Situation

How do you manage the following situations ?

1 Diaphragm involved by big tumour, query lung or bowel liver metastasis

2 ACE inhibitors and Angiotensin II inhibitors and ACE levels in sarcoid

Opinion

Opinion

1 Diaphragm involved by big tumour, query lung or liver metastasis (previously had carcinomas of the colon)

A laparoscopy may help.

2 ACE inhibitors and Angiotensin II inhibitors and ACE levels in Sarcoid

ACE inhibitors and Angiotensin II inhibitors do not affect ACE levels in the lab, so have no effect on the diagnosis of Sarcoid.

3 Carotid disease pre thoracotomy

If symptomatic and severe stenosis then a carotid endarterectomy may be needed. Beware of cerebral metastasis masquerading as carotid disease, so do a CT head. Otherwise just keep the pressure up.