The authors describe a case of 60-year-old male patient presented with a 6 month history of progr... more The authors describe a case of 60-year-old male patient presented with a 6 month history of progressive weakness of all the four limbs, ataxia, droopy eyelids and bulbar features. Further laboratory and electrodiagnostic studies confirmed the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS). MRI of the brain showed a cerebellar tumour which, following surgery was revealed to be a metastatic small-cell lung carcinoma. Paraneoplastic LEMS together with solitary cerebellar metastasis was diagnosed but no evidence of primary malignancy was detected. An extensive search for related malignancies failed to get any clue. The patient underwent a total surgical excision of tumour and the histopathology revealed a metastatic small cell carcinoma. This case highlights that rarely both paraneoplastic LEMS and cerebellar mass can precede the primary malignancy causing them.
We describe a case of 23-year-old man, who presented with painful hypertrophic pulmonary osteoart... more We describe a case of 23-year-old man, who presented with painful hypertrophic pulmonary osteoarthropathy involving bilateral upper and lower extremities, resulting from intrathoracic metastasis. The patient had a history of undifferentiated nasopharyngeal carcinoma which was treated successfully 2 years ago. The painful osteoarthropathy had made the patient incapacitated. A single dose of 4 mg of intravenous zoledronic acid (ZA) was given which resulted in complete resolution of pain along with reduction of swelling. There was no recurrence on follow-up. Bisphosphonates by their action on bone metabolism might alleviate the symptoms and its use should be encouraged in cancer patients with debilitating arthropathies. This article aims at highlighting the role of bisphosphonates, particularly ZA in managing patients with hypertrophic osteoarthropathy (HOA) and sharing our experience with this drug because of the rarity of the condition and lack of sufficient data in the medical literature.
Cerebral venous sinus thrombosis (CVST) is not an uncommon cause of stroke but very often unrecog... more Cerebral venous sinus thrombosis (CVST) is not an uncommon cause of stroke but very often unrecognized at initial presentation due to lack of clinical suspicion and thus frequently left untreated. CVST is a potentially serious condition which manifests with diverse clinical manifestations, from isolated headache to focal neurological signs and even coma. CVST usually takes place either an inherited thrombophilia or any acquired hyperviscosity state and thus prompting anticoagulation was regimen as is the cornerstone of successful treatment. We describe a 47-year-old woman who presented with recurrent bouts of vomiting in the post-operative period and later developed cortical blindness and asymmetric limb weakness. Magnetic resonance imaging (MRI) showed hyperintensity involving bilateral parieto-occipital corticomedullary junction. MR venography showed signal void in the superior sagittal sinus. She was diagnosed as CVST and achieved complete recovery with anticoagulation therapy. Bilateral occipital infarction as a consequence of cerebral venous thrombosis is a rare cause of visual loss. Thrombosis in the superior sagittal sinus was related to her cortical blindness and weakness. This case illustrates that cerebral venous thrombosis should be considered in cases of occipital vascular lesions leading to acute painless loss of vision prompting anticoagulation therapy which can improve the outcome significantly. Dehydration could be considered as a risk factor for development of CVST in appropriate situations.
Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent... more Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and pre-operative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting image-guided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacilli on Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.
Alcoholism is a health problem not only in developed countries but also in developing countries. ... more Alcoholism is a health problem not only in developed countries but also in developing countries. Cirrhosis due to alcohol is a common cause of death among individuals abusing alcohol. A better knowledge of the spectrum of alcoholic liver diseases, its clinical, biochemical and histopathological features could result in early detection and prevention of alcoholic liver diseases before it's catastrophic and life threatening effects. A total of 200 patients with alcoholic liver diseases were studied with respect to alcohol consumption, clinical features, biochemical and histopathological changes. The clinical features, biochemical parameters, and histopathology of liver including Ishak's modified histological activity index (HAI) were correlated with the amount and duration of alcohol consumed. Majority of the patients were in the age group of 40-49 years and all the cases were males. Majority consumed alcohol of about 75-90 grams per day for a duration of 10-12 years. Anorexia and jaundice were the most common symptom and clinical finding respectively. Hyperbilirubinemia and hypoalbuminemia were the most common abnormalities observed in liver function tests. Advanced HAI stages with features of cirrhosis were most frequent histo-pathological finding noted in this study. Clinico-biochemical profile was significantly correlated with degree of alcohol ingestion as well as with liver histopathology. The wide prevalence of alcoholic liver disease including cirrhosis among Indian males was noted with significantly lower quantity and duration of alcohol ingestion. The severity of liver damage is directly proportional to the quantity and duration of alcohol consumed. Clinical features and biochemical changes may forecast the liver histopathology among the patients of alcoholic liver disease.
