Case Studies by Kmc Class of ’64

By Kanakadurga R. Poduri MD FAAPMR

This book is a compilation of case studies contributed by the members of the class of 1964 from different specialties.

Dr. Kanakadurga R. Poduri, Professor & Chair of Physical Medicine and Rehabilitation (PM&R) at the University of Rochester Medical Center in Rochester, New York, USA and a member of the 1964 class of KMC has edited a volume rich with clinical insights about highly complex patients. The authors, all members of the same medical school class, have accumulated a vast collection of clinical experiences and expertise that they share with the reader in a precise and passionate way. Readers are not only exposed to rare conditions that present in other settings of the world, but also expand medical knowledge based on clinical data. Every contributor to this volume should not only be congratulated on celebrating their 50th anniversary, but also on their contributions to improving patient care and the rare insights they have shared with fellow physicians and interested readers. Dr. Poduris compilation of the case presentations is exemplary.
Elizabeth R. McAnarney, M.D. is Professor of Pediatrics and Chair Emerita
Department of Pediatrics, University of Rochester Medical Center
Rochester, NY, U.S.A


The case studies presented in this multi-authored book both stimulate and challenge students and practicing physicians to think broadly and creatively about achieving the best outcomes in patient care. It is frequently true that the most difficult situations and puzzling diagnostic dilemmas provide insight into better ways to treat the common cases. Dr. Kanakadurga. Rao Poduri has brought together a unique resource for those who wish to expand their clinical capabilities and to improve the lives of their patients.


Bradford C. Berk, MD, PhD
University Senior Vice President for Health Sciences
University of Rochester Medical Center
Rochester, New York

• Language: English
• Publisher: Xlibris US
• Release date: Sep 27, 2014
• ISBN: 9781499075076

Kanakadurga R. Poduri MD FAAPMR

Dr. Kanakadurga R. Poduri, Professor & Chair of Physical Medicine and Rehabilitation (PM&R) at the University of Rochester Medical Center in Rochester, New York, USA and a member of the 1964 class of KMC has edited a volume rich with clinical insights about highly complex patients. The authors, all members of the same medical school class, have accumulated a vast collection of clinical experiences and expertise that they share with the reader in a precise and passionate way. Readers are not only exposed to rare conditions that present in other settings of the world, but also expand medical knowledge based on clinical data. Every contributor to this volume should not only be congratulated on celebrating their 50th anniversary, but also on their contributions to improving patient care and the rare insights they have shared with fellow physicians and interested readers. Dr. Poduri’s compilation of the case presentations is exemplary. Elizabeth R. McAnarney, M.D. is Professor of Pediatrics and Chair Emerita Department of Pediatrics, University of Rochester Medical Center Rochester, NY, U.S.A The case studies presented in this multi-authored book both stimulate and challenge students and practicing physicians to think broadly and creatively about achieving the best outcomes in patient care. It is frequently true that the most difficult situations and puzzling diagnostic dilemmas provide insight into better ways to treat the common cases. Dr. Kanakadurga. Rao Poduri has brought together a unique resource for those who wish to expand their clinical capabilities and to improve the lives of their patients. Bradford C. Berk, MD, PhD University Senior Vice President for Health Sciences University of Rochester Medical Center Rochester, New York

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Copyright © 2014 by Kanakadurga R. Poduri, MD, FAAPMR.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Rev. date: 09/25/2014

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Contents

Foreword

Preface

Acknowledgements

Introduction

1. Anti- N-methyl-D-aspartate (NMDA) receptor Encephalitis

Vijaya Radhakrishna (Bendigeri)

2. Antipsychotic-Induced Prolactinoma: Case 1

Vinaya Koppikar (Kumbla)

3. Antipsychotic-Induced Prolactinoma: Case 2

Vinaya Koppikar (Kumbla)

