Emphysematous pyelonephritis: non surgical treatment approach.

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma tissues. It is a life threatening complication of bacterial interstitial nephritis, and it mainly occurs in patients with diabetes mellitus. We report a case of a 37 year old female who complained of fever and pain in left lumbar region on admission. Her past medical history included uncontrolled type 2 diabetes mellitus. On USG (ultrasonography), left kidney swollen and show echogenic linear specs with dirty shadowing suggestive of air in pelvicalyceal system (PCS). She was treated with intensive antibiotic therapy in high doses. On repeat USG there was marked reduction in air shadow in kidney and patient improved clinically.

Acute Myeloid Leukemia Presenting as Acute Bulbar Palsy.

Myeloid Sarcoma1 (also termed as chloroma, granulocytic sarcoma, extra medullary myeloid tumor) is a rare extra medullary tumor composed of immature myeloid cells (myeloblast)2. It is usually associated with leukemia or other myeloproliferative disorder. Myeloid Sarcoma in the central nervous system, around the brain stem is the commonest site of presentation and require high suspicion for diagnosis. We report a forty years male patient with history of dysphagia, dysphonia for last two months. MRI showed chloromas around the brain stem. Laboratory investigations revealed the presence of AML. This is a rare case of Myeloid Sarcoma around the brain stem in a patient of AML.

Cholecystocolic Fistula: A Diagnostic Dilemma.

Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools a high degree of suspicion is required to diagnose it preoperatively1,2. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10-20%), and the least common is the cholecystogastric fistula accounting for the remainder of the cases. Even a case of choledochocolonic fistula through a cystic duct remnant has been reported3. These fistulae are treated by open as well as laparoscopic surgery with no difference in intraoperative and postoperative complications. We report a case of obstructive jaundice, which was relieved by itself and was investigated with abdominal ultrasonography and routine investigations but none of these gave us any clue to the presence of the fistula which was discovered incidentally during an open surgery and was appropriately treated.

Ascariasis in the Gall Bladder - A Rare Case.

Settlement of adult form ascariasis parasite in the gall bladder is rare constituting 2.1 % of hepatobiliary ascariasis4. Radiologic imaging methods play an important role in the diagnosis of the parasite in the biliary tree. Computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP) are used in the diagnosis of hepatobiliary ascariasis. However, ultrasonography is still the first method and most preferred due to its ease of applicability and the fact that it is inexpensive and non-invasive. We report a rare case of Ascariasis lumbricoides present in gall bladder.

Macrodystrophia lipomatosis : a rare congenital anomaly.

Macrodystrophia Lipomatosis is rare congenital hamartomatous enlargement of soft tissue components leading to gigantism of single, multiple digits or entire limb. Clinical findings are recognised as early as in neonatal period to late adulthood. Patients usually present for either cosmetic corrections or mechanical problems. We report a case of 8 year old female with progressive increase in size of left 2nd and 3rd toes. X-ray findings show congenital focal enlargement of soft tissues and bones of 2nd and 3rd toes and adjacent metatarsals. Clinical and radiological features of our patient points out towards this uncommon condition.

Subacute Sclerosing Panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a rare, invariably fatal degenerative disease of central nervous system developing after measles infection. Neurological symptoms are initial presenting symtoms but rere reports of pure psychiatric symtoms preceding neurological symtoms have been reported.. We here report a case of 18 years old male patient suffering from Subacute sclerosing panencephalitis (SSPE) who initially had behavioural changes and then subseqently devloped neurological symptoms.

Comparison between Allopurinol and Febuxostat in management of gout patients - a prospective study.

Aim:To assesses the efficacy of a relatively new drug-Febuxostat in management of gout and its comparison with allopurinol. Method: A comparative study of both Allopurinol and Febuxostat was done on 100 patients of gout. Both were studied for efficacy. side effects and for gout flare up. Results: Primary efficacy end point (baseline values) - a serum urate concentration of less than 6.0mg per deciliter at the last three measurements was reached by 54 %( 27/50) of group A patients taking 80mgs of febuxostat and 25 %( 12/50) of group B patients taking allopurinol 300mgs per day (P<0.001) Secondary efficacy end point(follow up values)- At first visit( after 2 weeks of onset of study), the proportions of subjects with serum urate concentration of less than 6.0mg/dl was significantly higher in the group A receiving febuxostat than the group B receiving allopurinol(P<0.001)[Tableno-1]. Conclusion: Febuxostat, at a daily dose was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate. Results of side effects and gout flare up were similar in both groups.

Gummatous ulcer of leg: an uncommon entity in present era.

Gummatous ulcer due to Treponematoses is quite rare in present era of potent antibiotics, increased social awareness and due to improvement in living standards of society .Better hygiene and improved medical care have contributed to containment of late benign syphilis or gummas. However, pockets of endemic treponematoses are still persisting in the underdeveloped, third world countries.

Zinc taste test in pregnant women and its correlation with serum zinc level.

Pregnant women in different trimesters of pregnancy were divided into control (n = 58) and study (n = 104) groups. Study group subjects were given 45 mg zinc/p.o./day as 200 mg 'zinc sulphate tablets from the day of reporting till term. Body zinc status was clinically assessed by 'zinc taste test'. Blood samples were drawn at the same time and serum zinc levels measured. Zinc taste test scores decreased with advancement of pregnancy (P < 0.05) and increased significantly following zinc administration (P < 0.05). Serum zinc level declined significantly with advancement of pregnancy (P < 0.001). Following zinc administration, serum zinc level increased significantly (P < 0.001). Accuracy of zinc taste test in individual cases ranged between 70 and 100 percent. On the whole, zinc taste test was well correlated with serum zinc level, and provides a fair idea of zinc deficiency.