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Nephron Sparing Surgery in Renal Tumors : A Case Report A 69 yrs old male presented to our OPD with h/o left sided varicocele. A known case of Diabetes, hypertension and bilateral medical renal disease, he underwent MRI abdomen which revealed a large lower pole lesion in left kidney with no renal vein or IVC thrombus. DTPA Scan revealed a 61% function in the affected kidney. Due to his bilateral medical renal disease and poorly functioning contra lateral kidney, he was planned for Nephron Sparing Surgery / partial nephrectomy (L) and DJ Stenting under cold ischaemia. Post op patient initially showed a rise in creatinine levels which gradually settled down to pre operative levels. Before we go into the discussion of partial nephrectomy or nephron sparing surgery (NSS) in RCC, I would like to emphasize on the presenting complaint. Varicocele in the left side is one of the presentation of Left sided kidney mass, which occurs due to the drainage of the gonadal vein into the renal vein on the left side and generally indicates tumor thrombus in the venous system renal/ IVC, however in this case it was because of compression of left gonadal vein by the renal mass. Renal tumors comprise approximately 3.8% of all new cancers with median age at diagnosis of 64 yrs. It is the third most common urological malignancy. The rate of RCC has increased by 1.6% per year for last 10 yrs, the reason of which is unknown. Majority of them are renal cell carcinomas and 80% of them are clear cell variety. Smoking and obesity are high risk factors of RCC. Some genetic diseases are also associated with RCC, like Von Hippel Lindau (VHL) disease. At presentation 25% are locally advanced. More often patient presents with metastatic disease (20%) . Only a few patients present with Virchows Triad - the 'too late triad' ( of hematuria, abdominal pain and flank mass). A CT Scan or MRI of the whole abdomen including pelvis clinches the diagnosis. A NEEDLE BIOPSY IS NOT NE

Viral gastroenteritis, also known as stomach flu, is an inflammation of the mucous coating of the stomach and intestines caused by certain groups of viruses. They settled in the epithelial cells of the mucosa, where they multiply and cause damage to the normal structure and function. The stomach flu is a highly infectious and very common - every year there are tens of millions. Rotavirus. Rotaviruses are the leading cause of stomach flu in infants and young children. Incubation was continued for 1 to 3 days. Usually, the infection is accompanied by watery diarrhea, vomiting, fever and muscular pain for 3 to 7 days. Rotaviruses can infect and adults in contact with the ailing child. In adults, the stomach flu symptoms less severe. Calicivirus. Cause infections in people of all ages. Noroviruses are the most common calicivirus and the most common cause of stomach flu in adults. often reaching epidemic. Usually epidemics broke out from October to April, but are possible at any time of year. Typical stomach flu symptoms include nausea, vomiting, abdominal pain, fatigue, headache and muscle aches. The symptoms started 1-2 days after contact with the virus and still 1 to 3 days. Adenoviruses. Mainly infects children under 2 years. There are 49 types of adenoviruses, one of which affects the gastrointestinal tract and causes nausea and diarrhea. The incubation period is 8-10 days and symptoms persist between one and two weeks. Adenoviral infections may occur at any time of year. Astroviruses. Infect mostly infants and children less adults. The symptoms are watery diarrhea and vomiting, continuing for up to one week, and appears after an incubation period of 3-4 days. Symptoms were less severe than Norovirus or rotavirus infections. Astroviruses stomach flu are most common during the winter months.

"Dr. Jodie Burton is the acting principal investigator (PI) of the dose-escalation trial of oral vitamin D3 with calcium supplementation in patients with multiple sclerosis with Dr. O'Connor. She started the trial as his fellow, while doing an additional 2 years of training in MS specifically after she received her neurology certification. She completed her fellowship training in 2007. Now she is staff doing clinical research and continuing with the vitamin D trial. As of August 2009, she will be Assistant Professor in Neurology in the Department of Clinical Neuroscience in Calgary and at the University of Calgary. She will be part of the MS team there with Dr. Luanne Metz and the MS group. Please scroll down for an abstract of the trial: A Phase I/II dose-escalation trial of oral vitamin D3 with calcium supplementation in patients with multiple sclerosis." Conclusions: High-dose VD3 (~10 000 IU/day, possibly higher) in MS is safe and tolerable, with evidence of clinical improvement.

"April 28, 2009 (Seattle) -- High doses of vitamin D dramatically cut the relapse rate in people with multiple sclerosis, a study shows. Sixteen percent of 25 people with multiple sclerosis (MS) given an average of 14,000 international units (IU) of vitamin D a day for a year suffered relapses, says Jodie Burton, MD, a neurologist at the University of Toronto. In contrast, close to 40% of 24 MS patients who took an average of 1,000 IU a day -- the amount recommended by many MS specialists -- relapsed, she says. Also, people taking high-dose vitamin D suffered 41% fewer relapses than the year before the study began, compared with 17% of those taking typical doses. People taking high doses of vitamin D did not suffer any significant side effects, Burton tells WebMD."

Thanks! I think, almost every vitamin taken in high doses can lead to health issues. Personally I prefer double checking the information about the medications (including vitamins and supplements).