scholarly journals GESTATIONAL TROPHOBLASTIC NEOPLASIA (GTN) WITH HYPERTIROIDISM (CASE REPORT)

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Devi Rahmadhona ◽  
Betty Agustina Tambunan
Keyword(s):  
Left Kidney ◽  
Malignant Lesion ◽  
Left Lung ◽  
Thyroid Stimulating Hormone ◽  
Ca 125 ◽  
Villous Trophoblast ◽  
Life Threatening ◽  
History Of ◽  
Invasive Mole ◽  
Loss Of Appetite

Introduction. Gestationaltrophoblastic neoplasia(GTN) is a malignant lesion arising from placental villous and extra-villous trophoblast, occuring in 1:40,000 pregnancies. Invasive mole and choriocarcinoma are the vast majority of GTN, produce substantial amounts of human chorionic gonadotropin (hCG). Hyperthyroidism in GTN is due to stimulation of thyroid gland by hCG which has a similar structure with thyroid stimulating hormone (TSH).Case. A 28-year-old female, suspected with choriocarcinoma and anemia, had history of recurrent vaginal bleeding in 8 months, accompanied with loss of appetite, weight loss, palpitation and tremor. Physical examination: pulse rate 114x/minutes, respiration rate 26x/minutes, temperature 38 0C, conjunctival anemia and dyspneu. Laboratory: anemia, leukocytosis, hypoalbuminemia, hypokalemia, increase ofLDH, increase of bhCG >1,500,000 mIU/mL, T4 14.1 ug/dL (4.40-10.90 ug/dL), FT4 1.95 ng/dL (0.89-1.76 ng/dL), and decrease of TSH. Abdominal CT Scan suggested uterine mass suspected as malignancy infiltrating to rectum with metastatic features in liver, base of left lung, spleen and left kidney. Increased CA-125, and metastatic features of lung right paracardial and left suprahilar from Chest X-ray were found.Discussion.GTN diagnostic criteria include: increased bhCG examined ³4 x; increased bhCG ³3 weekly examination; histology diagnosis of choriocarcinoma; increased bhCG > 20,000 more than 4 weeks post evacuation and the presence of metastasis. Hyperthyroidism in GTN is potentially life threatening because of heart failure and thyroid storm.Conclusion.Hyperthyroidism increases morbidity and mortality in GTN patient, so periodic thyroid examination is essential to prevent further complication of hyperthyroidism.  

scholarly journals Clinico-radiological profile of COVID-19 in a tertiary care hospital of western Rajasthan

2021 ◽  
Vol 6 (3) ◽  
pp. 152-155
Author(s):  
Priyanka Soni ◽  
Laxman Kumar Soni ◽  
K.C Agarwal
Keyword(s):  
Tertiary Care ◽  
Left Lung ◽  
Care Hospital ◽  
Lung Involvement ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Radiological Data ◽  
Life Threatening ◽  
History Of ◽  
Novel Coronavirus

Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death. The purpose of our research was to evaluate the presentation of COVID19 disease based on the clinical and radiological characteristics of our population. 100 COVID19 patients recorded by RTPCR. Clinical, biochemical and radiological data from April-May, 2021. Of the 100 patients, in our study 66% were males and 26% patients had history of recent travel. Majority of patients were asymptomatic and don’t have comorbid illness. Thrombocytopenia and lymphopenia, increased levels of lactate dehydrogenase (LDH) and serum ferritin and C-reactive protein were common in these patients. CT finding were 63% had normal CT chest. Among the 37% patients who had CT chest findings, 25% had bilateral diseases, 8% patients had right lung involvement while 4% patients have left lung involvement.  COVID-19 disease has a relatively mild course in this part of the subcontinent. Clinical and laboratory findings are similar to those found in viral diseases. Studies involving larger sample size and interventional trials are need of the hour.

scholarly journals SAT-480 Myxedema Madness: A Rare Case of Severe Hypothyroidism Presenting as Psychosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kevin Kohm ◽  
Shivani Vekaria ◽  
Jack Xu ◽  
Carol Nasr ◽  
Lauren Hogshire
Keyword(s):  
Mental Status ◽  
Suicide Attempts ◽  
Thyroid Stimulating Hormone ◽  
Medical Emergency ◽  
Thyroid Function Tests ◽  
Myxedema Coma ◽  
Rare Manifestation ◽  
Life Threatening ◽  
History Of ◽  
One Year

