An unusual cause for rings in the brain

We report the case of a 35-year-old man from North India who presented with generalised tonic-clonic seizures and was found to have ring-enhancing brain lesions. He had a coincident adrenal mass lesion. Cultures from both regions grew Histoplasma capsulatum. He improved on treatment with itraconazole. This case is being reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, and coincident adrenal involvement is also a rarity in an immunocompetent individual.     

Neurocysticercosis, IgG immunoglobulins, and nitric oxide

This study evaluated the role of parasite load and nitric oxide on IgG levels in neurocysticercosis. Total serum IgG, IgG antibodies specific for cysticercus antigens, and nitric oxide were compared between 85 neurocysticercosis patients, 65 with solitary cysts and 20 with multiple cysts, and 13 normal healthy controls. Sixty-six percent of patients were seropositive for cysticercus IgG antibodies. Among seropositive patients, IgG levels did not differ between those infected with multiple or solitary cysts whose serum nitric oxide levels were low (<40 nmol/ml). Among seropositive solitary cyst infected patients, IgG levels were significantly higher in those whose serum nitric oxide was low compared to those with high nitric oxide levels (p < 0.001). IgG levels were significantly higher in patients with multiple compared to single cyst infections among those negative for cysticercus antibodies (p < 0.001). Parasite load and nitric oxide modulated IgG production in neurocysticercosis. IgG levels were not determined by the number of infecting cysts in seropositive patients who did not mount a nitric oxide response. IgG production correlated to parasite load in patients negative for cysticercus antibodies.     

Horizontal flip pedicled genioplasty for correction of asymmetric chin in adult unilateral temperomandibular joint ankylosis

It has been the desire and a great challenge to clinicians treating maxillofacial deformities to bring about symmetry in asymmetric faces. As one understands, it is very difficult to reproduce nature, that is, the normal side out of abnormal side, and it is easier to manage bilateral symmetrical deformities. Temporomandibular joint (TMJ) ankylosis, when it occurs in early childhood, will have devastating effects on the future growth and development of the jaws and teeth with obvious facial deformity including the chin, which worsens with advancing age and the time elapsed between the onset of ankylosis and the treatment instituted. We have been treating these chin deformities in adult unilateral TMJ ankylosis cases for over more than a decade with horizontal flip pedicled genioplasty, which has a mathematical basis of turning a scalene triangle to an isosceles triangle and thereby achieving symmetry. Fixation of the genial segment in an overriding position not only adds to the length of mandible but also overcomes the obstructive sleep apnea many times associated with TMJ ankylosis. We have successfully treated 15 patients using horizontal flip pedicled genioplasty during last 14 years. This instantaneous corrective and unique technique requiring minimal patient compliance is put forward with refinements developed during a period of years.     

Treatment of midline cleft of the mandible-A 2-stage approach

Midline clefts of the lower lip and mandible are rare congenital anomalies. They may present as complete or incomplete in nature along with associated bifid tongue and ankyloglossia. Some may present with cleft of lower lip, cleft of mandible, fissured tongue, absent hyoid bone, cleft of manubrium sterni, or an extremely rare anomaly known as Tessier cleft no. 30. We present this unique case of midline cleft of the lower lip (incomplete) and mandible (complete) with initial soft-tissue surgery for the lower lip. The hard-tissue surgery for this case is deferred at a later date, and the reasons are discussed.     

Chondromyxoid fibroma of the seventh cervical vertebra

Chondromyxoid fibroma is a rare benign bone tumor representing less than 0.5% of all bone tumors. It commonly involves the long tubular bones. Involvement of the spine is rare. A 35-year-old man presented with history of neck pain, restriction of neck movements, pain and numbness along the medial aspect of the left forearm and weakness with wasting of the left hand. A presumptive diagnosis of a bony tumor such as an aneurysmal bone cyst or a giant cell tumor involving the seventh vertebral body was made on plain X-rays, MRI and bone scan. He underwent C7 central corpectomy, incomplete intralesional curettage with iliac bone grafting and C6 to T1 interspinous wiring. The histological diagnosis was chondromyxoid fibroma. On eight years' follow-up, CT scan showed no progression of the tumor with good alignment and fusion of the graft at the site of the corpectomy. The authors conclude that corpectomy and iliac bone grafting for chondromyxoid fibroma has a good outcome on long-term follow-up.     

The promise and harms of screening for plasma cell dyscrasias

In this perspective, we highlight both the promise and harms of screening for plasma cell dyscrasias, as well as the implications of the use of mass spectrometry for diagnosing monoclonal gammopathy of undetermined significance in routine practice.