Search

A seizure is a symptom of brain dysfunction, resulting in 1.6 million emergency department visits each year. The evaluation of new seizures in the emergency department is a process looking for triggers of seizures such as toxins, mass lesions, or metabolic derangements. Maintaining a broad differential diagnosis is essential to prevent premature closure of the diagnostic evaluation. Timing of neurologic imaging and electroencephalogram depends on the clinical situation. In this case, a young woman presents with a "new-onset" seizure with subsequent elevation of white blood cells and serum lactate levels. Neurologic imaging identified a large dermoid cyst in the frontal lobe. We review how seizures can elevate the serum lactate distinguishing a general tonic-clonic seizure from pseudoseizures and how dermoid cysts can be implicated in seizures.

Blood cysts of the mitral valve are mostly benign diverticuli lined by endothelium and filled with blood and can be safely monitored with echocardiographic follow-up. We report a case of asymptomatic blood cyst of the mitral valve in a 63-year-old woman referred for a systolic murmur. At 3-year echo follow-up, the patient is free from notable clinical events.

The diagnosis and management of true nonparasitic splenic cysts has markedly changed in recent years. The use of serum CA 19-9 has been increasingly advocated for diagnosis, while the advent of minimally invasive surgery has radically altered surgical management. We present the first case of a true nonparasitic splenic cyst in which serum CA 19-9 was not elevated. Treatment was by laparoscopic cyst decapsulation utilising the endoscopic Ligasure.

Objective: To evaluate laparoscopic treatment of postmenopausal women with an adnexal cystic mass predicted to be benign., Methods: Selection criteria were transvaginal sonographic appearance other than a complex cyst and a normal serum CA 125 level. During the period May 1988 to June 1993, 55 women fulfilled the criteria and underwent operative laparoscopy. During the same period, 75 postmenopausal women underwent exploratory laparotomy for an adnexal cystic mass that was complex in appearance or associated with elevated serum CA 125., Results: Laparoscopic bilateral oophorectomy was performed in all 55 women. All had benign masses (positive predictive value 100%). Malignant tumors were found in 23 of the 75 women undergoing laparotomy (negative predictive value 30.7%). There was no significant difference in size of the tumors between women undergoing laparoscopy or laparotomy., Conclusion: Because of its safety and efficacy, laparoscopic management is the preferred procedure in postmenopausal women with a non-complex adnexal mass and a normal CA 125 level.

Studies were conducted in 343 women on the clinical utility of the newly developed tumor-associated mucin-type glycoprotein, CA 54/61, as a tumor marker in serum for ovarian cancer. The overall positivity rate of the new marker was 60%, lower than the rate of 88% obtained with CA 125 measured concurrently. Concerning tumor histology, CA 54/61 had a positivity rate of 78% in mucinous adenocarcinoma, compared with 44% with CA 125. There was no correlation between the serum levels of CA 54/61 and CA 125 (r = 0.05). CA 54/61 showed a low rate of positivity in benign disease and only exceeded the cutoff value in one patient with an endometrial cyst, whereas CA 125 had a positivity rate of 60%. The false-positive rates for CA 125 during the first trimester of pregnancy and during menstruation were 57 and 16%, respectively, whereas the rates for CA 54/61 were only 11 and 5%, respectively. Assay of both CA 54/61 and CA 125 increased the success rate in diagnosing ovarian cancer to 95% (38 of 40 patients).

Serial plasma levels of the glucoprotein tumor markers carcinoembryonic antigen (CEA) and gross cyst disease fluid protein (GCDFP) were evaluated in 83 patients undergoing treatment for predominant osseous metastases from breast carcinoma. Abnormal plasma levels of CEA (greater than 10 ng/ml) and/or GCDFP (greater than 150 ng/ml) were observed in 53 (63.8%) subjects. Fifty-six courses of hormonal and chemical therapy were evaluated. Clinical response to therapy correlated positively with alterations in serial plasma levels of CEA and/or GCDFP. Increasing plasma levels of tumor markers were associated with clinical disease progression whereas decreasing plasma levels were associated with and generally preceded clinical disease remission. Of patients with metastatic carcinoma of the breast, responses to therapy are most difficult to evaluate in those with bone metastases. Serial determinations of plasma levels of CEA and/or GCDFP provide an objective indication of disease progression and regression and appear to be useful with skeletal x-rays and bone scans in evaluating patients with carcinoma of the breast.

A radioimmunoassay has been developed for one of the major proteins isolated from human breast cyst fluid. Immunologically this protein is identical to a protein present in both human milk and saliva. Ninety-two normal women had plasma levels of this protein below 100 ng/ml (range 7-81 ng/ml; mean 31 ng/ml), and 85% had plasma levels below 50 ng/ml. More than one-half of the women with active gross cystic disease of the breast had plasma levels above 50 ng/ml. None of these women, however, had plasma levels above 150 ng/ml. A significant percentage of women with advanced breast carcinoma have been found to have plasma concentrations of this protein greater than 150 ng/ml.

One hundred eighty-four patients with benign breast disease (BBD) were studied and compared with 50 normal women. All of the women had ovulatory cycles according to a biphasic basal body temperature and a plasma prolactin in the normal range. Their corpus luteum function was evaluated by way of plasma progesterone (P) and estradiol (E2) determinations at days 5, 7, and 9 of the hyperthermic phase. In the 184 patients, plasma P over plasma E2 ratio during the luteal phase was found significantly lower than in normal women. When the patients were grouped according to type of breast lesions, it appeared that plasma P was constantly lower in all groups than in the normal women, while plasma E2 was either normal or elevated in the groups of patients with adenosis tumors and increased nodularity of both breasts. From these results it may be postulated that an imbalance in the secretion of E2 and P by the corpus luteum is a constant finding in women with benign breast disease.

Acquired dysfibrinogenemia was documented in a 4-year-old child with obstructive jaundice of 1-month duration, secondary to a choledochal cyst involving the distal common bile duct. It was characterized by decreased thrombin coagulable protein with elevated immunoassayable fibrinogen resulting in abnormal thrombin and reptilase times. The liver morphology was compatible with extrahepatic obstruction, without evidence of cirrhosis or hepatocyte abnormality. All the coagulation abnormalities promptly resolved after surgical correction of the obstruction. Dysfibrinogenemia has been associated with serious liver disease in adults, including tumors, chronic active hepatitis, and cirrhosis, but never with isolated obstructive jaundice. This report documents a case of acquired dysfibrinogenemia due to extra-hepatic biliary obstruction and also emphasizes the importance of the consideration of this disorder in coagulation abnormalities associated with hepatobiliary disease.