Disseminated blastomycosis is rare in India, particularly in the pediatric population. We discuss the clinical picture, progress and outcome of disseminated blastomycosis in a 4-year-old child. We also present a brief review of the literature focussing on the scenario of blastomycosis in India.
1087 stricture in the sigmoid colon. At laparotomy a large carcinoma was found in the sigmoid colon and a second similar lesion was found in the transverse colon. While resecting the large sigmoid growth a portion of the right ureter was removed. A primary colonic anastomosis was performed and covered by a double-barrelled colostomy fashioned in the transverse colon after resection of the second lesion. Urinary leakage occurred soon after operation and an intravenous pyelogram confirmed a leak from the right ureter. Urinary leakage continued postoperatively, and because of the poor general health of the patient renal embolisation was considered. The left femoral artery was catheterised under local anaesthesia and a right renal arteriogram was obtained. Two, or most probably three, renal arteries were seen supplying the right kidney and embolisation of two of these was achieved with Gelfoam and wire springs. Urinary leakage was considerably diminished subsequently. A further intravenous pyelogram showed minimal delayed excretion from the right kidney, suggesting perfusion from a small accessory artery. Leakage ceased completely after two months. CommentUreteric damage may occur during resection of any extensive colonic or pelvic growth and if it is recognised at the time primary repair or transureteroureterostomy, reimplantation into the bladder and nephrectomy are the procedures of choice.' 2 Ureteric ligation is simpler, but there is a risk of subsequent infection and leakage. If this occurs, or if the injury is not recognised at the time, the surgeon is faced with the prospect of further surgery in the postoperative period if the leak does not stop spontaneously. Renal embolisation is an alternative in the elderly, poor-risk patient not fit for further surgery, provided contralateral renal function is adequate. This can be assessed by intravenous urography or divided renal function tests with a renal scan. Leakage of urine by vesicoureteric reflux must also be excluded.In one patient the leakage ceased dramatically, and was reduced in the second patient, though it did not stop completely for several weeks owing to a small aberrant renal artery. Both patients left hospital after a simple procedure and neither experienced any appreciable loin pain. Transrenal ureteric embolisation with direct closure of the defect has also been described.3Therapeutic embolisation is now widely practised by radiologists for several indications including renal tumours, hepatic metastases, bleeding oesophageal varices, and complicated arteriovenous fistulae.4 In certain poor-risk patients it would appear to be useful for postoperative ureteric leakage. Although amyloidosis may be localised to the central nervous system, and localised disease of the gasserian ganglion2 has been described, we have been unable to find previous reports of localised amyloid affecting the spinal extradural space. Case reportA 76-year-old woman was admitted with a six-month history of increased weakness and paraesthesis of the legs with nocturia and incon...
Large congenital melanocytic nevi (> 20 cm in greatest diameter) are very rare and are seen in approximately 1 in 20,000 newborns. The major risk these patients face is the development of neurocutaneous melanosis or malignant melanoma. We report a rare case of large congenital melanocytic nevus with metastatic melanoma in a 40-year-old woman. In this case, though the primary was not established with certainty, on the basis of clinical course and radiological evaluation of various organs, we presume that the primary could be in the lung.
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