Multiple renal calculi due to hypercalcaemia induced by over-the-counter vitamin D intoxication.

Renal stone disease is a common and painful condition. Even though it is rarely fatal, patients describe it as the worst pain in their life. While dietary calcium may decrease the risk of stone formation, patients on supplemental calcium are at higher risk. Moreover, patients with diabetes are more prone to develop renal calculi. Hypervitaminosis D is a rare cause of hypercalcaemia. This is a case of an elderly diabetic man who developed multiple calcium oxalate renal stones due to hypercalcaemia following calcium-vitamin D supplementation.

2D Shear Wave Elastography of Liver in Patients with Primary Extrahepatic Portal Vein Obstruction.

AIMS: To evaluate liver stiffness (LS) in patients of primary extrahepatic portal vein obstruction (EHPVO) using 2D shear wave elastography (SWE) and compare it with healthy volunteers. METHODS: Fifty patients (mean age: 22.4 years) of EHPVO and 25 healthy volunteers were included in the study. Liver function tests and viral markers were done in both groups and endoscopy in EHPVO group, followed by ultrasonography and SWE of liver. Liver elastography was done with patients/volunteers in supine position through right intercostal space. The LS for right lobe of liver was recorded in kilopascals. Three such measurements were taken and the mean of both groups were compared. The variables were also correlated with mean LS using Pearson's correlation coefficient in EHPVO group. RESULTS: There was no significant difference in the mean LS in patients of EHPVO (5.96 kPa) and healthy volunteers (5.47 kPa) (P = 0.093). There was no significant correlation between LS with duration of symptoms, hematemesis, esophageal varices, total bilirubin, serum alkaline phosphatase and aspartate aminotranferase levels in EHPVO group. CONCLUSION: SWE of liver may be used as a simple additional tool in the diagnosis of patients of EHPVO who show LS values similar to normal liver.

Post Tracheostomy Carotid-Tracheal Fistula.

Tracheostomy is the life saving procedure in patients presenting with upper airway obstruction. The procedure is also performed in patients on chronic ventilatory support. It is generally considered a safe procedure with a low complication rate. Vascular injuries are the most serious and life threatening complications. Injury to a high lying innominate artery is the most frequent vascular injury in such cases. Injury to other vessels e.g. carotid arteries is less frequent. We are presenting one such rare type of vascular injury with a fistulous communication between trachea and carotid artery leading to massive hemoptysis.

Unusual cord transection in a patient with traumatic spondylolisthesis.

Spinal cord injury is one of the most debilitating injuries in patients with spinal trauma. Cord injury may range from simple cord edema to frank transection. Cord transection is the most severe form of cord injury as it results in complete and irreversible loss of all neural functions. Generally, it is a result of unstable spinal fractures with associated spondylolisthesis or spondyloptosis. Generally, the level of cord transection corresponds to the level of spinal fracture/spondylolisthesis. However, here we are presenting a case having a traumatic spinal fracture with spondylolisthesis where the level of cord transection was much higher than the level of the spinal fracture. Due to the traumatic traction, the cord distal to transection is displaced inferior leaving behind a long segment of the empty thecal sac.