Synchronous Parathyroidectomy and Extended Thymectomy in Multiple Endocrine Neoplasia Type 1.

A 49-year-old man presented with symptoms of hypercalcemia that had been present for 3 months. An initial chest x-ray showed a large anterior mediastinal mass. Subsequent computed tomography also demonstrated a calcified lesion in the uncinate process of the pancreas, and a neck ultrasound showed parathyroid lesions. The combination of symptoms and tumors raised the possibility of multiple endocrine neoplasia type 1 as the diagnosis. The lesions were later biopsy-proven to be atypical carcinoid neuroendocrine tumors. The patient underwent simultaneous neck dissection for bilateral subtotal parathyroidectomy and midline sternotomy for thymectomy of the large mediastinal mass.

Surgical Repair of Complete Congenital Sternal Cleft Associated With Pectus Excavatum.

Complete congenital cleft sternum associated with pectus excavatum is a rare abnormality. Case reports and case series currently provide the technical standards for comparison in surgical repair. We present a case report of surgical repair of cleft sternum and anterior pericardial defect associated with pectus excavatum in a 13-year-old girl. The surgical repair of the cleft sternum and pectus excavatum was performed with a modified Ravitch procedure, closure of the defect with stainless steel wires, and insertion of a pectus bar. Preoperative imaging is important in better defining the defect.

Loin to groin pain: The importance of a differential diagnosis.

INTRODUCTION: Ureteric colic frequently presents as loin to groin pain and accounts for a significant proportion of emergency urological admissions. However, a number of differential diagnoses should be considered in a systematic approach when assessing patients. PRESENTATION OF CASE: We report a case of a 30 year old man admitted with severe unilateral loin to groin pain following lumbar specific weightlifting exercises. After a significant delay due to initial mis-diagnosis he was diagnosed with acute paravertebral lumbar compartment syndrome (PVCS) and managed conservatively. DISCUSSION: Exertional PVCS is a rare and potentially life threatening condition arising following lumbar specific exercise that has only been recorded a handful of times previously. Patients typically present with intractable lumbar pain and rhabdomyolysis 6-12h following exercise. Due to initial diagnostic delay our case was managed conservatively with fluid resuscitation and monitoring of renal function. CONCLUSION: Assessment of patients with loin pain requires a systematic approach. PVCS is a rare cause of lumbar back and loin pain but one that should be considered, particularly in active young males. Early diagnosis is key to prevent the potential sequalae of untreated rhabdomyolysis. There is currently no consensus on management option for PVCS with only a few cases being reported in the literature. We describe successful management with supportive non operative treatment.