All Journals from V Anand
A 74 year gentleman was admitted with a 6 month history of dizzy spells, malaise, generalised weakness and weight loss of over a stone. He attributed his weight loss to poor appetite due to persistent nausea. He had no significant past medical history apart from moderate mitral regurgitation and recent cholecystectomy. He felt some of these symptoms began after laparoscopic cholecystectomy 12 months before. The procedure had been complicated by a self-limiting biliary leak. He had been recently evaluated by chest physicians and gastroenterologists for clubbing and weight loss. Computerised tomography (CT) of the chest showed right basal fibrosis, CT of the abdomen and pelvis was normal, and upper endoscopy revealed a non-obstructive mild pyloric stenosis. Routine blood tests were unremarkable.
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A sixty-six year old lady was admitted after describing two ‘vacant’ episodes with collapse. She had also complained of chronic fronto-occipital headache and more than 10kg weight loss over the preceding three month period. She denied any gastrointestinal, respiratory or cardiac symptoms. She was a non-smoker and did not drink alcohol regularly. She had a past history of hypertension and hypothyroidism for which she was taking ramipril and thyroxine. On examination she appeared cachexic, but no other abnormality was detected.
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The MRI images (see page 27) show lobulated meningeal thickening along the medial aspect of the right middle cranial fossa extending into sylvian fissure, suprasellar cistern, interpenduncular cistern and roof of 4th ventricle which enhanced on postcontrast images. These appearances are diagnostic of metastatic leptomeningeal carcinomatosis.
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A 60 year old female was admitted with jaundice, malaise & loss of appetite. Two weeks before admission she had complained of diarrhoea with abdominal pain. There was no previous history of jaundice, blood transfusion or foreign travel. She denied pruritus, and stools were of normal colour, although her urine was dark. She was non-smoker & did not drink alcohol regularly. She was known to have ischaemic heart disease & hypercholestolaemia and had been taking ramipril 5mg , clopidogrel 75mg, simvastatin 20mg & omeprazole 20mg daily for the previous two years.
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