Paediatric dermatofibrosarcoma protuberan-a case report in an Afro-Caribbean boy.

Dermatofibrosarcoma protuberans is a rare low-grade sarcoma, which rarely metastasizes, but it is locally aggressive with a propensity to recur. It usually affects persons of African descent and is extremely rare in childhood with a favourable prognosis. We present a case of paediatric dermatofibrosarcoma protuberans to the midline of the lower back of a 9-year-old Afro-Caribbean boy who was biopsied with a 2-mm margin. After histological confirmation, a 4-cm margin was then performed. Surveillance for recurrence, though none has been seen thus far after 6-month follow-up, will be done for at least 5 years and possibly longer, given this is the first case of this nature ever seen in our institution and the Caribbean region.

Pleomorphic hyalinizing angiectatic tumour of the lower back - a rare case and review of the literature.

Pleomorphic hyalinizing angiectatic tumour (PHAT) is a very rare low-grade indeterminate neoplasm of connective and other soft tissue, which is not known to metastasize though local recurrence has been documented. It most commonly presents in the lower extremities, but other anatomical locations have been described. This is the second known case of PHAT from the Caribbean region and adds to the limited reported cases of the condition in the literature.

Anomalous vascular perforator of the internal thoracic artery supplying a pedicled transverse rectus abdominis myocutaneous flap-a case report.

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap is an infrequently performed procedure relative to the more current microsurgical free tissue transfers in most centres around the world. However, in resource-limited centres where procedures requiring microsurgical intervention are rarely employed, the pedicled TRAM whose vascular axis is that of the superior epigastric artery, is an invaluable tool in the plastic surgeon's armamentarium both for breast reconstruction and chest wall soft tissue resurfacing. This a report of a case of variable anatomical vascular perforating branch of the internal thoracic artery, which was encountered while using a TRAM to resurface a chest wall defect after mastectomy was performed for locally advanced breast cancer.

Kimura disease: a rare cause of a recurrent cheek mass in a Jamaican man.

Kimura disease (KD) is a chronic, inflammatory, benign disorder endemic to Asia that typically manifests as a triad of painless masses in the head and neck region, elevated eosinophils and serum immunoglobulin. It usually affects young men in their second and third decades of life and is rarely seen outside of the orient. This is a report of a case of KD in a young man of African descent who presented with a cheek mass. KD was not included in our differential diagnosis, and this report highlights the need to consider this entity, which can be easily missed due to its rarity in the Western world. There is no cure for the disease, and management includes medical and surgical modalities, but local recurrence or relapse is not uncommon.

A case of metastatic malignant granular cell tumour of the scalp.

Granular cell tumours of the scalp are rare. Malignant transformation of these tumours is even more uncommon, making the diagnosis exceedingly difficult. The recommended treatment of surgical excision with negative margins is not easily achieved in this location, given the anatomy of the scalp.

Gestational gigantomastia-a rare entity complicated by life-threatening haemorrhage.

Gestational gigantomastia is a psychologically and physically debilitating disease of unknown aetiology. Underlying diseases that present as gigantomastia should be excluded by a thorough workup. Most cases respond to the preferred approach: conservative management, as foetal viability and well-being is of significant importance. However, in those cases where the maternal mortality is at risk, the surgical approach is preferred. Life-threatening haemorrhage may occur and early recognition and treatment is paramount to outcome. A case of gestational gigantomastia complicated by life-threatening haemorrhage is presented and discussed.

The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve.

PURPOSE: The variability of the recurrent branch (RB) of the median nerve lends itself to an increased risk of injury when performing the minimally invasive approach for carpal tunnel release without its direct visualization. This risk is less so when it is released via the more invasive open approach as the RB can be easily identified, but the drawback is that of longer postoperative patient recovery time. Therefore, performing these releases via the less invasive approach should be more favorable for patients providing it could be done safely. Hence with there being a positive link between the hypertrophy of the thenar musculature and the course of RB according to previous studies. METHODS: We dissected 28 hands of 14 donated bodies fixed using Thiel's method to try to demonstrate these findings of the associations among the RB, palmar creases and other superficial anatomical landmarks. Fisher's exact test was conducted to verify the relationship between those structures statistically. RESULTS: Statistically significant links were found between the type of the RB and the type of the palmar creases (p value = 0.0094) and between the RB type and the palmaris longus muscle presence (p value = 0.028). CONCLUSION: It was inferred that palmar creases and other superficial anatomical landmarks listed in the text could not be used to predict the variability of the RB and the choice of mini-invasive approach should not be based on their course.

