Bronchial Adenoma

The term bronchial adenoma is a misnomer. As even though being ADENOMA, it has malignant potential.

Bronchial adenomas are a histologically and clinically diverse group of respiratory tract neoplasms arising from mucous glands and ducts of the tracheobronchial tree. They represent 1% of pulmonary malignancies. The traditional concept of a single, histologically benign form is challenged and the malignant potential of these tumors is stressed.

Three main cell types with their characteristic histopathologic and clinical features are discussed: carcinoid, adenoid cystic carcinoma, and mucoepidermoid carcinoma.

A case of bronchial carcinoid with hepatic metastases is reported, emphasizing the malignant potential of this controversial group of tumors. The appropriate diagnostic evaluation is outlined and aggressive surgical management is stressed. Chemotherapy and radiation therapy which are reserved mainly for palliation do not add to overall five year survival rates.

Sebaceous Cyst

Sebaceous cyst is actually a misnomer, since these cysts do not arise from sebaceous glands. The correct name is epidermoid cyst. You will also see "epidermal inclusion cyst" commonly used, but epidermoid cyst is the more general and preferred term.

They are produced when epidermal cells (from the outermost layer of the skin) become implanted within the deeper layer of the skin, the dermis. Subsequent shedding of dead epidermal skin cells into a closed space within the dermis leads to an accumulation of cheesy material that may leak to the surface of the skin. They range in size from a couple of millimeters to over an inch in diameter, and are typically firm, round, mobile under the skin, and are usually slow-growing and painless. They can become infected however, which usually leads to removal. Their color ranges from yellow to white.

The most common areas where these occur are the face, trunk, neck, extremities, and scalp, but these cysts can occur anywhere there is skin. Removal is indicated for cosmetic reasons, or if a cyst becomes infected.

Tumor Suppressor Genes

In a sense, the term tumor-suppressor genes is a misnomer because the physiologic function of these genes is to regulate cell growth, not to prevent tumor formation.

Because the loss of these genes is a key event in many, possibly all, human tumors and because their discovery resulted from the study of tumors, the names tumor suppressor and antioncogene persist.

Osteoarthritis

The term osteoarthritis is a misnomer, because inflammation is not the primary pathologic process observed in this form of articular joint disruption.

More accurately described as degenerative joint disease, the disease represents a final common pathway of injury to articular cartilage. Although the true nature and cause of osteoarthritis are unclear, radiographic findings and gross and microscopic pathologic features are fairly typical in most cases.

Prostatodynia

The term "prostatodynia" is a misnomer, as the prostate is actually normal.

Prostatodynia is a noninflammatory disorder that affects young and middle-aged men and has variable causes, including voiding dysfunction and pelvic floor musculature dysfunction.

Medical Clearance

Medical Clearance is the term sometimes used for PreOperative Risk Clearence of Patient before Aurgery but frequently used term medical clearance is a misnomer because a complete perioperative evaluation should serve three purposes:

1.Assessing the patient's incremental risk of death or serious morbidity as a consequence of (potentially not yet diagnosed) cardiovascular conditions during surgery or the postoperative period.

2.Minimizing the risk of these adverse cardiovascular events through medical, behavioral and (rarely) invasive measures.

3.Using the opportunity to alter cardiovascular risk and disease progression, independent of the upcoming surgery.

Tripod Fracture

The zygomatic complex, also known as the trimalar complex, is a facial bone commonly injured in low-velocity trauma. Lateral trauma will sometimes produce an isolated zygomatic arch fracture; however, more severe force can fracture the entire zygomatic complex.

Although commonly referred to as a "tripod" fracture, this name is a misnomer: a zygomatic complex fracture constitutes four discrete fractures.

The components of this fracture are

(1) the zygomatic arch,

(2) the orbital rim,

(3) the frontozygomatic buttress, and

(4) the zygomatico-maxillary buttress.

