Adrenocortical Carcinoma With Contralateral Renal Metastases And Tumor Thrombus: A Case Report

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy. ACC with renal vein or inferior vena cava (IVC) thrombus is very rare. ACC with contralateral renal metastasis with renal vein thrombus has never been reported. Here we report first such case in the literature where a 40-year-old male presented with right flank pain and weight loss. Definitive reoperative diagnosis failed to be established. Intraoperatively, there was right adrenal mass with left renal vein thrombus invading its wall and extending upto IVC. Right adrenalectomy with left radical nephrectomy with thrombectomy was done. On cut specimen, there was a small mass lesion in the left kidney (upper pole). The diagnosis of ACC with left renal metastasis and renal vein tumor thrombus was confirmed by pathological and immune-histochemical examination. We faced various perioperative challenges in our case. Care must be taken in preoperative diagnostics, intraoperative planning, and postoperative management as ACC may present with contralateral renal metastasis and tumor thrombus.

A study of pattern of self medication practices among medical students in government medical college of Madhya Pradesh, India

Background: Self medication practice has tremendously increased in the society that leads to unwanted consequences such as drug resistance and adverse drug reactions. The objective of this study was to evaluate the self-medication practices among the second year medical students of Government Medical College, Sagar.Methods: It was a questionnaire based descriptive study. A prevalidated questionnaire were given to the second year medical students. Data were analyzed using excel sheet and result were expressed as counts and percentages.Results: Males outnumber females in this study, 40 versus 35. The most common indication for which self medication was opted was cold and cough. The most common source of information used by the respondent were text book (61.29%) and pharmacist (45.16%). The attitude was positive towards self medication and favored self-medication saying that it was acceptable. Drug groups commonly used for self-medication included analgesics 77.41% and antipyuretics 50% and anta-acids 48.38%. Among reasons for seeking self-medication, 79.03% felt that their illness was minor while 64.51% preferred as it is due to previous experience.Conclusions: This study shows that self-medication is widely practiced among second year medical students of this institution. There is intense need to make them aware about the pros and cons of self-medication in order to ensure safe usage of drugs.

Effect of Sertraline on biomarker alterations in patients of multidrug resistant tuberculosis with depression: a prospective clinical trial

Background: Lipid profile parameters may be used as biomarker for depression. Sertraline belongs to selective serotonin reuptake inhibitors (SSRIs), the most commonly used group to treat the depression in multidrug resistant tuberculosis patients.Methods: A prospective clinical trial was carried out in department of Psychiatry and department of Tuberculosis and Respiratory disease G.S.V.M. Medical College, Kanpur. Diagnosed MDR TB patients were screened for depression applying Hamilton Depression Rating Scale (HDRS) and these patients were referred to Psychiatrist for diagnosis of depression. Total 25 diagnosed patients of MDR TB with mild to moderate depression were selected. HDRS Score and morning blood sample of 5ml were collected to analyze biomarker for depression before intervention. Same test was repeated in 18 patients who completed the study at day 30 and 120 after administering Sertraline (50mg). Data were compiled and analyzed using SPSS 20.0 and paired t - test.Results: The mean decrease in HDRS score from base line at day 30 and 120 of administering Sertraline were 6.22 (±1.26) and 2.72 (±0.67) which were significant (p?0.001). The mean increase in serum cholesterol at day 30 was 153.94 (±19.31) and at day 120 was 157.83 (±19.36) which were significant (p?0.001). Rest of Tg, HDLc, LDLc and VLDL cholesterole levels were not increased significantly.Conclusions: As the depression symptoms improved by sertraline. The biomarkers of depression were also increased (within the normal range) from baseline but significant increase was observed in serum cholesterol only.

Innocuous cardiac gunshot that proved fatal: A bitter lesson learned / 中华创伤杂志(英文版)

The management of hemodynamically normal patients with retained intra-pericardial foreign body remains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.

