Large anterior abdominal wall fibrosarcoma in a known case of recurrent dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans is a rare soft tissue sarcoma of low to intermediate malignant potential. Incidence is estimated to be 0.8 to 4.5 cases per million persons per year. The tumor is highly aggressive locally and is known to recur. Punch biopsy or excisional biopsy (in case of small tumors) are diagnostic. Computer tomography (CT) and magnetic resonance imaging (MRI) are useful in determining the size and extent of the tumor’s treatment is primarily surgical, with a wide local excision with at 2 cm margin. However, local recurrence after apparently adequate surgical excision is common. Mohs micrographic surgery has been recommended as it enables maximum preservation of tissue. When surgery is insufficient, imatinib mesylate is shown as a safe and effective treatment in dermatofibrosarcoma protuberans (DFSP), especially in cases of locally advanced or metastatic disease. Here, we report a case of a giant fibrosarcoma on the anterior abdominal wall, measuring 27×18×9 cm, which occurred in a recurrent dermatofibrosarcoma protuberans. Diagnosis was done by histopathological examination (HPE) of the previously excised tumor and CT was done. The tumor was excised with a 3 cm margin and extensive reconstruction of the anterior abdominal wall defect was done using synthetic mesh, myocutaneous flaps and split skin grafting. Keeping in view the recurrent nature of our case, large tumor size, DFSP-fibrosarcomatous (FS) transformation and close negative margins in the HPE of the postoperative specimen, the patient was planned for adjuvant radiotherapy.

Sero-prevalence of HCV and associated infections with HIV and HBV among prisoners in Lahore

Hepatitis C Virus [HCV] infection and its co-infection with HIV or HBV is associated with an accelerated course of the disease and may result in more rapid progression of either or both, but knowledge on these dynamics in the imprisoned is scarce particularly in the developing world. Hence in this study we evaluated the prevalence of HCV infection and its associated co-infections with HBV or HIV in the prison population of Lahore. This was a descriptive cross-sectional study aimed to estimate the prevalence of HCV infection in prisons of Lahore [Pakistan] between May and November 2009. In this study, 4915 prisoners participated; 91.5% of them were males, and 8.5% females. Median age of prisoners was 28 years. Jail inmates were tested for serological markers-HBsAg, HCV antibodies and HIV antibodies-by chromatographic immunoassay. Initially reactive sera were retested for HBV and HCV with ELISA and for HIV with another rapid method. In total, 783 [15.93%] prisoners were positive for HCV and 105 [2.13%] of all prisoners were registered having co-infection with HIV, HBV or both. Among 783 HCV positive prisoners 72 [9.19%] had HIV co-infection, HCV/HBV co-infection was observed in 30 cases [3.83%] and triple co-infection [HCV/HBV/HIV] in three cases [0.38%]. The prevalence rate of HCV infection is quite high in the prison population of Pakistan and is mainly complicated with HIV co-infection. It is imperative that HCV, HIV and HBV prevention strategies be intensified in this community

Frequency of hepatitis B and C infections in the general population of Lahore, Pakistan

In the recent times, viral hepatic infections [HBV and HCV] have become common and the most important cause of liver disease. It is posing a great health problem especially in the developing world. The importance of hepatitis B and hepatitis C is illustrated by the fact that these infections are imposing a heavy burden on national economy and individual families due to considerable morbidity and mortality from both acute infection and chronic sequelae including chronic active hepatitis, cirrhosis and hepatocellular carcinoma. The present study was carried out to determine the frequency of HBV and HCV infections in the general population of Lahore and to highlight the magnitude of the problem. The study was conducted during the 'Free Hepatitis Camp' held at Services Hospital, Lahore - Pakistan for a period of one week from May 18 to May 25, 2007. It is a descriptive / cross sectional study. Blood specimens were collected using approved medical techniques and tested for HBsAg and anti-HCV on 3rd generation ELISA system. This study was conducted in the general population of Lahore and a total of 992 subjects were screened for both hepatitis B and C. Sero-positivity for hepatitis B and C were detected in 30.94% of the subjects. The prevalence of HCV among the total subjects studied was 21.7%, hepatitis B, 8.06% and hepatitis B and C [dual infection] 1.31%. Sero-prevalence in females and males of HBsAg was 1.61% and 6.45% and of anti HCV antibodies 10.38% and 11.19% respectively. It is concluded that about 1/3rd of the studied population is sero-positive for hepatitis B or hepatitis C or both infections and this figure is alarmingly high. It further concludes that the frequency of HCV infection is much more common than that of HBV. It raises concern about the increasing disease burden in future and effectiveness of preventive programs/methodologies. Practical implementation of recommended preventive measures in true sense is crucial to prevent or at least reduce the consequences of viral hepatitis in risk groups. There is considerable HCV and HBV threat to our population and require a genuine need for strict adherence to preventive measures

Pre-operative screening for HBV and HCV infections: a preventive measure! Where are we today?

Viral hepatitis B and C are common causes of chronic liver disease and a major public health issue all over the world. Chronic hepatitis B and hepatitis C infections are indolent, often subclinical diseases that may lead to cirrhosis and hepatocellular carcinoma after decades. In this study, our aim was to find out the frequency of HBsAg and Anti-HCV in the subjects planned to undergo eye surgery and to stress the importance of pre-operative screening by using cost effective immunochromatographic test kits. Subjects of both genders [n=6340] attending Madina Teaching Hospital, Faisalabad for ophthalmic surgery were randomly selected as study subjects and were screened for HBsAg and Anti-HCV during the pre-operative period. This study was conducted for a period of 27 months, in Faisalabad, Pakistan. Blood specimens were collected and tested for the qualitative detection of HBsAg and Anti-HCV in serum using simple, one step immunochromatographic assay. Our study was conducted in hospital based population and a total of 6340 subjects were screened for both hepatitis B and C. The carrier state of hepatitis was detected in 19.97% of the subjects. The prevalence of HCV among the total cases studied was 17.85%, hepatitis B, 1.35% and hepatitis B and C [dual infection] 0.46%. More than half [51.06%] of the adults: 60 years of age were HCV seropositive indicating a strong increase in the older age group. A higher percentage of male subjects showed positive results for HBsAg as compared to females but this difference was insignificant in Anti-HCV reactive subjects. This study concludes that frequency of HCV infection is quite high in the studied population and is much higher than that of HBV infection that is much lower in this population. Routine and preoperative screening for HBV and HCV infection can help reduction in transmission of infection. The simple and accurate ICT for HBsAg and Anti-HCV immunoassays provide a flexible, technically undemandable and relatively inexpensive approach to ensure a safer blood supply and pre-operative screening of surgical patients and donors