Superior mesenteric artery syndrome secondary to tuberculosis induced cachexia.

Superior mesenteric artery (SMA) syndrome is a rare cause of obstruction of 3rd part of duodenum between abdominal aorta and the overlying superior mesenteric artery caused by decrease in the angle between the two vessels as a result of rapid loss of retroperitoneal fat. It is seen in conditions causing severe weight loss and catabolic states. We report a case of pulmonary tuberculosis leading to superior mesenteric artery syndrome.

Multiple focal nodular hyperplasia, an incidental finding on autopsy.

Focal nodular hyperplasia (FNH) is a benign condition of the liver often discovered incidentally on radiological investigation. Although FNH is a well-described lesion in the literature considerable diagnostic problems regarding this entity still remains. We report a case of multiple FNH in a 23-year-old male patient detected as an incidental finding in autopsy.

Extensive alopecia areata: not necessarily recalcitrant to therapy!

Background: Extensive alopecia areata includes alopecia universalis, alopecia totalis, ophiasis and patients having more than 50% scalp involvement. Alopecia universalis (AU) and totalis (AT) are considered to be resistant to single modalities of treatment. Our study highlights the efficacy and safety of combination therapy in extensive alopecia areata.

A study of the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis.

Background: The association between psoriasis, diabetes, and cardiovascular disease remains largely unelucidated in the Indian population.

Aims: To study the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis.

Materials And Methods: Seventy-seven patients of chronic plaque psoriasis and ninety two age- and sex-matched controls were enrolled in the study over a period of one year.

Clinical characteristics and outcomes of patients with acute lung injury and ARDS.

Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical illnesses associated with significant morbidity and mortality.

Aims: This was designed to assess various etiologies of ALI/ARDS, to determine the correlation between the diagnostic criteria and need of mechanical ventilation, and to correlate biochemical factors with the outcome of patients.

Settings And Design: An observational, prospective study was conducted in a medical intensive care unit (MICU) of a tertiary care hospital, for a period of 1 year.

Anesthetic management of a patient with sickle cell disease for common bile duct exploration.

Patients with sickle cell disease (SCD) may present to the anesthetist in different clinical settings like perioperative care, management of acute painful crisis and intensive therapy for acute respiratory failure. We describe the successful management of a 34-year-old female patient with SCD, posted for cholecystectomy with common bile duct exploration under general and epidural anesthesia. The importance of preoperative stabilization and careful anesthetic strategy is emphasized.

Kikuchi fujimoto disease and systemic lupus erythematosus--a rare association.

Kikuchi-Fujimoto disease is rarely associated with systemic lupus erythematosus (SLE). Kikuchi Fujimoto disease may precede, follow or coincide with the diagnosis of SLE. We report a case who was initially diagnosed as Kikuchi Fujimoto disease with SLE.

Acquired localized cutis laxa of the face: a rare presentation.

We report a rare case of acquired localized cutis laxa in a teenage boy, without any preceding skin lesions. The area affected was the midface, extending to the chin, and involving the ears, leading to a prematurely aged appearance. Only five such cases have been previously published in the literature.

Penicillamine-induced elastosis perforans serpiginosa with abnormal "lumpy-bumpy" elastic fibers in lesional and non-lesional skin.

Four types of elastosis perforans serpiginosa (EPS) have been described in literature: 1) idiopathic EPS, 2) reactive perforating elastosis associated with connective tissue disorders, 3) in some instances of pseudoxanthoma elasticum (PXE), disease-specific calcified elastic tissue is extruded, producing a clinical picture indistinguishable from other types, may also be seen in patients undergoing hemodialysis and 4) EPS induced by long-term treatment with D-penicillamine is observed in patients suffering from Wilson's disease. Long term D-penicillamine therapy causes an alteration in the dermal elastic tissue. D-penicillamine induced EPS has a distinctive histopathologic feature - serrated appearance of elastic fibers due to perpendicular budding from their surface giving a "lumpy-bumpy" look.

Pheochromocytoma presenting as hypertension in pregnancy.

Pheochromocytoma is a curable, rare cause of hypertension, characterized by symptoms and signs related to increased catecholamine secretion. Pregnancy and labour increase the risk of hypertensive crisis. However, antepartum diagnosis reduces both maternal and foetal mortality, allowing for safe cesarean section and resection of tumor.

