Intra-operative diagnosis of hypopituitarism in a patient undergoing radical nephrectomy

A 43-year-old woman presented for elective radical nephrectomy. After induction of anaesthesia, she developed hypotension that failed to respond to standard treatment measures. Her core temperature decreased to 34 degrees C in spite of active warming. She required very low concentrations of anaesthetic agents to maintain an adequate depth of anaesthesia for abdominal surgery. After excluding the common causes of hypotension, the possibility of subclinical hypopituitarism was considered and subsequently confirmed.

Contralateral pneumothorax following thoracotomy for vertebrectomy

A 21-year-old woman underwent correction of congenital thoracic kyphoscoliosis. The procedure was completed in two stages. The first stage involved right thoracotomy and anterior vertebrectomy. Following positional obstruction of her right-sided chest drain she developed a very large, left-sided pneumothorax in the immediate postoperative period. No attempt at central venous line placement had been made on the left side. Breach of the midline at vertebrectomy may allow pleural gas to cross and cause a contralateral pneumothorax.

An unusual case of Ecstasy poisoning

We describe a case of poisoning with 3,4-methylenedioxymet-amphetamine Ecstasy that presented with all the features suggestive of a fatal outcome, including a creatinine phosphokinase level markedly higher than any previously reported. The patient, a paraplegic, was treated with dantrolene and made a full recovery.