Peutz-Jeghers syndrome: A case report

Peutz-jeghers syndrome is a rare inherited autosomal dominant disease which is characterized by mucocutaneous pigmentation and multiple polyps in the gastrointestinal tract. We report a case of 10 years old female who was referred to us from surgical department for the evaluation of brownish pigmented macules over lips, face, palms and soles. Patient was presented with recurrent abdominal pain along with vomiting and blood mixed stool for a month. Ultrasound of abdomen revealed jejuno-jejunal intussusception for which laparotomy was done during which multiple polyps were visualized. Polypectomy was done and biopsy revealed it to be tubulovillous adenoma. Patient was diagnosed as Peutz-jeghers syndrome as there were multiple polyps in the jejunum along with the characteristics mucocutaneous involvement.

Endocrinopathy Causing Skeletal Decalcification and Ectopic Calcification Highlighted by Imaging Tour

Primary Hyperparathyroidism (PHPT) is an endocrine disorder which is caused by increased production of Parathyroid Hormone (PTH). Hypercalcemia leads to a number of symptoms and may cause patient's morbidity and even mortality if left untreated. In the present case, a 21-year-old female presenting with frequent attacks of urinary tract infection, diffuse bone pain and episodic pain abdomen since 15 months. On clinical, biochemical and radiological evaluation, the case was diagnosed as PHPT due to left superior parathyroid adenoma. Patient underwent uneventful surgical parathyroidectomy following preoperative optimisation. She achieved normocalcaemia without any surgical complications. This case is presented to highlight the impact of hyperparathyroidism on calcium metabolism leading to extensive skeletal decalcification and ectopic deposition of calcium leading to end organ damage. Various images are used to highlight this phenomenon of decalcification and calcification.

A COVID-19 Patient Who Underwent Endonasal Endoscopic Pituitary Adenoma Resection: A Case Report

BACKGROUND AND IMPORTANCE A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic. CLINICAL PRESENTATION The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not. CONCLUSION The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.