Skull Base Surgery

Although in widespread use, the term "skull base surgery" is a somewhat of a misnomer. Only a minority of such procedures is undertaken to expose lesions actually located primarily within the skull base. The majority of procedures is conducted to expose deep-seated intracranial lesions situated either adjacent to the brainstem (eg, midbrain, pons, or medulla) or beneath the cerebral cortex.

Previously, many such tumors were approached via simple openings in the calvaria, which requires vigorous and often injurious degrees of brain retraction.

The fundamental principle in transbasal craniotomy is removal of the skull base bone in order to minimize the need for brain retraction. Although current techniques represent a major enhancement in our ability to control inaccessible tumors while minimizing morbidity, they are not panaceas. For example, experience has shown that these procedures are far more suitable for benign lesions (eg, meningiomas, schwannomas, and paragangliomas) and even for low-grade malignant growths (eg, chordomas and chondrosarcomas) than they are for high-grade malignant lesions (eg, squamous cell carcinoma, adenocystic carcinoma, and soft tissue sarcomas). Currently, more emphasis is placed on the preservation of function, especially cranial nerves, than on the necessity for radical resection in every case. The value of neurophysiologic nerve monitoring for motor nerves within the surgical field has become well established. In the developmental years of skull base surgery, two-stage procedures were common. More recently, single-stage procedures have become preferred in most centers, even for tumors with sizable intra- and extracranial components, as well as those involving multiple cranial fossae. Computerized imaging modalities provide localizing information that guides the surgeon around vital structures and helps to enable thorough tumor removal.

NonSpecific or Solitary Rectal or Colon Ulcer

Nonspecifc ulceration of the colon and rectum is a clinical entity characterized by ulceration in various segments of the large intestine and rectum.

The common term “solitary ulceration” is a misnomer, as ulcers may be multiple. Rectal ulcers account for 5% of solitary ulcers, with the remainder occurring in the cecum (45%), ascending colon (20%), and sigmoid (16%).

Three distinct syndromes are seen:

Nonspecific colonic ulcers,

Dieulafoy-type ulcer, and

Solitary rectal ulcer syndrome.

Pyloric Stenosis due to PUD

The term pyloric stenosis is normally a misnomer. The stenosis is seldom at the pylorus. Commonly, when the con­dition is due to underlying peptic ulcer disease, the stenosis is found in the first part of the duodenum, the most common site for a peptic ulcer.

True pyloric stenosis can occur due to fibrosis around a pyloric channel ulcer.

The two common causes of gastric outlet obstruction are gastric cancer (see below) and pyloric stenosis secondary to peptic ulceration. Previously the latter was more common. Now, with the decrease in the incidence of peptic ulceration and the advent of potent medical treatments, gastric outlet obstruction should be considered malignant until proven otherwise, at least in the West.However, in recent years the most common cause of gastric outlet obstruction has been gastric cancer.

Epicondylitis

Medial (‘golfer’s elbow’) and lateral (‘tennis elbow’) Epicondylitis are in fact misnomers as inflammation is secondary to the primary pathology, tendon degeneration.

The common flexor origin and the extensor carpi radialis brevis are the respective culprits. Anti-inflammatories, oral and locally injected, are usually ineffective and attention should focus on correcting playing style, grip size (tennis racquet) and equipment (light, graphite racquet) before reducing the frequency of playing. Local physical therapies are beneficial but if these measures fail, the degenerate area is excised and the tendon repaired.

Mycotic Aneurysm

The term mycotic is a misnomer because, while it indicates infection as a causal element in the formation of the aneurysm, this is hardly ever due to a fungus.

In general, mycotic aneurysms are due to bacteria.

Pyogenic granuloma

Pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically.

The term is used for an exuberant outburst of highly vascular granulation tissue at the site of previous relatively trivial trauma.

These lesions are very friable, bleed easily, and may grow rapidly. They respond to either curettage or simple excision. They occur most commonly on the fingertips.

Diverticulitis

Diverticulitis is the result of a perforation of a colonic diverticulum. The term is somewhat of a misnomer because the disease is actually an extraluminal pericolic infection caused by the extravasation of feces through the perforated diverticulum.


