We report a six-week-old boy with genitourinary structural abnormalities who presented with profound hyponatraemia and hyperkalaemia due to transient type 1 pseudohypoaldosteronism (PHA) precipitated by a urinary tract infection (UTI), which responded rapidly to intravenous saline and antibiotics. In infants with structural abnormalities of the urinary tract, we wish to highlight the importance of recognizing type 1 PHA and its association with a UTI since prompt and appropriate treatment rapidly corrects the associated metabolic abnormalities. Conversely, the identification of type 1 PHA in an infant should precipitate a search for a UTI and structural abnormalities of the urinary tract.
Background: Laparoscopic cholecystectomy (LC) can be the easiest or the most difficult laparoscopic operation. Conversion to open surgery has been a traditional marker of difficult LC. Recent studies have shown that C-reactive protein (CRP) may be helpful to surgeon in knowing the pathological condition of gall bladder before removal. Aim of this study was to evaluate the role of CRP as a predictor of difficult LC or its conversion.Methods: This study was done from 1 march 2016 to may 2017 in department of general surgery, SMS hospital Jaipur, under single unit. All patients with cholelithiasis admitted in single unit of SMS hospital undergoing LC were included in this study. Exclusion criteria were high BMI (>35), proven congenital anomaly of gall bladder, previous abdominal surgery, any conditions increasing CRP and immunocompromised patients. CRP was done for each patient.Results: Mean age of our 148 patients was 50.41 years. Female to male ratio was 4.28:1. Mean CRP was 22.2±18.2 mg/dl for simple cholecystectomy, 46.5±32.0 mg/dl for difficult cholecystectomy and 83.6±22.4 mg/dl for laparoscopic converted to open cholecystectomy, which was statistically significant (p value 0.0002).Conclusions: CRP is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high CRP have higher chance of complication intraoperative and high chances of conversion to open.
Metaplastic breast carcinoma is very rare neoplasm. Authors report a case of metaplastic breast carcinoma containing characteristic features of infiltrating ductal carcinoma and chondrosarcoma. A 62-year-old female presented with complaint of a lump in the right breast for the last 2 years. FNAC was suggestive of mucinous tumour. Tru-cut biopsy had been performed outside the institution, which was suggestive of a Ductal carcinoma with mucinous component. Modified radical mastectomy of the right breast was performed and histopathology was suggestive of infiltrating ductal carcinoma and chondrosarcoma of the right breast. All resected lymph nodes were free of metastasis. Immunohistochemistry was suggestive of a metaplastic carcinoma with components of ductal carcinoma and chondrosarcoma with moderately positive ER, negative PR, positive Pancytokeratin in ductal carcinoma component, positive S-100 and KI-67.
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