COMPARISON OF TOPICAL PHENYTOIN WITH NORMAL SALINE IN THE TREATMENT OF CHRONIC TROPHIC ULCERS IN LEPROSY

Background. Trophic ulceration, one of the most common complications of leprosy, is disabling, distressing, and demoralizing for the patient. Methods. The wound healing effects of topical phenytoin powder were compared with those of normal saline in a controlled in-patient study of 100 patients with 110 trophic leprosy ulcers of varying chronicity, over a 4-week study period. Fifty patients were assigned to the topical phenytoin group and 50 to saline therapy group. Ten patients had two ulcers each, and, in these cases, one ulcer was treated with phenytoin and the other with saline. Results. Over the 4-week treatment period healthy granulation tissue appeared earlier, and mean percentage of ulcer volume reduction was greater, in the phenytoin group (72.1 ± 19.9% versus 55.5 ± 21.6%) compared with the control group. Conclusions. This difference was statistically significant at the level of P < 0.001. Phenytoin appears to be a useful agent for the promotion of healing of trophic leprosy ulcers.     

HORMONAL MARKERS IN THE STUDY OF PITUITARY ADENOMAS

Twenty pituitary adenomas were studied using light microscopy, immunohistochemistry and electron microscopy. Based on clinical manifestations of hormonal hypersecretion they were divided into two groups, i.e. group-I (12 patients) with no endocrine dysfunction and group-II (8 patients) with endocrine dysfunction. Group-I could be further sub-divided into two groups based on IHC : group LA in which no hormone could be localised in the tissue (null cell adenomas) and group IB where hormones could be localised in the tissue (1). Tumours in group II, with light microscopy, were acidophil (n=5), basophil (n=1) or mixed (n=2) adenomas. Eight of these 20 cases were plurihormonal. Growth hormone, and prolactin were the commonest combination. This study has helped in the reclassification of the pituitary adenomas according to the hormone they produce.KEY WORDS: Pituitary neoplasms, Diagnosis, Immunohistochemistry, Electron microscopy     

Autoantibodies to nucleolar antigens in systemic scleroderma: clinical correlations

Indirect immunofluorescence(IIF) and double immunodiffusion (DID) were performed on the sera of 64 patients who had a nucleolar immunofluorescence pattern on HEp-2 cells. Forty-nine of the sera were from 296 patients with systemic scleroderma (SSc) and 15 sera were from 214 patients with systemic lupus erythematosus (SLE). A homogeneous nucleolar staining pattern was found in 45 of the 64 sera (70.3%), a clumpy fluorescence associated with fibrillarin antibody in 14 (21.8%) and a speckled pattern was found in five of the sera (7.8%). There was a clear correlation between the sera which showed a homogeneous nucleolar staining pattern with symptoms of the polymyositis/scleroderma overlap syndrome that differed from SSc with concomitant myositis. The clumpy pattern was mainly associated with diffuse scleroderma and the speckled pattern with limited scleroderma (previously called acrosclerosis).     

Does obesity affect recovery?

One hundred and twenty unpremedicated patients, scheduled for minor gynaecological procedures, were randomly allocated to receive Althesin or methohexitone to supplement N2O and O2 anaesthesia. Patients were assessed as thin, medium or fat according to the degree of obesity as measured by skinfold calipers. The range of mean times for the patients to open their eyes was 3.1-4.0 minutes, to be orientated was 4.4-6.7 minutes and to perform a manipulative test was 27.7-32.1 minutes. No statistically significant differences were seen in these indices of recovery whether they received Althesin or methohexitone or whether they were thin, medium or fat. A paper and pencil test was also performed. Induction doses of the intravenous agent were calculated on a body weight basis and increments given only in response to movement. The mean total dose of Althesin was decreased from 1.33 mg total steroid/kg for thin patients to 1.06 mg total steroid/kg for fat patients (p less than 0.01). The mean total dose of methohexitone was decreased from 3.4 mg/kg for thin patients to 2.9 mg/kg for fat patients which was not significant.