Infantile congenital parotid lipomatosis: a rare case report

A case of congenital parotid lipomatosis in an infant is reported and literature is reviewed. This rare condition in children presents as gradually increasing parotid swelling, which is difficult to diagnose preoperatively as this condition is not considered in the differential diagnosis of a parotid mass. Complete excision with superficial or total parotidectomy with preservation of facial nerve is the treatment of choice.     

Efficacy and Toxicity Profile of Methotrexate Chloroquine Combination in Treatment of Active Rheumatoid Arthritis

Background

The present study was conducted to study the efficacy and toxicity profile of methotrexate chloroquine combination in treatment of active rheumatoid arthritis.

Methods

24 patients of rheumatoid arthritis confirming to revised American Rheumatism Association (ARA) criteria were studied prospectively for twenty months. Clinical evaluation was made every 3 months. Clinical disease variables measured at each visit were number of joints with swelling, number of joints with tenderness and pain, duration of morning stiffness and physician and patient assessment of disease activity. Blood counts, liver function tests and other adverse effects due to drugs were monitored every 2 months.

Results

10 patients demonstrated more than 50% improvement. 4 patients withdrew from study, 2 because of excessive nausea and vomiting and 2 because of noncompliance. Other side effects noted were hyperpigmentation, photosensitivity, skin rashes, raised transaminases and stomatitis.

Conclusion

Methotrexate chloroquine combination has good efficacy and toxicity profile. Gastrointestinal side effects are most common and usually responsible for the discontinuation of the drugs.Key Words: Rheumatoid arthritis, Methotrexate, Chloroquine, Efficacy, Toxicity     

Microalbuminuria and coronary heart disease risk in an ethnically diverse UK population: a prospective cohort study

Microalbuminuria (MA) is a strong risk factor for subsequent chronic disease, both renal and coronary heart disease (CHD), in European origin populations, but CHD risks differ by ethnicity, and it was hypothesized that prevalence of MA and relations with CHD may also differ. Combined analyses of two population-based cohorts started in 1988 and consisted of 1460 Europeans (70% male), 946 South Asians (78% male), and 559 African Caribbeans (51% male) who resided in London and were aged 40 to 69. Baseline fasting blood, overnight urine collection, and clinical measurements were performed. Prevalent CHD was defined by clinical history or major electrocardiogram changes. Age-adjusted albumin excretion rates (AER; geometric means, mug/min) were significantly higher in African Caribbeans (men: 6.1, 95% confidence interval [CI] 5.5 to 6.7; women: 5.7, 95% CI 5.2 to 6.2) than in South Asians (men: 4.3, 95% CI 4.0 to 4.5; women 3.4, 95% CI 3.0 to 3.8) and Europeans (men: 4.5, 95% CI 4.3 to 4.8; women: 3.3, 95% CI 3.1 to 3.6). MA was associated with both prevalent CHD and CHD mortality in South Asian men (hazard ratio 2.5; 95% CI 1.3 to 4.8) and in European women (hazard ratio 13.0; 95% CI 2.6 to 64.2) but not in any other group. Greater AER in African Caribbeans and the absence of association with CHD contrast with lower AER in South Asian men and European women, both strongly associated with CHD prevalence and mortality. These differences suggest that the pathogenesis of kidney disease and its link with CHD differ by ethnicity and gender.     

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

Background. Stellate ganglion block (SGB) causes vasodilatationin the skin of the head and neck because of regional sympatheticblock. Its effects on cerebral haemodynamics, in health or indisease, are not clear. We evaluated the effects of SGB on ipsilateralmiddle cerebral artery flow velocity (MCAFV), estimated cerebralperfusion pressure (eCPP), zero flow pressure (ZFP), carbondioxide reactivity (CO₂R) and cerebral autoregulation usingtranscranial Doppler ultrasonography (TCD). Methods. Twenty male patients, with pre-existing brachial plexusinjury, and undergoing SGB for the treatment of complex regionalpain syndrome of the upper limb, were studied. For SGB, 10 mlof plain lidocaine 2% was used and the onset of block was confirmedby presence of ipsilateral Horner's syndrome. The MCAFV, eCPP,ZFP, CO₂R, and cerebral autoregulation were assessed beforeand after SGB using established TCD methods. The changes inthese variables were analysed using Wilcoxon's signed rank test. Results. The block caused a significant decrease in MCAFV frommedian (inter-quartile range) value of 61 (53, 67) to 55 (46,60) cm s^–1, a significant increase in eCPP from 59 (51,67) to 70 (60, 78) mm Hg, and a significant decrease in ZFPfrom 32 (26, 39) to 25 (16, 30) mm Hg. There were no significantchanges in CO₂R or cerebral autoregulation. Conclusion. The increase in eCPP, decrease in ZFP, and no changesin CO₂R or cerebral autoregulation suggest that the SGB decreasescerebral vascular tone without affecting the capacity of thevessels to autoregulate. These effects may be of therapeuticadvantage in relieving cerebral vasospasm in certain clinicalsettings.     

Clinical profile and serum beta-carotene levels in oral submucous fibrosis

Clinical profile and serum beta-carotene levels in 100 cases of oral submucous fibrosis (OSMF) were studied. Prevalence of OSMF was noted to be 0.93% of new cases attending ENT OPD Age of cases varied from 12 to 78 years (mean 29.09 years) with male—female ratio of 3.3:1 and 80% literacy. Students constituted the single largest group. Burning sensation in oral cavity and inability to open mouth were the chief complaints in 95% cases. In all cases changes in colour of buccal mucosa and palpable fibrous bands in oral cavity were present followed by trismus (99%). About 52% patients were in grade-III OSMF (Journal of Indian Dental Association, 49: 187), oral habits of chewing tobacco, betal nut, etc. were present in 95% patients. Excessive use of chillies was present in 60 and 74% patients were non-vegetarian. Serum beta-carotene levels were below normal in all the three grades of OSMF, lowest being in grade III.