Extragingival pyogenic granuloma of the lower lip masquerading as a vascular lesion.

Pyogenic granuloma (PG) is a benign nonneoplastic mucocutaneous lesion. It occurs as a result of chronic irritation or due to hormonal changes. The most favorable site for this fairly common lesion is gingiva, but rarely, it can occur outside the oral cavity, later often difficult to diagnose, as a diverse group of the pathologic process can produce such lesions outside the oral cavity. The diagnosis is also challenging as the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated mimicking malignancies. The purpose of this article is to report a rare case of extragingival PG of the lower lip simulating as a vascular lesion in young male of 30 years old diagnosed by ultrasound followed by histopathological examination.

Colonoscopic findings in Patients of Portal Hypertension Due to Different Etiologies and their Correlation.

INTRODUCTION: Recently, it is established that portal hypertension also produces vascular changes throughout the colon similar to lesion on Upper GI endoscopy. So we planned this study to see the spectrum and frequency of colonic lesions in patients with portal hypertension due to different etiologies, to assess whether the presence of portal hypertension related colonic lesions correlates with severity of liver disease as indicated by CTP and MELD scores and to study the relationship between upper GI lesions of portal hypertension and colonic lesions. MATERIAL AND METHODS: This study was done over a period of one year. In this study, 100 patients of portal hypertension due to different etiologies were taken if they met the inclusion criteria. RESULTS: The frequency of portal hypertension related colonic lesions including rectal varices, rectopathy and portal hypertensive colopathy increases with increase in the severity of liver disease as ascertained by Child-turcotte-Pugh score. Portal hypertension related colonic lesions and hemorrhoids are more frequent in cirrhotic patients with higher MELD score. Rectal varices are more frequent among who had esophageal varices on upper GI endoscopy. There is significant increase in bleeding PR as frequency of hemorrhoids increases, whereas there was not any significant relationship between bleeding PR and rectal varices suggesting that cause of lower GI bleeding in present were haemorrhoids most likly. CONCLUSION: Patients with portal hypertension due to any etiology have significantly higher frequency of colonic lesions as severity of liver disease increases indicated by worsening CTP and MELD scores. Inspite of large number of lower GI manifestations of Portal Hypertension seen in our patients none had significant life threatening lower GI bleeds. So it can be concluded that only upper GI manifestation of Portal Hypertension are clinically significant.

Combination of Levamisole with Prednisone in Treating Recurrent Major Aphthous Ulcer in a Young Boy: A Case Report.

Recurrent aphthous stomatitis (RAS) is an oral condition characterized by painful oral ulcerations. While the clinical features of this disease are easily defined, the etiology remains unclear. Thus, existing treatments are still unsatisfactory in reducing the severity, healing, and recurrence rate; however, there is no permanent and definitive treatment. Effective treatment for aphthous stomatitis is not available, and those treatments available mainly focus on suppressing its symptoms. We are reporting a case of a 17-year-old boy who presented with a 3-year history of multiple recurrent major ulcers in the oral cavity. Levamisole with steroids has been used in many clinical trials to treat aphthous ulcers, showing an improvement in pain, discomfort, healing time, and reduction in the number of ulcers. The same method was used to treat our patient, who showed promising results, with no recurrence for one year. Levamisole is a safe, easily tolerable and promising drug for the treatment of RAS.

Sine Scleroderma.

Systemic sclerosis (SSc) is a connective tissue disorder of unknown aetiology. A small subset (10%) of patients with limited systemic sclerosis have all other features of the disease without any skin involvement and is known as systemic sclerosis sine scleroderma (ssSSc). Severe Critical Limb Ischaemia is rare in sine scleroderma.The present case showed severe critical limb ischaemia with severe PAH,Esophageal dysmotility,Glomerulonephritis(a rare association) with hypertension. Although skin thickening is considered as a hallmark of systemic sclerosis, there should be a high index of clinical suspicion in patients presenting with possible manifestations of systemic sclerosis without sclerodermatous cutaneous involvement because early diagnosis and treatment can reduce the morbidity and mortality in it.

MEN Type I (Wermer Syndrome).

MEN I inherited as an autosomal dominant disorder leads to hyperplastic/ neoplastic changes in parathyroid, pituitary and endocrine pancreas along with other characteristic tumours. Hyperparathyroidism is the most common manifestation of MEN I. Our case was a female patient aged 42 years who was diagnosed with parathyroid adenoma, coincident with pancreatic neoplasm and adrenal adenoma. Hyperparathyroidism was noted initially and hemiparathyroidectomy was performed. Though adrenal adenoma and pancreatic neoplasm were detected on CECT, patient was symptom free from them and thus steps were taken to treat the chief complaint of presentation which was multiple bone pains. Post-operatively patient's serum Ca levels, serum PTH levels dropped drastically to normal ranges and there was remarkable improvement in complaints of patient. A multidisciplinary approach involving physicians, endocrinologists, oncologists, ENT surgeons and radiologists is pivotal for optimizing patient treatment. Treatment consists of surgery and drug therapy, often in association with radiotherapy or chemotherapy.