von Hippel Lindau syndrome is a rare genetic disease which may present with bilateral adrenal masses requiring surgical intervention. Previous practice at UP-PGH was to perform outright total adrenalectomy on pathologic adrenal glands and rely on lifelong steroid replacement for patients who had both adrenals removed. Presented here is a case of a patient diagnosed with von Hippel Lindau syndrome with bilateral adrenal masses, surgically managed initially with open adrenalectomy on the right side, followed by the first ever performed minimally invasive cortical sparing adrenalectomy at UP-PGH on the left side.
Adrenalectomy

Introduction: Ruptured mycotic aortic aneurysm is a rare and life-threatening condition. An early and proper initiation of antibiotics aside from aneurysmal repair is of paramount importance. The typhidot IgG and IgM may help with this dilemma, especially when the blood culture is negative and during the waiting period for the the aortic sample result. Case: A 47-year-old male Filipino with type 2 diabetes mellitus presented with severe back pain for one month and intermittent fever for three weeks. Complete blood count showed anemia and leukocytosis with predominance of neutrophils. On computed tomography of the aorta, a segmental calcification and wall discontinuity in the right posterolateral wall of the infrarenal abdominal aorta with heterogenous collection of blood in the retroperitoneal region was seen and aortic rupture secondary to mycotic aneurysm was considered. He underwent emergency abdominal aortic aneurysm repair with debridement, antibiotic lavage, aortoiliac grafting, anastomosis and omental packing. The typhidot IgG and IgM test was positive and was given ceftriaxone 2gm/IV every 24 hours for six weeks. Blood cultures did not reveal significant growth of any pathogen. The aortic wall culture showed heavy growth for salmonella species sensitive to ceftriaxone, confirming and guiding the management. He was then discharged improved. Conclusion A mycotic aneurysm secondary to salmonella should be one of the considerations in an adult male diabetic presenting with prolonged fever, abdominal and back pain with or without a tender pulsatile mass. The Typhidot test is an easy and affordable test that allows rapid detection of salmonella infection. Early surgical intervention and antibiotics are the treatment of choice
Aneurysm, Infected ; Salmonella

The chronic indeterminate phase of Chagas’ disease is asymptomatic despite positive test results for antibodies specific to Trypanosoma cruzi. CD62P-APC (P-selectin) and PAC-1 FITC (GpIIb/IIIa) may improve diagnosis as biomarkers of platelet activity. Nine asymptomatic seropositive subjects, previously untreated, were selected from a blood bank within a year of Chagas’ disease detection, in addition to a control group of four. All subjects were evaluated by flow cytometry for CD62P, PAC-1 and CD41, and in a complementary study, by Tissue Doppler Echocardiography for isovolumic relaxation times (IVRT) and E/A ratios. The subjects were classified as positive or negative for CD62P and PAC-1 by a cut off obtained from their mean±2SD. For IVRT and E/A ratios, cut offs were obtained from the American Society of Echocardiography and the European Association of Cardiovascular Imaging recommendations. Fisher’s exact test was used for associated findings. Pre-test and post-test probability, sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Abnormalities were expressed as platelet hyperactivity and ventricular dysfunction in CD62P, PAC-1, IVRT and E/A ratios. CD62P appears to have greater sensitivity (0.75) and PAC-1, more accurate specificity (0.75), which may explain thrombotic events in Chagas’ disease. We recommend the use of CD62P and PAC-1 as biomarkers of platelet hyperactivity in patients in the chronic indeterminate phase of Chagas’ disease.