Disseminated violaceous plaques in a HIV-1-positive patient from eastern India: A manifestation of Kaposi's sarcoma.

Kaposi's sarcoma (KS) is an angioproliferative disorder primarily of viral etiology, though multiple cofactors are also responsible. Human herpes virus-8, a gamma herpes virus, is considered to be the causative agent. Acquired immunodeficiency syndrome-associated KS has different clinical pictures than those seen in other types of KS. As it progresses rapidly, early institution of highly active antiretroviral therapy (HAART) after proper diagnosis is expected. Though HAART has reduced the prevalence of KS in HIV disease, HAART has not eliminated the disease. Here, we report a case who is HIV 1 and hepatitis B surface antigen positive with numerous violaceous plaques over the face, upper extremities, and trunk along with oral mucosal involvement. He had received ten sessions of electron beam radiotherapy on the face, and the facial lesions have healed with residual hyperpigmentation.

Internal hemipelvectomy with ischiectomy, partial acetabulectomy, and femoral head and neck excision in a cat with a pelvic osteochondroma.

CASE DESCRIPTION: A 2-year-old 5.1-kg (11.2-lb) castrated male Siberian cat was examined because of a history of an abnormal right pelvic limb gait and a 4- to 5-month history of progressive constipation. Radiographs obtained by the referring veterinarian showed an osteoproductive and osteolytic bony lesion that involved the right ischium and filled the obturator foramen. CLINICAL FINDINGS: A hard mass was palpable in the right inguinal area, and rectal examination revealed a smooth bony mass on the ventral aspect of the right pelvic floor with marked reduction in the pelvic canal space. A 3.9 × 3 × 4.6-cm, mineralized mass bridging the right obturator foramen was present on CT images. The ventral component of the mass was slightly larger than its dorsal component, and lysis of the right pubic bone was present. There was no obvious soft tissue involvement. TREATMENT AND OUTCOME: A limb salvage procedure involving internal hemipelvectomy with ipsilateral ischiectomy, contralateral partial ischiectomy, ipsilateral partial acetabulectomy, and femoral head and neck excision was performed. Histologic examination revealed that the mass was an osteochondroma. The cat recovered well and had good functional limb use immediately after surgery. The cat was still alive 1 year after surgery with good limb use. CLINICAL RELEVANCE: Internal hemipelvectomy involving ischiectomy, partial acetabulectomy, and femoral head and neck excision can result in a good functional outcome in cats if the procedure is planned appropriately with a full understanding of the regional anatomy and adherence to surgical oncologic principles.

Survival time of juvenile dogs with oral squamous cell carcinoma treated with surgery alone: A Veterinary Society of Surgical Oncology retrospective study.

OBJECTIVE: To report the signalment, staging, surgical treatment, and survival time of juvenile dogs treated surgically for oral squamous cell carcinoma (OSCC). STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: Twenty-five dogs, <2 years of age with OSCC treated with surgery. METHODS: Cases were solicited from the Veterinary Society of Surgical Oncology. Data retrieved included sex, breed, age, weight, clinical signs, tumor location, preoperative diagnostics and staging, histopathological diagnosis with margin evaluation, disease-free interval, and date and cause of death. A minimum follow-up time of 3 months was required for inclusion. RESULTS: Eighteen dogs were <12 months of age, and seven were <24 months. Various breeds were represented, with a mean body weight of 22.3 ± 14.4 kg. No dogs had evidence of metastatic disease prior to surgery. All dogs underwent partial maxillectomy or mandibulectomy. Histological margins were complete in 24 dogs and incomplete in one. No dogs had evidence of metastatic disease or tumor recurrence. The median follow-up time was 1556 days (92 to 4234 days). All dogs were alive at the last follow-up except for one documented death, due to dilated cardiomyopathy. Median disease-specific survival time was not reached. CONCLUSION: The prognosis after wide surgical excision of OSCC in juvenile dogs was excellent. CLINICAL SIGNIFICANCE: OSCC in juvenile dogs can be effectively treated with surgery alone.

Preoperative autologous blood donation and transfusion in dogs undergoing elective surgical oncology procedures with high risk of hemorrhage.

