Two cases of subungual glomus tumor.

Glomus tumors are uncommon, small, painful, and usually benign hamartomas arising from the arterial end of the glomus body. They often present early in the subungual stage because of intense pain. Two female patients with subungual glomus tumor are reported here. The intense pain associated with this tumor had led to disuse atrophy of the upper limb in one case. Hildreth's sign and Love's test were positive in both, but imaging did not help in preoperative diagnosis. Tumors were resected by transungual approach, leaving a 3-mm-wide margin. There was no recurrence after 1-year follow-up in both instances.

Skin changes in internal malignancy.

BACKGROUND: Internal malignancies are accompanied by various skin changes which may be specific infiltrates or non-specific changes. This study is aimed at determining the frequency of such changes in malignant disease treatment center attendees in India. METHODS: A study of 300 confirmed cases of internal malignancy at a malignant disease treatment center was undertaken to evaluate these skin changes. Specific infiltrates were confirmed by histopathology. Statistical methods were employed to calculate significance in non-specific lesions by comparing with 300 controls not suffering from internal malignancy. RESULTS: Skin changes were present in 82 (27.3%). Cutaneous metastases were found in 19 (6.3%); non-contiguous in 5 (1.6%); contiguous in 14 (4.3%). Non-specific skin lesions numbered 74 (11.6%) in 52 patients. Statistically significant non-specific skin changes were acquired ichthyosis, herpes zoster and generalized pruritus. CONCLUSION: Metastases usually occurred late in internal malignancy (17, 5.6%) except in a case each of histiocytic lymphoma and non-Hodgkin's lymphoma (2, 0.7%) where the lesions preceded malignancy by 3 months and 1 month respectively. Contiguous nodules were a marker of relapse after surgery in 3 (1%).

HIV prevalence in patients with herpes zoster.

To monitor HIV seroprevalence and to determine the sexual risk behaviour of men with herpes zoster (HZ), a study was conducted from Jan 98 to Dec 99 among 115 men of 21 to 55 years of age suffering from HZ. The diagnosis of HZ was clinical and relevant investigations when indicated were carried out to exclude immunodeficiency state. None of the cases were on immunosuppressive drugs. All cases were tested for HIV by immunocomb method and if found positive were confirmed by Western blot assay. Out of 115 cases of HZ 11 (9.5%) were found to be HIV positive. 11 (10.8%) of HIV positive cases were 21-40 years of age. More than one dermatome was involved in 7 (63.6%) HIV positive and in 2 (1.9%) HIV negative cases. 2 HIV positive cases had multiple cranial nerve involvement and one had generalized HZ. None of the cases showed evidence of progression to symptomatic HIV disease. Out of 11 HIV positive cases 9 (81.8%) gave history of multiple unprotected sexual exposures with female commercial sex workers and 2 (18.1%) with amateurs. None of our cases had used condom during sexual intercourse. None gave history of blood transfusion in the past or intravenous drug use.

Management of pemphigus vulgaris during acute phase.

We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7%) were young adults, 30-40 years of age. Fifteen (71.4%) were men and 6 (28.6%) were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10,000) and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50 mg/day and the dose was escalated to 100 mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptom-free. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20 (95%) had undergone clinical resolution of the disease. During follow up study 15 (71.4%) patients remained symptom-free and undergone clinical remission. Five patients (23.8%) had relapse, out of which 4 (19%) remained symptom free, after subsequent treatment. There was one death (4.7%) in our study.

Vitiligo: a study of 120 cases.

Vitiligo is a common pigmentary disorder and of major social and cosmetic concern in India. Purpose of the study was to find out age at onset and sex incidence in vitiligo, role of hereditary factors and associations with other diseases. 120 self reporting vitiligo patients attending out patient department of a service hospital were selected for the study and this data was analysed. In the present series out of 120 cases 62 (51.6%) were males and 58(48.35%)were females. There was practically no difference in sex incidence. The lowest age of onset was two years and the oldest was 65 years. In the majority of patients,52(43.2%), disease started before twenty years of age.8 (6.6%) cases gave definite family history of vitiligo. Exposed areas of the body were commonly affected in majority (66.6%) of cases. The legs were commonest site of involvement in 60(50%) cases. Circumscript type of vitiligo (46.6%) was heading the list. Majority of patients (56.6%) had multiple lesions. Diabetes mellitus was found in 2 (2.6%) patients. Cause of vitiligo is still idiopathic. Hereditary factors hardly play any role in manifestation of vitiligo.

A study of psoralen photochemotherapy with topical tar in the management of psoriasis vulgaris.

