White End of Hairy Leukoplakia to the Dark End of Human Immunodeficiency Virus: A Diagnostic Challenge.

As commonly accepted hairy leukoplakia may be highly associated with human immunodeficiency virus (HIV) infection and may be the first sign of the infection. Even though it is highly associated with immunosuppression, the awareness of oral hairy leukoplakia became prevalent with the advent of HIV and AIDS and it became the first suspicious sign of HIV and later the hallmark of disease process. A 36-year-old male taxi driver presented with the complaint of deposits on his teeth. Medical history revealed chronic cough, weight loss, loss of appetite, recurrent episodes of fever since 1-year, which was not investigated. Examination revealed multiple palpable cervical lymph nodes with intraoral findings such as pigmentation on buccal mucosa, erythema of palate, non-scrapable and non-tender white patch on lateral border of tongue, papillary atrophy on the dorsal surface of the tongue, and gingival inflammation (Figures 1-3). Patient was referred to higher medical center for investigation where the patient was diagnosed as HIVpositive.

De Novos Presentation of Cannon’s Disease.

White spongy nevus (WSN) is a rare hereditary disorder belonging to genodermatosis with a suggested etiology as a mutation in a gene.1 Lesions usually appear in younger age which can be seen in any part of the oral mucosa.2 WSN can affect any mucosa in body with or without oral involvement. A 12-year-old female patient came to our department for dental evaluation. A general examination of body showed no abnormalities. The intraoral examination revealed generalized white patches in the oral mucosa with the wrinkled surface (Figures 1-4). The lesion was totally asymptomatic and the patient was aware of roughness in oral mucosa which she noticed from her childhood. There were no mucosal changes anywhere in the body. There was no history of a similar lesion in family members. An incisional biopsy was done from the buccal mucosa. Fromclinical and histopathological features, we arrived at a diagnosis of WSN.

Bisphosphonate-Associated Osteonecrosis of the Jaw Posing as a Diagnostic Tight Spot.

Clinical acumen is an acquired trait, something one gain by experience. Many a time one may not be able to explain how the correct diagnosis was given in some critical situations, and this is not accidental. It is the subconscious that analyses the previous knowledge and correlates with the current situation. Here is a case report, which underlies the need for theoretical knowledge to be support practical success and highlighting the need for updating. Even in the era of apps and androids one’s mind can work faster than all of these. A 60-year-old male patient was referred for dental consultation by a physician following bone necrosis of jaw bones. He had difficulty in having food as the exposed bone was chipping off, but pain was minimal. He had a history of multiple myeloma 10 years back which was treated by both radio and chemotherapy. Three years back another course of radiotherapy was given. The patient was currently on many medications. On examination, the patient was of average built and no specific findings were present on general and extraoral examinations. Intraoral examination revealed denuded necrotic bone bilaterally on the posterior aspect of both the jaws (Figures 1-3). There was practically no tenderness on palpation. The absence of signs of inflammation put us in a dilemma.

Painless Management of Speckled Leukoplakia using Cryosurgery.

Cryosurgery is a well-known and well-documented treatment modality in orofacial lesions since 1960. According to review of literature various studies has already proved the efficacy of cryosurgery in leukoplakia.2,3 Cryosurgery was done for a male patient of age 38 years who was diagnosed with speckled leukoplakia on the left buccal mucosa (Figure 1). Cryosurgery was selected because of patients fear for scalpel surgery. The Patient was treated in outpatient department using liquid nitrogen and cryogun. Liquid nitrogen was sprayed directly into lesion using cryogun till ice ball was formed in the lesion (Figure 2). There was no intra operative or post-operative pain during cryosurgery and no anesthetic agents were used during treatment. The patient was recalled after 7 days and intra oral examination revealed a healing ulcer formation in the area of treatment (Figure 3). There was no pain or any symptoms on the site of treatment. The patient was recalled after 15 days of treatment, which showed healed ulcer and areas of re-epithelization (Figure 4). Patient compliance toward the treatment was good. The patient was advised to do review after 1-month.

Tip of the Iceberg: The Dental Radiograph.

Most of the lesions involving the mandible are inflammatory or infectious or odontogenic or fibro-osseous lesions. Osteosarcoma of the mandible is comparatively rare and hence is not usually included in the primary differential diagnosis. A 66-year-old male patient came to oral medicine and a radiology department with a complaint of pain and swelling in the left lower jaw of 3 weeks duration (Figure 1). Medical history revealed chronic liver and respiratory diseases and personal history disclosed heavy smoking and alcohol consumption since 40 years. On extraoral examination, a diffuse hard swelling was present on left lower posterior region of the mandible with a step deformity in the lower border of the mandible.

For the old stones in the duct: do we need a new gold standard?