OBJECTIVE: To describe preoperative autologous blood donation (PABD) and transfusion in dogs undergoing elective surgical oncology procedures with a high risk of intraoperative hemorrhage. STUDY DESIGN: Prospective study. ANIMALS: Twelve dogs. METHODS: Dogs undergoing surgical oncology procedures associated with a high risk of hemorrhage were enrolled. Blood was collected a minimum of 6 days before surgery and separated into fresh frozen plasma (FFP) and packed red blood cells (pRBC). Dogs received FFP at the start of surgery and pRBC intraoperatively when hemorrhage ensued. The mean packed cell volume/total solids (PCV/TS) were calculated on the day of PABD preoperatively, immediately postoperatively, and 24 hours after transfusion. The dogs were monitored for transfusion-related adverse reactions, including hyperthermia, hypotension, tachycardia, bradycardia, pale mucous membranes, prolonged capillary refill time, or tachypnea/dyspnea. RESULTS: Dogs enrolled in the study underwent mandibulectomy, maxillectomy, chest wall resection, and liver lobectomy. Ten of the 12 dogs that underwent PABD received autologous transfusion at first signs of hemorrhage intraoperatively. Iatrogenic anemia was noted in two dogs (PCV 30% and 31%). The mean PCV/TS levels on the day of blood collection, preoperatively, immediately postoperatively (after transfusion), and 24 hours posttransfusion were 45.1%/7.1 g/dL, 42.2%/6.73 g/dL, 33.2%/5.42 g/dL, and 36.5%/5.65 g/dL, respectively. No dog developed transfusion-related complications. CONCLUSION: Preoperative autologous blood donation was well tolerated and led to uneventful autologous transfusion in 10 of 12 dogs. CLINICAL SIGNIFICANCE: Preoperative autologous blood donation and autologous transfusion are feasible for dogs undergoing elective surgical procedures with a high risk of hemorrhage.

Cutaneous Signs in Dermatological Diseases; An Overview.

Cutaneous signs in dermatology are pathognomonic or diagnostic for certain conditions. A knowledge of these signs is a useful skill, which must not be forgotten in the recent trend towards relying on molecular biology and other investigative tools including histological findings to make a diagnosis. The aim of this review is to summarize all cutaneous signs in dermatology in a systematic way that would benefit dermatologists, trainee or experienced, in identifying diseases and sharpening their clinical skills. A keyword search for the terms "cutaneous signs," "sign" AND "dermatology" was conducted through PUBMED, Google, and the major textbooks in dermatology (i.e., Rooks Textbook of Dermatology; Fitzpatrick's Dermatology in General Medicine and Dermatology). References were searched thoroughly for all cutaneous signs described. One hundred and nineteen signs were noted and summarized under the following categories: autoimmune, infective, inflammatory, neoplastic, genetic, trauma/miscellaneous. This review would serve as a good reference for those wanting to improve their clinical acumen in diagnosing dermatological disease.

Osteosarcoma of the proximal tibia in a dog 6 years after tibial tuberosity advancement.

A 9-year-old spayed female Cane Corso dog was presented with a 1-week history of an acute right hind limb non-weight-bearing lameness. Six years previously, a right tibial tuberosity advancement (TTA) procedure had been performed. Orthogonal radiographs of the right pelvic limb taken before presentation revealed a comminuted displaced mid-diaphyseal tibial fracture. An aggressive bone lesion with osteolysis and periosteal reaction of the proximal tibia were evident that were most consistent with a primary bone tumor. The owner elected to have the dog euthanized. After euthanasia a fine-needle aspirate of the right proximal tibia was submitted for clinical pathology. Cytology and alkaline phosphatase staining of the fine-needle aspirate were consistent with osteosarcoma. Key clinical message: To the authors' knowledge, this is only the second reported case of osteosarcoma at the site of a TTA. Implantassociated osteosarcoma has been associated with tibial plateau levelling osteotomy (TPLO) and fracture repair.

Une femelle Cane Corso stérilisée âgée de 9 ans fut présentée avec une histoire d'une boiterie sans appui de la patte arrière droite apparue de manière aiguë depuis 1 semaine. Six ans auparavant, une chirurgie d'avancement de la tubérosité tibiale droite (TTA) avait été réalisée. Des radiographies orthogonales du membre pelvien droit prises avant la présentation ont révélé une fracture comminutive déplacée du tibia au niveau mi-diaphysaire. Une lésion osseuse agressive avec ostéolyse et réaction du périoste du tibia proximal étaient évidentes et considérées compatibles avec une tumeur osseuse primaire. Le propriétaire opta pour l'euthanasie du chien. À la suite de l'euthanasie une aspiration à l'aiguille fine du tibia proximal droit fut soumise pour examen en pathologie clinique. La cytologie et une coloration à la phosphatase alcaline de l'aspiration à l'aiguille fine étaient compatibles avec un ostéosarcome.Message clinique clé :À la connaissance de l'auteur, ceci est seulement le deuxième cas rapporté d'un ostéosarcome au site d'une TTA. Les ostéosarcomes associés aux implants ont été associés avec l'ostéotome de nivellement du plateau tibial (TPLO) et la réparation de fracture.(Traduit par Dr Serge Messier).