Giant pleuropericardial cyst: an unusual cause of hoarseness

Unilateral vocal cord paralysis [UVCP] is a major cause of dysphonia and can be diagnosed during laryngoscopic examination. UVCP is secondary to several causes. Idiopathic left recurrent laryngeal nerve [RLN] paralysis is a relative common clinical entity. In certain cases, a mediastinal cause can be identified. When a patient presents with vocal cord palsy, physicians should never overlook a cardiovascular cause that will help to diagnose the paralysis. Immediate treatment should be administered. This case report presents an interesting and rare cause of hoarseness due to a giant pleuropericardial cyst in an elderly person. We highlight this case due to the rarity of a giant pleuropericardial cyst affecting the left RLN

Malignant peripheral nerve sheath tumour of nose and paranasal sinuses with orbital extension

Malignant peripheral nerve sheath tumours are rare softtissue tumours consisting of a spindle-cell malignancy arising from a peripheral nerve. Most of these tumours arise on the extremities and are rare in the head and neck region. A 33-year-old woman patient was referred to our hospital with progressive nasal obstruction and discharge occasionally mixed with blood since 1 year. Anterior rhinoscopy revealed a polypoid mass completely occupying the right nasal cavity, with a grossly left-deviating nasal septum. Computed tomography of the paranasal sinuses revealed an expansile soft-tissue mass filling the right nasal cavity, which extended to the right maxillary sinus with an erosion of the right lamina papyracea and an extension to the right orbit. Biopsy revealed the mass to be a malignant peripheral nerve sheath tumour, which was confirmed by immunohistochemical tests. The tumour was removed under general anaesthesia by nasal endoscopy and right medial maxillectomy. The patient recovered uneventfully and was discharged on day-6 after. She was given chemotherapy and is under regular follow-ups, with no recurrence of the disease since 2 years

Multicystic peritoneal mesothelioma: not always a benign disease

Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural, peritoneal or pericardial mesothelium. It shows a predilection for the surfaces of the pelvic viscera and has a high rate of recurrence after excision. Cystic mesotheliomas are not associated with asbestos exposure. We report a case of cystic mesothelioma of the peritoneum encasing the ovary, which presented as a cystic adnexal mass. As highlighted in this case and other recent reports, a cystic mesothelioma should not be referred to as a benign cystic mesothelioma, as it has potential for locoregional invasion, as well as distant nodal and serosal metastases. This tumour should be treated with aggressive cytoreductive surgery and appropriate chemotherapy. We review the differential diagnosis of this rare entity and suggest guidelines for its differentiation.

Analytical study of compound Unani drug Habb-e-Mudir

The drugs used in Unani Medicine consist of materials from plant, animal and mineral origin that are either used single or in combination with other drugs as poly-pharmaceuticals. Habb-e-Mudir is a poly-ingredient formulation comprising Sibr [Aloe species], Zafran [Crocus sativus] and Hira Kasees [Ferrous Sulphate], in the ratio of 2:1:1 [NFUM I] indicated for the treatment of amenorrhoea. Present study is aimed to standardize the formulation for quality control purpose. Standard sample of the formulation was prepared in laboratory following the NFUM methodology [National Formulary of Unani Medicine]. Separate studies were undertaken for each ingredient in respect of pharmacognostical characters, physico-chemical constituents and HPTLC profile. Standard formulation was subjected to chemical analysis viz. extractive values, ash values, etc. including chromatographic profile in line with standard pharmacopoeial protocols. The results may ensure the quality of Habb-e-Mudir through determining the genuineness and quality of ingredients as well as the manufacturing process

Hastyăyurvĕda--a complete treatise on elephants.

Ayurvĕda, the oldest existing medical science of India, which is not only responsible for the health of human beings but also, plays an important in Veterinary sciences. In India, history of traditional Veterinary medicine dates back to the era of Mahăbhărata i.e.5000 B.C., recorded in the form of "Nakula Samhhită". Hastăyurvĕda is a treatise on elephants, Palkăpya wrote this Samhită. The present book is available as a complete Samhită, edited by Pandit Shivadutta Sharma. Hastăyurvĕda was printed at Anandăśrama press in 1894. Hastăyurvĕda has 160 Adhyăyăs. This Samhită is based on fundamental principles of Ayurvĕda, containing all aspects of Sharir including Anatomy & Physiology, Rog Vigyăna, Surgery and Treatment of elephants as well as their care. It is the one and only complete printed Samhită and rare book on Hastăyurvĕda by Palkăpya.