Squamous cell carcinoma complicating vitiligo in an Indian man

An elderly man, a known case of generalized vitiligo of long duration, presented to us with an ulcerated exophytic growth arising from the vitiliginous skin. The histopathological study confirmed the clinical suspicion of squamous cell carcinoma. Cutaneous neoplasia arising from the vitiliginous skin is a rare situation. Lack of melanin leaves the skin vulnerable to ultraviolet radiation damage, which may predispose to cutaneous neoplasia. Therefore, the importance of photoprotection has been stressed upon through this illustration.     

Fixed-drug eruption caused by ashwagandha (Withania somnifera): a widely used Ayurvedic drug

A 28-year-old man with decreased libido received ashwagandha in the usual daily dosage of 5 g for 10 days. During this period, he experienced a burning and/or itching sensation as well as discoloration of the skin/mucous membrane confined to the penis. He had a similar type of eruption at the same site 6 months prior while taking ashwagandha. Examination of the skin surface was conspicuous and marked by the presence of a dusky, erythematous, oval, eroded plaque of 3 cm, affecting the glans penis and prepuce (Figure). The drug was withdrawn and topical 0.05% clobetasol propionate cream was administered along with cetrizine dihydrochloride, an H1-receptor blocker, 10 mg daily for 1 month. There was a perceptible amelioration of the lesion, resulting in residual greyish white pigmentation. He was prescribed oral drug provocation with 1 g of ashwagandha powder. Within 12 hours, a flare-up developed at the earlier site, confirming the causality.     

Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up

This study reports the long-term effectiveness of meniscal allograft transplantation performed by a single senior operating surgeon. In this study 22 meniscus transplantations in 22 patients were evaluated at a minimum of 7-year follow-up (mean 8.5 +/- 1.3 years) using standardized scoring scales. Subgroup analysis was performed to stratify outcomes based on medial (59.1%) versus lateral (40.9%) meniscus transplantation, and transplantations performed in isolation (36.4%) versus those performed concomitantly (63.6%). Patients reported significant improvement in all scoring scales (p < 0.05). Average satisfaction was 8.8 out of 10. All the patients were completely or mostly satisfied with the results of their surgery. Overall subjective knee condition improved from 3.5 to 6.9 (p < 0.05). Patients undergoing medial compartment repair and combined transplantations reported greater improvement from baseline to followup than did their counterparts. An overall success rate of 88% was found for all patients at the final follow-up. Based on this data, meniscal allograft transplantation is a viable treatment option for meniscal-deficient patients in reducing pain, increasing range of motion, and improving patient function and satisfaction at a minimum of 7 years postsurgery.     

Origin and evolution of syphilis: drifting myth

The venereal form of treponematosis, caused by the spirochete Treponema pallidum, plagued every major city in the preantibiotic era. "Civilization means syphilization," was an idea touted by Richard von Krafft-Ebing in the late 19th, and early 20th centuries that the effects of modern life make men more susceptible to syphilis and other diseases. Christopher Columbus was thought of as an importer of syphilis to Europe. Because his serendipitous voyages to the New World initiated the process of Spanish colonization, which foreshadowed general European colonization of the New World, it is difficult to rule out the cultural and political animosity created by Columbus and his men. These recent revelations are intriguing and may create dialogue that may subsequently challenge the age-old theory of "East to West" spread of venereal syphilis. This contribution warrants the continuation of study in this direction, taking into account skeletal studies that utilized radiocarbon dating technique and the phylogenetic analysis of the bacterial strains, offering a possible consensus on the origin and evolution of syphilis.     

Outcomes of liver transplantation for patients with Alagille syndrome: the studies of pediatric liver transplantation experience