Breast Cancer Awareness and Prevention Behavior Among Women of Delhi, India: Identifying Barriers to Early Detection.

BACKGROUND: Globally, breast cancer (BC) has become the leading cause of mortality in women. Awareness and early detection can curb the growing burden of BC and are the first step in the battle against BC. The aim of this qualitative study was to explore the awareness and perceived barriers concerning the early detection of BC. METHODS: A total of 20 focus group discussions (FGDs) were conducted during May 2013-March 2014. Pre-existing themes were used to conduct FGDs; each FGD group consisted of an average of ~10 women (aged ≥18-70 years) who came to participate in a BC awareness workshop. All FGDs were audio taped and transcribed verbatim. The transcripts were inductively analyzed using ATLAS.ti. Based on emerged codes and categories, thematic analysis was done, and theory was developed using the grounded theory approach. RESULTS: Data were analyzed in three major themes: i) knowledge and perception about BC; ii) barriers faced by women in the early presentation of BC; and iii) healthcare-seeking behavior. The findings revealed that shyness, fear, and posteriority were the major behavioral barriers in the early presentation of BC. Erroneously, pain was considered as an initial symptom of BC by most women. Financial constraint was also mentioned as a cause for delay in accessing treatment. Social stigma that breast problems reflect bad character of women also contributed in hiding BC symptoms. CONCLUSIONS: Lack of BC awareness was prevalent, especially in low socioeconomic class. Women's ambivalence in prioritizing their own health and social and behavioral hurdles should be addressed by BC awareness campaigns appropriately suited for various levels of social class.

Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease.

OBJECTIVE: The Covered vs Balloon Expandable Stent Trial (COBEST) is the first multicenter trial to investigate the patency of covered stents (CSs) and bare-metal stents (BMSs) in the treatment of aortoiliac arterial disease. The short-term results demonstrated that CSs were superior to BMSs in maintaining patency for TransAtlantic Inter-Society Consensus (TASC) C and D lesions at 18 months and were equivalent to BMSs for TASC B lesions. The current study was conducted to determine if the initial patency advantage of CSs over BMSs was sustained at the 5-year follow-up. METHODS: A retrospective post hoc analysis of COBEST was performed. Originally, 125 patients with 168 iliac arteries were prospectively enrolled and randomly assigned to receive a CS or BMS. In this study, 77 of the 125 patients (61.6%; 119 limbs) were assessed at 60 months for the primary and secondary end points, with particular attention paid to the outcomes stratified according to TASC lesion severity. The primary end point was the rate of binary stenosis or freedom from stent occlusion of the treated area, as determined by ultrasound imaging or quantitative visual angiography. RESULTS: The 5-year results of the COBEST showed that the CS had a significantly higher patency rate than the BMS at 18, 24, 48, and 60 months (95.1%, 82.1%, 79.9%, 74.7% for CS vs 73.9%, 70.9%, 63% and 62.5% for BMS; log-rank test, P = .01). On multivariate analysis, the type of stent used (hazard ratio [HR], 2.797; 95% confidence interval [CI], 1.471-5.318; P = .002) and the Rutherford classification (HR, 2.019; 95% CI, 1.278-3.191; P = .026) significantly affected the adjusted primary patency. On subgroup analysis, the CS showed significantly higher patency and a survival benefit compared with the BMS in TASC C and D lesions (HR, 8.639; 95% CI, 54.253-75.753; P = .003). Moreover, fewer patients received target limb revascularization in the CS group than in the BMS group (odds ratio, 2.32; 95% CI, 1.47-3.36; P = .02); however, there was no statistically significant difference in the rate of amputations between the groups. CONCLUSIONS: The 5-year results of the COBEST demonstrated that the CS has an enduring patency advantage over the BMS in both the short and long terms. Furthermore, the CS showed acceptable patency rates for the treatment of more severe TASC C and D lesions, and patients who received a CS required fewer revascularization procedures. However, the choice of stent did not affect the rate of major limb amputations.