4. Breast Cancer: A Deadly Disease

Sharab P. Shettar, MBBS

5. Cancer of the Neck

Brian Tucker

6. Carcinoid Tumor Mistaken for Persistent Neurogenic Bowel Symptoms in a Patient with Paraplegia

Kanakadurga Rao Poduri

7. Cerebellar Stroke

Ratnaprabha Ugargol

8. Congenital Jejunocolic Fistula

Prakash Mahalingashetty

9. Dementia: Behavioral and Psychological Symptoms of Dementia (BPSD) Evidence-Based Management and Caregiver Burden

Gangolli, Vinod, MB, M CPsych (Eng)

10. Diabetes Mellitus and Its Prevention

Ulhas, Lad

11. Diffuse Alveolitis on a small dose of Penicillamine

Shettar, S. P

12. Drug-Related Lupus Misdiagnosed as Fibromyalgia

Kanakadurga R. Poduri

13. Fournier’s Gangrene

Brian Tucker

14. Heterotopic Ossification as a Complication of Toxic Epidermal Necrolysis

Charles J. Gibson

15. Hyperbilirubinemia

Vijaya Radhakrishna, (Bendigeri)

16. Hypercalcaemia and Phaeochromocytoma

Fairhurst, BJ, MD, FRCP; Sharab P. Shettar

17. Hypokalemic Periodic Paralysis

Sham Mangalvedkar

18. Late-Life Depression: Challenges in Diagnosis and Treatment

Gangolli, Vinod

19. Lymphoma

Ratnaprabha Ugargol

20. Metabolic Acidosis

Sham Mangalvedkar

21. Neurosyphilis

Sham Mangalvedkar

22. Obstructed Labour Due to Hydrocephalus

Usha Mohan (Rao)

23. Peters’ Anomaly

Vijaya Radhakrishna (Bendigeri)

24. Pheochromocytoma

Vijaya Radhakrishna (Bendigeri)

25. Polypoid Tumour of the Pericardium: A Previously Unrecognised Macroscopic Appearance of Metastatic Bladder Carcinoma

Gibbs, J. L.; Subbarao R., MS; Williams, G. J.

26. Primary Pleural Liposarcoma

Evans, A. R.; Wolstenholme, R. J.; Sharab P. Shettar

27. Repair of Total Anomalous Pulmonary Venous Drainage (TAPVD)In an Infant

Subbarao, R.

28. Spinal Cord Infarction with von Hippel-Lindau (VHL) Disease

Kankadurga R. Poduri (Ayyagari)

29. Uterine Rupture

Usha Mohan (Rao)

30. Weeping Dermatitis (Miracle of Sorts)

Chitguppi, V. R.

Dedication

To our teachers and mentors

for their commitment to excellence in education!

