Cutaneous lesions in colorectal carcinoma: a rare presentation

No abstract available.

Factors affecting the duration of phase I of dexamethasone - cyclophosphamide pulse therapy.

Background: The introduction of dexamethasone-cyclophosphamide pulse (DCP) therapy for the pemphigus group of disorders by Pasricha has revolutionized the therapy for pemphigus. There are very few studies regarding factors affecting duration of phase I of the DCP. Aims: Our purpose was to study the relationship between various factors and duration of the phase I. Methods: A retrospective study of 98 patients of pemphigus on Dexamethasone Pulse therapy was conducted. Patients were classified according to duration of Phase 1 as those with phase I less than 6 months and those more than 6 months and analyzed for variable factors affecting duration of phase I. Results: Disease severity in pemphigus significantly prolonged the duration of phase I of DCP. Longer duration was also observed in patients on concurrent oral steroid therapy (both statistically significant). Conclusion: The findings from our study help us to address patient expectations and apprehensions regarding duration of therapy. A detailed understanding of the various patient and disease related factors responsible for affecting Phase I duration will help in better management of the patient, and the disease.

An Interesting Case of Tuberculous Colitis Mimicking Crohn's Disease.

Intestinal tuberculosis is a rare disease in western countries and may mimic a variety of gastrointestinal disorders. Here, we report the case of a 29-yr-old male patient who presented with loose motions, loss of appetite and loss of body weight since two years. On colonoscopy transverse colon, ascending colon, caecum and ileocaecal mucosa was inflamed, swollen and showed multiple superficial longitudinal ulcerations. Crohn’s disease was suspected based on colonoscopic finding. However histopathological examination of biopsies from colonic mucosa then revealed caseating granulomas in the colonic mucosa typical for mycobacterium tuberculosis infection. Our diagnosis is supported by raised serum IgM levels.The patient responded nicely to antitubercular therapy. This case emphasizes the need to include intestinal tuberculosis in the initial differential diagnosis of ulcerative colorectal lesions.

Subungual hyperkeratosis nail biopsy: A better diagnostic tool for onychomycosis.

Background: Onychomycosis is one of the most common nail disorders. Mycological examination by potassium hydroxide (KOH) mount and fungal culture is the most commonly used diagnostic method. However, it is associated with a low sensitivity. Aims: To evaluate the technique of subungual hyperkeratosis nail biopsy in diagnosing onychomycosis in HIV-infected and immunocompetent adults and compare it with mycological examination. Methods: 34 HIV-positive patients who presented clinically with onychomycosis were recruited in the study from the beginning. There was no screening done for patients with onychomycosis. This has been clarified in manuscript under the heading of methods. Results: All the fungal cultures yielded dermatophytes correlating with the biopsy findings. Only hyphal form of fungus was detected in KOH examination, indicating it was not a contaminant. Clinical types of onychomycosis are stated in discussion. Conclusions: PAS stain of subungual hyperkeratosis nail biopsy was the most sensitive in the diagnosis of onychomycosis in both HIV-infected and non-infected groups.

Unusual Case of Sialoangiolipoma.

Sialoangiolipoma is extremely rare in adults. We report a case with an extremely unusual and atypical presentation of sialangolipoma of submandibular gland. The diagnosis of which is done on histopathology in a case with high index of clinical suspicion of pleomorphic adenoma.

Trigeminal trophic syndrome: A rare entity.

Trigeminal trophic syndrome is a rare condition resulting from self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The syndrome consists of a classic triad of anaesthesia, paraesthesia, and a secondary persistent or recurrent facial ulceration. We describe a 60 year-old woman who developed this syndrome as a sequel to the gasserian ganglion block for trigeminal neuralgia. She had also developed melasma within 1 year. A remarkable benefit was achieved by proper patient education and topical antibiotics which led to the healing of all ulcerations within 4 weeks. In the case reported here, the diagnosis of the trigeminal trophic syndrome was made primarily as a result of the physician's experience with the syndrome previously.

Penicillamine-induced elastosis perforans serpiginosa with abnormal "lumpy-bumpy" elastic fibers in lesional and non-lesional skin.

Four types of elastosis perforans serpiginosa (EPS) have been described in literature: 1) idiopathic EPS, 2) reactive perforating elastosis associated with connective tissue disorders, 3) in some instances of pseudoxanthoma elasticum (PXE), disease-specific calcified elastic tissue is extruded, producing a clinical picture indistinguishable from other types, may also be seen in patients undergoing hemodialysis and 4) EPS induced by long-term treatment with D-penicillamine is observed in patients suffering from Wilson's disease. Long term D-penicillamine therapy causes an alteration in the dermal elastic tissue. D-penicillamine induced EPS has a distinctive histopathologic feature - serrated appearance of elastic fibers due to perpendicular budding from their surface giving a "lumpy-bumpy" look. D-penicillamine induced elastic fiber alteration may not always manifest clinically as EPS. We report a case of D-penicillamine induced widespread alteration in skin elastic tissue with distinct histopathologic features.