Circulating cell-free DNA and its integrity as a prognostic marker for breast cancer.

The aim of our study was to look for alternative predictive biomarkers for breast cancer management in limited resource setup. A comprehensive analysis of circulating cell-free DNA (CCFD) in serum at baseline was performed to assess its prognostic potential. Quantitative polymerase chain reaction (qPCR) of ALU sequences using ALU115 and ALU247 primers was carried out in patients (N: baseline 148, postoperative 47) and 51 healthy controls. Mean serum DNA integrity, levels of ALU 247 and levels of ALU 115 were significantly higher in patients than in healthy females. No significant differences were observed in the levels ALU 247 and ALU 115 between stage IV and earlier stages of the disease. The DNA integrity was significantly higher in stage IV than earlier stages. A significant decrease in DNA integrity was observed after surgery (pre: 0.55 ± 0.23 vs post: 0.43 ± 0.30; P = 0.002) while no such change could be observed for ALU 247 and ALU 115. Baseline DNA integrity was significantly higher in relapsed patients than in patients who were free of disease (P = 0.005). Higher baseline DNA integrity was also indicated, though statistically not significant, in patients who died (P = 0.14). In contrast, ALU 247 and ALU 115 levels were decreased in died patients as compared to survivors (24.8 ± 34.80 vs 73.5 ± 170.83, P = 0.02 for ALU 247 and 41.0 ± 47.99 vs 159.5 ± 299.54, P = 0.005 for ALU 115). Baseline levels of ALU 115 and ALU 247 were lower in relapsed patients, though statistically not significant. In univariate analysis, the only clinic-pathological parameter associated with disease prognosis was tumor size. The hazards of 5-year overall mortality was 3.60 (95 % CI: 1.03 12.53, P = 0.03) among patients with lower baseline serum levels of CCFD (ALU 247 < 21 and ALU 115 < 41). Similarly the 4 year hazards for recurrence was 2.30 (95 % CI: 0.96 5.52, P = 0.05) among patients with higher DNA integrity. Baseline serum levels of CCFD and its integrity were found to be potential prognostic biomarkers in patients of primary breast cancer at our centre.

Results and complications of silicone frontalis sling surgery for ptosis.

PURPOSE: Frontalis suspension is the treatment of choice for severe blepharoptosis with poor levator function. Several materials are available for this purpose. Autologous fascia lata is considered best among naturally occurring materials; however, it may not be possible to harvest fascia lata in young children. Among various synthetic materials, silicone has been used frequently and has given good results. METHODS: This is a retrospective analysis of patients operated on from September 2008 to August 2013. All of these patients underwent silicone rod frontalis suspension for severe blepharoptosis with poor levator function and completed a minimum of 6 months of follow-up. RESULTS: There were 38 eyes of 25 patients with ages ranging from 3 to 21 years (average: 10.68 ± 6.26 years). Of these 25 patients, 10 had blepharophimosis syndrome, 10 had congenital ptosis, 3 had third nerve palsy, 1 had double elevator palsy, and 1 had post-levator resection. Good cosmetic correction was achieved in 34 eyes (89.4%) after a mean follow-up of 18 months (range: 6 to 60 months). Complications observed included significant eyelid lag and lagophthalmos (5 eyes), undercorrection (4 eyes), suture granuloma (3 eyes), sling exposure at forehead incision (3 eyes), bilateral chronic eyelid edema (1 patient), and late recurrence of ptosis (1 eye). CONCLUSIONS: Silicone is a safe material for frontalis suspension in patients with severe ptosis; however, recurrence, granuloma formation, sling exposure, and chronic inflammation can occur with use of silicone rod.

Management of traumatic dacryocystitis and failed dacryocystorhinostomy using silicone lacrimal intubation set.

The aim of this work is to study the management and success rate of traumatic dacryocystitis and failed dacryocystorhinostomy (DCR) using Silicone lacrimal intubation set. A prospective study was conducted at a tertiary eye care hospital, India from February 2006 to January 2008. This study material comprised 50 patients of traumatic dacryocystitis and failed dacryocystorhinostomy. Anterior single flap external dacryocystorhinostomy with Silicon intubation was performed in all the patients. The patients were followed up at weekly intervals for 1 month and thereafter every 2 months for 1 year post operatively. Criteria determining success were based on resolution of epiphora and patency on syringing. In traumatic dacryocystitis, 21(91.3%) cases fulfilled these criteria while 23(85.2%) cases of failed DCR were successful. The overall success rate (88%) was determined with an average follow-up of 1 year. Globally, the technique was effective in 85% of cases. The results were comparable with other similar studies. This study concludes that performing a DCR in traumatic dacryocystitis and failed DCR taking into consideration the complications and chances of failure is a challenge for the surgeon. We opine that External dacryocystorhinostomy with Silicon Intubation is one of the most effective modality in dealing with such cases.