Peridiverticulitis would actually be the term to more appropriately describe the infectious process. Recognition that the infection is actually caused by a perforation of the colon, an event that is often controlled by the body's natural defenses, provides a basis for understanding the signs and symptoms of the disease as well as the rationale for determining appropriate diagnostic tests and treatment.

Neurogenic Shock

High spinal cord injuries can also result in systemic hypotension because of loss of sympathetic tone. The patient will usually have hypotension and relative bradycardia and will show evidence of good peripheral perfusion on physical examination. The term neurogenic shock is used but is somewhat of a misnomer because these patients are typically hyperdynamic, with high cardiac output secondary to loss of sympathetic vascular tone.

After hemorrhagic causes of hypotension have been ruled out, the hypotension associated with high spinal injury can be treated by the administration of an a-agonist such as phenylephrine.

Pulmonary Burn

The term "pulmonary burn" is a misnomer. True thermal damage to the lower respiratory tact and pulmonary parenchyma is extremely rare, unless live steam or exploding gases are inhaled.

The air temperature near the ceiling of a burning room may reach 540°C (1000°F) or more, but air has such poor heat-carrying capacity that most of the heat is dissipated in the oropharynx, nasopharynx, and upper airway. Thus the heat dissipation in the upper airway can cause significant thermal injury to the proximal tracheobronchial tree.

Thermal injury to the respiratory tract is usually immediate and manifests as mucosal and submucosal erythema, edema, hemorrhage, and ulceration.124 Thermal injury is usually limited to the upper airway (above the vocal cords) and proximal trachea for two reasons: (1) the oropharynx and nasopharynx provide an effective mechanism for heat exchange because of their relatively large surface area, associated air turbulence, and mucosal fluid lining that acts as a heat reservoir; and (2) sudden exposure to hot air typically triggers reflex closure of the vocal cords, reducing the potential for lower airway injury. Animal models have demonstrated that significant heat exchange also occurs in the subglottic airway between the vocal cords and the tracheal bifurcation, with protection and sparing of the distal airways. Thus the lower tracheobronchial tree is rarely exposed to hot, ambient gas at a fire scene. An exception is the inhalation of super-heated steam, where because of heat dissipation in the respiratory tract as the steam condenses into water, severe injury has been reported in the distal airways with measurable injury in the alveoli. In these patients the lower tracheobronchial tree is rapidly obstructed, and they usually die from untreatable asphyxiation.

Biliary Colic

Biliary Colic is steady rather than intermittent as would be suggested by the word colic, which must be regarded as a misnomer, although in widespread use.

Biliary colic begins quite suddenly and may persist with severe intensity for 30 min to 5 h, subsiding gradually or rapidly. The pain is described as a bandlike tightness of the upper abdomen that may be associated with nausea and vomiting. This is due to a normal gallbladder contracting against a luminal obstruction, such as a gallstone impacted in the neck of the gallbladder, the cystic duct, or the common bile duct. The pain is most commonly triggered by fatty foods, but it can also be initiated by other types of food or even occur spontaneously. An association with meals is present in only 50% of patients, and in these patients, the pain often develops more than 1 hour after eating.

An episode of biliary pain persisting beyond 5 h should raise the suspicion of acute cholecystitis. Nausea and vomiting frequently accompany episodes of biliary pain. An elevated level of serum bilirubin and/or alkaline phosphatase suggests a common duct stone. Fever or chills (rigors) with biliary pain usually imply a complication, i.e., cholecystitis, pancreatitis, or cholangitis. Complaints of vague epigastric fullness, dyspepsia, eructation, or flatulence, especially following a fatty meal, should not be confused with biliary pain. Such symptoms are frequently elicited from patients with or without gallstone disease but are not specific for biliary calculi. Biliary colic may be precipitated by eating a fatty meal, by consumption of a large meal following a period of prolonged fasting, or by eating a normal meal; it is frequently nocturnal, occurring within a few hours of retiring.