Subungual malignant melanoma clinically resembling granuloma pyogenicum

A 37-year-old labourer developed longitudinally split dystrophic nail with blackish discolouration in the centre 5 months following blunt trauma to the right thumb nail. Six months later, a well defined exudative erythematous to violaceous nodule developed and this recurred inspite of repeated surgical interventions. Patient had large, firm to hard epitrochlear and axillary lymphadenopathy. Histopathological examination confirmed the diagnosis of malignant melanoma.     

Leprosy and herpes zoster; an association or dissociation?

Nerve involvement is common to the pathogenesis of both leprosy and herpes zoster. We report two cases of borderline leprosy in which the skin lesions characteristically spared the healed zoster scar. Possible mechanisms and relationship are discussed.     

Hair in psoriasis: a prospective, blinded scanning electron microscopic study

We examined hairs from psoriatic plaques by scanning electron microscopy, and compared the morphological changes in the hairs with those from the corresponding nonlesional skin of the same patients and those from healthy subjects, in a observer-blinded prospective study. Micropits or macropits (sharply demarcated defects on the cuticle < 0.5 µm or > 0.5 µm, respectively, in diameter), dystrophy (areas showing generalized roughness and ragged appearance of the cuticle), upturned edges of cuticular cells, transverse and longitudinal fissures were seen in varying frequency in all three groups. Micropits were significantly more frequent in the lesional hair compared with hair from the nonlesional area and controls. Dystrophic changes were significantly more severe in lesional hairs compared with hair from the nonlesional area. Upturning of cuticular edges was more frequent (but not significantly so) in hair from psoriatic plaques. The presence of micropits and hair dystrophy could contribute to the thinning and loss of hair in the psoriatic plaques.     

Prevention of acute cadmium toxicity by Picroliv

The potential of Picroliv, a herbal extract against acute cadmium (Cd) intoxication, was evaluated in male rats. Biochemical and histopathological profile in rats pretreated with Picroliv (12 mg/kg, oral) followed by a single dose of Cd as cadmium chloride (CdCl2) (3 mg/kg, ip) revealed marked suppression of oxidative stress in liver and testes. The Cd-induced enhanced levels of lipid peroxidation, membrane fluidity and reduced levels of nonprotein sulphydryls and Na(+)K(+)ATPase were significantly restored to near normal by Picroliv pretreatment. In addition, the Cd-induced serum levels of glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, gamma glutamyl transpeptidase and lactate dehydrogenase were restored to near basal levels. Hepatic and testicular histopathological damage was also minimized. The results strongly suggest definite hepato- and testicular protection by Picroliv. The antioxidant potential of the herbal extract in the major part, and not its chelating property, seems to be responsible for its ameliorative action.     

Neodymium-YAG laser core through urethrotomy in obliterative posttraumatic urethral strictures after failed initial urethroplasty

OBJECTIVE: To assess the feasibility, problems and results of Nd-YAG laser core through urethrotomy in the management of failed urethroplasty for posttraumatic bulbomembranous urethral strictures. MATERIAL AND METHODS: 61 patients with obliterative posttraumatic urethral strictures were treated by Nd-YAG laser core through urethrotomy between May 1997 to April 2000. Of these, 5 patients had failed end-to-end urethroplasty done as an initial procedure at various periods of time. The procedure was performed as day care and patients were discharged within 6 h of procedure. RESULTS: At 24-30 months of follow-up, all patients are voiding well and are continent. Auxiliary procedures were required in 2 cases. CONCLUSION: Nd-YAG laser core through urethrotomy is a feasible day care option for patients of obliterative urethral strictures following failed initial urethroplasty with successful outcome.     

Impact of imaging and thrombus level in management of renal cell carcinoma extending to veins

OBJECTIVES: To evaluate the role of newer imaging modalities in the diagnosis and evaluation of management according to extent of renal vein (RV) or inferior vena cava (IVC) thrombi in patients with renal cell carcinoma. MATERIAL AND METHODS: Fifty-nine patients with renal cell carcinoma and tumor thrombus extension into the RV or IVC were studied. Diagnosis was based on contrast-enhanced CT, magnetic resonance imaging or color-Doppler ultrasonography. Surgical treatment was contemplated in 42 suitable patients and complete resection could be done in all but 3 cases. RESULTS: There were 48 males and 11 females with mean age of 51.8 years. Isolated RV involvement was seen in 27 cases whereas IVC extension was present in 32 cases. The thrombus extent was infrahepatic in 62.5% (20/32) patients with IVC extension. With the newer imaging modalities like contrast-enhanced CT, color-Doppler ultrasound and/or magnetic resonance imaging, correct diagnosis of the extent of the thrombus was possible in 95% of the patients. The accuracy of color-Doppler ultrasound was same as magnetic resonance imaging in the evaluation of the extent of the thrombus. In the present series a median follow-up of 4 years revealed a high incidence of local and distant recurrences and decreased survival in patients presenting with advanced disease, who had venous wall invasion. CONCLUSIONS: The extent of RV or IVC thrombi can be accurately diagnosed with contrast-enhanced CT scan and in case of doubt color-Doppler ultrasound is a good alternative to magnetic resonance imaging. Management can be planned according to the level of the tumor thrombus. Invasion of the venous wall was found to be a bad prognostic factor affecting survival.     

Video analysis of Hammersmith lateral tilting examination using Kalman filter guided multi-path tracking

Video object tracking plays an important role in many computer vision-aided applications. This paper presents a novel multi-path analysis-based video object tracking algorithm. Trajectory of the moving object is refined using a Kalman filter-based prediction method. The proposed algorithm has been used successfully to analyze one of the complex infant neurological examinations often referred to as Hammersmith lateral tilting test. This is an important test of the infant neurological assessment process, and this test is difficult to grade by visual observation. It has been shown in this paper that the proposed video object tracking algorithm can be used to analyze the videos of fast moving objects by incorporating application-specific information. For example, the proposed tracking algorithm can be used to assess lateral tilting test of the Hammersmith infant neurological examinations. The algorithm has been tested with several video recordings of this test which were captured at the neurodevelopment clinic of the SSKM Hospital, Kolkata, India during the period of the study. It is found that the proposed algorithm is capable of estimating the score for the test with high values of sensitivity and specificity.     

Optical coherence tomography following successful management of endophthalmitis

Optical coherence tomography (OCT) was done in 20 eyes to detect causes of poor visual outcome, at least three months after successful management of endophthalmitis, which obtained clear media and best corrected visual acuity of < 20/40. Only four (20%) eyes had normal foveal contour on OCT. Eleven (55%) eyes showed treatable lesions, including epiretinal membrane with macular thickening in five (25%), epiretinal membrane without macular thickening in three (15%), cystoid macular edema in two (10%) and subfoveal serous detachment in one (5%) eye. Five eyes (25%) had foveal atrophy. OCT was helpful in segregating treatable conditions like cystoid macular edema from nontreatable causes like neurosensory atrophy in the postendophthalmitis patients.