Nutrition therapy in critically ill elderly patients.

Nutrition therapy in critically ill patients is as important as curative pharmacotherapy or advanced cardiac life support. Nutrition support indeed improves the disease outcomes and must be given due importance in any therapeutic regimen. High incidence of co-existent malnutrition in elderly patients emphasizes the added value of nutrition therapy in this subgroup of patients. Enteral route of nutrition therapy is always preferred over parenteral route until and unless indicated otherwise, by virtue of being non-invasive and easy to administer. In addition it has local gut protective effects, lesser incidence of infectious morbidity and better cost-effectiveness. However, parenteral route may be the only viable option in certain clinical scenarios.

Inflammatory pseudotumour of the liver: a diagnostic dilemma.

Inflammatory pseudotumour is a rare, focal, benign inflammatory lesion of the liver parenchyma. It is largely a self-limiting entity and has favorable prognosis; it is thus important to preoperatively distinguish this lesion from malignancy, which it closely imitates. Inflammatory pseudotumour may present variously. We present the case of a 54-year old gentleman who presented with a three-month history of low-grade intermittent fever. Ultrasonography and computed tomography revealed a mass in the left lobe of the liver and the erythrocyte sedimentation rate was raised with coincident hypergammaglobulinaemia. A diagnostic laparotomy with left lateral hepatectomy was performed and histopathological evaluation of the specimen along with special staining and tissue culture revealed an inflammatory pseudotumour. On the second day post-operative the fever subsided and following an uneventful five days the patient was discharged and remains well at one-year follow up with no recurrence or relapse.

Spontaneous bacterial peritonitis in isolated splenic vein thrombosis with portal hypertension.

Spontaneous bacterial peritonitis (SBP) is a known complication of ascites due to cirrhosis; it has also been reported in some non-cirrhotic conditions with ascites. We report a 50-year-old lady with isolated splenic vein thrombosis who developed SBP due to E. coli .

Interlobar hydropneumothorax.

We report a case of interlobar hydropneumothorax in a 42-year-old male with chronic obstructive pulmonary disease and a history of tuberculosis in the past. The diagnosis was suspected from chest roentgenograms that showed an incompletely circumscribed air containing space with a fluid level. The diagnosis was confirmed by computed tomography. This unusual presentation of hydropneumothorax with striking radiological features prompted us to report this case.

Chronic necrotising pulmonary aspergillosis: a rare complication in a case of silicosis.

Chronic necrotising pulmonary aspergillosis (CNPA) is a rare complication of silicosis whose diagnosis requires a high index of suspicion as it mimics tuberculosis. We report a case of a 52-year-old male with a long history of silica dust exposure and progressively increasing dyspnoea for the past eight years, productive cough, fever, weight loss for past three months and hemoptysis for preceding three weeks. Based on the clinical, radiological and microbiological evidence, he was diagnosed to be a case of CNPA with aspergilloma complicating silicosis.

Scimitar syndrome: imaging by magnetic resonance angiography and Doppler echocardiography.

We report magnetic resonance angiographic demonstration of both an anomalous pulmonary venous drainage and an anomalous systemic arterial supply in a patient with scimitar syndrome. Contrast-enhanced magnetic resonance angiography provides an excellent non-invasive diagnostic tool for demonstrating this complex congenital lesion in detail. A two-dimensional and colour Doppler echocardiography was also performed to show the anomalous venous drainage and to analyse the anomalous flow velocity pattern.