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doctor bhaskaaran

doctor bhaskaaran

wkfvcepdupscibtlbsbo, http://www.lmyhjkaety.com iaroburchp

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Provisional Diagnosis-ITP ?Thrombocytopenia secondary to Hypersplenism Thyroid nodule evaluation to r/o malignancy Work up for inherited thrombophilia
Final Diagnosis-Extra hepatic portal vein obstruction(EHPVO) Portal hypertension & Hypersplenism Papillary carcinima thyroid(S/p Total thyroidectomy) Vit D Def Neurasthenia
History and Findings-Referred by Dr.Pavithran Prof Med oncology A k/c/o ITP on management from CMC Vellore(age 17-27) & from TVM MCH by Dr.Pavithran from age 27 onwards.Off steroids since 2004 h/o Gen Oedema/polyarthritis/Polymyalgia/DOE class II,snoring,sllep apnoea,recurrent throat infection x 4yrs.Past H/o B/l renal calculi & obstructive hydroureteronephrosis in 2006.Ureterolithotomy Rt on 25/08/06 Wt-104kg BMI-37.3,Thyroid nodule Lt lobe+
Investigation-Hb-12.8,ESR-28,plat-150.0,uric-5.9,HBA!c-5.3,LFT N 25(OH)vit D -14.18,IgE-147,TSH-2.03,ATg-0.82,TPO-0.30,ANA-Neg,ACE-53(N),Cortisol-10.1,CA-125-12,CEA-1.94,APLA IgM,IgG-N,AFP-3.38,CA 19-9-21.48,Beta HCG <1.20,PT with INR APTT-n,Thrombophilia work up normal,MDCT abd contrast 04/04/11-Liver volume redistribution with hypertrophy of caudate lobe,no IHBRD,few nodules s/o hemangioma,splenic & portal vein not visualised.Splenic artery aneurysm & multiple spleno renal collaterals,splenomegaly 15mm s/o extrahepatic portal vein obstruction & PHTN OGD scopy 06/04/110-No varices severe Portal hypertensive gastropathy.FNAC Thyroid Lt Lobe 06/04/11-S/o Papillary carcinoma Total thyroidectomy done on 28/04/11(HNS dept).HPR Papillary thyroid carcinoma Lt lobe,no nodes identified
Treatment-On I 131 therapy followed by oral LT4 Oral calcium & calcirol,Zosert,Evion,Razo D
Follow Up-Pt doing well on treatment

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Provisional Diagnosis-ITP ?Thrombocytopenia secondary to Hypersplenism Thyroid nodule evaluation to r/o malignancy Work up for inherited thrombophilia
Final Diagnosis-Extra hepatic portal vein obstruction(EHPVO) Portal hypertension & Hypersplenism Papillary carcinima thyroid(S/p Total thyroidectomy) Vit D Def Neurasthenia
History and Findings-Referred by Dr.Pavithran Prof Med oncology A k/c/o ITP on management from CMC Vellore(age 17-27) & from TVM MCH by Dr.Pavithran from age 27 onwards.Off steroids since 2004 h/o Gen Oedema/polyarthritis/Polymyalgia/DOE class II,snoring,sllep apnoea,recurrent throat infection x 4yrs.Past H/o B/l renal calculi & obstructive hydroureteronephrosis in 2006.Ureterolithotomy Rt on 25/08/06 Wt-104kg BMI-37.3,Thyroid nodule Lt lobe+
Investigation-Hb-12.8,ESR-28,plat-150.0,uric-5.9,HBA!c-5.3,LFT N 25(OH)vit D -14.18,IgE-147,TSH-2.03,ATg-0.82,TPO-0.30,ANA-Neg,ACE-53(N),Cortisol-10.1,CA-125-12,CEA-1.94,APLA IgM,IgG-N,AFP-3.38,CA 19-9-21.48,Beta HCG <1.20,PT with INR APTT-n,Thrombophilia work up normal,MDCT abd contrast 04/04/11-Liver volume redistribution with hypertrophy of caudate lobe,no IHBRD,few nodules s/o hemangioma,splenic & portal vein not visualised.Splenic artery aneurysm & multiple spleno renal collaterals,splenomegaly 15mm s/o extrahepatic portal vein obstruction & PHTN OGD scopy 06/04/110-No varices severe Portal hypertensive gastropathy.FNAC Thyroid Lt Lobe 06/04/11-S/o Papillary carcinoma Total thyroidectomy done on 28/04/11(HNS dept).HPR Papillary thyroid carcinoma Lt lobe,no nodes identified
Treatment-On I 131 therapy followed by oral LT4 Oral calcium & calcirol,Zosert,Evion,Razo D
Follow Up-Pt doing well on treatment

