Brian Zeman is a medical specialist in Rehabilitation Medicine practising in Sydney. He completed his medical degree at UNSW and then specialist training with the ACRM becoming one of the first four graduates. The ACRM later became a Faculty in the RACP. He has presented papers overseas on various subjects and is involved in medical student teaching as Lecturer. As well he is Clinical Supervisor for specialist training in rehabiliation medicine. He has interests in neurological rehabilitation, burns rehabilitation and medicolegal reports.
Ms M is a 42 year old woman with cerebral palsy affecting her mobility and speech. She was independent in the community and\r\nworking. She also had unrelated chronic asthma and after an exacerbation was prescribed prednisone. She then developed\r\npsychosis gradually over four weeks. The prednisone was stopped and she was prescribed an antipsychotic. She then developed\r\nextrapyramidal reaction causing torticollis and limb spasm. The antipyschotic was ceased and she was prescribed Benztropine.\r\nShe did not improve and remained hospitalised. She had Botulinum toxin injections to the neck and later leg as well as extensive\r\nphysiotherapy with gradual improvement. There was some improvement but not to previous mobility levels. About two monhts later,\r\nshe again gradually developed psychosis with auditory and visual hallucinations. She had extensive investigations but there were no\r\nobvious causes. Management of the psychosis with medications has been difficult and she required admission to psychiatric unit to\r\nhave these monitored. Was the psychosis due to triggered by prednisone, related to her CP and immature brain or was it spontaneous\r\nand unrelated?
Faria Khan has done his M.B.,B.S. from University Of Health Sciences in 2011 at the age of 24. Now she is doing her post graduate residency from Chughtai Lab.\r\nin Histopathology
Primary neuroendocrine tumors of testis are less common accounting for <1% of all testicular neoplasms and even rare when arise\r\nin testicular teratomas. Herein, we present a case of neuroendocrine tumor arising in postpubertal teratoma in 32 year old male\r\nwho presented with complaints of abdominal swelling associated with history of undesended left testis. His serum levels of beta-\r\nHCG, AFP and LDH were slightly elevated. Later, left orchidectomy was performed. Macroscopically, a grey white well circumscribed\r\ntumor of 2.5x2.0x1.8cm within testicular parenchyma is identified. Histological examination of entirely submitted tumor reveals a\r\nneoplasm showing organoid arrangement of round blue cells with salt and pepper chromatin, rosettes formation and occasional\r\nmitosis. Features of mature teratoma were seen in background. No other germ cell component (choriocarcinoma, seminoma, yolk\r\nsac tumor and embryonal carcinoma) was noted. Immunohistochemistry reveal positivity for Synaptophysin and Chromogranin-A\r\nwith Ki-67 index of 3-20% which confirmed a well differentiated neuroendocrine tumor (Grade 2) arising in postpubertal teratoma.\r\nPrognosis of these malignant transformation depend upon stage of tumor, as teratoma with malignant transformation carry excellent\r\nprognosis following radical orchidectomy if confined to testis (Stage 1). Postpubertal teratomas are considered itself malignant with\r\nthe chances of metastasis at time of presentation, so close follow-up is advised so that earliest possible interventions could be done\r\nprior to advanced stage/metastasis for better prognosis and long term survival.