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.

Evaluation of Adenosine Deaminase (ADA) Activity for Diagnosis of Tubercular Pleural Effusion.

To find out a sensitive and specific marker for early diagnosis of tubercular pleural effusion, this cross sectional study was carried out in the of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka. One hundred and three pleural effusion cases were enrolled in the study. Out of the 103 cases, 62 were tubercular pleural effusion cases and 49 were nontubercular cases. Among the nontubercular cases, 30 cases were due to malignancy, 8 were due to pneumonia and rest 3 cases were due to nephrotic syndrome, congestive cardiac failure and rheumatoid arthritis. Considering 40 U/L as a cut off value for ADA level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specificity of the test to 88%. ADA levels were significantly higher in tuberculous than in nontuberculous cases (p value <0.001). It may be concluded that ADA levels are significantly high in patients with tuberculous pleural effusion compared to that in non-tubercular group. Sensitivity (94%) and specificity (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of tubercular pleural effusion (TPE) which, in addition, can be made quickly in a noninvasive way.

Scanning electron micrographs of medically important dust mite, Suidasia pontifica (Acari: Astigmata: Saproglyphidae) in Malaysia

Scanning electron microscope (SEM) images of dust mites, Suidasia pontifica, is presented to provide an improved visualization of the taxonomic characters of these mites. Suidasia pontifica can easily be identified by its scale-like cuticle, presence of external vertical setae (ve), longer external scapular setae (sce) compared to internal scapular setae (sci) and 3 ventral spines on apex of tarsus I. The differences in morphology of male and female S. pontifica are also discussed.

Role of rosiglitazone in induction of ovulation in obese women with polycystic ovary syndrome and insulin resistance

To evaluate the role of rosiglitazone in treatment of obese polycystic ovarian women with insulin resistance and its effect on ovulation induction and pregnancy outcome together with looking for any synergistic effect of metformin when combined with rosiglitazone. Double blind, randomized, prospective, placebo-controlled trial. Kasr El-Aini Teaching Hospital Cairo University, Egypt. 75 obese women with PCOS and insulin resistance. Patients were divided into three groups with 25 women each. During the first month, the first group received rosiglitazone alone, the second group received a combination of resiglitazone-metformin and the third group received placebo. All participants had a base-line measurement of total testosterone level together with and oral glucose tolerance test for determination of insulin resistance in terms of fasting glucose and insulin and peak insulin levels. Ovulation was then induced for all patients using CC and HMG for one month while continuing the original medication. Re-assessment of total testosterone level and fasting glucose and insulin was then done at the end of the two months study period. Primary outcome measures are changes in serum total testosterone level and in measures of insulin resistance. The secondary outcome measures are the occurrence of ovulation and pregnancy rates. The two groups receiving insulin sensitizers showed marked improvement in insulin resistance. However, no improvement in hyperandrogenemia was elicited which may be due short duration of exposure. They also demonstrated high ovulation and pregnancy rates with a significant difference compared to the placebo group. These findings suggest that short-term rosiglitazone therapy is effective in improving insulin sensitivity and patient's response to induction of ovulation in obese PCOS cases with insulin resistance. Furthermore, combination of metformin-rosiglitazone did not prove superiority over the use of rosiglitazone alone

Evaluation of the MAST CLA allergy system for diagnosis of allergies to house dust mites and cats.

The MAST CLA system was evaluated against skin prick test (SPT) for diagnosis of allergies to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cats. Forty three asthmatic children were examined by SPT and MAST CLA. Chi-square analysis indicated significant association between SPT and MAST CLA results for the house dust mites but not for cats. The sensitivities of MAST CLA for house dust mites and cats were 100 and 25% respectively; specificities were all less than 50%. The efficiency of MAST CLA for detection of allergy to the house dust mites was 88% and 44% for cats. A significant linear correlation was found between SPT wheal size and MAST CLA grade for D. farinae but not for D. pteronyssinus and cats. It is concluded that the MAST CLA allergy system can be used to supplement SPT for diagnosis of allergies to house dust mites but not to cats.