A Retrospective Analysis of Fetal and Maternal Outcome in Patients with Intrahepatic Cholestasis of Pregnancy

Background: Introduction: Intrahepatic cholestasis of pregnancy (ICP), is the most common liver disease specific to pregnancy. Previous studies of fetal effects have suggested that ICP is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome (RDS), meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. Material & Methods: This was a 4 year retrospective observational study including 43,344 female who delivered in our hospital out of which 1126 cases of ICP were identified, who were compared with 1136 age and parity matched controls. Results: : Previous history and family history of ICP was significant in the ICP group. Gestational diabetes and preterm labour were more frequent in the ICP group. Mean birth weight was lower in the ICP group, rate of small for gestational age foetuses was not significantly different. Cesearean section and post-partum haemorrhage was more frequent in the ICP group. Adverse neonatal outcomes i.e. respiratory distress syndrome (RDS) and need for NICU admission were more in the ICP group. Conclusion: ICP is associated with increased rate of preterm delivery, post-partum hemorrhage and increased neonatal morbidity. Management of patients with ICP should be individualized based on the severity of symptoms and associated medical complications.

Labial hypertrophy as a cause for vulvae pruritis

Labia minora hypertrophy is a relatively uncommon surgical condition being popularised in the realm of vulvovaginal plastic surgeries. Apart from the unaesthetic appearance of the hypertrophied minora, these cases are also associated with itching, hygiene problem, pain while sitting down, sports activities, difficulty in wearing tight clothing, bleeding and discomfort while or after sexual intercourse, social embarrassment, insecurity and psychological diminution of confidence and self‐esteem. In a country like India, due to sociocultural reasons, patients hesitate to consult a doctor for such deformities. Most of the patients suffer in silence for years. Although common in the west, very few surgeons in the country perform this simple and rewarding surgery. Here, presenting a case of married women of reproductive age group presented to the study side with complains of severe vulvar itching, the cause of itching was labia minora hypertrophy.

Rubber band ligation of hemorrhoids: a hospital based study

Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.

A study of clinical and histopathological correlation of lichen planus

Introduction: Lichenoid tissue reaction or interface dermatitis embraces several clinical conditions, the prototype of which is lichen planus and its variants. Others include drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and other disorders all of which have salient clinical and histological features. The aim of this study was to correlate the clinical features with histopathological findings in all clinically suspected cases of lichen planus and assess the clinical diagnostic accuracy. Materials and methods: This study had been carried out over a period of 2 years from July 2015 to June 2017 in the Department of Pathology, Gandhi Hospital. Histopathological sections of skin biopsies from 85 patients were studied after routine H and E staining and morphological changes were noted. The patients’ clinical findings were then correlated with the histological changes. The results were then analysed. Results: Total numbers of biopsies inclusive of LP and LP like lesions were 85. Among them, the number of patients having LP was 50. The age ranged from 18 to 65 years (mean 37.1 years). The mean duration of the lesion was 12.02 months (approx 1 year). Males were affected more than females. Out of the 85 cases, 50 were Lichen planus and 35 were lichenoid eruptions. Of the Lichen planus, 31 (61.6%) cases were of classical lichen planus, 6 (13.3%) cases were of hypertrophic lichen planus, 4 (8.3%) cases were of lichen planus pigmentosus, 4 (6.6%) cases were of actinic lichen planus, 3 (5%) cases were of eruptive lichen planus, 1 (1.6%) case each of atrophic lichen planus, annular lichen planus. N. Srivani, B.V.N. Sravani, Shyamala Srujana, O. Shravan Kumar. A study of clinical and histopathological correlation of lichen planus. IAIM, 2017; 4(9): 136-144. Page 137 Conclusion: In the present study, maximum number of cases occurred in age group of 18-28 years. Though pruritis is a common symptom, it is nonspecific. Therefore, histopathology remains the most important diagnostic tool for proper evaluation of Lichenoid eruptions/ Lichen planus.

Rash in a foreign worker

Hookworm-related cutaneous larva migrans (HrCLM) is a zoonosis which is endemic in many subtropic and tropical countries including Malaysia. We report a case of a 40-year old plantation worker who presented with a pruritic rash on his abdomen. It is important for clinicians to diagnose and treat HrCLM promptly as this condition results in considerable morbidity when treatment is delayed.

Radiation-induced eosinophilic, polymorphic, and pruritic eruption in a pig skin model / 한국실험동물학회지

Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) can occur in cancer patients after irradiation. In this study, we characterized the clinical and histopathological features of pig skin that developed widespread polymorphic and pruritic skin lesions following localized 50 Gy gamma-irradiation. The pigs developed pruritus 5-7 weeks after irradiation, and infiltration of the dermis by eosinophils was detected 4-7 weeks after irradiation. The irradiated animals also showed transiently increased numbers of peripheral eosinophils 5-7 weeks after treatment. Irradiation induced desquamation after 2-4 weeks, which and the desquamation gradually resolved after 7 weeks. These pathological changes correspond to those seen in irradiated human skin, indicating that this model could be useful for elucidating the pathogenesis of EPPER and for developing therapeutic and prophylactic methods.

