Resolution of granuloma annulare following treatment with bendamustine and rituximab in a patient with follicular lymphoma: a serendipitous finding.

Granuloma annulare is a benign inflammatory dermatosis. Cell-mediated immunity and delayed hypersensitivity are proposed pathogenic mechanisms. We report in this paper a case of generalized granuloma annulare that resolved after the patient was treated with rituximab and bendamustine for stage IV follicular lymphoma.

Anaphylaxis to pegylated liposomal Doxorubicin: a case report.

Liposomal doxorubicin is used for the treatment of various cancers like epithelial ovarian cancers, multiple myeloma and sarcomas. We report the first case of anaphylaxis to pegylated liposomal doxorubicin.

A Rare Case of Port-a-Cath Migration into the Mediastinum.

Port-a-cath is commonly used in patients who require frequent administration of intravenous medications. We describe a rare case of port-a-cath migration into the mediastinum 16 months after its insertion.

Delayed diagnosis of abdominal mass due to morbid obesity.

Obesity has become an increasing problem in developed countries. Obesity is associated with many of the most common causes of morbidity and mortality, including diabetes mellitus, coronary artery diseases, sleep apnoea, and many types of cancers. Not only is morbid obesity associated to a greater extent to the many medical problems related to obesity, but the body habitus of a morbidly obese patient causes limitation to physical examination, radiologic evaluations, and therapeutic interventions that can delay diagnosis and treatment of the patient. We present a case of a morbidly obese patient whose diagnosis of liposarcoma was delayed for over a year as his obesity hindered proper diagnosis and medical treatment.

Fatal neutropenic enterocolitis due to clostridium septicum.

We describe a case of Clostridium septicum enterocolitis in a patient with pre-B acute lymphoblastic leukaemia undergoing autologous stem cell transplant. In the setting of neutropenia, Clostridium septicum should be suspected in patients who develop signs and symptoms of acute abdomen.

Seroprevalence of hepatitis B virus among Bhutanese refugees residing in Nepal.

The carrier rate of HBsAg is about 6% in Bhutan and 1% in Nepal. Since outbreaks of viral hepatitis are also known, its high prevalence in a migrated community, if any, maybe a potential threat to the local people. The present study was conducted in Beldangi 2 Extension Camp, a Bhutanese refugee camp located in eastern Nepal to know the HBsAg carrier rate among the refugees. With the help of semi-structured questionnaires, 500 volunteers enrolled were interviewed for the risk factors for HBV transmission. Blood samples of 467 subjects were tested for HBsAg by an immunoassay based on immunochromatographic sandwich principle. Out of 467 samples 4 were positive for HBsAg a prevalence rate of 0.9%. HBsAg carrier rate was found to be low in Bhutanese refugees. From the questionnaires it was also found that they were not engaged in any practice that could increase the chances of HBV transmission. The study shows that the Bhutanese refugees in Nepal in this geographical area are not a threat to the local people as far as HBV transmission is concerned.

Magnetic resonance imaging of spinal plasmacytoma.

AIM: To describe the magnetic resonance imaging (MRI) features of spinal plasmacytoma. MATERIALS AND METHODS: The clinical records and MRI findings in six patients (five men, one woman; age range 41-61 years) with histologically proven plasmacytoma of the spine were reviewed. All studies included sagittal T1- and T2-weighted spin-echo sequences and axial T1-weighted spin-echo sequences. Intravenous gadolinium DTPA was administered in four cases. RESULTS: MRI showed a characteristic appearances in four cases of low signal intensity curvilinear areas within the vertebra or cortical irregularity. CONCLUSION: Recognition of these imaging features can initiate the appropriate investigation as the commonest differential diagnosis for such lesions is metastasis.Shah, B. K. (2000). Clinical Radiology55, 439-445.

Cystic liver metastases from extracranial primitive neuroectodermal tumour: a case report.

We report a rare case of cystic metastases to the liver from a peripheral primitive neuroectodermal tumour in a child. Ultrasound and CT appearances are described with a discussion on the histological findings and the differential diagnosis.

On the antifeedant and anthellmintic potential of anacardium occidentale L.

The antifeedant and anthelmintic activities of crude extracts of the shells of Anacardium occidentale were studied by comparing it's activity with the activity of Azadirachta indica A Juss (Kernel), a commercial standard. The test extracts of A. occidentale in petroleum ether, dichloromethane: methanol showed better activities compared to A. Indica. To Study the anthelmintic activity, the addition of piperine to the formulation significantly enhances the activity. The phytochemical investigation of test extracts showed the presence of phenols namely cordol, cardanol and anacardic acid by TLC studies. The most potent extracts are non toxic to mice.

MHC class II alleles and haplotypes in patients with pemphigus vulgaris from India.

