Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.
Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.
IntroductionClinical diagnosis of dermatological manifestation of neoplastic skin lesion can pose a diagnostic difficulty at times. Histopathological diagnosis is mandatory for accurate characterization of disease entity for proper and timely management of cases.ObjectiveThe aim of this study was to analyze malignant tumor of skin with respect to age, sex, clinical features and histopathological features and to evaluate the accuracy of clinical diagnosis with histopathological correlation.MethodologyThis is hospital based cross-sectional study conducted at Nepalgunj Medical College and Teaching Hospital, Kohalpur from February 2010 to January 2011. A total of 70 histopathological specimens of skin biopsies were studied and correlated with the clinical diagnosis. The data was entered into Microsoft office excel and analyzed using statistical package for social sciences (SPSS 17.0).ResultsMalignant tumor of skin constituted 21.4% of total cases. In malignant tumor, most common sites were head and neck regions followed by lower limb with keratinocytic tumors being in the majority. Most of the specimens (65.7%) were obtained as excisional biopsies. Seven cases diagnosed as benign lesions clinically, turned out to be malignant on histopathological examination. Out of 13 cases in which clinical diagnosis was of malignancy, only 8 turned out to be malignant, thus for malignant lesions, the clinical diagnosis had a sensitivity of 53.3%, specificity of 90.9% and a positive predictive value of 61.5%.ConclusionsSquamous cell carcinoma was the most common malignant tumor in this study and histopathological correlation significantly modifies the overall management in dermatological disorders where clinical diagnoses are equivocal.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 156-161
Prostate cancer metastasis to the ureter is extremely rare because only 45 such cases have been reported worldwide in the last century. It accounts for 30% of ureteral metastasis. Neuroendocrine differentiation is approximately 1% of the entire primary prostate adenocarcinoma pathology. Metastatic prostate cancer may pose as upper tract urothelial carcinoma. Prostate may look normal on clinic-radiological examination in prostate cancer. Majority of such cases are managed with nephroureterectomy. Herein, we report a case of 62-year gentleman, who presented with refractory left flank pain with repeated imaging suggestive of neoplastic left ureteric stricture and normal prostate on clinic-radiological examinations. The case was later found with the diagnosis of metastatic prostate adenocarcinoma with neuroendocrine differentiation after left sided nephroureterectomy done for a provisional diagnosis of Upper Tract Urothelial Carcinoma (UTUC).
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