A 32-year-old man presented with uniform enlargement of right upper limb for 6 years. Examination... more A 32-year-old man presented with uniform enlargement of right upper limb for 6 years. Examination revealed painful disorganised elbow joint along with sensory impairment in the affected limb with weakness of small muscles. The patient was given empirical antileprotic therapy from outside without any benefit. Ultrasonography showed pan-hypertrophic nature of local tissues. Although axonal type of sensorimotor neuropathy involving right ulnar and median nerve was detected in nerve conduction velocity study, biopsy of the same failed to confirm any axonal degeneration or evidence of leprosy. Considering the nature of sensory abnormality MRI of cervical spine was done which revealed a syrinx extending from C3 till D2. Tests for vasomotor tone showed positive results on the affected limb. Syringomyelia can rarely give rise to pan-hypertrophy of limb due to sympathetic overactivity, which is infrequently reported in literatures and deficient in logical grounds.
Most urethral strictures arise from iatrogenic, traumatic, or inflammatory causes. We report the ... more Most urethral strictures arise from iatrogenic, traumatic, or inflammatory causes. We report the familial occurrence of a congenital bulbar urethral stricture in two brothers. Retrograde and voiding cystourethrography was performed. A Cobb's collar was diagnosed after radiological and endoscopic evaluation in both cases and was successfully managed with urethroplasty. Cobb's collar is a rarely recognized cause of a membranous stricture of bulbar urethra that can lead to several urinary problems. In cases of adolescent and young adults presenting with symptoms of progressive urinary obstruction and enuresis with or without urinary tract infection, Cobb's collar can be seen as a minor constriction in the bulbar urethra, but is not frequently symptomatic, and the familial occurrence of such a stricture is even rarer.
The authors describe a case of 60-year-old male patient presented with a 6 month history of progr... more The authors describe a case of 60-year-old male patient presented with a 6 month history of progressive weakness of all the four limbs, ataxia, droopy eyelids and bulbar features. Further laboratory and electrodiagnostic studies confirmed the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS). MRI of the brain showed a cerebellar tumour which, following surgery was revealed to be a metastatic small-cell lung carcinoma. Paraneoplastic LEMS together with solitary cerebellar metastasis was diagnosed but no evidence of primary malignancy was detected. An extensive search for related malignancies failed to get any clue. The patient underwent a total surgical excision of tumour and the histopathology revealed a metastatic small cell carcinoma. This case highlights that rarely both paraneoplastic LEMS and cerebellar mass can precede the primary malignancy causing them.
We describe a case of 23-year-old man, who presented with painful hypertrophic pulmonary osteoart... more We describe a case of 23-year-old man, who presented with painful hypertrophic pulmonary osteoarthropathy involving bilateral upper and lower extremities, resulting from intrathoracic metastasis. The patient had a history of undifferentiated nasopharyngeal carcinoma which was treated successfully 2 years ago. The painful osteoarthropathy had made the patient incapacitated. A single dose of 4 mg of intravenous zoledronic acid (ZA) was given which resulted in complete resolution of pain along with reduction of swelling. There was no recurrence on follow-up. Bisphosphonates by their action on bone metabolism might alleviate the symptoms and its use should be encouraged in cancer patients with debilitating arthropathies. This article aims at highlighting the role of bisphosphonates, particularly ZA in managing patients with hypertrophic osteoarthropathy (HOA) and sharing our experience with this drug because of the rarity of the condition and lack of sufficient data in the medical literature.