Authors

1. Chitguppi,V. R., MBBS, FCGP, FIAMS

Consulting Family Physician

102/3 Sarvoday Garden,

Pandurang Wadi,

Dombivli, East Mumbai,

Maharashtra, India

2. Gangolli, Vinod, MB, MRC Psch (Eng), FRCP (Can), DABPN andDSGP (USA)

Dean of Academics,

Department of Psychiatry,

Masina Hospital,

Maharashtra, India

3. Koppikar, Vinaya (Kumbla), MD

Staff Psychiatrist,

Monroe Clinic, 515 Twenty-Second Avenue,

Monroe, Wisconsin, USA

4. Lad, Ulhas, MBBS

General Practitioner

Backamans Bay, Hobart City,

Tasmania, Australia

5. Mahalingashetty, Prakash, MS, MD

Professor of Surgery

SDM College of Medical Sciences and Hospital

Manjushreenagar,

Dharwad, Karnataka, India

6. Mangalvedkar, Sham, MD

Private practice in internal medicine

Dallas, Texas, USA

7. Mohan, (Rao) Usha, MD

Online Consultant Gynecologist at DocEngage

E 503 Jacaranda Block, Brigade Millennium, J. P. Nagar,

Bangalore, Karnataka, India

8. Poduri (Ayyagari), Kanakadurga Rao, MD, FAA PMR

Professor and Chair, Residency Program Director, and

Medical Director

Department of Physical Medicine and Rehabilitation

University of Rochester School of Medicine and Dentistry

Rochester, New York, USA

9. Radhakrishna (Bendigeri), Vijaya, MD, FAAP

Pediatrician in Private Practice

155 Stelton Road,

New Jersey, USA

10. Shettar, S. P., MBBS, DTCD (Eng)

Consultant Chest Physician

Karnataka Cancer Therapy and Research Institute

Navanagar, Hubli,

Karnataka State, India

11. Subbarao, R., MS

Cardiothoracic Surgeon

Bangalore, Karnataka, India

12. Tucker, Brian, MBBS

Chief Medical Officer

Koomsong Tea Estate,

Doomdooma, Tinsukia District,

Assam, India

13. Ugargol, Ratnaprabha, MBBS, DA

General Medical practitioner

Cauvery Medical Centre

58E Cottage Beck Road,

Scunthorpe, DN16 1LE, UK

Only the class of ’64 is listed as authors. Coauthors are listed with the cases.

The names in parenthesis are the maiden names of the authors

Foreword

Congratulations to these alumni of what is now the Karnatak Institute of Medical Sciences, who began their medical studies some 50 years ago in 1964. These case studies are clear evidence of this group’s outstanding scholarship, clinical acumen, medical experience, and dogged determination to help their patients. The diseases discovered in these patients were clearly no match for these KIMS alumni.

I wholeheartedly endorse these case studies for medical students, residents and practitioners who want to improve their clinical skills. These cases demonstrate the importance of combining a thorough history with a skilled physical examination…and then with the appropriate lab tests and even surgeries…to make the right diagnosis.

I also began my medical studies in 1964. A lot has changed in 50 years…we now have computers, oral diuretics, cures for many types of cancer, etc. that we didn’t have in 1964. This exponential change in medical practice will continue for the foreseeable future, and requires that all physicians…regardless of age…continuously keep up to date. We must use these KIMS alumni as an example of and follow their practice of lifelong learning.

Again, my congratulations to the 1964 entering class of KIMS on this outstanding publication of case studies!

Randall L. Braddom, M.D., M.S.

Clinical Professor of PM&R and Medicine

Rutgers Robert Wood Johnson School of Medicine

Rutgers New Jersey Medical School

Preface

The year 2014 marks the fiftieth anniversary of the beginning of our medical education in 1964, which started at the Karnataka Medical College (KMC), now known as the Karnataka Institute of Medical Sciences (KIMS) in Hubli. We celebrate our golden jubilee reunion, which is a landmark in our lives. The class of ’64, as we fondly called ourselves, came from all parts of India and abroad. Our class had a special yearning for knowledge and was serious about learning. Our college started in 1957 and was one of the premier teaching medical colleges in the country, where we received our education in all important aspects of medicine. Our outstanding and dedicated teachers were trained both in India and England. The prestigious place and the teachers were instrumental to our learning for the practice of medicine.

We are thankful to our alma mater as we celebrate our golden jubilee reunion in Hubli in the college grounds. As we reconnect with this great place, we have decided to leave a legacy for our future medical students, residents, and practitioners by publishing a book, The Case Studies of KMC Class of ’64.

This book is a compilation of case studies contributed by the members of the class of 1964 from different specialties. Although the cases contain an abundance of clinical information, prior knowledge of the specialties is not needed to assimilate their contents.

These studies present a wide variety of usual and unusual cases. They are intended for medical students to stimulate their critical thinking and analytical skills required to diagnose and treat patients. They are very useful for postgraduates, junior practitioners, and faculty in academic settings. Senior professionals may find them interesting as well.

Many practitioners might have come across similar cases at some point, but reading them in a book written by those who experienced them firsthand can be educational and stimulating. The cases may challenge the reader to solve the clinical puzzles when patients present with unusual signs and symptoms not necessarily described in textbooks.

