35 year old gentleman, diagnosed chronic kidney disease in 2010 ,received renal allograft in August 2014.His native kidney disease was IgA Nephropathy.In November 2019 he developed graft dysfunction and hemodialysis was initiated. He presented with Hb 5 g/dl. His stool occult blood was positive. CT Angiography showed jejunal loop thickening? ischemia/enteritis. Push enteroscopy revealed jejunal ulcerations with polypoidal protrusions. Jejunal biopsies showed amyloid deposition in the lamina propria with Congo red stain demonstrating apple green birefringence under polarized light.
A 62 year old lady presented with history of recurrent urinary tract infection since six months , left lower abdominal pain since 3 months and occassional faeculent discharge per vaginum since 1 month. On examination there was tenderness in left iliac fossa. CT abdomen showed sigmoid diverticulitis with microperforation and pericolic abscess formation. She underwent laparotomy , dismantling of colovaginal fistula, primary closure of vaginal opening and anterior resection.
The concept of sepsis has changed considerably over the years. Newer methods of diagnosis and prognostic markers are discussed in this lecture by Dr Abby Cyriac focusing on sepsis especially in the cirrhotic patient. Click on images for highlights. This is part of Cochin IMA’s lecture summary series that will help other doctors enjoy the content of CME programs.
Ranitidine is a drug used by millions of patients worldwide. Costing less than a rupee, it was an economical and effective choice. Lately it has come under scrutiny, prompting questions from several practising doctors. This document provides the present status. As it exceeds 600 characters, it is being uploaded as an image. Click the image to view document.
A 27 year-old woman with acne came with painful swallowing of ten days duration, not responding to Ranitidine prescribed by her GP. The pain was located in the mid chest. She denied medication intake. Upper GI endoscopy revealed a tiny 3 mm ulcer in the mid Esophagus. It was difficult to detect, and required careful examination. On later questioning the patient recalled taking Doxycycline recently for acne after consulting a dermatologist.
59year male patient presented with recurrent abdominal pain right lower abdomen.CECT abdomen suggestive of mucocele of appendix.Laparoscopic assisted Rt hemicolectomy performed.Biopsy suggestive of low grade mucinous neoplasm.
As part of Cochin IMA’s academic initiative, the summary of CME programs will be published on JCP-IMA. As the abstract exceeds 600 characters, it is being published as an image. This abstract is from Weight Loss CME by Aster Medicity 24.11.19.
A 55 year old lady presented with upper abdominal pain and fullness of 3 months duration. A triple phase CT scan revealed (Fig1) A multiloculated cystic lesion measuring 9 x 8 cm from the right lobe of liver with multiple enhancing septae and solid areas with intense enhancement of some of the septae on arterial phase. Biliary cystadenocarcinoma was considered on CT scan. Hydatid serology was negative. She underwent surgery of the lesion with safe margin of liver. Histopathology revealed sarcomatoid hepatocellular carcinoma, confirmed with IHC. There is no role for follow up in such cases
A delirious 86 year old man was brought with high jaundice, cholangitis and cachexia. Evaluation revealed an advanced periampullary CA with inaccessible papilla. Didn't want to encourage them for any invasive interventions but they insisted saying he had a strong last wish to attend marriage of his grand daughter which was one month later. So EUS guided choledochoduodenostomy was done. He had a surprising recovery. One year has passed now and he is having a near normal quality of life for age. Now he has changed his last wish...viz. baptism of his great grand child!
60 year old male diagnosed 6years back as chronic liver disease- ethanol related. He has stopped ethanol since then and is on regular follow up since then. Now presented with worsening of breathlessness. On examination detected to have right sided pleural effusion. CXR- massive right pleural effusion. Further evaluation of pleural fluid revealed high SPAG, ADA of 52U/L, cultures- sterile. He was diagnosed to have tubercular effusion and started on ATT after careful monitoring of LFTs. His symptoms have improved and pleural effusion has settled.