Atypical Presentation of Typical Carcinoid of Lung with Therapeutic Cryoextraction –A Case Report

Introduction: Leptospirosis is a widespread zoonosis causedby the spirochete leptospira. Epidemic leptospirosis is beingreported from Kerala during the monsoon. Its incidence hasincreased over the past two decades. Severe leptospirosisresults in sepsis with multi organ dysfunction syndrome andmortality rate varies from 5-40%. In this study we attemptedto identify the risk factors associated with mortality ofleptospirosis.Material and methods: This was a retrospective case-controlstudy among patients diagnosed with severe leptospirosisand admitted in a tertiary care hospital in Thrissur District ofKerala during the monsoon of 2014. Data was collected fromcase records of 48 patients out of which 21 were cases (nonsurvivors) and 27 were controls (survivors) and Statisticalanalysis was done using X2 test with Epi info software.Results: Mean age of study population was 42 yrs. There were38 male (79%) out of which 14 were cases and 10 females(21%) out of which 7 were cases. Mortality rate was 44%. 77%of them presented with myalgia. Among cases 62% had icterus,81% had oliguria, 66% underwent mechanical ventilationand 62% undergone blood and blood product transfusion.Dyspnoea (p=0.08), Chest crepitations (p=0.005), decreasedurine output(p=0.012), acute kidney injury(p=0.005), hepaticdysfunction(p=0.06), shock (p=0.019), haemoglobin less than10g% (p=0.03) and platelet count less than 20000(p=0.025)were found to have significant association with mortality.Conclusion: The severe disease is more common in middleaged males but mortality is more in female. Platelet countless than 20000 and shock were found to be the independentpredictors of mortality.

Sudden natural death due to takayasu’s arteritis.

A young male aged 23 yrs with alleged history of chest pain was brought to the emergency medicine department of St John’s Medical college hospital. On arrival was declared brought dead. There was no previous significant medical history. A Medico-legal autopsy was done which revealed left anterior descending coronary artery lumen to be occluded by grey white material. On Histo-pathological examination of the heart, it was diagnosed as Takayasu’s arteritis. Takayasu arteritis, also known as Pulseless disease, occlusive thromboaortopathy, and Martorella syndrome, It is a Granulomatous inflammation of unknown aetiology affecting medium and large arteries leading to vessel wall thickening and occlusion . Females are more likely to be affected than males. Patients often notice the disease symptoms between 15- 30 years of age. Symptoms range from malaise, fever, night sweats, weight loss, arthalagia, fatigue and can present with absent pulses, limb claudication, blood pressure, discrepancies, Hypertension, retinopathy Ischemia, postural dizziness, seizures, hemi paresis and many more. Sudden death due to Takayasu’s arteritis affecting coronary artery is rarely reported during medico-legal autopsy, hence this case is reported.

Congenital inclusion tumours in spinal dysraphism.

Objective. To review the presentation, diagnosis and management of children with spinal dysraphism and CIT. Methods. It is a retrospective review of 146 children of spina bifida over 9 years (2000-2008) and details the clinical course and outcome of seven with associated congenital inclusion tumors. Results. 7/146 (4.7%) had spina bifida with CIT, 5 dermoid cysts and 2 mature teratoma. The diagnosis was missed by the primary physician even in the presence of a neurocutaneous marker. Spinal imaging with MRI was conclusive. All were managed with multilevel laminectomy, near total/total excision of the CIT and detethering of cord. Intramedullary involvement and established neurological deficits at presentation were associated with persistent deficits. Conclusion. Early detection and comprehensive management of CIT with spinal dysraphism ensures social fecourinary continence, preserves renal function, achieves ambulation and enables patients to lead an acceptable quality of life.