Cerebral venous sinus thrombosis (CVST) is not an uncommon cause of stroke but very often unrecog... more Cerebral venous sinus thrombosis (CVST) is not an uncommon cause of stroke but very often unrecognized at initial presentation due to lack of clinical suspicion and thus frequently left untreated. CVST is a potentially serious condition which manifests with diverse clinical manifestations, from isolated headache to focal neurological signs and even coma. CVST usually takes place either an inherited thrombophilia or any acquired hyperviscosity state and thus prompting anticoagulation was regimen as is the cornerstone of successful treatment. We describe a 47-year-old woman who presented with recurrent bouts of vomiting in the post-operative period and later developed cortical blindness and asymmetric limb weakness. Magnetic resonance imaging (MRI) showed hyperintensity involving bilateral parieto-occipital corticomedullary junction. MR venography showed signal void in the superior sagittal sinus. She was diagnosed as CVST and achieved complete recovery with anticoagulation therapy. Bilateral occipital infarction as a consequence of cerebral venous thrombosis is a rare cause of visual loss. Thrombosis in the superior sagittal sinus was related to her cortical blindness and weakness. This case illustrates that cerebral venous thrombosis should be considered in cases of occipital vascular lesions leading to acute painless loss of vision prompting anticoagulation therapy which can improve the outcome significantly. Dehydration could be considered as a risk factor for development of CVST in appropriate situations.
Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent... more Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and pre-operative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting image-guided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacilli on Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.
Alcoholism is a health problem not only in developed countries but also in developing countries. ... more Alcoholism is a health problem not only in developed countries but also in developing countries. Cirrhosis due to alcohol is a common cause of death among individuals abusing alcohol. A better knowledge of the spectrum of alcoholic liver diseases, its clinical, biochemical and histopathological features could result in early detection and prevention of alcoholic liver diseases before it's catastrophic and life threatening effects. A total of 200 patients with alcoholic liver diseases were studied with respect to alcohol consumption, clinical features, biochemical and histopathological changes. The clinical features, biochemical parameters, and histopathology of liver including Ishak's modified histological activity index (HAI) were correlated with the amount and duration of alcohol consumed. Majority of the patients were in the age group of 40-49 years and all the cases were males. Majority consumed alcohol of about 75-90 grams per day for a duration of 10-12 years. Anorexia and jaundice were the most common symptom and clinical finding respectively. Hyperbilirubinemia and hypoalbuminemia were the most common abnormalities observed in liver function tests. Advanced HAI stages with features of cirrhosis were most frequent histo-pathological finding noted in this study. Clinico-biochemical profile was significantly correlated with degree of alcohol ingestion as well as with liver histopathology. The wide prevalence of alcoholic liver disease including cirrhosis among Indian males was noted with significantly lower quantity and duration of alcohol ingestion. The severity of liver damage is directly proportional to the quantity and duration of alcohol consumed. Clinical features and biochemical changes may forecast the liver histopathology among the patients of alcoholic liver disease.
A 32-year-old man presented with uniform enlargement of right upper limb for 6 years. Examination... more A 32-year-old man presented with uniform enlargement of right upper limb for 6 years. Examination revealed painful disorganised elbow joint along with sensory impairment in the affected limb with weakness of small muscles. The patient was given empirical antileprotic therapy from outside without any benefit. Ultrasonography showed pan-hypertrophic nature of local tissues. Although axonal type of sensorimotor neuropathy involving right ulnar and median nerve was detected in nerve conduction velocity study, biopsy of the same failed to confirm any axonal degeneration or evidence of leprosy. Considering the nature of sensory abnormality MRI of cervical spine was done which revealed a syrinx extending from C3 till D2. Tests for vasomotor tone showed positive results on the affected limb. Syringomyelia can rarely give rise to pan-hypertrophy of limb due to sympathetic overactivity, which is infrequently reported in literatures and deficient in logical grounds.
Most urethral strictures arise from iatrogenic, traumatic, or inflammatory causes. We report the ... more Most urethral strictures arise from iatrogenic, traumatic, or inflammatory causes. We report the familial occurrence of a congenital bulbar urethral stricture in two brothers. Retrograde and voiding cystourethrography was performed. A Cobb's collar was diagnosed after radiological and endoscopic evaluation in both cases and was successfully managed with urethroplasty. Cobb's collar is a rarely recognized cause of a membranous stricture of bulbar urethra that can lead to several urinary problems. In cases of adolescent and young adults presenting with symptoms of progressive urinary obstruction and enuresis with or without urinary tract infection, Cobb's collar can be seen as a minor constriction in the bulbar urethra, but is not frequently symptomatic, and the familial occurrence of such a stricture is even rarer.
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