Sialolithiasis is not uncommon condition. Its historical roots can be laid back even to the writings of Oribasius. Over the years diagnostic and therapeutic modalities have changed. Currently there are many imaging modalities which can be used to detect sialolith and even 3D imaging is available. But for all practical purposes the conventional radiograph will suffice when the sialolith is in the anterior floor of the mouth.

Spontaneous tumour lysis syndrome associated with non-Hodgkin's lymphoma--a case report.

Spontaneous tumour lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, metabolic acidosis and hypocalcemia, that occur even prior to the treatment of a neoplasm. This rare occurrence was encountered in a patient with non-Hodgkin's lymphoma (NHL), of follicular cell type. Conservative but intensive treatment led to complete resolution. Subsequent chemotherapy was well tolerated.

Microsurgical anatomy of the middle cerebral artery.

BACKGROUND: The microsurgical anatomy of the middle cerebral artery (MCA) is of particular interest to the cerebrovascular surgeon. The purpose of this study was to define the microsurgical anatomy of the MCA and its various branches in the Indian population. METHODS: Ten MCAs were studied from five cadaveric brain specimens. The authors studied the outer diameter, length, branches, perforators and site of these on the main trunk (M1), the division of the main trunk, the secondary trunks and their various cortical branches using the operating microscope under 5-20x magnification. RESULTS: The outer diameter of the MCA main trunk ranges from 2.5 to 4 mm with a mean of 3.35 mm. The superolateral branches consisted of polar temporal artery and anterior temporal artery that had a common origin and sometimes the uncal artery or the accessory uncal artery. Perforators or lenticulostriate arteries were seen in the inferomedial surface all along the length of M1. Eight bifurcations and two trifurcations were noted. Cortical branches and their origin are discussed. CONCLUSION: Although the microsurgical anatomy of the MCA in Indian population correlated with the findings in the western literature, some structural and statistical variations were noted.

Oral health status of 5 years and 12 years school going children in Chennai city - An epidemiological study.

India, a developing country, faces many challenges in rendering oral health needs. The majority of Indian population resides in rural areas of which more than 40% constitute children. The purpose of this study was to assess the oral health status of 5 years and 12 years school going children in Chennai city. The study population consisted of 1200 school children of both the sexes (600 private and 600 corporation school children) in 30 schools, which had been selected randomly. The survey is based on WHO, 1999 Oral Health Assessment, which has been modified by including gingival assessment, enamel opacities/ hypoplasia for 5 years. Evaluation of the oral health status of these children revealed, dental caries is the most prevalent disease affecting permanent teeth, more than primary teeth and more in corporation than in private schools, thereby, correlating with the socioeconomic status. It may be concluded that the greatest need of dental health education is at an early age including proper instruction of oral hygiene practices and school based preventive programs, which would help in improving preventive dental behaviour and attitude which is beneficial for life time.

Supravalvular aortic stenosis and coronary ostial stenosis in homozygous familial hypercholesterolemia.

Patients with homozygous familial hypercholesterolemia exhibit severe hypercholesterolemia, cutaneous and tendon xanthomata, and premature atherosclerosis from childhood. A rare presentation of this condition with supravalvular aortic stenosis and coronary ostial stenosis is described.

Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: a transesophageal echocardiographic study.

BACKGROUND: The frequency of occurrence of left atrial thrombi, and the effect of anticoagulation in patients with rheumatic mitral stenosis and atrial fibrillation is not well established. This study was conducted to evaluate the occurrence of left atrial body and left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation, and to document the effect of long-term anticoagulation on clot dissolution. METHODS AND RESULTS: Consecutive patients with severe rheumatic mitral stenosis and atrial fibrillation were assessed by transesophageal echocardiography. Those with left atrial body or left atrial appendage clots were anticoagulated with oral nicoumalone. Transesophageal echocardiography was then repeated in patients on anticoagulation who were on regular follow-up, and in whom percutaneous transvenous mitral commissurotomy could be considered. Of the 490 patients studied, 163 had left atrial body or left atrial appendage clots. A repeat transesophageal echocardiographic examination was done in 50 patients who had optimal anticoagulation for a period of 6 months. Only 2 of the 17 patients who had left atrial body clots had successful clot dissolution after long-term anticoagulation, while the left atrial appendage clots disappeared in 31 of 33 patients (p<0.001). CONCLUSIONS: Left atrial clots are present in a third of patients with severe rheumatic mitral stenosis and atrial fibrillation. Isolated left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation can disappear with long-term anticoagulation, while thrombi that extend into the left atrial body may persist despite optimal anticoagulation.

Hirschsprung's disease associated with Ondine's curse.

This is a case report of a very rare combination of congenital aganglionosis of the intestine (Hirschsprung's disease) and congenital central hypoventilation syndrome-CCHS- (Ondine's curse). The combination is also called Haddad syndrome. In about 50% of the cases of CCHS there is associated Hirschsprung's disease. There are only about 48 cases reported worldwide. The disease has a very high mortality especially in the settings of a developing country.