In a random study of 150 patients with psoriasis vulgaris, oral psoralen photochemotherapy using natural sunlight (PUVASOL) used alone was compared to PUVASOL plus adjunctive topical therapy with tar. The combined PUVASOL and topical therapy with tar in 75 patients (group-I) with 30 minutes sunlight exposure done in every alternate day showed complete clearing of lesions in 68 (90.6%) patients. The average rate of clearance of lesions started to appear 12-24 days with a mean of 18 days. Group I patients who received topical therapy in conjunction with PUVASOL, their skin lesions cleared more quickly with fewer treatments at a lower final 15 PUVASOL doses as compared to 22 PUVASOL doses in the control patients. Ninety percent of 51 patients using topical therapy on their scalp cleared their psoriasis in this area by the time their body psoriasis had cleared. Only 2 of the 45 (4.4%) patients with scalp involvement cleared receiving PU VASOL alone. All 7 patients with psoriatic arthritis cleared their psoriasis, but none of them noted any symptomatic alteration in the severity of their arthritis during the course of treatment in both the groups.

Investigation of malaria prevalence at National Thermal Power Corporation, Shaktinagar, Sonbhadra District (Uttar Pradesh), India.

Malaria in industrial complexes is promoted by extensive mosquitogenic potential generated by excavations and importation of parasite through migratory labor. The National Thermal Power Corporation (NTPC), Shaktinagar, Sonbhadra district was surveyed for malariogenic conditions from 1994 to 1996. The major mosquito breeding sites were drains, storm-water drains, lakes, outside tanks, overhead tanks, sluice-valve chambers, ornamental tanks, wells, pit wells and water reservoirs, etc. Anopheles culicifacies was the major vector of malaria in this area. Sibling species identification of An. culicifacies revealed that species C predominated during the transmission season and responsible to transmit malaria. Insecticide susceptibility tests against An. culicifacies sl showed that An.culicifacies population was 100% susceptible to malathion, fenitrothorn and deltamethrin while it was found 44% resistant to DDT. The malaria cases recorded in 1994, 1995 and 1996 were 847, 590 and 409 respectively. In vitro study on P. falciparum cases showed that 41, 70, 50% of the isolates tested were resistant to chloroquine in 1994, 1995 and 1996 respectively while an in vivo follow-up study showed 20-30% P. falciparum cases resistant to chloroquine. An integrated approach involving alternate vector control measures along with judicious use of insecticides has been suggested to bring down malaria in industrial complexes.

A clinicopathological study of multidrug therapy in borderline tuberculoid leprosy.

A study was undertaken to evaluate the efficacy of multidrug therapy as per WHO recommendation in 50 fresh cases (46 males and 4 females) suffering from borderline tuberculoid leprosy. All were given multidrug therapy consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for 6 months. At the end of 6 months all were evaluated clinically and histopathological examinations of the lesions were studied. The lesions were still active in 60% of patients clinically; 32% cases receiving multidrug therapy had shown marked improvement. Histologically lymphocytic infiltration in skin still persisted in all the slides examined and nerve infiltration was still present in 68% of cases at the end of 6 months after receiving multidrug therapy. The study shows that treatment with multidrug regimen for 6 months may not be sufficient to treat borderline tuberculoid leprosy cases.

A clinico-pathological study of macular lesions in leprosy.

One hundred twenty histologically confirmed cases of leprosy having macular lesions were evaluated clinically and histopathologically according to Ridley-Jopling classification. Of these 120 cases, the majority (91 or 75.8%) were young adults. The main clinical findings were: a single macule in 42 patients (35%), multiple macules 2-5 in numbers in 35 patients (29.1%), 6-10 macules in 17 patients (14.1%) and more than 10 macules in 26 patients (21.6%). Impairment of sensation over the macular lesions was present in 62 cases (51.6%), total loss of sensation was noticed in 31 patients (25.8%) and sensation was intact in 27 patients (22.5%). Acid-fast bacilli were detected in 11 cases (9.1%) by slit-skin smear examination. Clinical examination of the 120 cases revealed features of TT in 16 (13.3%), BT in 41 (34.1%), BB in 11 (9.1%), BL in 13 (10.8%), LL in 7 (5.8%) and indeterminate leprosy (IL) in 32 patients (26.6%). On the contrary, histologically there were 22 cases of TT (18.3%), 38 cases of BT (31.6%), 8 (6.5%) BB, 10 BL (8.3%), 7 LL (5.8%) and 35 cases of IL (29.1%). Histopathological features were consistent with the clinical picture in 84 patients (70%).

Evaluation of psoralen with solar ultraviolet light (puvasol) and adjunctive topical tar therapy in psoriasis.

Fifty patients having psoriasis were studied with a view to assess the efficacy of 'puvasol' (Oral psoralen with sun-rays exposure) alone and in combination with topical tar therapy and were placed in 2 groups, each group being consisted of 25 patients. At the end of 8 weeks, out of 25 patients (Group 1) receiving 'Puvasol' in combination with topital tar therapy 15 patients (60%) showed complete clearance, marked improvement of lesions were seen in 4 cases (16%) and deterioration in one case (4%). Out of 25 patients (Group I) receiving 'Puvasol' alone 8 cases (32%) showed complete clearance of lesions and 11 patients (44%) showed marked im-provement of lesions. It is found that topical tar therapy when used as an adjunct to 'Puvasol' was more effective than 'Puvasol' alone.

