A 70-year-old male, with history of type 2 diabetes mellitus, hypertension, bronchial asthma, ischemic heart Disease – S/P PTCA, history of pancreatitis 10 years ago was admitted with epigastric pain and vomiting. Blood investigations showed elevated triglycerides 2089 mg/dl, lipase 8383 U/L, amylase 1423 U/L and prothrombin time > 200. He was adequately hydrated and treated with fenofibrate. On 4th day of admission, he developed sudden right-sided weakness lasting for few minutes. Immediate CT brain and angiogram were unremarkable. Within one hour, he had weakness of both lower limbs. He was initiated on low molecular weight heparin and aspirin. Later on the same day, he had sudden deterioration in GCS and respiratory distress, associated with tachypnea, tachycardia and developed petechial rash over his chest. Neurological examination showed weakness of all 4 limbs, power on left (grade 1/5) and on right (grade 4/5) with hypotonia. Repeat MRI brain showed star field pattern of hyperintensities suggestive of fat embolism in the setting of hypertriglyceridemia and acute pancreatitis.
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Dr.RR, 50-year old person with diabetes for 5 years presented to the hospital ER with low urine output for 5 days and drowsiness. There was no history of fever, loose stools, vomiting, chest pain, breathlessness or intake of NSAID’s. Clinically he was euvolemic with a stable hemodynamic state. Investigations revealed that he had severe renal failure (urea 200 mg % and creatinine 7.5 mg %) with normal-sized kidneys on ultrasonogram. His blood sugars were marginally high ( 275 mg / dl), and cardiac evaluation was normal. Urine analysis could not be done as he was anuric; the other investigations including electrolyte profile, CBC, liver function tests, and calcium were normal.

He was anuric and was taken on hemodialysis. His drowsiness reduced. His vasculitis workup – ANA, ANCA, and anti GBM antibodies were negative.

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ABSTRACT
Retroperitoneal sarcomas are the common form of sarcomas in humans, yet vascular sarcomas arising from vessel walls are extremely rare. These vascular leiomyosarcomas [LMS] most commonly arise from IVC. IVC LMS constitutes only about 0.5 % of the soft tissue sarcoma in adults. Overall, IVC LMS is a very rare neoplasm contributing to less than 1 in 100,000 adult malignancies. The goals of management include achieving R0 resection, restoring the patency of IVC, and reducing local recurrence rate by addition of the most effective adjuvant therapies. Complete surgical resection offers the greatest 5-year survival rate that ranges between 30 and 70%. We report a case of IVC LMS in a 56-year-old female and its management, to highlight the importance of this rare yet aggressive malignancy and review the literature.
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ABSTRACT
The chronic mesenteric ischaemic disease is becoming commonplace in the Indian scenario along with coronary arterial disease, peripheral vascular disease, and carotid arterial stenotic disease. Here we present a case of a 68-year-old lady who presented with abdominal pain and “food fear”. She had a loss of appetite and weight over a period of nine months. Ct angiogram carried out revealed a “shaggy” atherosclerotic aorta with bilateral renal artery stenosis and stenosis/occlusion of all three mesenteric vessels. She was diagnosed to have chronic mesenteric ischaemia and underwent an open retrograde ileo-mesenteric bypass. Post-operative period was complicated by paralytic ileus, and she developed unstable angina which was managed medically. She recovered well and was later discharged on the 9th post -operative day. She is doing well six months post-surgery.
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Clinical History – 68 years old female presented with acute onset of altered sensorium. No history of fever or seizures.
Imaging findings – Cortical thickening with T2/FLAIR hyperintensity in the right medial temporal lobe which shows increased signal on DWI and no signal loss in ADC–Limbic Encephalitis.
CSF analysis was aseptic. Patient is a known case of CA Breast, post MRM status, hence diagnosis of paraneoplastic limbic encephalitis was made.
Discussion:
The term “autoimmune encephalitis” generally refers to a family of closely related disease processes that share overlapping clinical features and neuroimaging findings but are ultimately differentiated by the specific antibody subtypes driving the underlying immune-mediated attack on different CNS structures.

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We present an interesting case of peripartum cardiomyopathy
successfully managed at our hospital.41 years old unbooked 32weeks primi came to our emergency around 5am with severe breathlessness on rest. Breathlessness for 2days, generalized edema worsening for past 2weeks but no history of fever and cough, no previous history of any heart disease. She’s not able to lie flat. Patient was diagnosed to have high blood pressure two days back and was prescribed oral anti hypertensivemedications.we had a double challenge in front of us, a precious child and a unbooked mother in heart failure who is just in end of second trimester. Patient Pulse rate- 134/ minute, blood pressure -180/110 mm of Hg , RR 32/min. Spo2 – 92 in room air, 96 with 4litres of face mask oxygen. Lung Ultrasound showed extensive B lines bilaterally and basal pleural effusion.

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