The clinical experience of the novel drug temsirolimus on eight patients with metastatic renal cell carcinoma and who were refractory to other forms of treatment is reported. Although none of the patients showed complete or partial response, three patients had stable disease. One patient was prematurely withdrawn due to pneumonitis. Five patients died during the period of observation of twenty months and the median survival time from start of treatment was ten months. Three patients showed no evidence of adverse events (AE). Five patients showed dyslipidemia and two had pneumonitis for which, the drug had to be withdrawn in one of them. None had significant leucopenia. We conclude that temsirolimus has activity even in heavily pretreated patients in advanced renal cell carcinoma and in addition, has the benefits of ease of administration and good tolerability.
Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
Filariasis continues to be one of the endemic problems worldwide with 40% of the cases in India. We report a case of lymphatic filariasis in a 32-year old female who presented with a non-tender swelling over left upper arm. Blood sample showed no eosinophilia while the FNAC was diagnostic of W. bancrofti. Patient responded well with oral diethylcarbamazine. High index of suspicion of filariasis is indicated when dealing with a swelling of unknown cause especially in filariasis endemic areas.
Kimura's disease is a rare condition and typically presents as non-tender subcutaneous swellings in the head and neck region, usually in the pre-auricular and submandibular areas. It is associated with lymphadenopathy (both local and distal), marked peripheral eosinophilia, and an elevated IgE level. It can easily be mistaken for a malignant disorder. Fine needle aspiration can be misleading, and a diagnosis is established only by histopathological examination. Renal involvement, which may affect up to 60% of patients, is the only systemic manifestation. We report a case of Kimura's disease in a Malay patient who was associated with steroid-responsive nephrotic syndrome.
Acute suppurative thyroiditis is a rare disorder. We saw a 24 year old man with this condition that present atypically. The patient had a non-tender thyroid enlargement associated with fever and leukocytosis. FNA cytology clinched the diagnosis. The abscess was associated with Klebsiella pneumoniae septicemia and required surgical drainage after failing antibiotic therapy.