Pemphigus vulgaris (PV) is a blistering disease of the skin and mucous membranes characterized by an autoantibody response against a keratinocyte adhesion molecule, desmoglein 3, causing acantholysis and blister formation. We compared high resolution MHC class II alleles and haplotype frequencies (HLA-DRB, DQA1 and DQB1) in 37 patients with PV to 89 haplotypes of normal relatives from New Delhi and Ahmedabad. We found that PV patients had significantly increased frequencies of DRB1*1404 (P < 0.0001), DQA1*0101 (P = 0.001), and DQB1*0503 (P < 0.0001). These associations were due to the increased frequencies of the haplotype HLA-DRB1*1404, DRB3*0202, DQA1*0101, DQB1*0503 in patients compared to control haplotypes (p < 0.0001). Also, patients from Ahmedabad had a significant increase in HLA-DQB1*0302 (p = 0.03). An identical amino acid sequence (Leu-Leu-Glu-Arg-Arg-Arg-Ala-Glu), in positions 67-74 of the beta domain of DRB alleles is restricted to some DR14 alleles. Therefore, there are three possible explanations for class II allele involvement in autoantibody in PV patients with class II haplotypes marked by HLA-DR14. First, the class II alleles could be markers for an unidentified susceptibility gene in linkage disequilibrium with them. Second, the primary association could be with DQB1*0503 and the association with HLA-DR14 alleles would be the result of linkage disequilibrium. Third, the HLA-DRB1 locus susceptibility could involve a specific amino acid sequence in the third hypervariable region shared by several HLA-DR14 alleles.

Facial palsy due to tuberculosis: the value of CT.

This case report demonstrates the value of CT in the investigation of facial palsy due to tuberculous mastoiditis. This is the best imaging modality available for identifying features suggestive of tuberculosis, the disease extent, presence of complications and demonstration of anatomy prior to surgery.

Doxepin therapy for duodenal ulcer: a controlled trial in patients who failed to respond to cimetidine.

Ten patients with endoscopically proven active duodenal ulcers completed a double-blind placebo-controlled trial of doxepin hydrochloride. All ten had previously failed to respond to conventional cimetidine therapy. Doxepin was given at bedtime in a single 50-mg dose for the first week and, if needed, in a single 75-mg or 100-mg dose for the remainder of the six-week trial. After two weeks of therapy the decrease in average ulcer size was 54% in the doxepin group versus 38% in the placebo group (P less than 0.01); at the end of six weeks the decrease in mean ulcer size was 69% in the doxepin group versus 97% in the placebo group, a difference that was not significant. No serious side effects were attributed to doxepin, but two patients complained of mild dryness of the mouth. Suggestions for using this tricyclic antidepressant and possible mechanisms of action are discussed.

Doxepin and cimetidine in the treatment of duodenal ulcer: a double-blind comparative study.

Twenty-one patients with endoscopically proven active duodenal ulcers were studied in a double-blind randomized trial comparing doxepin hydrochloride (50 mg during the first week, and 100 mg thereafter, at bedtime) and cimetidine (1,200 mg/day in four divided doses). After two weeks, the average size of the ulcers had decreased 94% in the doxepin group (n = 8) versus 66% in the cimetidine group (n = 13) (P less than 0.01). After six weeks, the average size of the ulcers had decreased 97% in both the doxepin group (n = 5) and the cimetidine group (n = 10). Doxepin was significantly (P less than 0.01) more effective than cimetidine in women. Although cimetidine was less effective than doxepin, it was more effective in men than in women. Neither drug significantly altered ratings of the patients' anxiety or depression, most of which were within the normal range before and throughout treatment. Possible mechanisms of action of this tricyclic antidepressant and suggestions for its use in ulcer therapy are discussed.

Consultation to line staff and its impact on the care of chronic patients.

This study was carried out to determine whether long term chronic deteriorated patients could be taught skills in activities of daily living by therapy aides to improve their quality of life in the hospital. It was designed as a controlled trial comparing active intervention in the experimental wards with routine nursing care in the control wards. The results showed that, even in such a short period as 3 months, active treatment produced results which were statistically significantly better than the controls. It is concluded that mental hygiene therapy aides, given adequate support and encouragement, can make measurable and observable improvements in the behavior of long term patients. The implications of the results are considered.

Data analysis problems in the area of pharmacokinetics research.

Of interest in compartment analysis is the estimation of kinetic first order rate constants and quantification of the amount of drug present in each compartment at every point in time. From the data pertaining to only one compartment, it is not always possible to estimate all the first order rate parameters of linear and non-linear compartment systems. When multiple varying doses are administered at different intervals of time, the equations quantifying the maximum and minimum amount of drug accumulated in each interval may be used. To obtain estimates of kinetic parameters, statistical adjustments may be used in the kinetic equations.