Benign paroxysmal positional vertigo

Findings & Diagnosis Please.

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M.65yrs. Cough with sputum Irregular fever 3 months

Diabetic gangrenous toe *Chief Complaints* Pain less Foul smelling toe with discolouration of toe *History* Known case of diabetic since 15 years history of Ingrowing toe since 15 years *Vitals* Stable *Physical Examination* Pain less toe with discolouration of toe *Investigations* Routine blood test all r stable for amputation *Diagnosis* Dry Gangrene *Management* Amputation

BILATERAL OVARIAN MASSES *Chief Complaints* 48 year old female presented with noticing mass per abdomen over a period of one year. Associated with abdominal discomfort. *History* Patient was case of previous one Caesarean section who presented with mass per abdomen for one year and abdominal discomfort . No bowel bladder disturbances. No history of distension of abdomen . No loss of weight. Patient was perimenopausal. *Vitals* Pulse 84/ min. BP 126/80 mmHg. *Physical Examination* Per abdomen there was mass palpable arising from pelvis arpund 26 weeks size of gravid uterus occupying hypogastric , right ileac fossa , right lumbar region and umbilical region. Vertical infra umbilical scar noted. No guarding / rigidity/ free fluid / tenderness Per speculum cervix vagina normal Per vaginal examination mass felt as felt in abdominal examination plus one more mass felt in pouch of Douglas around 8*8 cm. Appeared impacted in POD. *Investigations* CA 125 was 32. Ultraound showed bilateral ovarian masses Right side 18*15*10 cm and left side 9*8 cm. CECT abdopelvis showed same findings. *Diagnosis* Bilateral ovarian neoplasm *Management* Patient was taken for laparotomy and proceed. OT findings. Uterus normal size. Right side cystic mass around 20*18 cm. No surface excrescences. Capsule intact. No mural nodule. No solid areas noted. Left ovary normal. Left paraovarian cyst 8*8 cm with torsion along fallopian tube axis of two and half turns. No free fluid. Omentum, undersurface of diaphragm and liver normal. No palpable intra abdominal lymphadenopathy. TAH with Bilateral salpingo ovariotomy done.