One of my case studies is about von Hippel-Lindau disease, and the term interestingly was codified as a disease entity in 1964 by Melmon and Rosen, the very year we started our medical education. And fifty years later, a case of von Hippel-Lindau disease is published in this book, Case Studies by KMC Class of ’64.

A case study is like a puzzle that has to be solved. The first thing to remember about presenting a case study is that it should have a problem for the reader to solve. Even if the readers cannot solve the clinical problem, the presentation itself keeps them engaged in the case and educates them.

Kanakadurga R. Poduri (Ayyagari)MD;FAAPMR

Rochester, NY USA

Acknowledgements

This book is the work of a number of dedicated physicians from the KMC class of 64. We express our gratitude to the patients from various places for their willingness to share their medical problems to educate the future generations in the medical profession. We thank the publishers of the following journals for granting permission to use the previously published cases: Archives of Physical Medicine and Rehabilitation, British Journal of Rheumatology, Indian Heart Journal, International Journal of Cardiology, Journal of Musculoskeletal Pain, Postgraduate Medical Journal and Thorax.

I would like to thank the contributors who helped me to compile these informative cases despite their busy clinical schedules and family commitments. Special thanks to my staff at the University of Rochester Medical Center in Rochester, New York and my family whose patience and continued encouragement which provided me the stimulus for fulfilling the goal to publish.

Finally, this publication would not have been possible without the financial support from the authors and some of the classmates.

Kanakadurga Rao Poduri (Ayyagari), MD; FAAPMR

Rochester, New York

Introduction

This book of case studies describes thirty interesting clinical scenarios from General Medicine, Neurology, Obstetrics and Gynecology, Oncology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry, and Surgery. The management of these cases varied based on the availability of resources, including complementary and alternative medicine approaches.

The cases presented here reflect the important and diverse experiences of the authors from the KMC class of ’64. The purpose of publishing these cases is to share them with our classmates and others and to highlight our fifty years of experience at our Golden Jubilee reunion.

As Deuteronomy Rabbah says, In vain have you acquired knowledge if you have not imparted it to others. The continuous pursuit of knowledge is crucial for the practice of medicine. We hope the reader will find in this book a wealth of knowledge that cannot be gained from textbooks alone. The Dalai Lama is quoted as saying, "Share your knowledge. It is a way to achieve immortality."

Like the rest of the class, the authors had the good fortune of serving patients in India, our country of origin, and also in the other parts of the world including Africa, Australia, Canada, United Kingdom, and the United States of America. A common theme here is that, no matter where the patients were encountered, the curiosity of these authors led them to think outside the box to solve these clinical puzzles. The foundation laid by our teachers at KMC (KIMS), our alma mater, was the cornerstone for our curiosity.

Kanakadurga Rao Poduri (Ayyagari), MD; FAAPMR

Rochester, New York

Case 1

Anti- N-methyl-D-aspartate (NMDA) receptor Encephalitis

Vijaya Radhakrishna (Bendigeri), MD, FAAP

Case History

A.K is a seventeen-year-old Indian female who presented to the office on May 17, 2013 complaining of intermittent headaches for the past five months. Headache located in frontal lobe, rated 7 out of 10 on a scale of 0 to 10 in severity, improves with sleep and ibuprofen (Motrin), lasts for approximately two hours, occurs once a week. Associated symptoms of photophobia and pressure around the eyes. No nausea and vomiting. Patient’s menstrual history: menarche at twelve. No dysmenorrhea. Menstrual cycle regular every four weeks and lasts for four days. Patient was born full term via spontaneous vaginal delivery. There were no major neonatal complications. Mother’s pregnancy was normal. Neuro-developmentally, is age-appropriate. Attends regular school and does well. Physical exam demonstrated significantly elevated BP of 148/96, obese with weight of 227 lbs.,