Carcinoma buccal cavity: Late presentation and salvage, experience from a North Indian center.

Carcinoma buccal cavity, the most common oral cavity cancer was seen in our set up in more than 50% cases. Forty patients of carcinoma buccal cavity were studied at JN Medical College, Aligarh Muslim University, and Aligarh over a period of last 5 years (2003-2008). Mean age at presentation 36.5 years (30-55) years. Male: Female, 27:13. Most common association was with smoking and chewing tobacco and pan over a mean long period of 15 years (8-22 years). Most common location was lateral wall of buccal cavity over cheek area related to their typical chewing habit of keeping the tobacco over that area over a prolonged period. Most of them, more than 90% (36 cases) presented late involving both mucosa and skin and in 25% cases also involving the alveolus and mandible. Wide excision and modified radical neck dissection with or without mandibulectomy (marginal, partial or hemimandibulectomy) done in all cases. Reconstruction was done by pedicled pectoralis major (PM) and deltopectoral (DP), the workhorse flaps for head and neck reconstruction for mucosal lining and skin cover respectively in 25 cases. Five cases needed only lining done by PM flap. Ten cases were salvaged by pedicled forehead flap for both lining and cover. All the cases healed properly with acceptable results and good functional recovery. Two cases reported recurrence treated with postoperative radiotherapy. Poor socioeconomic status, smoking and chewing habit, poor oral hygiene, malnutrition and moreover lack of awareness led to late presentation. However, an attempt was made for salvage at our center.

Dynamic imaging of emerging resistance during cancer therapy.

One of the greatest challenges in developing therapeutic regimens is the inability to rapidly and objectively assess tumor response due to treatment. Moreover, tumor response to therapeutic intervention in many cases is transient, and progressive alterations within the tumor may mask the effectiveness of an initially successful therapy. The ability to detect these changes as they occur would allow timely initiation of alternative approaches, maximizing therapeutic outcome. We investigated the ability of diffusion magnetic resonance imaging (MRI) to provide a sensitive measure of tumor response throughout the course of treatment, possibly identifying changes in sensitivity to the therapy. Orthotopic 9L gliomas were subjected to two separate therapeutic regimens, with one group receiving a single 5-day cycle (1omega) of low-dose 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and a second group receiving two cycles at the same dose, bisected with 2 days of rest (2omega). Apparent diffusion coefficient maps were acquired before and throughout treatment to observe changes in water mobility, and these observations were correlated to standard measures of therapeutic response and outcome. Our results showed that diffusion MRI was indeed able to detect the emergence of a drug-resistant tumor subpopulation subsequent to an initially successful cycle of BCNU therapy, leading to minimal gains from a second cycle. These diffusion MRI findings were highly correlated with tumor growth delay, animal survival, and ex vivo growth inhibition assays showing emerging resistance in excised tumors. Overall, this study highlights the ability of diffusion MRI to provide sensitive dynamic assessment of therapy-induced response, allowing early opportunities for optimization of therapeutic protocols.

Sodium magnetic resonance imaging of chemotherapeutic response in a rat glioma.

This study investigates the comparative changes in the sodium MRI signal and proton diffusion following treatment using a 9L rat glioma model to develop markers of earliest response to cancer therapy. Sodium MRI and proton diffusion mapping were performed on untreated (n = 5) and chemotherapy 1,3-bis(2-chloroethyl)-1-nitrosourea-treated rats (n = 5). Animals were scanned serially at 2- to 3-day intervals for up to 30 days following therapy. The time course of Na concentration in a tumor showed a dramatic increase in the treated brain tumor compared to the untreated tumor, which correlates in time with an increase in tumor water diffusion. The largest posttreatment increase in sodium signal occurred 7-9 days following treatment and correlated to the period of the greatest chemotherapy-induced cellular necrosis based on diffusion and histopathology. Both Na MRI and proton ADC mapping revealed early changes in tumor sodium content and cellularity. This study demonstrates the possibility of Na MRI to function as a biomarker for monitoring early tumor treatment and validates the use of monitoring changes in diffusion MRI values for assessing tumor cellularity.