Read more...

Provisional Diagnosis-PUO/Mediastinal L.Adenopathy/B/l lower lobe collapse consolidation,High ESR,CRP,ulcerative Mantoeux(ATT Emperical) Hypothyroidism/Thyroiditis Spondyloarthritis/Vit D def?Poncet's disease Liver dysfn(NASH)-liver biopy not done
Final Diagnosis-Tuberculous L.Adenitis (Mediastinal) Thyroiditis Spondyloarthritis/Vit D def NASH
History and Findings-Referred by Dr.Pavithran,Prof Med Oncology Fever >2weeks,Polyarthritis,skin nodules,one episode of syncope on 5.03.11.Past h/o polyarthritis from age 21 not evaluated,h/o migraine
Investigation-Hb-14.3,ESR-52,Pre op serology(HBSAg,anti HCV,HIV)Neg,CRP-205.6,Corrected ca-9.4,creatinine-1mg,ANA neg(0.47),ds DNA-3.7(Neg),GGT-99.8,SGOT-63.8,SGPT-82.5,ALP-92.6,HbA1c-6,4,TSH-4.90,FT4-0.82,RA & ASO neg,LDH-264,Ck-35.5,CK MB-10.9,Na-135,k-4.9,c3-202,C4-64.4,SA-0.620,TPO-3131.2,ACE-27,Uric acid-6.4,Mg-1.8,Anti CCP <0.05 25(OH)Vit D-8.68,HLA B 27 Neg,24hr urine uric acid-472.7,ASCA IgA-6.57,FNAC Thyroid-Hashimottos thyroiditis,IgM Brucella Neg,IgM Mycoplasma-Neg,ECG-Wnl,cxr-Bronchovascular markings Rt base Lt hilar shadow Lt basal patchy haziness.CT chest HRCt 14/03/11-Mediastinal lymph adenopathy B/l segmented basal collapse consolidation.toxoplasma IgM Neg,Bronchoscopy didnot reveal any obvious lesion BAL Cytology Neg for malignancy,AFB Neg,Smear-No atypical cells,Biopsy no granuloma,BAl AFB culture neg for AFB after 6weeks.OGD & Colonoscopy 31/03/11-Normal,Mantaeux strongly +ve & ulcerative,ATT emperically started on 23/02/11 modified regime in view of altered LFT.Repeat CT Chest HRCT 30/4/11-Collapse consolidation resolved mediastinal nodes regressing in size ATT ctd for total 8months with complete remission.Repeat CT chest HRCT on pts arrival from Gulf-Full regression on L.Nodes with mild hepatomegaly Hb-14.8,ESR-16,TSH-6.94,TPO-3328,HBA1c-5,6%,SGOT-57.5,SGPT-75.1,CRP-1.18
Treatment-Inj.Amikacin 750mg IV odx 5months & A/D x 2 months Ethambutol x 8months,Clarythromycin bd x 6months INH reintroduced after LFT became normal with B6,Udiliv,LT4,Citromacalvit,Calcirol,HCQS & Leflunamide
Follow Up-Pt became asymtomatic except for mild spondyloarthritis & mild transaminitis.He is advised to ct Thyronorm,Citromacalvit,HCQS 7 Lefra

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