Subcutaneous phaeohyphomycosis caused by cladophialophora boppii.

Subcutaneous phaeohyphomycosis is an infection of the skin and subcutaneous tissue, caused by dematiaceous fungi. An adult male presented with a history of multiple reddish nodules over the face and hands. Histopathological examination of the skin biopsies showed a dense granulomatous infiltrate of macrophages, containing intracytoplasmic basophilic bodies throughout the dermis. Gomori methenamine-silver stained sections revealed yeast cells within macrophages. Multiple cultures on Sabouraud's dextrose agar grew Cladophialophora boppii. The patient was treated with oral itraconazole for a year and the response monitored with dermal ultrasound. This is the first case report of subcutaneous phaeohyphomycosis caused by Cl. boppii in India.

Acroangiodermatitis of mali: A rare vascular phenomenon.

Acroangiodermatitis (synonym pseudo-Kaposi sarcoma) is an unusual, benign condition which clinically presents as purple-colored patches, plaques or nodules, mostly on the extensor surfaces of lower extremities in patients with chronic venous insufficiency and arteriovenous malformations. It resembles aggressive conditions like Kaposi's sarcoma and requires histopathological examination for its diagnosis. We report two such cases of acroangiodermatitis. Histopathology of both the cases showed dilated capillaries in the dermis with extravasated red blood corpuscles (RBCs), hemosiderin deposits, and hyperplastic granulation tissue. Both were treated with oral antibiotics and topical steroids. The ulcers showed a good response within 2 months of treatment.

Effects of radiation and alpha-tocopherol on saliva flow rate, amylase activity, total protein and electrolyte levels in oral cavity cancer.

OBJECTIVE: The objective of the present study was to evaluate early and late effects of radiation and a-tocopherol on the secretion rate of saliva and on selected saliva salivary parameters in oral cavity cancer patients. PATIENTS & METHODS: Eighty-nine histologically confirmed oral cavity cancer patients (OCC) were enrolled in the study. Resting whole saliva was collected before, during and at the end of the radiation therapy (RT) and simultaneous supplementation with alpha - tocopherol to the radiation treated patients (RT + AT). RESULTS: Salivary flow rate, pH, amylase activity, total protein, sodium and potassium were analyzed. Increased pH, potassium and decreased flow rate, amylase activity, protein content and sodium were observed in 6 weeks of radiation treated patients when compared to OCC patients. A significant improvement of those parameters was observed on alpha - tocopherol supplementation in RT + AT patients. CONCLUSION: Supplementation with alpha - tocopherol improves the salivary flow rate thereby, maintains salivary parameters.

Effect of alpha-tocopherol on pro-oxidant and antioxidant enzyme status in radiation-treated oral squamous cell carcinoma.

Objectives: The relationships between alpha-tocopherol, pro-oxidant and antioxidant enzyme status, and radiation toxicity were studied in stage II, III, and IVA oral squamous cell carcinoma patients. The low levels of malondialdehyde and increased activities of antioxidant enzymes were correlated with decreased oxidative stress by alpha-tocopherol in oral cancer patients treated with radiotherapy. The objective of the present study was to evaluate the effect of alpha-tocopherol on oxidant-antioxidant enzyme status in oral squamous cell carcinoma patients treated with radiotherapy. Materials and Methods: The study included three groups with histologically confirmed oral squamous cell carcinoma patients (untreated), and they were further divided into two groups, viz., one consisting of patients who underwent radiotherapy alone (radiotherapy was given at the dosage of 6000 cGy in five fractions per week for a period of 6 weeks); and the other group treated with radiotherapy plus alpha-tocopherol supplementation (alpha-tocopherol was supplemented at a dosage of 400 IU/day) for the entire period of radiotherapy. Results: A significant decrease ( P P Conclusion: It was seen that alpha-tocopherol played a role in protecting against the damage caused by irradiation in oral squamous cell carcinoma patients treated with radiotherapy, by enhancing the antioxidant enzyme status and reducing the pro-oxidant status.

Outcome of liver resection for liver tumours in children : an institutional review from a developing country

Availability of gadgets like Harmonic Scalpel allows liver resection to be performed with ease andminimal blood loss. The scenario is different in a developing country which lacks these modern gadgets. We present a review of our results of liver resection from a referral institute in a developing country. We reviewed children with liver resection done at our Institute from July 1999 - July 2006. Children with liver trauma and non operated tumour cases were excluded. Twenty one resections were carried out in 7 years; achieving a 68.4disease free survival rate. The most common presenting complaint was abdominal mass (19 /21-90). The majority (85; 18/21) were found to be malignant on histopathological examination. Anatomical resections were performed in 16 (85) children; 4 developed tumour recurrence; 3 with recurrence did not respond to second line chemotherapy and diedwhilewaiting for reoperation. One with recurrent liver tumour refused further treatment.Two (10)were lost to followup. Liver resections can be safely performed in the absence of the modern gadgets; although presence of such gadgets would facilitate resection in terms of operating time and blood loss

Photodynamic therapy in dermatology.