Abstract Introduction Myxedema coma is a rare, life-threatening medical emergency resulting from uncontrolled hypothyroidism. Myxedema coma refers to the neurological sequelae of severe hypothyroidism, which classically manifests as depressed mental status. Rarely, myxedema coma can present with a hyperactive mental state and psychosis. We present an unusual case of a drug overdose secondary to myxedema coma-induced psychosis. Clinical Case A 48 year old woman with a history of seizure disorder and hypothyroidism presented to the hospital after lamotrigine overdose. The patient’s spouse witnessed her ingest forty-five tablets of lamotrigine after an argument. The patient had no previous psychiatric diagnoses or suicide attempts. On examination, the patient was hemodynamically stable but was agitated, disoriented, and uncooperative. She had a normal neurologic exam and no peripheral edema. Her lamotrigine level was 25.4 ug/ml (2.5-15.0 ug/ml). The patient’s mental status did not improve with lamotrigine cessation. Psychiatry determined that the patient’s psychosis was not consistent with lamotrigine overdose. Given these recommendations, alternative causes of psychosis were considered. The patient’s husband stated she had not taken levothyroxine for over one year. Thyroid function tests revealed a thyroid stimulating hormone (TSH) of 299 mcIU/ml (0.35-5.50 mcIU/ml) with a free thyroxine (T4) level of 0.27 ng/dl (0.89-1.76 ng/gl). The patient was started on levothyroxine intravenously. After five doses of intravenous levothyroxine, her mental status improved to baseline and she was transitioned to oral levothyroxine. She denied that the lamotrigine ingestion was a suicide attempt. Based on the patient’s presentation and clinical course, we concluded that her overdose was due to severe hypothyroidism leading to myxedema madness. Conclusion Severe hypothyroidism with myxedema coma often presents with depressed mental status, which can manifest as progressive confusion, lethargy, and eventually coma. However, in the case of our patient, severe hypothyroidism presented as psychosis, a rare manifestation. Remarkably, the patient had no other obvious physical manifestations of severe hypothyroidism. Psychosis, though rare, has been seen in cases typically after thyroidectomy or in patients with previously undiagnosed Hashimoto’s thyroiditis. In this patient’s case, it is likely that her myxedema madness was precipitated by long-term nonadherence with her thyroid replacement therapy, as the patient had no prior psychiatric history. Additionally, her rapid reversal of symptoms after the administration of levothyroxine supports the diagnosis of hypothyroid-induced myxedema madness.

scholarly journals Pulmonary Mucormycosis in Chronic Lymphocytic Leukemia and Neutropenia

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Izza Mir ◽  
Sijan Basnet ◽  
David Ellsworth ◽  
Elan Mohanty
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Thoracoscopic Surgery ◽  
Left Lung ◽  
Lymphocytic Leukemia ◽  
Pulmonary Mucormycosis ◽  
Life Threatening ◽  
History Of ◽  
Video Assisted Thoracoscopic Surgery

Pulmonary mucormycosis is a rare life-threatening fungal infection associated with high mortality. We present the case of a 61-year-old man with history of chronic lymphocytic leukemia who presented with fever and cough, eventually diagnosed with pulmonary mucormycosis after right lung video-assisted thoracoscopic surgery. The patient was successfully treated with amphotericin B and right lung pneumonectomy; however, he later died from left lung pneumonia.

scholarly journals Case report of pulmonary endometriosis and review of the literature

2019 ◽  
Vol 47 (4) ◽  
pp. 1766-1770
Author(s):  
Shan-Shan Tong ◽  
Xiu-Yan Yin ◽  
Shan-Shan Hu ◽  
Ying Cui ◽  
Hui-Ting Li
Keyword(s):  
Wedge Resection ◽  
Left Lung ◽  
Middle Lobe ◽  
Thoracic Pain ◽  
Pathological Result ◽  
Pulmonary Endometriosis ◽  
History Of ◽  
Loss Of Appetite ◽  
The Right ◽  
Thoracic Endometriosis

Pulmonary endometriosis is a rare form of thoracic endometriosis. We herein describe a 29-year-old woman with recurrent hemoptysis associated with her menstrual cycle. The patient had a 4-month history of catamenial hemoptysis without thoracic pain, respiratory embarrassment, cough, fever, night sweating, or loss of appetite. Chest computed tomography revealed exudation shadows in the right lower pulmonary lobe and small fiber lesions in the right middle lobe and left lung. Thoracoscopic wedge resection of the right lower pulmonary lobe was performed, and the pathological result was pulmonary endometriosis. No evidence of hemoptysis during menstruation was found following the operation.

scholarly journals Adrenal Incidentaloma In Patient with Bilateral Nephrolithiasis and Infectef Right Kidney Cyst

