Interesting Cases (3) in General Surgery

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INTERESTING CASES IN GENERAL SURGERY

• Presentation-Dr.Hema chandra D.N.B 2d year.
• Moderator -Dr.T.Varun raju
• H.O.D-Dr.R.S.Satwalekar

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Case -1

• 30 years old lady presented with a chief
  complaint of a progressively growing swelling
  over her scalp since 3 years with no neurological
  symptoms.
• Local examination revealed a boggy,compressible,no
  n pulsatile sub cutaneous swelling.
• Clinical diagnosis of haemangioma is examined
  with more details by M.R .I and confirmed no
  intra cranial extension.

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SCALP HEMANGIOMA
Superficial vs. Deep Hemangiomas
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Hemangiomas

• Most common tumor of infancy (10)
• Slight female predominance
• 60 arise in head and neck cosmetic
• Concerns

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Complications

• Occur in 20
• Ulceration
• Compression of vital structures
• High-output cardiac failure
• Bleeding
• Kasabach-Merritt syndrome

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DIAGNOSIS

• History and physical examination
• Certain cases radiology
• Ultrasound, MRI

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TREATMENT

• Why and when to treat?
• Normal skin in 50 that involute within 5 years
• Other 50-- 80 substantial deformity

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TREATMENT

• Systemic steroids
• Careful selection criteria
• Prednisone 2-4mg/kg for up to 6 weeks
• Varied results (30)
• Side effects

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TREATMENT

• Intra lesional steroids
• Usually for vision threatening lesions
• Combination of betamethasone
• and
• triamcinolone

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TREATMENT

• Pulse-dye lasers
• Useful for superficial variety
• Good for ulcerations/residual cosmesis

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Surgery

• Eyelid lesions, bulky
• lesions, vermillion border, nasal tip,
• eyebrow
• CO2 laser for subglottis.

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TREATMENT

• Arterial embolization
• ! Radiation therapy
• ! Alpha-2b interferon

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CASE - 2

• 18 years old lady presented with the chief
  complaints of bilateral multiple breast lumps
  since 1 year duration with occasional pain during
  menstruation.
• Local examination revealed multiple non tender
  breast mouse like feel on the lump.
• Both axillae and nipples are un remarkable
• Complete pre operative work up done including
  FNAC.

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CASE - 3

• 22 years old lady presented with the chief
  complaint of progressively increasing left breast
  lump since 6 months with no other symptoms.
• Local examination revealed a huge lump within the
  left breast .Nipple and axilla is un remarkable.
• Complete pre operative investigations done
  including FNAC.

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