Photodynamic therapy is a new modality of therapy being used for the diagnosis and treatment of many tumors. It is now being increasingly used for skin tumors and other dermatological disorders. With its range of application it is certainly the therapy of the future. Its mechanism of action is by the Type II photo-oxidative reaction. The variables are the photosensitizer, the tissue oxygenation and the light source. It has been used to treat various disorders including Bowen's disease, actinic keratoses, squamous cell carcinomas, basal cell carcinomas, and mycosis fungoides. The side-effects are fortunately mild and transient. Newer photosensitizers like methyl aminolevulinate hold a lot of promise for better therapy.

Risk factors for esophageal cancer in Coimbatore, southern India: a hospital-based case-control study.

BACKGROUND: Cancer of the esophagus is common in India. The risk factors predisposing to cancer in southern Indian patients are not known. AIM: To determine the role of smoking, alcohol and their combination, and diet factors in the etiology of cancer of the esophagus. METHODS: Risk factors like alcohol consumption, smoking, tobacco chewing, and pre-illness diet details in 90 patients with cancer of the esophagus were compared with those in age- and sex-matched control subjects. RESULTS: The risk for esophageal cancer was 3.5 times higher with alcohol consumption, 2.5 times higher for tobacco users, and 2.8 times higher each for betel nut chewers and smokers. The calculated odds ratio for the social habits and diet factors was significant amongst cases of cancer esophagus. CONCLUSION: Alcoholism, smoking, and chewing of tobacco are factors predisposing to esophageal cancer in southern India.

Modulatory effect of quercetin on azathioprine induced membrane changes in the mouse spleen.

Modulatory effect of quercetin on azathioprine induced toxic changes was studied in spleen of experimental animals. Azathioprine treatment caused an increase in serum albumin/globin ratio and a decrease in total protein in spleen tissue. An increase in a membrane bound ATPases was also noted. Supplementation of quercetin with azathioprine increased the protein content and lowered the activities of membrane ATPase in spleen. There was a decrease in serum albumin globulin ratio. It was concluded that quercetin modulated the protein and membrane bound ATPase activities and protected the spleen from azathioprine induced membrane damage.

Histopathological and lipid changes in experimental colon cancer: effect of coconut kernal (Cocos nucifera Linn.) and (Capsicum annum Linn.) red chilli powder.

Influence of coconut kernal and red chilli on the metabolism of lipids was studied in animals given 1,2-dimethylhydrazine (DMH). The average weight gain by the animals in the coconut kernal group was more than DMH and chilli treated groups. The concentration of cholesterol showed a decrease and phospholipids an increase in most of the tissues studied, of the kernal groups. The cholesterol-phospholipid ratio was found to be increased in most of the tissues of all experimental groups, when compared to control animals. HMG CoA reductase activity decreased in the high fat and most of the tissues of the kernal + DMH, kernal + chilli and kernal + chilli + DMH groups, while it increased in the DMH, chilli and chilli + DMH groups. Histopathological studies showed that coconut kernal supplemented animals had fewer papillae, lesser infiltration into the submucosa and lesser changes in the cytoplasm with decreased mitotic figures. Coconut kernal, thus reduced the mutagenic and carcinogenic effect of chilli and DMH respectively.

Role of redchilli (Capsaicin) in the formation of colonic carcinoma.

The effect of feeding redchilli (Capsaicin) powder on the histopathological changes occurring in the colonic mucosa was studied in rats. These animals were compared with those treated with a colonic carcinogen 1,2-dimethylhydrazine (DMH). Animals fed with redchilli, dimethylhydrazine, dimethylhydrazine plus redchilli powder showed polyp and dysplasia, malignant tumour and malignant tumour with transitional area of dysplasia.

Influence of red chilli on lipids and bile acids in different tissues in experimental colon cancer.

Effect of feeding red chilli on the levels of lipids, fecal bile acids and fecal sterols was studied in animals given 1,2-dimethylhydrazine (DMH). When the three experimental groups were compared with control, the levels of cholesterol increased while phospholipids and free fatty acids decreased or showed no alteration in most of the tissues studied. Cholesterol-phospholipid ratio was high in both DMH as well as in the chilli + DMH treated groups. Weekly assessment of bile acids and neutral sterols showed a significant increase in all the three experimental groups, when compared to the control rats. Morphological and histopathological studies show that there were a number of visible malignant tumors in the colon and intestine of all the three experimental animals.