Kimura's Disease (KD) is an uncommon, chronic inflammatory disorder of unknown etiology which is endemic in Orientals. It is characterized by painless, large solitary or multiple nodules in subcutis of head and neck region or the major salivary glands, associated with regional lymphadenopathy, blood eosinophilia and elevated IgE levels. Its treatment ranging from conservative observation in asymptomatic patient to surgical resection of the mass, corticotherapy and irradiation therapy for the symptomatic ones.
Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to
excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called
Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the
presence of unilateral adrenal adenoma. It can be cured with surgical resection of the
aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and
increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man
with previous ischemic heart disease (IHD) who presented with resistant hypertension.
Investigations for secondary causes of hypertension revealed an elevated aldosterone level
and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed
a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling
showed lateralization of aldosterone secretion towards the right. He subsequently underwent
a laparoscopic right adrenalectomy which improved his BP control promptly. This case
highlights the importance of recognizing the need to investigate for secondary causes of
hypertension. It also underscores the importance of dynamic tests, which may not be easily
accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective
treatment.
Biopsy is a crucial step in the management of musculoskeletal sarcoma. The surgical approach to the biopsy site is important, as the tract must be removed en bloc with the tumour during limb sparing surgery so as to reduce the risk of local recurrence. The biopsy tracts of 26 osteosarcoma patients were evaluated histologically for tumour infiltration. Horizontal sections of 1 mm thickness with 2 cm radius from were evaluated from each excised biopsy tract. Five out of 26 cases (19.2%) showed positive tumour infiltration. One case (3.85%) had tumour infiltration in the pseudocapsule, two cases (7.69%) had tumour infiltration into the muscle and two other cases (7.69%) had tumour infiltration into the subcutaneous tissue. None had skin infiltration. We conclude that resection of the entire biopsy tract is indeed mandatory for surgical treatment of osteosarcoma.
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. The rarity of the condition as well as absence of a proper definition has contributed to under-reporting of cases. We report a 59-year-old woman who sustained fracture of the neck of her left femur and underwent an elective hybrid total hip replacement surgery. She collapsed during surgery and was revived only to succumb to death twelve hours later. Post mortem findings showed multiorgan disseminated microembolization of bone marrow and amorphous cement material.
Tuberculosis (TB) is a highly infectious disease on the rise caused by the organism Mycobacterium tuberculosis and health care workers working in emergency departments, medical wards and autopsy rooms are in danger of contacting this disease. We present a case of a 42 year old man found dead under a pedestrian bridge with no medical history available. Post mortem computed tomography showed multiple cavities involving upper lobes of both lungs and areas of consolidation in both lung fields raising the suspicion of pulmonary tuberculosis. This was followed by a computed tomography guided lung biopsy and a limited conventional autopsy done in situ in a special high risk autopsy suite with appropriate ventilation. This case highlights the importance of cross sectional imaging which can be coupled with image guided biopsy in cases of infectious disease to reduce the risk of transmission to health care workers.