Multifocal primary amyloidosis of the bladder presenting with gross hematuria: A case report and review of literature

Amyloidosis is defined as extracelluar deposition of amyloid, a fibrillary protein in one or more body sites. It can involve genito-urinary tract, primarily or secondarily, but isolated primary bladder amyloidosis is an extremely rare presentation. We herein report a rare case of 48-year-male patient presented with symptoms mimicking carcinoma urinary bladder especially painless haematuria. Transurethral resection of the mass was done in one sitting. The histopathological examination revealed to be a primary bladder amyloidosis. In the follow-up, patient had improvement in symptoms and no recurrence. We also briefly review the literature on primary bladder amyloidosis.

Case report- acute pre-operative gall bladder perforation (Type-1) with generalized biliary peritonitis in younger age group without any comorbid illness

Gall bladder related disease is now one of the commonest indications for elective and emergency surgery and laparoscopic cholecystectomy is the mainstay treatment in patients with gall bladder stones, however some patient delay their surgical intervention for some period of time which might lead to life threatening complications in later stages such as GBP which is rarest but when it occurs along with other predisposing risk factors (hypoalbuminemia and SIRS) might increase the morbidity and mortality rate. Here we report a case of pre-operative Type-I GBP with generalized biliary peritonitis with sepsis with hypoalbuminemia in younger age group. Acute cholecystitis patient of younger age group without any comorbid illness, needs prompt surgical intervention (cholecystectomy).

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Acute cholecystitis patient of younger age group without any co-morbid illness, also needs prompt surgical intervention (cholecystectomy).

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GBP should be considered with acute cholecystitis, when the clinical condition is deteriorating rapidly.

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GBP associated with pre-operative risk factors (such as hypoalbuminemia and SIRS) needs prompt surgical intervention, as these factors might increase the morbidity and mortality in this rarest life threatening complication of acute cholecystitis.

Case report--mechanical bowel obstruction with appendicitis without strangulation and leukocytosis

Intestinal obstruction is a common surgical emergency caused by varied conditions. Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction. Here we report a Case of 62-years-old male who presented here with a clinical picture of small bowel obstruction. On laparotomy, there was a dilated gut with long appendix having inflamed tip buried into adjoining mesentery and then appendectomy was done and obstruction was relieved. Also, bowel was found to be viable hence simple appendectomy was found to be sufficient treatment. Histopathological findings was suggestive of chronic fibrosing appendicitis. Hence, in cases of bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery which may require resection in later stages.

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Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction.

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A case of 62-years-old male who presented here with a clinical picture of small bowel obstruction.

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Bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed ---with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery.

Bowel ischemia and gangrene-primary true enterolith

Enterolithiasis, or presence of stone concretions in the gastrointestinal tract, is an important but relatively uncommon clinical condition that has recently gained significant attention with advances in the gastrointestinal field. Here, we present a case of an old male having features of bowel Ischemia and gangrene formation. Patient underwent exploratory laparotomy and there was a presence of inflamed Gut with a perforation just one and half feet away from IC junction and an obstruction was also identified by following the dilated bowel loops distally, palpation revealed a hard stone and enterotomy incision at the site delivered a stone. Following it, resection of thickened mesentery was done and loop ileostomy was made. The most important prognostic factor in such cases relies on time interval between onset of symptoms and definitive treatment. By improving the awareness and early recognition of mesenteric ischemia will lead to improved survival in the condition.

Comparative study of automated cryopreservation of red blood cells

BACKGROUND

Strategic blood reserves are an important component in meeting blood needs and this can be accomplished through the establishment of a frozen blood program.

METHODS

One hundred units of packed RBC were glycerolized using the Haemonetics ACP 215 automated cell processor and placed in a -86 °C deep freezer for freezing and storage. Product weight, hematocrit, RBC count, WBC count and hemoglobin were recorded prior to freezing. Twenty five bags were thawed and deglycerolized after every three months starting at one year from the date of first glycerolization In addition to the earlier parameters the bags were assessed for supernatant osmolality, pH, supernatant hemoglobin, ATP levels and supernatant potassium and from these red cell recovery, percentage hemolysis, supernatant glycerol and red cell viability were estimated. All tests were repeated at the end of 7 and 14 days.

RESULTS

The mean red cell recovery was found to be 86.12% on Day 0 and 84% on Day 14. All the bags showed residual glycerol and pH within the acceptable limits upto Day 14. Percentage hemolysis, Mean ATP levels and mean supernatant potassium levels were within acceptable limits upto Day 14. All the units were sterile upto Day 14.

CONCLUSION

The data in this study showed that the red cells which were glycerolized using the automated platform ACP 215, frozen at -80 °C for more than a year and deglycerolized again using the ACP 215 had excellent viability while being stored at 4 °C during the 14 days of post-thaw storage.

Multifocal Langerhans Cell Granulomatosis (Hand-schuller - Christian Disease)

A 47 year old female developed multifocal Langerhans cell granulomatosis (Hand-Schuller-Christian disease) manifesting as papulo-pustular, nodular, crusted and scaly lesions, xanthelasma, ulceration of gingival mucosa with loss of teeth, vaginal granulomatosis, diabetes insipidus, multiple osteolytic bone lesions and honeycombing of the lungs. Skin biopsy confirmed the diagnosis. Treatment with prednisolone 45 mg methotrexate 2.5 mg daily, led to regression of lesions, reduction of bone of partial clearance of lung lesions and osteolytic bone lesions. However, the patient died due to widespread nature of the disease.