Primary CNS lymphoma vs. tumefactive multiple sclerosis: a diagnostic challenge

Primary CNS [central nervous system] lymphoma is a rare condition with the incidence of less than 1% of all non-Hodgkin lymphomas [NHLs] and approximately 2% of all primary brain tumours. Diagnosis can be challenging and necessitates brain biopsy for definitive diagnosis. A 41-year male presented with history of impaired cognition, facial asymmetry, visual impairment and left sided body weakness. MRI brain demonstrated multiple enhancing lesions with one larger lesion in right basal ganglia with surrounding oedema and mass effect. These findings suggested the differential diagnoses of tumefactive multiple sclerosis [MS], primary CNS lymphoma [PCNSL] and tuberculosis. The patient had normal CT chest, abdomen and pelvis, normal CSF examination and cytology, negative CSF oligoclonal bands [OCBs] and negative HIV screening. It was impossible to differentiate between tumefactive MS and PCNSL without undertaking brain biopsy. Diffuse large B cell lymphoma [DLBCL] was the final diagnosis. Diagnosing PCNSL can be challenging and brain biopsy should not be delayed for definitive diagnosis and targeted treatment

Frequency and extent of foot lesion and the susceptibility pattern of infective organisms in diabetic foot

To determine frequency and extent of foot lesion and the susceptibility pattern of infective organisms in Diabetic foot. [Descriptive] cross sectional study. Surgical Unit -II Holy Family Hospital, Rawalpindi completed in 4 months [5 Feb.2008 to 5 June, 2008]. A total of 50 consecutive patients with diabetic foot lesions were assessed for angiopathy, neuropathy and extent of foot lesion. Necessary investigations including x-ray foot, pus for culture and sensitivity and fungal scraping were carried out. 40% of total patients were insulin dependent diabetics [IDDM] out of which 80% were on irregular treatment. 52% of total patients were non insulin dependent [NIDDM] out of which 73% were on irregular treatment and 8% of total patients were getting no treatment. Most of the infection were due to staphylococcus aureus [22%], pseudomonas [18%] Proteus [16%] E.Coli [12%] Streptococci[12%]. Angiopathy was present in 62% patients and partial or complete sensory loss was present in 74% patients. 54% patients had Osteomyelitis. 61% patients had partial or complete sensory loss in Grade I, II, III and in [Grade IV and V], 100% patients had partial or complete sensory loss. All the patients in Grade IV and V had random blood sugar values more than 200md/dl, showing poor glycaemic control. Diabetic foot lesions are more common in older age group, mostly in males and present in fairly advanced grades [Grade III, IV and V]. Main contributing factors are sensory neuropathy, angiopathy, poor glycaemic control. Most common infecting organisms are staphylococci and pseudomonas