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Introduction: Multiple myeloma is a plasma cell neoplasm that is commonly associated with lytic bone lesions; however, osteosclerotic multiple myeloma is a rare entity. Osteosclerotic multiple myeloma has been reported in association with POEMS syndrome. Case Presentation: A 60-year-old female patient presented to us with low back pain for 2 months. The investigations revealed that the patient had multiple osteosclerotic lesions in the axial skeleton with a L4 ivory vertebra. The serum immunoelectrophoresis was negative. Positron emission tomography scan was done which showed multiple skeletal lesions in the right iliac bone, left femoral neck, thoracic vertebrae T1, T6, T12, and lumbar vertebra L4. Biopsy and immunohistochemistry of the lesion showed plasma cell proliferation; producing lambda light chains. However, there were no features of POEMS syndrome including polyneuropathy, organomegaly, endocrinopathy, and skin changes. The patient was started on chemoradiation and achieved clinical remission and was asymptomatic at 12 months follow-up. Conclusion: Osteosclerotic myeloma without the features of POEMS syndrome is an extremely rare entity. This case reports documents a unique clinical scenario of osteosclerotic non-secretory light chain myeloma without POEMS syndrome.
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The n-butanol extract of the leaves Polyscias fruticosa (L) Harms (Araliaceae) was tested for its anti-inflammatory activity plethismometrically in egg white induced paw oedema in rats, antipyretic activity and analgesic activity by writhing method phenyl butazone, paracetamol and aspirin were used as positive controls for anti-inflammatory, antipyretic and analgesic activity screening studies receptivity. It as observed that the n-butanol fraction mainly contains terpenoid type of saponins and designated as NBES fraction- (n -butanol extract containing saponins). Molluscicidal screening studies proved the effectiveness of NBES to control certain kind of snails which are considered as the primary host of fluke worms.
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The major diagnostic characters and qualitative chemical and physical tests responsible for the pharmacognostic identity of the leaf and of root of Polyscias fruticosa (L) Harms have been reported. Literature survey showed the absence of any systematic pharmacognostic studies for this plant.
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We critically evaluated several diagnostic modalities (clinical criteria, subxiphoid pericardial window (SPW) and laparoscopy) used in the detection of occult cardiac injury in haemodynamically stable patients at high risk of cardiac injury. Over 5 years, 122 patients were admitted to a Level I trauma centre with such an injury. They sustained 69 stab wounds, and 53 gunshot wounds. Sites of penetration were: precordial (81), right chest (25), lateral chest (13), thoracoabdominal (40) and abdominal (19). Vital signs in the emergency room were (mean +/- SD): systolic BP, 111 +/- 23.2 mmHg; HR, 106 +/- 18.7; GCS, 13.6 +/- 1.3; and CVP, 17 +/- 7.8 cmH2O. SPW was performed in all patients and was positive for haemopericardium in 26 patients, 24 (92 per cent) of whom had a cardiac injury at operation. Two patients had pericardial lacerations without cardiac injury. In addition, 14 patients with lower precordial and thoracoabdominal wounds underwent laparoscopy. At laparoscopy, the pericardium was evaluated by transdiaphragmatic inspection in 10 patients. The presence (two) or absence (eight) of blood within the pericardium was accurately predicted and verified by SPW. Univariate and multiple logistic regression analysis of clinical data failed to reveal any significant predictor of cardiac injury. SPW remains the standard means of diagnosing occult cardiac injury in high-risk patients. Since the incidence of occult cardiac injury in haemodynamically stable patients is 20 per cent, SPW should be used liberally. Laparoscopy may have a role in evaluating the pericardium in the subgroup of patients with lower chest wounds, and it facilitates inspection of intra-abdominal viscera and diaphragm at the same time.
