Two Unusual Presentations of Gestational Trophoblastic Neoplasia: Cutaneous Metastasis and a Large Solitary Lung Lesion

Gestational trophoblastic tumors, an uncommon group of pregnancy-related neoplasms, should be considered in any premenopausal patient presenting with metastatic disease from an unknown primary. A raised hCG and exclusion of pregnancy are often the only requirement in this situation. Although a potentially curable condition, a late diagnosis and the extent of the metastatic disease often determine the prognosis. Here we describe two young women with metastatic GTN, the first presenting with a very unusual finger metastasis and the second with a rare large solitary lung lesion with brain metastasis.

Impact of post‑operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India.

BACKGROUND: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast‑conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx). MATERIALS AND METHODS: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student’s t‑test was used for comparative analysis of the means. RESULTS: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14–3.48). The mean Dmean of LAD for L‑EBC and R‑EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77–1.60). The mean‑Dmax of LCx for patients with L‑EBC (2.9 Gy; range: 1.2–4.35 Gy) was statistically higher than that for R‑EBC (1.3 Gy; range: 0.7–3.2 Gy) (P = 0.045). The mean‑Dmean of LCx for L‑EBC (2.1 Gy; range: 0.6–3.6 Gy) was also significantly higher than that of L‑EBC (0.9 Gy; range: 0.7–2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m‑Dmax and m‑Dmean of LCx). CONCLUSION: This pilot dosimetric study confirms the assumption that patients with left‑sided EBC are at higher risk of developing long‑term cardiac morbidity when treated with PORT due to increased dose to LAD.

Detection of urinary leishmanial antigen by latex agglutination test (KAtex) in kala-azar patients.

Background: A new unique latex agglutination test (KAtex) that detects a stable, nonprotein, disease specific parasite antigen in the freshly voided urine of patients suffering from active kala-azar has been introduced by Kalon Biological Ltd. UK. This is absolutely non-invasive method of diagnosis for visceral leishmaniasis and suitable for implementation as a rapid diagnostic tool at the point of care. Objective: Diagnostic potential of KAtex was evaluated among clinically suspected kala-azar patients in an endemic zone of Bangladesh. Methodology: KAtex was done using freshly voided urine according to the manufacturer’s instructions for sixty (60) clinically suspected patients of kala-azar admitted in Rajshahi Medical College Hospital (RMCH), Bangladesh and forty (40) healthy controls during December 2005 to June 2006. Leishmania nested Polymerase Chain Reaction (Ln-PCR) using peripheral blood buffy coat was performed for all study population (100) and Ln-PCR positive cases were considered as confirmed cases of kalaazar. Results: Out of 60 clinically suspected kala-azar patients, 56 were Ln-PCR positive and 53 of 56 Ln-PCR positive cases were KAtex positive (sensitivity, 94.64%; Mantel- Haenszel Chi sq. 79.66, p= 0.0000, confidence interval [CI], >95 to 100%). None of the healthy controls was found positive by Ln-PCR but 2 of 40 were KAtex positive (specificity, 95%; confidence interval [CI], >95 to 100%). The positive and negative predictive values of KAtex were noted as 98.10% and 92.85% respectively. Conclusion: This limited prospective study suggests that KAtex is an absolutely non-invasive urinebased antigen detection test with high sensitivity and specificity and may be useful for screening active kala-azar patients, particularly suitable for field use.

Ventricular Septal Defect as a Complication of Blunt Chest Trauma: A Rare Occurrence and First Case-Report in Bangladesh.

Traumatic ventricular septal defect (VSD) is a very uncommon condition, especially in association with blunt chest trauma. A healthy young adult was diagnosed as a case of VSD one week after a road-traffic accident. History and other medical records suggest it was an acquired post-traumatic VSD. Thus, all patients of blunt chest trauma deserve close cardiac evaluation.

Effect of fenugreek seeds on the fasting blood glucose level in the streptozotocin induced diabetic rats.

In this experiment defatted Trigonella foenumgraecum (fenugreek seeds/methi seeds) has used as the antidiabetogenic herbal medicine. The experiment was carried out in Bangabandhu Sheikh Mujib Medical University and BIRDEM from 1996 to 1998 on a total of 58 Long Evans rats of either sex. They were 50-60 days young rats with average body weight 72-174 gm. Among the total, 10 rats were treated with only vehicle called as non-diabetic control rats, 48 rats were treated with Streptozotocin (STZ) at a dose of 90 mg in 1 ml of citrate buffer solution per kg body weight, among which 20 were diabetics. Ten (1 died, 1 escaped) diabetic rats were again treated with fenugreek called as Fenugreek-treated diabetic rats and the rest 10 diabetic rats were called as diabetic control rats. The change in the mean fasting blood glucose (FBG) level in different groups of rat from day 5 from streptozotocin injection were higher in diabetic control group and in fenugreek-treated diabetic group than in non diabetic control group. The FBG level on day 13 the mean in non-diabetic control group was 5.21 mmol/L. In diabetic control group and in fenugreek-treated diabetic group the mean FBG level were 24.33 mmol/L and 9.89 mmol/L respectively. So, from this experiment it may be concluded that fenugreek decreases the FBG level considerably by improving diabetes mellitus.

Effect of combination therapy in Mycobacterium paratuberculosis infected rabbits.

Rabbits, infected with M paratuberculosis of caprine origin, were treated with streptomycin sulphate and rifampicin in combination with levamisole hydrochloride for a period of 2 months. Marked clinical response including significant rise in total serum protein, albumin and globulin were recorded in treated groups. Highly significant higher leucocyte migration inhibition indicating enhanced CMI reaction, occurred in rabbits treated for 4 weeks. Complete elimination of M. paratuberculosis from faeces, intestines and mesenteric lymph nodes was observed. They were also absent from spleen, kidneys, lungs and liver of rabbits treated with rifampicin and levamisole, whereas were present in lungs of the rabbits administered with streptomycin and levamisole. Absence of characteristic lesions of paratuberculosis and evidence of regenerative reaction were observed in visceral organs of rabbits treated with rifampicin and levamisole. Effectiveness of rifampicin is attributed to its effect on lymphocyte, the primary cell involved in cell mediated immunity. Rifampicin-levamisole combination appeared superior to streptomycin-levamisole in eliminating the infection of M. paratuberculosis from infected rabbits. Approximate cost of treatment was calculated to be Rs 8.50 per kg body weight. Cattle, sheep and goats, if treated in early stage of infection may recover from paratuberculosis.