2020 ◽  
Vol 1 (2) ◽  
pp. 31
Author(s):  
Kholidatul Husna ◽  
Hermina Novida
Keyword(s):  
Left Kidney ◽  
Malignant Lesion ◽  
Adrenal Incidentaloma ◽  
Signs And Symptoms ◽  
Kidney Cyst ◽  
Abdominal Ct Scan ◽  
Suprarenal Mass ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Adrenal incidentaloma (AI) is a rare case, with a prevalence of 3-7% in the general population. We report a case of a 66 year old female, presented with the history of bilateral flank pain. The patient was performed urologic evaluation due to suspicion of right perirenal abscess and left kidney tumor, and from abdominal CT scan it was found suprarenal mass. There were no signs and symptoms of hormonal hyperfunction. Radiological evaluation in the patient showed the present of malignant lesion. Therefore, adrenalectomy was planned. Before undergoing adrenalectomy, the patient had passed away 6 days after first surgery (right pyelolitotomy and unroofing cyst), with septic shock suspected as cause of death due to hospital-acquired pneumonia.

scholarly journals Hemoptisis pada Pasien Aspergilloma Paru Kiri

2018 ◽  
Vol 4 (2) ◽  
pp. 38
Author(s):  
Gilang Muhammad Setyo Nugroho ◽  
Laksmi Wulandari
Keyword(s):  
Surgical Therapy ◽  
Lung Tissue ◽  
Physical Condition ◽  
Left Lung ◽  
Fungus Ball ◽  
Good Physical Condition ◽  
Superior Lobe ◽  
Examination Result ◽  
Life Threatening ◽  
History Of

Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the parenchyma due to previous lung disease. This fungus ball can move inside the cavity but does not invate the cavity wall. The presence of fungus ball causes recurrent hemoptysis. Case: We present a 45-year-old female patient with left lung Aspergilloma. Diagnosis of Aspergilloma was based on histopathology from FNAB CT guiding of left pulmonary which showed Aspergillus. Patient was treated with left superior lobe lobectomy at the hospital. The examination result of anatomical patology obtained from lung tissue was aspergillosis, from GeneXpert examination lung tissue showed positive MTB with rifampisin sensitive. Post-operative condition of the patient was stable, surgical wound improved, took off drain patient. There were clinical improvements after the surgery. Discussion: Diagnosis of Aspergilloma was based on clinical, radiology, and microbiology. Aspergilloma with severe symptoms (hemoptysis massive with life-threatening or other complications that require more than 1 time hospitalisation) and good physical condition should undergo surgical therapy in the form of lobectomy in accordance with the extent of lung abnormalities. Patient got first category anti tuberculosis drugs for 6 months and fluconazole for 2 months. Conclusion: It is necessary to consider the suspicion of Aspergillus infection, in patient with history of previous tuberculosis accompanied by a history of recurrent hemoptysis. Patient with reccurent hemoptysis and good physical condition should undergo surgical therapy.

scholarly journals Thyroid Storm Associated with Testicular Choriocarcinoma

2020 ◽  
Author(s):  
Julio César Martínez ◽  
Ernesto Alfonso Ovalle-Zavala
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Rare Occurrence ◽  
Blood Tests ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Β Hcg ◽  
Very High

Thyroid storm is a rare, life-threatening condition that can be caused by various pathologies including serious conditions associated with human chorionic gonadotropin (hCG)-producing tumours. We present the case of a 17-year-old male patient with a 1-month history of dyspnoea and a 3-day history of palpitations and fever. General examination revealed a left testicular mass. Blood tests revealed β-hCG >225,000 mIU/ml, thyroid-stimulating hormone (TSH) 0.02 IU/ml, and thyroxine (T4) 19.07 µg/dl. He was admitted with thyroid storm. Treatment with antithyroid drugs and chemotherapy was started, but the patient died on the third day of admission. This case highlights a rare occurrence of thyroid storm linked to testicular choriocarcinoma, and provides a necessary reminder that, in some instances, hCG at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of TSH.

scholarly journals Spontaneous hemopneumothorax after laparoscopy: a case report and literature review

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052092532
Author(s):  
Zhenyan Gao ◽  
Qing Wang ◽  
Juntao Shi ◽  
Huihua Cao ◽  
Yugang Wu ◽  
...  
Keyword(s):  
Left Lung ◽  
Radical Resection ◽  
Bloody Stool ◽  
Left Chest ◽  
Clinical Disorder ◽  
Life Threatening ◽  
Rectal Mass ◽  
History Of ◽  
Adhesive Band ◽  
Spontaneous Hemopneumothorax

