Successful treatment of inflammatory myofibroblastic tumor by surgical resection and radiotherapy: a case report

Inflammatory myofibroblastic tumor [IMT] is a tumor composed of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. The most common sites of involvement include the lung, liver and orbit, but it has been reported to occur in nearly every site of the body, including oral cavity and soft tissue. Although common in other sites, such a tumor in rarer location including inguinal region is likely to be missed/misdiagnosed and hence need to be reported. We present an unusual case of a 50 year old male with bilateral inguinal swelling attended our institute few days back with history of local excision twice, but still showing recurrence. He was treated by wide local excision with bilateral orchiectomy this time. Histopathological report revealed inflammatory myofibroblastic tumor with malignant transformation. Adjuvant radiotherapy was also given and patient taken in followup. At one year of serial follow-ups, the patient is disease-free both clinically and on investigations, indicating successful combined surgery and radiotherapy in the treatment of malignant IMT. IMT of the inguinal region is very rare. Its clinical presentation may resemble malignant tumor, so IMT should be kept as differential diagnosis. The recommended treatment is complete surgical resection with adjuvant corticosteroid. Adjuvant radiotherapy may be considered depending upon the location of the tumor

Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India.

BACKGROUND & OBJECTIVES: Irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. This study was undertaken to determine the rate and pattern of antimicrobial prescribing in patients with uncomplicated acute respiratory infections, fever and diarrhoea attending a few rural and urban health settings. METHODS: The study was done in primary and secondary health care facilities of public/government and private settings at four sites in India. Patients with fever, cough, diarrhoea or ear, nose or throat infections of < 7 days were included. Pregnant women, lactating mothers, infants, seriously ill patients and patients with bloody diarrhoea or purulent nasal or ear discharge were excluded. RESULTS: Overall antimicrobial prescription rate was 69.4 per cent (95% CI 67.1, 71.7). Wide variation was observed (Thiruvananthapuram 47.6%, Lucknow 81.8%, Chennai 73.1% and Vellore 76.5%). Physicians practicing in rural and public/government settings prescribed antimicrobials more frequently than those in urban and private settings (83.8, 81.9, 68.3 and 68.2% respectively). Antimicrobials were more frequently prescribed for patients presenting with fever. Highest rate was noticed for children aged between 6 and 18 yr. Patients of the high-income group received antimicrobials more frequently (72.7%). In both public/ government and private settings, for patients who purchased medicines, the rate was higher (82.4 and 68.9% respectively), vs. those receiving free medicines (70.2 and 46.2% respectively). Two third of all antimicrobials prescribed were penicillins and co-trimoxazole, and > 40 per cent of prescriptions from private sector were quinolones and cephalosporins. INTERPRETATION & CONCLUSIONS: Our findings showed that prescription of antimicrobials for acute respiratory infections and diarrhoea was extremely common and warrants interventional strategies.

Whole lung lavage: the salvage therapy for pulmonary alveolar proteinosis.

A 53-year-old school teacher presented with progressive exertional breathlessness and dry cough of three months duration. His diagnosis was confirmed as pulmonary alveolar proteinosis on open lung biopsy. In about three months, the disease progressed to life threatening respiratory failure. He was subjected to whole lung lavage (WLL) as a salvage therapy. The technical details of WLL performed on this patient are described. At six months follow up, he was clinically and functionally stable and leading a near normal life.

evaluation of the latest ADA criteria for screening and diagnosing gestational diabetes at a tertiary care hospital in the United Arab Emirates

The American Diabetic Association [ADA] has recently recommended lowering the cut-off values for the two-step oral glucose tolerance test [OGTT] used for screening of gestational diabetes. This study reports on the appropriateness of applying the latest ADA diagnostic criteria when screening for gestational diabetes mellitus [GDM] in a tertiary care facility in the United Arab Emirates. The study was carried out at Mafraq Hospital, Abu Dhabi, United Arab Emirates [UAE] between November 1999 and April 2001. A total of 889 pregnant women who underwent at least one test of the two-step OGTT were studied retrospectively for adverse maternal and fetal outcomes. Subjects were classified as GDM positive or negative by applying the old and the latest ADA criteria and the occurrence of adverse outcomes in the various groups was compared. Applying the latest ADA criteria with the two-step OGTT identified 11% and 17% more patients at risk for fetal and maternal adverse outcomes respectively. Advanced maternal age [> 30 years in our population], multi-parity [> 4] and obesity [BMI > 30] were associated with increased risk of being diagnosed as having GDM. Application of the latest ADA criteria to the two-step OGTT was determined to be appropriate for UAE pregnant women tested for GDM in the tertiary care setting. Older [age > 30 years], multiparous [parity > 4], and obese women [BMI > 30] were at greater risk of GDM diagnosis by the latest ADA criteria