Glanzmann’s Thrombasthenia is a rare clotting disorder caused by impaired platelet function. Lack of awareness of the appropriate management of rare medical conditions may lead to patient dissatisfaction and potentially poor treatment outcome.

Electric burns are known for non-healing and plastic surgeons face with difficulty in wound management. In chronic wounds there will be a lack of growth factors. Insulin therapy is a method of wound healing by stimulation of growth factors and provide growth factors for wound healing. In this study we have used topical insulin for wound bed preparation of patient’s electric burns wound.

The prevalence of non-Hodgkin lymphomas (NHL) involving the heart ranges between 9-24% [1]. and very rarely cases of primary cardiac Burkitt Lymphoma (BL) have been reported. We present a case of a 59 year old female patient that presented with exertional chest pain and palpitations. On admission she was noticed to be tachycardic. An EKG showed right axis deviation with signs of right ventricular hypertrophy. Pro-BNP came out 665 pg/ml and 3 sets of troponin levels were negative. A CT scan of the chest was negative for pulmonary embolism (PE) but revealed a nodular thickening of the atrial septum with right atrial extension encasing the right coronary artery. A CT scan of the abdomen and pelvis with IV contrast (figure 1) revealed several nodular foci scattered in the subcutaneous fat of the abdominal wall bilaterally including a 2.0 x 1.4 cm nodular focus involving the anterolateral right abdominal wall. An initial transthoracic echocardiogram (TTE) (figure 2) revealed thickening of the interatrial septum with a 3.6 cm x 2.6 cm mass protruding from the interatrial septum into the left atrium and a 3.1cm x 5.3 cm pedunculated mass protruding from the interatrial septum into the right atrium with significant obstruction within the right atrium identified by color flow Doppler.

Primary synchronous breast and renal cancer is very rare. Bladder, prostate, colorectal and lung cancer are the most common synchronous primaries with Renal Cell Carcinoma (RCC) identified till date. We found metachronous tumours of breast with RCC in literature search which included both metastatic tumours as well second primaries. In this study, we represent a case of synchronous ductal breast carcinoma and RCC which is very rare because most of the multiple malignancies reported in the literature are metastatic tumours or metachronous breast malignancy with RCC.

A 62 years old female with history of Combined Variable Immunodeficiency (CVID) complicated by colitis (managed by 9mg Budesonide by mouth daily) and refractory ascites secondary to non-cirrhotic portal hypertension (status post Transjugular Intrahepatic Portosystemic Shunt- TIPS 3 weeks prior) presented to the hospital with Hyperosmolar Hyperglycemic State (HHS). Her initial insulin requirements were high but improved after discontinuation of Budesonide. She was able to be transitioned to a sliding scale and discharged on Metformin. When taken orally, Budesonide is subject to high first-pass metabolism resulting in minimal systemic effects. Development of HHS and dramatic insulin requirements within 3 weeks of TIPS with drastic improvement following the discontinuation of Budesonide leads us to postulate that this was bypassed leading to steroid induced diabetes. This case beckons us to be mindful of procedures that alter drug metabolism and make necessary adjustments to prevent complications.