A study from Nepal showing no correlation between lichen planus and hepatitis B and C viruses

A total number of 86 cases of Lichen planus (LP) were seen over a period of one and a half years. This constituted 0.58% of 14,833 new dermatological patients seen. Hepatitis B and C viral (HBV & HCV) serology was carried out in 64 patients and 43 age and sex matched controls. In the examined patients, 35 (54.27%) had the skin lesions only. Oral lesions were present in 15 (23.4%) of the patients in addition to skin lesions, while 14 (21.9%) had only oral involvement. Serology for HBsAg and HCV was negative in all types of LP patients and the controls. In Nepal, HBV and HCV seem to be not important in the pathogenesis of LP.     

Bilateral fronto-orbito-zygomatic craniotomy--a combined extended frontal and orbitozygomatic approach

In extensive skull base lesions involving the spheno-ethmoido-clival region and extending into both the cavernous sinuses and infratemporal regions, a combination of approaches is usually required, either in the same operation or at a second stage. The bilateral fronto-orbito-zygomatic craniotomy described in this report is a combination of an extended frontal approach and fronto-orbito-zygomatic craniotomy. This gives a wide exposure of the spheno-ethmoido-clival regions of both the cavernous sinuses and both the infratemporal regions. The exposure is thus greatly improved with minimal frontal lobe retraction. The single bone piece can be speedily replaced obviating the need for a complicated reconstruction technique and gives a superior cosmetic result. The operative technique is described in detail.     

Macroglossia due to venous malformation

Massive vascular malformation involving tongue can cause significant functional impairment. In this report we describe a rare case of extensive venous malformation involving tongue leading to obstructive sleep apnoea, inability to speak, eat, severe discomfort due to exposure induced dryness and ulceration. Multimodality treatment approach comprising of sclerotherapy, electrocautery and radiation therapy was used in this case.     

Prehypertension may be common in patients with central serous chorioretinopathy

Purpose To test an observational hypothesis that patients with central serous chorioretinopathy (CSCR) may have a tendency towards hypertension compared with normal individuals.Methods In this case–control study we evaluated resting blood pressure in 32 patients with CSCR and compared it with that in 32 healthy controls in a standard laboratory environment. Differences in resting systolic and diastolic blood pressure were measured.Results Mean systolic blood pressure was 123.56+/−4.8 in the CSCR group and 113.63+/−12.62 in the control group. Mean diastolic blood pressure was 84.75+/−10.2 in the CSCR group and 76.75+/−0.4 in the control group. The difference in mean blood pressure values between the two groups was statistically significant.Conclusion Patients with CSCR may be predisposed to prehypertension. Hence they should be advised on lifestyle modification and followed up periodically for early detection of progression to stage 1 or 2 hypertension.     

Advances in therapy for psoriasis: an overview of infliximab, etanercept, efalizumab, alefacept, adalimumab, tazarotene, and pimecrolimus

Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European population. Over the last several years, one of the major focuses in psoriasis research has been the development of biologic therapies for this disease. The aim of these therapies is to provide selective, immunologically directed intervention with fewer side effects than traditional therapies. The goal of this article is to review the progress of the biologic agents which are available, or under investigation for clinical use: infliximab, etanercept, efalizumab, alefacept, and adalimumab. In addition, two other investigational therapies, oral tazarotene and oral pimecrolimus will be discussed. Clinical data for these agents, including the most recent phase II and/or III study results, will be discussed, as well as the most recent safety data.     

Influence of sex and estrous cyclicity on conditioned cue-induced reinstatement of cocaine-seeking behavior in rats

Rationale Sex differences have been reported in physiological and behavioral responses to cocaine, but it is unclear whether sex differences exist in conditioned-cued relapse to cocaine seeking after prolonged abstinence. Furthermore, the role of estrous cyclicity in conditioned-cued relapse has not been investigated.Objective We assessed the influence of sex and estrous cyclicity on conditioned-cued reinstatement of drug-seeking behavior in Sprague–Dawley rats.Methods Rats were trained to self-administer intravenous cocaine (unconditioned stimulus, US; 0.25, 0.4, 0.5, 0.6, or 1.0 mg/kg per infusion) paired with light+tone conditioned stimuli (CSs) and were subsequently tested for the ability of the CSs to reinstate extinguished cocaine seeking (i.e., nonreinforced lever responding).Results Females exhibited more responding on the cocaine-paired lever during self-administration and extinction than males. Subsequently, males exhibited equally robust conditioned-cued reinstatement of extinguished drug-seeking behavior independent of cocaine training dose. Males and females trained on 0.4–0.6 mg/kg cocaine reinstated to a similar extent. However, females trained on the lowest dose (0.25 mg/kg) exhibited less reinstatement than males, and the source of this effect was the absence of reinstatement in estrous females. In addition, independent of estrous state, females trained on the highest dose (1.0 mg/kg) exhibited less reinstatement than males.Conclusions While males and females are equally responsive to cocaine-paired CSs when the conditions for CS–US association are optimal, females appear to attribute less motivational significance to the CS when it presumably acquires weaker motivational salience because of (a) a low cocaine dose or (b) weaker CS–US contiguity due to the prolonged effects of a high cocaine dose.     