Isolated symmetrical mediastinal lipomatosis.

Symmetrical mediatinal lipomatosis is a rare benign condition characterized by deposition of a large amount of mature adipose tissue within the mediastinum. Usually secondary to exogenous obesity, administration of steroids and Cushing's disease, it is more common in middle-aged males and is associated with alcohol abuse. Various other associations have been reported. CT and MRI can decisively diagnose this benign condition, which also helps in deciding treatment options. We present a case of a young female with a bizarre appearance on chest radiographs. Isolated, bilaterally symmetrical mediastinal lipomatosis was diagnosed on CT and MRI. The patient was thin and did not consume alcohol or steroids. Cushing's disease and other known associations were excluded.

Co-existing spinal cord and brain cavernous angiomas.

Cavernous angioma of spinal cord is an extremely rare vascular malformation. The association with brain cavernous angioma is even uncommon. There should be a high index of suspicion for a spinal cord lesion whenever a brain cavernous angioma is diagnosed, in cases with appropriate suggestive spinal symptoms. We present a case of cavernous angioma of the brain involving the genu of the corpus callosum, co-existing with spinal cord hemangioma. Involvement of the corpus callosum by a cavernous angioma is also uncommon. Intraventricular extension of this lesion was also detected.

Intrasacral meningocele with tethered cord syndrome.

We present a 65 year old, relatively asymptomatic man, who was found to have an intrasacral meningocele with tethered cord syndrome on Magnetic Resonance Imaging (MRI). Incidental detection of this entity at such an old age is very unusual.

Imaging findings in a giant hepatic artery aneurysm.

A rare case of relatively asymptomatic giant hepatic artery aneurysm of atherosclerotic aetiology is presented. The importance of imaging findings in the diagnosis of this condition and the differential diagnosis including the pertinent literature on the topic is discussed.

Intensive chemotherapy in children with stage IV neuroblastoma.

A retrospective analysis of effectiveness of sequential chemotherapy with cyclophosphamide, doxorubicin, cisplatin and etoposide in children with stage IV neuroblastoma was undertaken. Study group included 17 children of mores than one year old with median age of 3 years (range 18 months to 7 years). Fourteen were males and three females. Sites of primary tumor were abdomen in 12 patients, pelvis in 3, paravertebral in 1 and unknown in 1. Metastatic sites included bone marrow (88%), bone (82%), orbit (29.4%) and lymph node (11.7%). One patient had brain parenchymal disease and another had cerebrospinal fluid positivity for malignant cells. Fifteen of the 17 patients had major response with chemotherapy (complete response in two and partial response in 13). Ten of the 15 patients completed four courses of chemotherapy and five patients progressed while on chemotherapy and died. Only two of the ten patients, who had four courses chemotherapy are alive after 2 years. Hence the 2-year survival in this series is 11.7%. There was no toxic death in this study.

Getting higher yields of monoclonal antibody in culture.

Getting higher yields of monoclonal antibody (MAb) is a problem in Hybridoma Technology which has two major bottlenecks: a) poor yield of hybridized cells, b) low cellular productivity of MAb in culture. There are three ways of obtaining high MAb yield in vitro a) Large scale culture, b) high density culture and c) enhancing individual cellular productivity in culture. Currently, the focus is on the correct synergistic combination of fortified nutrient media, bioreactor design and mode of operation. Maximization of cell culture longevity, maintenance of high specific antibody secretion rates, nutrient supplementation, waste product minimization and control of environmental conditions are important parameters for improvement of large scale production of MAb. Though, MAb yields have improved rapidly over the decade, there is a growing concern for the decrease in quality of MAb secreted. Further research is therefore necessary to take full advantage of MAb as a potential diagnostic agent for in vivo therapy.

Heart in hypothyroidism--an echocardiographic study.

55 individuals, 44 of whom served as patients and 11 as controls were included in this study. Patient group was further divided into overt and subclinical hypothyroid group each having 22 patients. Patients were examined in a prospective manner and results compared with control group with an aim to evaluate the effect of hypothyroidism subclinical and overt on cardiac status by echocardiography. Variables of heart structure and function were assessed by cross sectional and Doppler echocardiography. IVS dimensions were significantly raised in moderate subclinical and in severe overt hypothyroidism (mean 0.911 +/- 0.038 and 0.973 +/- 0.217 cm). LVPW thickness was significantly increased only in overt hypothyroidism (mean 1.378 +/- 0.246). However RVW and LVID showed no definite pattern of change. Pericardial effusion and Diastolic dysfunction was seen in significant cases only in overt hypothyroidism. To conclude, hypothyroidism both subclinical and overt is associated with cardiovascular alteration both structural and functional. IVS and LVPW thickness are markedly affected, as well as there is impairment of left ventricular function more in diastole.