Thyroid carcinoma is a rare cause of compressive myelopathy. Quadriparesis as the presenting manifestation of follicular carcinoma of thyroid without any preceding features of malignancy is quite uncommon. We describe a case of a 55-year-old woman who presented with progressive quadriparesis of 2 months duration, on evaluation was found to have a large tumor destroying C1, C2 vertebrae and occupying craniovertebral junction. Histopathological examination of excised tumor was follicular thyroid carcinoma. She was successfully managed with surgical excision, stabilization of spine followed by radiotherapy.
SummaryMilk alkali syndrome has shown resurgence with increase in use of (prescription or non prescription) calcium supplements. Cases of iatrogenic vitamin D intoxication has also increased due to increasing use of high doses of injectable vitamin D formulations by physicians, surgeons, orthopaedicians, gynecologists and other specialties inadvertently. Here, we present an unusual case of a 17-year-old boy who presented with iatrogenic hypercalcemia as a result of combination of milk alkali syndrome with vitamin D intoxication despite being a case of hypoparathyroidism and concomitantly suffering from celiac disease.
Gitelman's syndrome is an inherited tubulopathy affecting thiazide-sensitive sodium chloride cotransporter, which manifests with hypokalemic alkalosis, hypomagnesemia, and hypocalciuria. Recently few cases have been described having an association of Gitelman's syndrome with pituitary abnormalities on imaging, though with normal hormonal status. We describe the first case of an adult patient having Gitelman's syndrome and hypopituitarism with abnormal pituitary imaging. She presented to us with hypotension, hypokalemia, hypomagnesemia with alkalosis, hypothyroidism, hypocortisolism, and hypogonadism. She was treated with replacement of electrolytes and hormones, to which she showed an excellent response.
A 46 years female underwent aortic arch repair surgery under deep hypothermic circulatory arrest (DHCA) and right antegrade cerebral perfusion. The patient was extubnated after 13 hours of the surgery and discharged from SICU on third post operative day and discharged from hospital on sixth postoperative day uneventfully and with excellent neurological functions. It was the first case of aortic arch repair in our hospital. Combination of DHCA and right antegrade cerebral perfusion may be the reason for better neurological outcome.Keywords : Aortic Arch Aneurysm, Deep Hypothermic Circulatory arrest CASE REPORTA 46 years female from Godavari, Lalitpur district was referred to SGNHC from Patan Hospital with the suspicion of a mediastinal mass.When she was presented in the OPD she had upper rretrosternal chest pain radiating to the back, more in the interscapular region, pricking in nature for the last 8 years, cough for two months, palpitation, h=headache, decreased appetite and marked weight loss.Her past medical history revealed that she had severe lower chest pain 10 years back and was seen at different hospitals. She was advised for the operation after CT scan of the chest TUTH. The size of the aneurysm of the aortic arch was 7.3 cm in diamerter. She had gioitre for the last 26 years and 10 years back FNAC was done which showed colloid goitre. She had the features of hypothyroidism and treated with thyroxin for the two years. Similarly she also had hoarseness of the voice since the last 10 years and on examination revealed left vocal cord palsy. She had an epidose of syncope 8 years back.She smoked since childhood and gave up last two years back. She does not consume alcohol. She is married and has a daughter of 25 years and a son of 23 years. She is a farmer by occupation. She is on atenolol 25 mg once daily for the last 10 years. General Physical examination:Thin built lady having weight of 42 kg and 155 cm height having some facial congestion and there was some degree of neck vein distension. Icterus, pallor, cyanosis, oedema, dehydration or clubbing not present. There was multioculated nodular swelling in the right side of the neck. Pulse was 92 per minute and regular, weaker in the left radial and lower extremeties. Blood pressure was 108/80 mmHg in the right arm and 88/60 mmHg in the left arm both in the sitting position. There was a globular multiobulated mass palpable in the right side of the neck. Systemic examination:No visible pulsation was observed over the chest. Systolic thrill and ejection systolic murmur was present at the aortic areal. Diminished air entry in the left lung field and occasional ronchi was heard Other systemic examination revealed no abnormality. Uupper airwasy was normal with Malampatti Classification grading-I. The Lab investigation were with in normal limits and patient was euthyroid. ECG showed T wave inversion in the lead III, aVL and V2. Echocardiography revealed aortic arch aneurysm of 11 cm in size. CT-Scan Thorax showed aneurysm of the arch of the aorta distal to...
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