Case Of Tree man

The man’s condition started when he cut himself at the age of 15 and the unchecked proliferation of the lesions has baffled local medical specialists who have tried drugs and surgery with no success.
“This warts began to grow and slowly radiate after my knee being scratch in an accident when i was a teenager.” Dede said, citated from Discovery Channel, Friday (16/11/2007).

After having laboratory test on Dede’s disease, Anthony Gaspari, he found that is was caused by HPV (Human Papiloma Virus) the virus which causes wart in Normal people.
Deficiency of white blood cells, which are crucial in fighting infections, and his weakened immune system couldn’t fight the HPV. The virus hijacked his skin cells, causing it to produce massive amounts of keratin, a protein found in hair and fingernails. The warts sprouted into dense growths known medically as “cutaneous horns” on his hands and feet.

Source: CNN, discovery websites

Conjoined twins

Interesting Cases Gallery

Facing strange cases are a regular part of Medical life. Here are some interesting pictures clicked in the Hospital, shared for educational purpose to all interested readers.

Gallery Of the Interesting cases:

1. Intrauterine Fetal death , still Birth
2. Conjoined Siamese twins
3. Third degree external hemorrhoid prepared for hemorrhoidectomy
4. Excised huge Sebaceous cyst( Initially  it was diagnosed as pleomorphic Adenoma with potential malignancy and biopsy was sent)

Submitted By :- Dr. Bibek KC

Tumorman - China

A Chinese male, with a giant facial tumor used to be recognized as a tumor man. At a very young age of four, he suffered from a  rare genetic disease called Neurofibromatosis , obscuring his external appearance and warping his backbone.  Tumor Growths on his face caused him to have a trouble to hear, to speak and even to eat. It grew larger and rapidly as he aged, knocking out his teeth, crushing his left ear to hang down his shoulder level, blocking his left eye and deforming his bone as well.

Neurofibromatosis - Plexiform

In July 2007, Chinese surgeons successfully removed a massive 33-pound (or about 15kg) tumor hanging down on his face. He also had another 25-pound tumor removed successfully.

Source- Medicalmad.com

Herpes Zoster Ophthalmicus caused by HZV ( Shingles)

External Hemorrhoids

Petechial Rashes Of meningococcemia

She had no other complains.

No similar History in tha past.

LMP was 3 months back.

On examination:

GC- Patient looked anxious

PILCyClOD- Pallor +

• Chest -NAD
• CVS-s1 s2 m0
• P/A- soft, non tender
• Tap on facial nreve= tingling �and twitching ( ? Chvostek)
• Hands:
  

  Accoucher's hand

  Knee Jerks: slightly exaggerated.

Our Differentials were:

• 1. Tetany
• 2. Conversion Disorder

Lab Reports revealed:

Hb: 8.3%

TC,DC,Urine R/m/e, �all within normal range

Urine pregnancy test- positive

Na+ 132 mEQ/l

Ca++ 6.1 mEQ/l

WHAT COULD BE THE DIAGNOSIS?

Is it likely to see features of tetany at 6.1 meq Ca++?

A 14 year girl complained of increased pv bleeding in her 2nd menstrual cycle,associated with severe dysmenorrhoea.Her first menstrual cycle was normal.There was no any significant medical,family,personal and treatment history.

O\E: she looked pale.

Her vitals were stable.

P\A- soft,no mass felt

INVESTIGATION

Hb% -low

coagulation profile- within normal limit

USG abdomen & pelvis- no any abnormality detected

DIAGNOSIS: PUBERTAL MENORRHAGIA

TEXT REVIEW OF PUBERTAL MENORRHAGIA

DEFINITION- Puberty menorrhagia is a threshold bleeding of adolescense caused by excess or unopposed oestrogen and absence of progesterone in the anovulatory cycle.It occurs in the form of excessive bleeding or normal but continuous bleeding lasting many days.

complication- anaemia,emotional stress

Management-

Investigations:

-Blood= Hb%-usually low

-Coagulation profile- BT,CT,Platelet count to rule out any bleeding disorder

-Thyroid profile-to rule out hypothyroidism that can lead to menorrhagia

-USG of pelvis to rule out pelvic pathology

Treatment-

Usually the mangaement is simple.If anaemia present,then it is corrected by blood transfusion,rest. The emotional aspect is corrected by adequate explanation, reassurance and psychological support.

If the above measures fails, then potent progesterone like medroxy progesterone acetate or noretisterone 5mg thrice a day is given till bleeding stops, which generally takes 3-7 days. Following withdrawal bleeding the same preparation 5mg is started on the day 5 and continued for 20 days. The condition usually becomes normal following 2-3 courses and the normal periods resume.

If the above progesterone therapy fails to control bleeding, conjugated estrogen 20-40mg iv is given every 6-8hrs. As the bleeding stops, we replace it with combined oral pills containing 50micro gm of oestrogen,

If the patient is unresponsive to the estrogen therapy as well, examination under anaesthesia[EUA] and dilatation and curettage is done and the material is sent for histopathological examination to rule out pelvic pathology. But while performing D&C, we should keep pregnancy complication in mind.

If the menorrhagia is secondary to ITP, hypothyroidism, we have to treat the underlying cause as well.

Case Collected and workedout By Dr. Anjali Subedi

A 19 years female primi at 29 weeks period of gestation complained of heavy pv bleeding for 3 hrs,clots+,no lower abdominal pain. she had perceived good fetal movement. she had anc visit in health post, took Iron tablets regularly and had taken 2 doses of Tetanus Toxoid inj.

She had normal menstrual cycle, no use of any contraceptive measures.her past,family and personal history are not significant.

On Examination:

General Condition-fair     Pallor Icterus Edema-nil       vitals- stable

per abdomen: uterus 24 weeks size , mild contraction +

per vaginum: no active bleeding, clots removed from vagina,os closed,cervix- ballooned up in upper part

Diagnosis- primi at 29 weeks Period Of Gestation with Antepartum Hemorrhage

Investigations:

Hb%- low

USG report- 26-27 weeks single live intrauterine pregnancy,breech,posterior placenta,oligohydraminos,fetal hydracephalus and deformed fetus

Management

Admission

Induction of labour with misoprostol 200micro gm per vaginum

Blood transfusion-

IV antibiotics

Monitoring of vitals and input output

After few hours, patient was shifted to ot for lscs as placenta was felt on p\v examination, diagnosis being central placenta previa

She was totaly transfused 4 units of whole blood to restore her haemoglobin

Image: Grossly malformed fetus

Case Collected and Worked Out By: Dr. Anjali Subedi

13 year Male child came with complains of swelling of the body starting from the periorbital area for 8 days and then pitting oedema on the legs for 2 days.There is no history of fever but he complains of headache, temporal aggravated by heat and there is Blurring of vision as well.