Greater Auricular and Ulnar Nerve Damage in Leprosy: Clinical and Electrophysiological Comparison

Clinically leprosy can have varied presentations ranging from an insignificant skin lesion to extensive disease causing profound disability and disfigurement by damaging peripheral nerves, eyes, bones and other tissues. Peripheral nerve involvement occurs sooner or later in the disease course leading to gross deformities and disabilities. Deformities in leprosy are secondary to nerve damage. However, by the time it clinically manifests, the nerve damage may already be quite advanced. If the preclinical damage is detected early, it can be prevented largely. The study was conducted in the Department of Dermatology, Venereology & Leprosy and Department of Neurology, Indira Gandhi Medical College, Shimla over a period of one year. This electrophysiological study included 20 patients with clinical manifestations of leprosy. 15/20 (75%) belonged to BL/LL types. 18 patients (90%) were multibacillary and 2(10%) were paucibacillary types. Nerve conduction velocity, amplitude and latency of greater auricular and ulnar sensory nerves were done. We found reduced conduction velocities, changes in latency and amplitude in the affected nerves. Ulnar nerve was more commonly involved than the greater auricular nerve. Out of 32 thickened ulnar nerves clinically, only 12 nerves (37.5%) had nerve function impairment. Two non-thickened nerves (2.5%) also had sensory impairment; in contrast 24 thickened nerves had normal functions. Thus, Nerve Conduction Studies can help in detection of early nerve impairment in some cases which otherwise may not be detected clinically. While overall these investigations appear to have limited value in diagnosis of disease and their prognostic value in monitoring the disease progression/response to intervention should be determined by follow-up studies. Valid conclusions with wider application value can only be drawn after carrying out follow up studies on a significant number of leprosy cases.

Clinico-Pathological Profile of Patients with Spinal Cord Lesions.

Background: Spinal cord is the site of variety of lesions and includes both non neoplastic and neoplastic lesions. Common non neoplastic lesions include meningomyeloceles, dermoid cysts, epidermoid cysts, arachnoid cysts and neurenteric cysts whereas neoplastic lesions include astrocytomas, ependymomas, schwannomas, neurofibromas and meningiomas. The aim is to study clinico-pathological profile of patients with spinal cord lesions. Methods: This was a prospective study conducted at Department of Pathology, Osmania General Hospital, Secunderabad from June 2010 to May 2013. All specimens received during study period. Only samples related to spinal cord were included. Results: Of all, non-neoplastic were 28 cases [43%] and neoplastic were 37 cases [57%]. Males were 30 cases [46%] and females were 35 cases [54%] with slight predominance in females. Of all most common were Meningomyelocele [23%] followed by Schwannomas [19%], Neurofibromas [12%], Lipomeningomyelocele [9%], Ependymomas [6%], Meningiomas [6%], Astrocytomas [5%], Dermoid cyst [5%], Arachnoid cyst [3%], Neurenteric cyst [3%], Teratoma [3%] and others include Paraganglioma, PNET, Oligodendroglioma, Metastatic deposits. Intramedullary lesions constitute 10 cases [19%] with [3 non neoplastic and 7 neoplastic], Intradural extramedullary lesions constitute 24 cases [54%] with [4 non neoplastic and 20 neoplastic], Extradural lesions constitute 31 cases [27%] with [21 non neoplastic and 10 neoplastic]. Conclusion: Most non neoplastic lesions in the spinal cord were due to developmental defects and present in younger age group whereas most neoplastic were acquired and occur in adults.

Sclerosing adenosis clinically feigning as carcinoma breast: A case report.

Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an “adenosis tumor of the breast” or “nodular sclerosing adenosis” if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA).

Pediatric caecal lymphoma involving ovary in a 12 year old girl – A bad prognostic sign: A rarity.

