ANTISMOOTH MUSCLE AND ANTIPARIETAL CELL ANTIBODIES IN INDIANS WITH ALOPECIA AREATA

Background. Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases. Methods. A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique. Results. Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Anti-smooth-muscle-antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata (P< 0.001). Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels. Conclusion. Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.     

Plexiform neurofibromas in neurofibromatosis type 1

Plexiform neurofibroma developing in neurofibromatosis type 1 is a fascinating overture whereby diagnosis is primarily based on clinical characteristics, the details of which are outlined. Nonetheless, it is imperative to establish a clear-cut clinical status vis-á-vis the adjoining tissues. Magnetic resonance imaging (MRI) may provide an additional supplement to the diagnosis and an aid to further management of the condition.     

Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) Is a rare congenital anomaly seen in 0.26% of all congenital heart defects. From 1978 to the present, we have encountered 11 such cases in patients ranging from 3 months to 60 years of age. A variety of procedures have been performed, such as ligation of the anomalous left coronary artery (n = 1), saphenous vein bypass (n = 2), subclavian to left coronary artery anastomosis (n = 4), Takeuchl repair (n = 1), and revascularizatlon using a 6-mm Gore-Tex tube (n = 1). No of these patients were children who also had prosthetic mitral valve replacements with a #1 M Starr-Edwards valve and left subclavian to left coronary artery anastomosis. Three patients died postoperatively, one Immediately after surgery due to low cardiac output, another on the eighth postoperative day due to renal failure, and the third was a child who died 3 months later due to bacterial endocarditis of the prosthetic valve. The surviving patients have been and are in NYHA Class I after a mean follow-up of 9 years. One patient, revascularized with a prosthetic graft, was lost for follow-up after 3 years. A two-coronary system appears more physiological and Is reported to be favored by most surgeons. Left subclavian to left coronary artery anastomosis has also been observed to give excellent results, with which we also agree. The mitral valve replacement In addition to this procedure, reported here, has not been described before in the literature.     

Geographical Variations in the Presentation of Ruptured Aneurysms of Sinuses of Valsalva: Evaluation of Surgical Repair

From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninty percent were in the 20-to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.     

Anteromedial Subtalar Dislocation

Subtalar dislocation is the simultaneous dislocation of the distal articulations of the talus at both the talocalcaneal and talonavicular joints. It can occur in any direction and can always produce significant deformity. The medial dislocation is most common. Less common presentations are lateral, anterior, and posterior dislocations. These dislocations are associated with osteochondral fractures. Closed reduction and immobilization remain the mainstays of treatment. Proper radiographs and computed tomography scan confirm the postreduction alignment stability of subtalar joints and intraarticular fracture fragments. We report a case of anteromedial subtalar dislocation with no osteochondral fracture fragments in a 25-year-old man.