A rare massive presentation of catamenial hemothorax.

Catamenial hemothorax is a rare manifestation of thoracic endometriosis syndrome. It is commonly seen associated with pelvic endometriosis in nulliparous reproductive-age women. Most cases are minor and self-limiting. We present a case of a 32-year-old woman who presented with prolonged worsening dyspnea and was found to have a massive hemothorax on evaluation.

Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury.

Thoracic splenosis is a rare heterotopic autotransplantation of the spleen into the thorax that occurs after trauma or surgery involving the spleen. It is most commonly found incidentally on imaging in the left hemithorax. To the best of our knowledge, only six symptomatic cases of thoracic splenosis have been described in the literature so far. We present a case of thoracic splenosis in a male with a remote history of a gunshot injury during childhood, who presented with chest pain and shortness of breath.

Adenocarcinoma of the Lung Presenting with Intrapulmonary Miliary Metastasis.

Miliary mottling on imaging is usually infectious in etiology and is less commonly seen with metastatic cancers. The cancers that are reported to cause miliary metastases include secondaries from cancers of the thyroid, kidney, trophoblasts, etc. Here, we report a case of a 63-year-old female who presented with prolonged cough and shortness of breath and whose imaging showed diffuse bilateral miliary nodules. Bronchoscopy with a transbronchial biopsy confirmed the diagnosis as adenocarcinoma of the lung with intrapulmonary miliary metastasis. Treatment with a combination of pemetrexed and carboplatin was not helpful and cancer had spread diffusely across the lung on repeat imaging after three months. It is essential to consider this clinical presentation as a separate subtype, with specific treatment protocols as compared to primary adenocarcinoma of the lung.

Hypotension, Severe Hyperthermia (42°C), Rhabdomyolysis, and Disseminated Intravascular Coagulation Induced by Lethal Dose of Methamphetamine.

Sympathomimetic drug overdose usually results in hypertensive crises, cardiac arrhythmias, rhabdomyolysis, seizures, and metabolic derangements such as hyperglycemia, acidosis, and electrolyte anomalies. Methamphetamine has fast become an increasing problem in the US with an exponential increase in drug-related hospital admissions and an average yearly 29% increase in deaths per year. The recreational dose of methamphetamine is about 5 mg to 60 mg of methamphetamine with lethality reported at around 200 mg. This report presents a fatal case of methamphetamine overdose (>1.5 gms) that presented with hypotension, severe hyperthermia (42.2°C), and rigidity, complicated by rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and multiorgan failure.

Formic acid poisoning in a tertiary care center in South India: A 2-year retrospective analysis of clinical profile and predictors of mortality.

BACKGROUND: Formic acid (FA), a common industrial compound, is used in the coagulation of rubber latex in Kerala, a state in southwestern India. Easy accessibility to FA in this region makes it available to be used for deliberate self-harm. However, the literature on intentional poisoning with FA is limited. STUDY OBJECTIVES: To determine the patterns of presentation of patients with intentional ingestion of FA and to find the predictors of mortality. A secondary objective was to find the prevalence and predictors of long-term sequelae related to the event. METHODS: We performed a 2-year chart review of patients with acute intentional ingestion of FA. Symptoms, signs, outcomes and complications were recorded, and patients who survived the attempt were followed-up by telephone or personal interview to identify any complications after their discharge from the hospital. RESULTS: A total of 302 patients with acute formic acid ingestion were identified during the study period. The mortality rate was 35.4% (n = 107). Bowel perforation (n = 39), shock (n = 73), and tracheoesophageal fistula (n = 4) were associated with 100% mortality. Quantity of FA consumed (p < 0.001), consuming undiluted FA (p < 0.001), presenting symptoms of hypotension (p < 0.001), respiratory distress (p < 0.001), severe degree of burns (p = 0.020), hematemesis (p = 0.024), complications like metabolic acidosis (p < 0.001) and acute respiratory distress syndrome (p < 0.001) were found to have significant association with mortality. The prevalence of esophageal stricture (n = 98) was 50.2% among survivors and was the most common long-term sequela among the survivors. Stricture was significantly associated with hematemesis (p < 0.001) and melena (p < 0.001). CONCLUSION: This study highlights the magnitude and ill-effects of self-harm caused by a strong corrosive, readily available due to very few restrictions in its distribution. Easy availability of FA needs to be curtailed by enforcing statutory limitations in this part of the world. Patients with hematemesis or melena after FA ingestion may be referred for early dilatation therapy in a setting where emergency endoscopic evaluation of all injured patients is not practical.

Rheumatic-musculoskeletal manifestations in type 2 diabetes mellitus patients in south India.

AIM: To determine the prevalence of rheumatic musculoskeletal disorders (RMSD) in type 2 diabetes mellitus (T2DM) and study their risk factors. METHODS: Diagnosed patients of T2DM attending the diabetic clinic in a premier teaching institution in south India were interviewed and requested to mark their RMS pain sites on a mannequin and intensity of pain on a visual analogue scale (VAS). A complete RMS examination was done and diagnoses were noted. These RMSDs were compared with those in age- and sex-matched, non-diabetic individuals from the general population. Association of RMSD with variables was determined using Chi-square test and multiple logistic regression models for risk factors were created using SPSS 17.0 software. RESULTS: Prevalence of RMSD in 310 cases and controls was 42.58%; 95% CI: 37.08-48.08 and 31.61%; 95% CI: 26.43-36.79, respectively. RMS pain was marked by 194 individuals. Knee was the most common site of pain (33.4%). Prevalence of common RMSD was osteoarthritis knee (20.64%; 95% CI 16.14-25.16), frozen shoulder (16.45%; 95% CI: 12.32-20.58), diffuse idiopathic skeletal hyperostosis (14.52%; 95% CI: 10.6-18.44) and limited joint mobility (8.06%; 95% CI: 5.03-11.09). Age (P = 0.046), duration of T2DM (P < 0.001) and glycosylated hemoglobin (P < 0.001) were found to have significant associations with RMSD. In logistic regression analysis, duration (OR: 1.467; 95% CI: 1.210-1.779) and severity (OR: 1.354; 95% CI: 1.169-1.569) of T2DM were identified as the risk factors. CONCLUSION: Thorough RMS examination should be included as an integral part of care in T2DM patients.