ Last year, he almost died.
It started when he woke up one day with numbness on one side of his body.
His doctor ordered an MRI. It found bad news: a tumor in his spinal cord, high up in his neck. He was referred to a neurosurgeon.
The plan was straightforward, but dangerous. First, radiation. Then, his spinal cord would be carefully cut open to remove the tumor. He was told he could end up paralyzed, or dead. Concerned, he called me, and we started a case at Best Doctors.
One of our nurses took a history, and we collected his records. Two internists spent hours reviewing them. The records noted our family history of a kind of malformed blood vessel. Our grandfather had hundreds of them in his brain when he died at 101, and our father has dozens of them in his. I have one in my brain, too. This was in my brother’s charts, but none of his doctors had mentioned it.
An expert in these malformations told us a special imaging study should be done to rule this out as a cause of the problem. Best Doctors gave that advice to my brother and his doctors. They agreed.
The test showed this was precisely what he had.
Quickly, the plan changed. He still needed surgery — if the malformation bled, it could also paralyze or kill him. But there would be no radiation, which might have caused the very bleeding we feared. Even if that didn’t happen, the surgeons were prepared to operate on a tumor. They would have been surprised to find a delicate malformation there instead.
In the end, his surgery went well. He is having a good recovery and is busy with his new show. But his case is a constant reminder of how important it is to have the right diagnosis, and how easy it is for things to go wrong.
Even in Hollywood.
After having spoken about when you seem to know more than your consultant, I was reminded of another incident from my internship year where a colleague of mine taught me that sometimes it is best to do certain things under cover of darkness.
