Pachydermoperiostosis: a case report of initial improvement with etoricoxib.

Introduction and importance: Pachydermoperiostosis (PDP) is a syndrome characterised by the triad of pachydermia, digital clubbing and periostosis of long bones and its scarce incidence and similarity in clinical features with acromegaly makes the diagnosis challenging. The elevated PGE2 levels have been hypothesised as one of its mechanisms and therapies have been targeted to inhibit this prostaglandin. Case presentation: A 25-year-old man with no comorbidities presented to OPD with a 10-year history of bilateral pain and swelling of the hands and feets associated with hyperhidrosis, grade IV clubbing and marked skin thickening on his forehead. X-rays revealed hyperostosis of the metacarpals, proximal and middle phalanges and periosteal bone formation with cortical thickening of the ankle joint. Tests done to rule out differentials such as thyroid acropachy, acromegaly, psoriatic arthritis were normal and a clinical diagnosis of PDP, a rare genetic disease characterised by pachyderma, digital clubbing and periostosis was made. Clinical discussion: The patient was managed conservatively with etoricoxib for 6 months on a follow-up basis. The symptoms were improving and a repeat X-ray showed partial improvement of soft tissue thickening and periostosis. Conclusion: PDP is a rare diagnosis with no clear consensus on a management approach. Its management with selective COX-2 inhibitors such as etoricoxib should be considered but its long-term effects should be studied further.

Nonhealing oesophageal ulcer: a case report.

Esophageal tuberculosis is a rare presentation of a common infectious disease. It may occur as a primary infection of the esophagus or as a secondary spread mostly from caseating mediastinal lymph nodes. The clinical diagnosis of the condition is presumed to be complex, owing to nonspecific biopsy findings, failure of isolation of bacilli, and a lack of predisposing conditions in patients. This study aims to present a rare condition of esophageal tuberculosis secondary to mediastinal lymphadenitis and highlights a unique modality of diagnosis of the condition, especially in a resource strained setting. Case presentation: This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing. Clinical discussion: Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia. Conclusion: Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient's response to standard antitubercular treatment to make a definitive diagnosis.

DFT study of conformational and vibrational characteristics of 2-(2-hydroxyphenyl)benzothiazole molecule.

The conformational and IR and Raman spectral studies of 2-(2-hydroxyphenyl)benzothiazole have been carried out by using the DFT method at the B3LYP/6-311++G(**) level. The detailed vibrational assignments have been done on the basis of calculated potential energy distributions. Comparative studies of molecular geometries, atomic charges and vibrational fundamentals of all the conformers have been made. There are four possible conformers for this molecule. The optimized geometrical parameters obtained by B3LYP/6-311++G(**) method showed good agreement with the experimental X-ray data. The atomic polar tensor (APT) charges, Mulliken atomic charges, natural bond orbital (NBO) analysis and HOMO-LUMO energy gap of HBT and its conformers were also computed.

Prostate cancer presenting as an endobronchial mass: a case report with literature review.

Endobronchial metastasis from a prostate cancer is uncommon. Diagnosis of prostate carcinoma after primary presentation with an endobronchial mass is very rare. The authors describe the case of an 84-year-old man with endobronchial metastases from prostatic carcinoma presenting primarily with pulmonary symptoms. The diagnosis of prostate cancer and endobronchial metastases was made by a bronchoscopic bronchial biopsy and confirmed by immunohistological staining with prostate-specific antigen. The importance of this manifestation along with clinical and therapeutic implications is discussed here.

Primary carcinosarcoma of the spleen: case report of a rare tumor and review of the literature.

Carcinosarcoma of extragenital organs is rare. In this article, a case of primary carcinosarcoma of the spleen, which presented as painful splenomegaly is reported. To the best of our knowledge, this is the second reported case of primary splenic carcinosarcoma in English literature. The pathogenesis of these tumors is incompletely understood. No specific treatment guidelines exist for these aggressive tumors, surgery being the mainstay of treatment. The prognosis remains poor regardless of the adjuvant therapy used.