Primary caecal lymphoma or the colonic lymphoma is a rare tumor of the gastrointestinal (GIT) tract and comprises only 0.2-1.2% of all colonic malignancies, both in adults and pediatric age group. The most common variety of colonic or caecal lymphoma is a on-Hodgkin’s Lymphoma (NHL) which arises from the lymphoid elements of the intestine. GIT is the most frequently involved site, accounting for 50-60% of all extra nodal lymphomas, and most of them are NHL. In adults, the stomach is the most common location of GIT lymphomas, followed by the small intestine, but the most common GI site of NHL in children is the terminal ileum and the ileo-caecal region. Diagnosis is difficult since lymphoma presents with vague abdominal pain with loss of weight and appetite. It may present as lump abdomen with complications such as intestinal obstruction, bleeding, perforation and peritonitis and intussusseption. Histologically it is B or T cell type with small or large cell variation, but frequently encountered is diffuse large B-cell cell lymphoma (DLBCL). DLBCL has low incidence but favorable outcome in young adults, lesions localized to one area or organ and children below 5 years of age, but has an aggressive course in children between 10-15 years of age and also in adults above 55 years of age. DLBCL or GIT Lymphomas in general have male preponderance. We present a rare case of caecal lymphoma (DLBCL) involving appendix and right ovary in a 12 year old girl who presented with vague symptoms of abdominal pain and abdominal mass. Clinically and radiologically, provisional diagnosis of Ileo-caecal tuberculosis with possibility of adhesions leading to a mass lesion was considered. Histopaththological examination (HPE) revealed the diagnosis and prognosis of the case.

Kikuchi-Fujimoto disease in inguinal lymph node – A rare site of occurrence.

Kikuchi-Fujimoto disease (KFD) is also known as histiocytic necrotizing lymphadenitis It is a benign, systemic lymphadenitis, self limiting disease first described independently by Japanese Pathologists Kikuchi and Fujimoto in Japan in 1972. The incidence of KFD is unknown. KFD is up to 4 times commoner in women. It presents as lymphadenopathy mainly involving the posterior cervical region, but can occur in any lymph node and even in extra nodal sites. Fever is associated with lymph node enlargement in half of the cases. Though viral and autoimmune cause is suggested by some studies, the exact etiology remains uncertain. There have also been reports of a relation between KFD and systemic lupus erythematosus. Most of the preoperative diagnostic tests are inconclusive. Definitive diagnosis depends on the histopathological examination of the lymph node biopsy. Clinically it has to be differentiated from other lesions like malignant lymphoma, mononucleosis tuberculosis and SLE as treatment and prognosis differs. Here we submit a case of Kikuchi-Fujimoto disease in an inguinal lymph node in a young adult auto driver.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

Abnormal pattern of lung functions in rubber factory workers.

The influence of suspended particulate matter, benzo(e) pyrene, benzo(e) pyrene and benzo(a) anthracene concentration on pulmonary lung functions ie, residual volume, total lung capacity, residual volume/total lung capacity, forced residual capacity were studied in 667 rubber factory workers during 1990-91. The respirable fraction of the particulate size (< 0.5 micron) showed high mean concentration of suspended particulate matter, benzo(a) pyrene, benzo(e) pyrene and benzo(a) anthracene in the compounding section (group III), when compared with vulcanising (group II) and packing loading (group I) units. While comparing the lung functions amongst these groups, the higher results of residual volume, residual volume/total lung capacity ratio, forced respiratory capacity and lower values of total lung capacity were observed in group III workers as compared with other two groups. And also these results seem to be correlated with the high pollutant concentrations to which group III workers were exposed, and reflect a clear combination of obstructive and restrictive pattern of lung functions in them.

Effect of dietary restriction with and without leucine supplementation on hepatic protein status in rats.

In the present study effect of dietary restriction with and without leucine supplementation was observed on body and liver weights, and liver protein status, in adult rats. Animals were fed on two diets ad lib or were on 50 per cent and 25 per cent intakes. Dietary restriction resulted in loss of body and liver weights, hepatic protein, free-alpha-amino nitrogen and RNA contents and liver cell size (liver weight/DNA ratio). When compared with the control group, the decrease in these parameters was more in the dietary restricted leucine supplemented group. However, hepatic DNA content was not changed with the change in dietary regimen. The results suggest that leucine supplementation with dietary restriction may be more harmful for the animal than dietary restriction alone.