Automated Digital Image Analysis (TrichoScan®) for Human Hair Growth Analysis: Ease versus Errors.

Background: TrichoScan(®) is considered to be time-saving, easy to perform and consistent for quantifying hair loss/growth. Conflicting results of our study lead us to closely observe the image analysis, and certain repeated errors in the detection of hair were highlighted.

Aims: To assess the utility of TrichoScan in quantification of diffuse hair loss in males with androgenetic alopecia (AGA) and females with diffuse telogen hair loss, with regard to total hair density (THD), telogen and vellus hair percentages.

Subcutaneous phaeohyphomycosis caused by Cladophialophora boppii.

Subcutaneous phaeohyphomycosis is an infection of the skin and subcutaneous tissue, caused by dematiaceous fungi. An adult male presented with a history of multiple reddish nodules over the face and hands. Histopathological examination of the skin biopsies showed a dense granulomatous infiltrate of macrophages, containing intracytoplasmic basophilic bodies throughout the dermis.

Evaluation of clinical skills for first-year surgical residents using orientation programme and objective structured clinical evaluation as a tool of assessment.

Background: Postgraduate specialities require a combination of knowledge and clinical skills. The internship year is less structured. Clinical and practical skills that are picked up during training are not well regulated and the impact is not assessed.

Langerhans cell histiocytosis presenting as hypopigmented papules.

A 1(1/2)-year-old boy with Langerhans cell histiocytosis presented with a frontal bone mass showing features of eosinophilic granuloma. He subsequently developed multiple asymptomatic discrete hypopigmented papules on the face, trunk and extremities, which, on histology, were confirmed as Langerhans cell histiocytosis, a presentation hitherto unreported in literature. He responded well to surgery and chemotherapy.

Gastrointestinal histoplasmosis mimicking abdominal tuberculosis.

We report an elderly male who presented with history of chronic diarrhoea. The patient underwent colonoscopy and CT scan of the abdomen which strongly suggested tuberculosis; however histopathology showed presence of budding forms of Histoplasma capsulatum. The patient was started on oral itraconazole on which he improved remarkably.

Hair evaluation methods: merits and demerits.

Various methods are available for evaluation (for diagnosis and/or quantification) of a patient presenting with hair loss. Hair evaluation methods are grouped into three main categories: Non-invasive methods (e.g.

Subarachnoid haemorrhage: possibly caused by the illegitimate use of sildenafil citrate.

Sildenafil (Viagra) has been developed as a drug to treat male impotence. It has also been used to reduce symptoms (e.g.

Maternal mortality: an autopsy audit.

Background: The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention.

Aims: This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis.

Juvenile hyaline fibromatosis and infantile systemic hyalinosis: divergent expressions of the same genetic defect?

We describe here a three year-old girl with classic clinical and histological features of juvenile hyaline fibromatosis. We found a history of similar skin findings in her eldest sister, in whom the disorder took a rapidly progressive and fatal course in the second year of life, suggesting either a very severe form of juvenile hyaline fibromatosis, or the possibility of infantile systemic hyalinosis. The similarities and differences between these two described types of hyalinoses have been reviewed in reference to the present report.

Goldenhar syndrome with unusual features.

We report here the case of a 17 year-old girl with the classic signs of Goldenhar syndrome in the form of multiple accessory tragi, bilateral ocular dermoids, mandibular hypoplasia (micrognathia) and cervical lordosis. She also had a high arched palate, gingival hypertrophy and malaligned teeth, features which are as yet unreported.

Sudden death in tuberculous myocarditis.

Tuberculous myocarditis is one of the rare causes of sudden death. We report a case of 65-year-old female who came with diabetic foot and died suddenly after 2 days of hospital stay. On autopsy, she was found to have tuberculous myocarditis with granulomatous inflammation only in the liver and without pulmonary or mediastinal lymph node involvement.

Spontaneous esophageal perforation in a patient with achalasia cardia and rheumatoid arthritis.

Perforation of stasis ulcers in achalasia cardia has not been reported in literature. We report a 45-year-old lady with achalasia and rheumatoid arthritis who developed perforation and esophago-mediastinal sinus at the site of stasis ulcers. She succumbed to respiratory infection after resection of the sinus tract, Heller's cardiomyotomy, cervical esophagostomy and feeding jejunostomy.