External pancreatic fistula as a sequel to management of acute severe necrotizing pancreatitis

BACKGROUND/AIMS: External pancreatic fistula (EPF) is a common sequel to surgical or percutaneous intervention for infective complications of acute severe pancreatitis. The present study was aimed at studying the clinical profile, course and outcome of patients with EPF following surgical or percutaneous management of these infective complications. METHODS: A retrospective analysis of clinical data of patients with EPF following intervention (surgical or percutaneous) for acute severe pancreatitis managed between January 1989 and April 2002 recorded on a prospective database was done. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) that could predict early closure of fistula was performed. RESULTS: Of 210 patients with acute severe pancreatitis, 43 (20%) patients developed EPF (mean age 38 (range 16-78) years, M:F ratio 5:1) following intervention for infected pancreatic necrosis (n=23) and pancreatic abscess (n=20) and constituted the study group. The fistula output was categorized as low (<200 ml), moderate (200-500 ml) and high (>500 ml) in 29 (67%), 11 (26%) and 3 (7%) patients, respectively. Fifteen patients (35%) had morbidity in the form of abscess (n=5), bleeding (n=1), pseudoaneurysm (n=2) and fever with no other focus of infection (n=7). Spontaneous closure of the fistula occurred in 38 (88%) patients. The average time to closure of fistula was 109+/- 26 (median 70) days. Fistula closed after intervention in 5 patients (2 after endoscopic papillotomy, 1 after fistulojejunostomy and 2 after downsizing the drains). Of the 38 patients with spontaneous closure, 9 (24%) patients developed a pseudocyst after a mean interval of 123 days of which 7 underwent surgical drainage of the cyst. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) failed to identify any factors that could predict early closure of fistula. CONCLUSIONS: EPF is a common sequel following intervention in acute severe pancreatitis. The majority of these are low output fistulae and close spontaneously with conservative management. One-fourth of patients with spontaneous closure develop a pseudocyst as a sequel, requiring surgical management.     

Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature

Development of a contralateral epidural haematoma during or immediately after cranial surgery is a well-described entity. However, in a case of acute subdural haematoma where the brain is usually tense, postoperative development of contralateral extradural haematoma is uncommon. We report two cases of contralateral extradural haematoma after decompressive surgery for acute subdural haematoma. We recommend routine postoperative CT immediately after cranial surgery for head trauma. This would help in timely detection and treatment of such a complication.     

Ductal Lavage Findings in Women With Mammographic Microcalcifications Undergoing Biopsy

Background We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL).Methods Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject .2 to 1 mL of Isovue 300 into the duct to determine whether the FYD corresponded to the duct containing calcifications (designated overlap). Additional FYDs were injected, if possible, until overlap was identified. DL cytology was compared with histology.Results Twenty women were enrolled (mean age, 54.2 years); the mean size of the calcification-bearing area was 190 mm². The histological findings were as follows: 1 invasive cancer, 9 ductal carcinomas-in-situ (DCIS), 5 atypical hyperplasias, and 5 usual hyperplasias or fibrocystic changes. Four women had no FYD. In 15 women who underwent DL and ductography, overlap of dye and calcifications was seen in 4 (27%): 1 fibrocystic change, 1 hyperplasia, 1 atypical hyperplasia (cytological diagnosis mildly atypical), and 1 DCIS (cytological diagnosis benign). Of the remaining 8 DCIS lesions, 4 had no nipple aspiration fluid, 1 showed extravasation, and 3 were lavaged but the duct did not overlap.Conclusions These results are consistent with data from women undergoing mastectomy for larger invasive cancer and DCIS and show that cancer-containing ducts do not yield nipple fluid in most cases.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Polio eradication initiative in India: deconstructing the GPEI.

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spear-heading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of "near success" by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.