Indeterminate leprosy: a therapeutic evaluation.

Out of 50 cases of indeterminate leprosy, 46 were male and 4 were female. The only clinical finding was a single hypopigmented macule in 38 (76%) cases. Nine (18%) patients had two and three (6%) cases had three hypopigmented macules. All patients were treated with multidrug therapy for one year. At the end of six months, the lesions were still active in 12 (24%) cases. At the end of one year of treatment it was found that 33 (66%) patients became inactive and 3 (6%) cases were still to be active. The study shows that all indeterminate leprosy cases must be treated with multidrug therapy till all signs of activity are subsided.

Isolation, partial purification and pharmacodynamics of a slow contractile substance in the venom sac extract of the wasp Vespa cincta Fabr.

The venom of V. cincta contains acetylcholine (ACh), histamine and 5-hydroxytryptamine (5-HT). Blockers of these agonists did not block completely the hypotensive and smooth muscle contractile activity of venom. On smooth muscle, there was a residual slow contraction. The active substance which produced this slow contraction was separated by solvent extraction, gel filtration and TLC. The purified material (which has been provisionally designated "Vecikinin") lowered cat, rat and guinea pig blood pressure, increased amplitude of cardiac contraction, and increased capillary permeability. Vecikinin contracted several smooth muscle preparations (rat uterus, rat ascending colon, guinea pig ileum, guinea pig colon and rat ileum), while relaxing rat duodenum. Its contractile activity was not lost on boiling, but acid or alkali-boiling reduced its contractile activity. It was inactivated on incubation with chymotrypsin and carboxypeptidase but not with trypsin, pepsin or leucine aminopeptidase. It is a peptide, appears to be of low molecular weight, and could be distinguished from substance P, angiotensin, bradykinin and hornet or wasp kinin.

Clinico-histopathological study of multidrug therapy in indeterminate leprosy.

A study was undertaken in 42 patients with indeterminate leprosy to evaluate the efficacy of multidrug therapy (MDT) in Indeterminate leprosy for 12 months. The main clinical finding was a single hypopigmented macule in 31 (73.8%) of the 42 cases. Histopathologically all cases showed lymphohistiocytic infiltration around skin appendages and dermal nerves. At the end of six months of MDT all the cases were evaluated clinically and 33 (85.5%) showed marked improvement or total inactivation while the lesions were still active clinically in 21.4% cases. Histopathological examination of lesions in 30 patients showed complete histological resolution in 9 cases only. At the end of one year of treatment it was found that 28 cases (66.3%) had become inactive and only 2 (4.7%) were found to be still active.

Study of multidrug therapy in paucibacillary leprosy.

A study was undertaken to evaluate the efficacy of multidrug therapy (MDT) in paucibacillary leprosy. Out of 155 fresh cases studied 48 had indeterminate, 38 tuberculoid and 69 had borderline tuberculoid leprosy. Out of 155 cases, 64 patients in the first group were treated with dapsone 100 mg daily for 12 months. In the second group, 91 patients were given MDT, consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for consecutive 12 months. The cases receiving dapsone and the cases having MDT remained clinically active at the end of 6 months in 56.1% and 37.2% respectively; 13.1% of cases having single lesion and 66.3% of patients with multiple lesions were found to be active after 6 months of MDT. At the end of one year 79.6% cases receiving dapsone and 91.2% cases having MDT became inactive.

ELISA (enzyme linked immuno sorbent assay) as a diagnostic tool in retinoblastoma.

Estimation of retinoblastoma antigen by double antibody sandwich ELISA technique was carried out in 20 histopathologically confirmed cases of retinoblastoma, 20 cases of pseudoglioma and 20 normal cases. The method of detection was done on the lines of Voller et al. (1976) with slight modification. The number of seropositive cases was more in cases with retinoblastoma.

A clinico-pathological study of multidrug regimen in paucibacillary leprosy.

Preliminary results of a clinical trial in one hundred untreated paucibacillary leprosy cases with multidrug therapy (MDT) as per WHO recommendation are presented. Out of 100 fresh cases studied 18 had indeterminate, 35 tuberculoid and 47 cases had borderline tuberculoid leprosy. All were given MDT consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for six months. At the end of six months all the cases were evaluated clinically and histopathological examination of lesions were studied. The lesions were still active in 35% of patient clinically and 47% histologically. Complete histological resolution have come across only in 4 cases suffering from indeterminate leprosy. Altogether 65% cases receiving MDT have shown marked improvement to total inactivation. Histologically, lymphocytic infiltration still persisted in 90% of slides examined and nerve infiltration were still present in 64% of cases at the end of six months receiving MDT.