Fallot's tetralogy. Its occurrence with absent pulmonary valve and sinus of Valsalva aneurysm in an adult

A patient with a right aortic sinus of Valsalva aneurysm, Fallot's tetralogy, and pulmonic valve absence survived into adulthood without surgical intervention.     

Salicylate toxicity masquerading as malignant hyperthermia

We report a case of hyperpyrexia presumed due to topical salicylate toxicity occurring immediately following general anaesthesia for appendicectomy in an eleven year old boy. Some of the features strongly suggested the diagnosis of malignant hyperpyrexia.     

The treatment of a hyperandrogenic and virilizing state in an elderly female with a synthetic LHRH agonist

A case of hyperandrogenism and virilization is described in an elderly female. She had elevated testosterone levels, but normal DHEAS and 24-h urinary 17-oxosteroid excretion, suggesting an ovarian tumor. Stimulation and suppression tests, and radioisotopic and radiological scans proved unhelpful in the diagnosis although hyperthecosis of the ovary was later suggested by ultrasound. Testosterone and gonadotropin levels fell during therapy with cyproterone acetate and subsequently ethinyl estradiol. Because of side effects encountered on these drugs, she was treated with a synthetic, slow-release preparation of an LHRH agonist, D-TRP-6-LHRH (Decapeptyl), with symptomatic and biochemical improvement. Long term LHRH agonists might be a valuable treatment for hyperandrogenic states in elderly patients.     

Oral bromazepam in premedication. A comparison with diazepam

Bromazepam, a relatively newly benzodiazepine with marked anxiolytic effects, was compared in a randomised, double-blind manner with diazepam for its effectiveness as an oral premedicant drug. A scoring system was used to assess sedation, relief of anxiety, nausea, and cardiovascular effects in two groups of women having gynaecological operations. No difference was demonstrated between the effectiveness of the two drugs.     

BILATERAL BREAST METASTASES FROM A RENAL CARCINOMA

SUMMARY Metastatic involvement of the breast is rare. The commonest cause is spread from a contralateral breast carcinoma. However, metastatic malignant melanoma, lymphoma and lung carcinoma have all been reported sporadically in the literature. Renal carcinoma is well recognised for its protean clinical manifestations ranging from loin pain, haematuria and an abdominal mass to less obvious metastatic effects such as pathological fracture of a long bone or one of a variety of associated paraneoplastic syndromes. We present a case of a renal carcinoma presenting with bilateral breast masses with literature review, and discuss the efficacy of the standard gamut of investigations in a breast mass of non-primary origin.