Plasma homocysteine is elevated in COPD patients and is related to COPD severity.

BACKGROUND: Although recent studies have found that total plasma homocysteine (tHCY) and chronic obstructive pulmonary disease (COPD) are both risk factors for cardiac disease, there have been few studies of plasma homocysteine levels in COPD patients. We tested the hypothesis that total plasma homocysteine (tHCY) would be elevated in patients diagnosed with COPD compared with controls. METHODS: We studied 29 COPD outpatients and 25 asymptomatic subjects (controls) over age 55 years with measurement of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), St. Georges Respiratory Questionnaire (SGRQ) score, tHCY and serum C-reactive protein (sCRP). RESULTS: There was no difference between controls vs. COPD patients in mean age or gender but mean (SD) FEV1 was 2.25 (0.77) vs. 1.43 (0.60) L; FEV1 per cent predicted 76.1 (17.2) vs. 49.1 (16.3) p < 0.001 in both cases. Median (IQR) tHCY was 8.22 (6.63, 9.55) in controls vs. 10.96 (7.56, 13.60) micromol/l for COPD, p = 0.006 and sCRP 0.89 (0.47, 2.55) vs. 2.05 (0.86, 6.19) mg/l, p = 0.023. tHCY(log) was also higher in (r, p) smokers (0.448, 0.001), patients with low FEV1 per cent (-0.397, 0.003), males (0.475, < 0.001), but high SGRQ Total score (0.289, 0.034), and high sCRP (0.316, 0.038). tHCY(log) was independently related to (regression coefficient, p) sCRP(log) (0.087, 0.024), male gender (0.345, < 0.001) and presence of COPD (0.194, 0.031). Median (IQR) tHCY GOLD Stage I and II 8.05 (7.28, 11.04), GOLD Stage III and IV: 11.83 (9.30, 18.30); p = 0.023. CONCLUSIONS: Plasma homocysteine is significantly elevated in COPD patients relative to age and sex-matched controls and is related to serum CRP and COPD severity.

Plasma homocysteine is elevated in COPD patients and is related to COPD severity.

BACKGROUND: Although recent studies have found that total plasma homocysteine (tHCY) and chronic obstructive pulmonary disease (COPD) are both risk factors for cardiac disease, there have been few studies of plasma homocysteine levels in COPD patients. We tested the hypothesis that total plasma homocysteine (tHCY) would be elevated in patients diagnosed with COPD compared with controls. METHODS: We studied 29 COPD outpatients and 25 asymptomatic subjects (controls) over age 55 years with measurement of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), St. Georges Respiratory Questionnaire (SGRQ) score, tHCY and serum C-reactive protein (sCRP). RESULTS: There was no difference between controls vs. COPD patients in mean age or gender but mean (SD) FEV1 was 2.25 (0.77) vs. 1.43 (0.60) L; FEV1% predicted 76.1 (17.2) vs. 49.1 (16.3) p < 0.001 in both cases. Median (IQR) tHCY was 8.22 (6.63, 9.55) in controls vs. 10.96 (7.56, 13.60) micromol/l for COPD, p = 0.006 and sCRP 0.89 (0.47, 2.55) vs. 2.05 (0.86, 6.19) mg/l, p = 0.023. tHCY(log) was also higher in (r, p) smokers (0.448, 0.001), patients with low FEV1% (-0.397, 0.003), males (0.475, < 0.001), but high SGRQ Total score (0.289, 0.034), and high sCRP (0.316, 0.038). tHCY(log) was independently related to (regression coefficient, p) sCRP(log) (0.087, 0.024), male gender (0.345, < 0.001) and presence of COPD (0.194, 0.031). Median (IQR) tHCY GOLD Stage I and II 8.05 (7.28, 11.04), GOLD Stage III and IV: 11.83 (9.30, 18.30); p = 0.023. CONCLUSIONS: Plasma homocysteine is significantly elevated in COPD patients relative to age and sex-matched controls and is related to serum CRP and COPD severity.