Background: Neuroendocrine tumor of the appendix is a rare neoplasm discovered only incidentally. They are mainly found in the histological examination of appendices operated due to acute appendicitis. The treatment is essentially surgical, and depending on the size of the lesion, it can range from a simple appendectomy to right hemicolectomy. Case presentation: In our work, we report the case of a neuroendocrine tumor of the appendix in a 15-year-old female patient admitted for symptoms of acute abdominal pain. She was diagnosed with appendicular peritonitis and admitted to the surgical unit. The anatomopathological examination of the vermiform appendix obtained after appendicectomy showed a histological aspect of a neuroendocrine tumor. Conclusion: We recommend that appendectomy specimens be routinely sent for pathological examination malignancy and NETs, may be missed without histopathological examination.

Coronary artery disease is a complex syndrome to get initiation from formation of atherosclerotic plaques in systemic circulation to cardiac arrhythmia causing morbidity/mortality. This study was conducted to compare hypolipidemic effects of Niacin and Indian date (Jujuba) in hyperlipidemic patients. Study was conducted from July 2019 to December 2019 at National Hospital Lahore-Pakistan. Sixty participants were enrolled of both gender male and female patient’s age range from 25 to 60 years. Consent was taken from all patients. They were divided in two groups. Group-I was advised to take 2 grams Niacin in divided doses for the period of two months. Group-II was advised to take 500 grams of fruit Jujube daily for the period of two months. All patients’ systolic and diastolic blood pressure was noted. Their baseline LDL and HDL cholesterol was determined by conventional method of measuring Lipid Profile. After two months therapy, their post treatment blood pressure and lipid profile was measured and mean values with ± SEM were analyzed biostatistically. Group-I which was on Niacin their blood pressure was reduced but it was non-significant change, LDL cholesterol decreased significantly and HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was decreased significantly but HDL increase was not significant with p-value of >0.05. It was concluded from the research work that Niacin is potent in lowering LDL and increasing HDL cholesterol, while Jujube has significant effect as LDL cholesterol lowering potential, but it does not increase HDL cholesterol significantly. Jujubes and vitamin B-3 did not reduced blood pressure, when analyzed statistically.

Hyperglycemia, hypertension, and hyperlipidemia are known as metabolic syndrome. In presence of high levels of blood LDL particles, free radicals (ROS), macrophages, cytokines, platelets, histamine, 5HT get involved in LDL oxidation, leading to formation of atherosclerotic plaques which get deposited in endothelium of coronary arteries causing coronary artery disease (CAD). Psyllium fibers and Ficus Carica (FC) are being considered to be useful in treating hyperlipidemia, hypertension, and hyperglycemia. This study was conducted to determine hypotensive, hypolipidemic, and hypoglycemic potential of Psyllium husk and FC. Study was conducted in National hospital, Lahore, Pakistan from January to April 2020. Seventy five hyperlipidemic, hypertensive and diabetic patients were enrolled selected from the hospital with their consent. They were divided in three groups ie 25 patients in each group. Group-1 was on placebo, group-2 was on 15 grams psyllium husk to be used in three divided doses. Group-3 was on 12 grams FC to be taken in three divided doses daily for two months. Their Lipid profile, FBS, and hypertension were determined before and after two months therapy by these two agents. Two analyze data we used SPSS version 10.01.001 2015 and t test was applied to determine changes in the tested parameters. In two months therapy by psyllium husk in 24 patients TG, TC, LDL-c was reduced 21.48, 10.09, 24.17 mg/dl respectively. HDL was increased 12.38 mg/dl in this group. FBS reduction was 28.66 mg/dl, systolic BP 6.30, and diastolic BP reduced in this group 7.52 mm of mg. We then concluded that FC and PH have good enough potential to normalize lipid profile, reduce BP, and FBS in patients suffering from metabolic syndrome.

Cystic lymphangiomas are benign tumors of the lymphatic vessels. It is characterized by its clinical polymorphism. Its retroperitoneal localization is rare. Its diagnosis relies mainly on imaging but needs histological confirmation. Its treatment is surgical. It can have an adverse evolution, especially when its volume causes compressive complications. We report the case of a 65-year-old male patient who presented abdominal distension and pain, whose abdominal scan showed a voluminous retroperitoneal mass. The interest of our case resides in the impressive volume of the tumor, its expressive scanographic semiology and its favorable evolution.

Introduction: Xanthogranulomatous pyelonephritis is a rare and unusual form of chronic pyelonephritis, characterized by the destruction of the renal parenchyma and its replacement by granulomas, abscesses and lipid-laden macrophage collections. Despite clinical and radiological knowledge, it remains a surprise for the surgeon. We are reporting through these two observations the diagnostic difficulties of this condition would lead to an inappropriate treatment as well as to a more severe disease. Observations: Two patients (52 and 57 years old), one of whom is followed fortype 2 diabetes mellitus , were hospitalized for pyonephrosis due to obstructive pyelic and ureteral lithiasis. The pyonephrosis was revealed by a chronic loin pain in a febrile context and confirmed by urogramme showing a destruction of the renal parenchyma, dilated pyelocaliceal cavities with rounded formations of pseudo-tumoral appearance on the lithiasis obstacles. Our initialtreatment consisted of percutaneous nephrostomy under antibiotic covering and secondarily of nephro-ureterectomy without bladder flange performed six weeks later. Histopathology studies showed diffuse xanthogranulomatous pyelonephritis. The postoperative follow up was simple in both cases. Conclusion: Xantogranulomatous pyelonephritis is a rare, severe and chronic form of pyelonephritis whose diagnosis is always histological. Its clinical picture is no specific, hence the problem is that it poses achalleng of differential diagnosis with renal tumors and urogenital tuberculosis. Its treatment is based on nephrectomy.

A renal artery aneurysm is a dilated segment of the renal artery that is larger than twice the diameter of a normal renal artery. Despite its rarity, the diagnosis and incidence of this entity have been steadily increasing as a result of the widespread use of cross-sectional imaging. Renal artery aneurysms can be clinically significant and potentially fatal in some cases. However, knowledge of their occurrence, natural history and prognosis, whether treated or not, is limited. We present a case of a renal artery aneurysm complicated by hypertension that did not respond to medical treatment and was treated with simple nephrectomy.

A 5-month-old male infant was admitted with the complaints of cough & fever for 18 days and respiratory distress for 4 days. He was febrile, tachypneic (RR-58/min) with SpO2 - 94% on 2 L/min with face mask with left sided restricted chest movement with diminished breath sound. Initially he was diagnosed as left sided pleural effusion. Chest x-ray was suggestive of encysted pleural effusion (left). CT of chest revealed collapsed left lower lobe with pleural effusion and inflammatory changes in left upper lobe. Per operative finding showed pleural thickening, adhesion of oblique fissure, and perforated lower lobe of left lung. And finally infant was diagnosed as ruptured lung abscess of lower lobe of left lung with empyema thoracis. The patient was managed with decortication with segmental resection, and inj. linezolid after getting C/S and recovered.