Carcinoma en cuirasse in a middle-aged woman with a unique spoke-wheel presentation: A case report.

Carcinoma en cuirasse is a rare form of cutaneous metastasis characterized by the spread of a primary malignant tumor to the skin, most commonly associated with breast cancer in women. It may present as papulonodular lesions, erysipeloid, sclerodermiform infiltration, or en cuirassed, typically appearing months or years after the initial diagnosis of the primary malignancy. Diagnosis of carcinoma en cuirasse can be challenging, but histology can help distinguish it from other skin conditions. Treatment options for carcinoma en cuirasse are not well-defined due to the limited number of reported cases. Here, we report a case of a 30-year-old female, who presented with invasive ductal carcinoma which presented as carcinoma en cuirasse with a spoke-wheel pattern over the course of 6 months.

Sedative hypnotic activity of manahshila (realgar) -an experimental evaluation.

Manahshila (Realgar) is one of the three major Arsenicals used in Ayurvedic therapeutics since ages. It is indicated in skin, respiratory, ophthalmic and psychological disorders. It is mentioned to be the best among Rasayanas and a good aphrodisiac. As Manahshila is indicated in Unmada (Psychological disorder); wide use of Manahshila in the formulations mentioned for psychological disorders; some of those formulations are used in treatment of sleeplessness and Ardraka (Zingiber officinale Roscoe) which is a commonly used Shodhana reagent of Manahshila is reported to be sedative, the potential sedative hypnotic activity is inferred and an experimental study was carried out to evaluate the sedative hypnotic activity of Manahshila. Effect of Ardraka Shodhita Manahshila (ASM) on the spontaneous motor activity of albino rats in actophotometer and on diazepam induced sleeping time was evaluated. There was a statistically significant reduction in the spontaneous motor activity (P<0.001) in the ASM treated Manahshila and there was early onset and hypnotic potentiation in the diazepam induced sleep in rats (P<0.01).

Management of spontaneous rupture of the oesophagus

AIMS: Spontaneous rupture of the oesophagus (SRO) is a rare and often fatal event. The aim of this study was to evaluate the presentation, management and outcome of SRO in a single unit. METHODS: Data were collected on all patients presenting with SRO over a 5-year period with respect to presenting features, diagnostic investigations and subsequent management. Statistical analysis was by Student's t test, chi2 and Fisher's exact tests. RESULTS: Fourteen patients were identified, 12 men and two women with a median age of 64 (range 18-78) years; eight were tertiary referrals. Thirteen of 14 patients presented with chest or upper abdominal pain following vomiting or retching and 13 had an abnormal initial chest radiograph; only one presented with Mackler's triad of pain, vomiting and surgical emphysema. The median delay to diagnosis was 21 (range 1-84) h; this delay did not significantly affect outcome (P = 0.16). An endoscopic assessment and contrast swallow were performed in all patients. Nine of ten patients with a demonstrable leak and full-thickness tear were managed surgically and the four patients with no leak were managed conservatively (P = 0.005); surgical management consisted of thoracotomy, lavage, repair of the perforation and a feeding jejunostomy. Seven patients had a repair over a T tube and two had a primary repair. All conservatively managed patients had contained, controlled or intramural perforations and two also required a feeding jejunostomy. Patients requiring surgery had a longer hospital stay (mean(s.d.) 57.9(34.8) versus 22.2(30.7) days; P = 0.081) and a significantly longer intensive care unit stay (P = 0.044). The overall mortality rate from SRO was 14 per cent (two patients); no deaths occurred in the conservatively managed group. CONCLUSIONS: SRO continues to be diagnosed late despite a classical history and/or abnormal chest radiograph. Endoscopic assessment of perforations is safe and in combination with a contrast swallow can confidently predict patients with contained or controlled rupture in whom non-operative management is successful.

Effect of pre-operative skin preparation on post-operative wound infection.

A prospective randomised trial was carried out to compare the efficacy of method of scrubbing the operative site for ten minutes with an antiseptic (GpA; n = 68) with a simplified method where the antiseptic was merely painted onto the operation site (GpB; n = 67). The median age, sex distribution and the types of procedures done in each group were similar as was the antibiotic policy. There were a total of 11 patients who got infected, 6 in the group A and 5 in the group B. No significant difference could be demonstrated in the infection rates between the two groups. It is concluded that the old method of prolonged scrubbing the operation site can safely be omitted to a more simplified version.