Primary erythromelalgia is characterized by burning pain, redness, and warmth in the extremities. We present two cases of primary erythromelalgia both of whom presented with a history of several months of severe burning pain in both hands and feet. Both patients had received multiple pain medications with no improvement in symptoms. Pain was relieved by putting affected parts in ice cold water, which resulted in immersion injury of the affected parts. Both patients stopped taking part in school and social activities. We tried oral mexiletine, a class Ib antiarrythmic agent, in view of its reported role in various chronic painful conditions. Dramatic improvement was observed with its use. Both patients improved after several weeks of use, and there were fewer soaking episodes. We observed no adverse effects with mexilitine therapy.
The packing and composition of ORS has undergone a change since its introduction. In India, some companies are manufacturing smaller pouches (4.2 g) to be dissolved in 200 ml of water. Therefore, out of confusion some prescribers routinely advise the patients to dissolve the standard formulation ORS pouch (21 g) in a glass (200 ml) of water. Two cases are discussed. First patient developed salt poisoning due to improper dilution and recovered after rapid correction. In the second patient improper reconstitution led to hypernatremia and death.
HighlightsA 62 year old man without any history of trauma presented with progressive dysphonia, dyspnoea, without any dysphagia.A fibreoptic laryngoscopic examination revealed nodular mass arising at the junction of posterior 1/3rd and middle 1/3rd of left vocal cord it was extending up to arytenoids.A computed tomography scan of the neck region showed a rounded and circumscribed mass without infiltration of the surrounding tissues. Histological investigation of the lesion revealed the presence of fibroelastic cartilaginous tissue, surrounded by a thin rim of fibrous tissue, with rare hypercellular areas, occasional binucleated cells, slight hyperchromasia, and an irregular nuclear profile. Mitotic activity was absent.Sub acute and progressive onset of clinical symptoms and histological and radiological findings helps to distinguish the chondrometaplastic nature of this nodule from true laryngeal cartilaginous tumours, such as chondroma and low grade chondrosarcoma.The recognition of chondrometaplasia is important because of its occasionally troublesome differential diagnosis from true cartilaginous neoplasms of the larynx, such as chondroma and low grade chondrosarcoma.
HighlightsEctomesenchymal chondromyxoid tumor (ECMT) is a rare benign intraoral tumor.Till date not more than 45 cases have been reported in literature.Histopathologically the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, ovoid or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background.Here, we present a rare case of ECMT occurring in a 17 years old male who presented to us with chief complaint of slow growing painless mass arising from anterior Dorsum of the tongue measuring about 1.5 cms × 1.5 cms. Mass was completely resected as excisional biopsy, it was found un encapsulated with muscle entrapment.
Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report two cases that presented at the otolaryngology department at our institute in 2016. Both patients presented with a history of diabetes and according to the LRINEC score they both showed a moderate risk of having the disease. LRINEC is a valuable tool in both diagnosing the case and can be used to follow up the case, as the first case showed a decrease in score during her stay in the hospital, the second case showed an increase in score. We advocate the importance of early detection, eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck.
Highlights
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