A Randomized, Open-Label, Multicenter Trial of Topical Tacrolimus for the Treatment of Pruritis in Patients with Atopic Dermatitis

BACKGROUND: Pruritis caused by atopic dermatitis (AD) is not always well controlled by topical corticosteroid therapy, but use of tacrolimus often helps to soothe such intractable pruritis in clinical settings. OBJECTIVE: To determine the anti-pruritic efficacy of topical tacrolimus in treating AD in induction and maintenance therapy. METHODS: Prior to the study, patients were randomly allocated into two groups, induction therapy followed by tacrolimus monotherapy maintenance, and induction therapy followed by emollient-only maintenance. In the induction therapy, the patients were allowed to use topical tacrolimus and emollients in addition to a low dose (<10 g/week) of topical steroids. Patients showing relief from pruritis were allowed to proceed to maintenance therapy. Recurrence of pruritis in maintenance therapy was examined as a major endpoint. RESULTS: Two-thirds of patients (44/68; 64.7%) showed relief from pruritis after induction therapy. Pruritis recurred in 23.8% (5/21) of the tacrolimus monotherapy group and in 100% (21/21) of the emollient group during maintenance period, a difference that was statistically significant. CONCLUSION: Use of topical tacrolimus is effective in controlling pruritis of AD compared to emollient.

Effect of Epidural Morphine, Morphine with Droperidol and Morphine with Nalbuphine after a Cesarean Section / 대한마취과학회지

BACKGROUND: A number of recent reports have described the usefullness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, an micro-receptor agonist, produces strong analgesic effects with side effects. Nalbupine, a micro-antagonist and kappa-agonis, has an analgesic effect comparable to morphine with little side effects. The comparison of side effects and analgesic effects of epidural morphine alone and a combination of nalbuphine and droperidol respectively to morphine were sutudied in cesarean section patients. METHODS: We divided 45 patients into 3 groups utilizing a two-day Boxter infusor in normal saline 100 ml at 2.0 ml/hr: Group M (n = 15) initially a 1 mg bolus 2 mg/day of maintenance morphine. Group M D (n = 15): initially received a 1 mg bolus 2 mg/day of maintenance morphine 1.25 mg/day of maintenance droperidol. Group M N (n = 15): initially received a 1 mg morphine bolus 2 mg/day of maintenance morphine 5 mg/day of maintenance nalbupine. The Analgesic effect was evaluated by a visual analogue scale (0 10) at 30 min, 4 hr, 12 hr and 24 hr postoperatively and the incidence of side effects was observed too. RESULTS: The average VAS scores are below 3 in all groups. In addition, there are no significant changes between groups. There are no significant differences in side effects between groups except sedation of patients is significantly (P< 0.05) high in group M D. CONCLUSIONS: We concluded that the analgesic effect of epidural morphine, morphine with nalbuphine and morphine with droperidol are good in all patients and there is no significant difference even though there is a belief that a combination of nalbuphine or droperidol increases analgesic effects of morphine. Comparing the incidence of side effects in the three groups, the sedative effect of morphine with droperidol is increased significantly over the other two groups.intubation.

Epicanthus as a Cause of Pruritis

According to the ophthalmic literature, the lack of epicanthus and termi-nal hairs at the medial side of punctum are unique features in most non-Asian eyelids.We wanted to examine the presence of terminal hairs at the medial side of punctum in Asian.A study was designed to examine 416 eyes of 208 patients who had visited our hospital between March 1999 and Sep-tember 1999.Physical examination included the presence of epicanthus, terminal hairs at the medial side of punctum, upper eyelid crease and pruritus in medial canthal area.The mean age of the patients was 56.5 years.Epi-canthus was seen in 256 eyes of 416 eyes (61.5%).The upper lid creases were detected in 242 eyes of 416 eyes (58.2%)and classified mostly as the medial tapering and lateral flaring type (83.5%).There were 250 eyes of 416 eyes (60.1%)who had terminal hairs at the medial side of punctum.Sixty eyes of 416 eyes (14.4%)complained of itching sensation in medial canthal area and had experienced once or two times per week (70.0%).They com-posed of 44 eyes of 60 eyes (73.3%)with epicanthus and terminal hairs, 10eyes of 60 eyes (16.7%)with only terminal hairs, and 6 eyes of 60eyes (10.0%)with only epicanthus.In our study, we found many patients had terminal hairs at the medial side of punctum in Asian and the presence of epicanthus and terminal hairs caused itching sensation at medial canthal area.

A Trial of Kampo Therapy for Primary Biliary Cirrhosis / 日本東洋医学雑誌

The results of a trial treatment of primary biliary cirrhosis using combined Kampo and conventional drug therapy are reported.<br>A 79-year-old female with a chief complaint of pruritis was diagnosed as having primary biliary cirrhosis because of elevations in serum alkaline phosphatase, serum bilirubin, serum IgM, and positive tests for antimitochondrial antibodies and anti-M2.<br>In accordance with the Kampo diagnosis, she was first treated with Shinbu-to, which, however, did not cause any clinical alleviaton of the itching. Shishihakuhi-to was then given concomitantly, which resulted in the disappearance of the pruritis on the second day. Ursodeoxycholic acid was also added to her treatment from the 2nd month on. The serum level of bilirubin was observed to decrease gradually thereafter.<br>This case suggests that Kampo therapy, combined with the Western medical drug ursodeoxycholic acid, may be effective in the treatment of primary biliary cirrhosis.