Background Spontaneous hemopneumothorax (SHP) is defined as the accumulation of >400 mL of blood in the pleural cavity in association with spontaneous pneumothorax. This rare clinical disorder may be life-threatening. Case presentation A 71-year-old woman presented with a 1-month history of recurrent bloody stool, and electronic colonoscopy suggested a rectal mass. Laparoscopic radical resection of rectal cancer was performed. Two days later, she developed chest tightness, shortness of breath, and slight pain in the left chest. Emergency chest radiography revealed mild left pneumothorax and pleural effusion. SHP was suspected and a thoracic drain was inserted. However, the patient developed hemorrhagic shock 3 hours after drainage. She underwent emergency video-assisted thoracic surgery (VATS), which revealed left lung tip rupture with bleeding and adhesive band fracture at the top of the left thoracic cavity. The ruptured lung tissue was removed and electrocoagulation at the adhesion band was performed for hemostasis. The patient was discharged on postoperative day 11. At the time of this writing, she had developed no SHP recurrence or any other complications. Conclusions This case shows that conservative treatment may have serious consequences in patients with SHP. Thus, chest X-ray examination and VATS should be performed in patients with SHP.

scholarly journals Multilocular Cystic Nephroma. Kidney Disease Difficult To Diagnose Before Surgery: A Case Report

2020 ◽  
Vol I (2) ◽  
pp. 24-27
Author(s):  
Salah Berkane
Keyword(s):  
Left Kidney ◽  
Large Diameter ◽  
Malignant Lesion ◽  
Balance Sheet ◽  
Lumbar Pain ◽  
Cystic Tumor ◽  
Renal Lesion ◽  
Cystic Nephroma ◽  
History Of

Cystic nephroma is a benign renal lesion. It is a benign and rare cystic tumor of the kidney whose diagnosis needs renal specimen after nephrectomy. We report an observation of 62-year-old woman, obese with a history of type 2 diabetes who consults for left lumbar pain without hematuria. The examination found no lumbar contact or signs of urinary tract infection. The first exploration by an abdominal echotomographic shows the existence of an inferior medieval and polar lesion of 84mm of the large axis, heterogeneous with multiple anechoic zones within it of small sizes. The interpretation made by the radiologist retained 3 possible diagnoses, namely: a renal mass suspected of malignancy, a heterogeneous multicystic lesion and a hydatid cyst stage III of Gerbi. The computed tomography found a heterodyne left medieval tumor process and lower polar poorly limited with several areas of necrosis of 80mm of large diameter taking the contrast and interpreted as a malignant lesion, without hilar lymphadenopathies or retroperitoneal visible. The rest of the extension balance sheet was free of anomalies. Hydatid serology was performed and returned negative. The patient was operated on with the diagnosis of kidney cancer. The intraoperative exploration showed the existence of a left kidney increased in volume in its compartment, the accidental break-in of the latter allowed even the multilocular cystic appearance of small infracentimetric sizes of this lesion. An enlarged total nephrectomy was realized. Macroscopic examination of the part reveals a kidney carrying multiple cystic lesions arranged one against the other without nephrogenic tissue in the septic letting out a clear liquid. The pathology study showed the appearance of a multilocular cystic nephroma. Our patient is alive at 48months and in well health.

Primary Amenorrhoea with Pituitary Dwarfism: A rare case report

2016 ◽  
Vol 2 (2) ◽  
pp. 145-147
Author(s):  
Siva S ◽  
Divya Gopineni ◽  
Shafi P ◽  
Chandra Sekhar
Keyword(s):  
Pituitary Gland ◽  
General Medicine ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Primary Amenorrhea ◽  
Pituitary Dwarfism ◽  
Primary Amenorrhoea ◽  
Sexual Characteristics ◽  
Loss Of Appetite ◽  
Secondary Sexual

Females with pituitary dwarfism and a multiple deficiency of pituitary hormones show ovarian dysfunction due to hypogonadotropism. Primary amenorrhea can be diagnosed if a patient has normal secondary sexual characteristics but no menarche by 16 years of age. A 16 year-old female patient admitted in general medicine department with chief complaints of shortness of breath on exertion since 15 days, swelling of both legs since 10 days, loss of weight since 5 months, loss of appetite since 3 months, history of pain during swallowing. Pelvis scan examination reveals that uterus measures 3.2×0.5×0.5cm; uterus is hypo plastic, ovaries not visualized. Patient parents reveled that from patient birth to 11years of age her growth and other developments were normal, after that her growth is stopped and no changes were observed in development since 5 years. Patient has hypothyroidism so pituitary gland make an important role to maintain hormone levels, pituitary gland produces thyroid stimulating hormone (TSH) which stimulates thyroid gland to produce thyroid hormones. Primary Amenorrhea, short stature and poorly developed secondary sexual characters which could have been contributed and should be subjected for karyotyping. This type of Pituitary Dwarfism is very difficult to manage.

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