Alagille syndrome (ALGS) is a multisystem disorder that manifests as childhood cholestasis. Reports of liver transplantation (LT) for patients with ALGS have come largely from single centers, which have reported survival rates of 57% to 79%. The aim of this study was to determine LT outcomes for patients with ALGS. We performed a retrospective analysis of the Studies of Pediatric Liver Transplantation database, which contains information about 3153 pediatric LT recipients. Data were available for 91 patients with ALGS and for 236 age-matched patients with biliary atresia (BA). The frequency of complex cardiac anomalies was lower in the LT group with ALGS versus published ALGS series (5% versus 13%). The pretransplant glomerular filtration rate (GFR) was <90 mL/minute/1.73 m(2) in 18% of the LT patients with ALGS and in 5% of the LT patients with BA (P < 0.001). The height deficit at listing was worse for the ALGS patients (66%) versus the BA patients (22%). The 1-year patient survival rates were 87% for the ALGS patients and 96% for the BA patients (P = 0.002). The deaths in the ALGS group mostly occurred within the first 30 days. No pretransplant factors associated with death were identified in the ALGS group. A survival analysis revealed that biliary (P = 0.02), vascular (P < 0.001), central nervous system (CNS; P < 0.001), and renal complications (P < 0.001) after LT were associated with death in the ALGS group. Renal insufficiency in the ALGS patients worsened after LT, and at 1 year, GFR was <90 mL/minute/1.73 m(2) in 22% of the LT patients with ALGS but in only 8% of the patients with BA (P = 0.0014). More LT pediatric patients with ALGS either were currently receiving special education (50% versus 30% for BA patients, P = 0.02) or had received special education in the past (60% versus 36%, P = 0.01). Vascular, CNS, and renal complications were increased in the ALGS patients after LT, and this reflected multisystem involvement. Although the 1-year survival rate was modestly lower for the ALGS patients versus the BA patients, the clustering of deaths within the first 30 days is notable and warrants increased vigilance and further investigation.     

Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation

AIM:To investigate the prevalence of clinically unrecognized mitral regurgitation(MR) in lone atrial fibrillation(AF).METHODS:We studied the prevalence and severity of MR by transesophageal echocardiography(TEE) in patients with "lone" AF as compared to a matched cohort of patients in normal sinus rhythm(NSR) undergoing TEE for other indications besides recognized valvular heart disease.RESULTS:A total of 157 subjects(57 in the AF group and 100 in the NSR group) with structurally normal cardiac valves were included in the study.In the AF group,moderate MR or more was noted in 66% of thepatients,mild MR in 18%,trace or no MR in 16%.In the control group,moderate MR was noted in 6% of patients,mild MR 31%,trace or no MR in 63 % of patients.Moderate MR or greater was significantly more prevalent in the AF group compared to the NSR group(66% vs 6%,P < 0.0001).CONCLUSION:Clinically unrecognized moderate MR is prevalent in "lone" AF-either as an etiologic factor leading to "lone" AF or developing after onset of AF.     

Reversible dementia in the elderly as a rare manifestation of neurocysticercosis

Neurocysticercosis ( NCC) is a leading cause of seizure and epilepsy worldwide. There are no path gnomonic features or a typical NCC syndrome. In this communication we describe an interesting case of multiple NCC in an elderly presenting only with dementia and responded well to steroid and cerebral decongestant. The case report highlights an uncommon presentation of NCC and recognizing this reversible cause will avoid unnecessary investigation and delay in treatment.     

Disseminated Mycobacterium gordonae infection in a child with cystic fibrosis

A 4-year-old girl with cystic fibrosis (CF) presented with unrelenting pyrexia commencing shortly after flushing of the central venous catheter (CVC). Mycobacterium gordonae was subsequently isolated from bronchoalveolar lavage, gastric washings, and lung biopsy. While this case most likely represents central line infection by a non-tuberculous mycobacterial (NTM) species, it is difficult to state this definitively in the absence of positive cultures from the CVC. We suggest that infection with NTM should always be considered in CF patients with indwelling devices and unexplained fever.     

Orthotopic liver transplantation: reversible Doppler US findings in the immediate postoperative period

Orthotopic liver transplantation (OLT) is the only definitive treatment for irreversible acute liver failure and chronic liver disease. In the immediate postoperative period after OLT, patients are closely monitored with Doppler ultrasonography (US) to detect treatable vascular complications and ensure graft survival. The first postoperative Doppler US examination is performed fairly early on the first postoperative day, before surgical wound closure has been performed. The immediate postoperative images, obtained when the effects of surgery are very recent, often reveal an array of findings that may appear alarming but that tend to normalize within a few days and are compatible with changes related to the surgery itself. These findings include a starry-sky appearance of reperfusion hepatic edema, transient foci of increased echogenicity, pneumobilia, small fluid collections, perihepatic hematomas, pleural effusion, temporary elevation of hepatic arterial velocity, transient elevation of resistive index (RI), decreased RI with tardus parvus waveform, increased portal venous flow and mono- or biphasic waveforms of the hepatic veins. Most of these changes revert to normal in the first postoperative week; deterioration atypical of transient changes requires further evaluation.