Plexiform neurofibroma affecting the upper parietal scalp, with cerebellar hamartoma: role of histopathology, colour Doppler imaging and magnetic resonance imaging.

We report a patient with plexiform neurofibroma, which is pathognomonic for neurofibromatosis type 1 (NF1) affecting the upper parietal region of the scalp. Cerebellar hamartoma was present, a finding that, to our knowledge, has not been reported previously. We highlight the role of histopathology, ultrasonography, colour Doppler imaging and magnetic resonance imaging, in addition to the seven existing criteria, for the diagnosis of NF1.

Juvenile, insulin-dependent diabetes mellitus, type 1-related dermatoses.

Juvenile insulin-dependent diabetes mellitus type 1 (IDDM) is a well-recognized worldwide entity, the significance of which has increased because of its recent upsurging trends, warranting attention on variety of its clinical expressions, in particular, pertaining to skin, an aspect seldom taken cognizance of. Hence an endeavour to recap the related dermatoses, such as limited joint mobility syndrome including sclerodermoid (scleroderma-like) changes, xerosis, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot syndrome, has been made. Complexities relating to the recently explored issues of atopic dermatitis and drug hypersensitivity syndrome have also been covered adequately. In addition, the current concepts of the physiopathology of type 1 diabetes-related dermatoses are briefly recapitulated for clarity.

Efficacy of fixed low-dose isotretinoin (20 mg, alternate days) with topical clindamycin gel in moderately severe acne vulgaris.

BACKGROUND: In view of the potentially serious side-effects of standard isotretinoin (0.5-1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low-fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne. METHODS: In this prospective, non-comparative study, 320 adult patients, with moderately severe acne were enrolled and treated with fixed-dose isotretinoin at 20 mg every alternate day (approximately 0.15 mg/kg/day to 0.28 mg/kg/day) for 6 months along with topical clindamycin gel. All female patients were assessed for polycystic ovarian disease. Patients were followed up for 6 months. RESULTS: A total of 305 patients completed the study. Overall, patients received a mean of 38.4 mg/kg cumulative dose of isotretinoin, and very good results were observed in 208 (68.20%), while good response was seen in 59 (19.34%) of patients. Failure of the treatment occurred in 38 (12.46%), while relapses occurred in 50 (16.39%) of patients. Relapses were commoner in females, and 37 of 43 (86.04%) patients had polycystic ovarian disease. Though mild chelitis (91%) and xerosis (43%) were common, laboratory abnormalities in the form of elevated hepatic enzymes (5%) and elevated serum lipids (6%) were rare. CONCLUSION: Six months of treatment with fixed-dose, alternate-day isotretinoin (20 mg) plus topical 1%clindamycin gel was found to be effective in the treatment of moderate acne in adult patients, with a low incidence of side-effects.

Topical Ciclopirox Olamine 1%: Revisiting a Unique Antifungal.

The injudicious use of antifungals, indiscriminate use of corticosteroids for instant relief, persistence of predisposing factors like sweat retention and uncontrolled diabetes, and emerging resistance to antifungals across the globe have rendered the management of an erstwhile simple infection, the superficial cutaneous mycoses highly complicated and tricky. Ciclopirox is an old yet efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Despite its numerous beneficial properties over the majority of other topical antifungals, it remains underutilized.

High incidence of IgG class of Epstein-Barr virus capsid antibody in Indian patients of lepromatous leprosy.

Low levels of Epstein-Barr virus capsid (EBVC) antibody of the IgG class were detected in the sera of 19 of 23 (82.6%) lepromatous leprosy patients and six of 38 (16%) healthy controls. In contrast, heterophile antibody was found in only six of 43 (14%) lepromatous patients and three of 41 (7%) normal subjects. Overlap of the two types of antibody occurred only in one normal serum. It is inferred that the presence of EBVC antibody against an unbiquitous virus in lepromatous patients who often suffer from impairment of cell-mediated immunity might be due to past infection leading to persistence of the virus in their lymphoid cells and subsequent production of specific anti-viral antibody. Further, the striking finding of low incidence and titre of EBVC antibody in the normal Indian adults is consistent with the rarity of EB virus-associated disease, such as Burkitt's lymphoma, nasopharyngeal carcinoma and infectious mononucleosis in India.

Natural resistance against tetanus in patients with lepromatous leprosy.

Tetanus antitoxin levels in the sera of unimmunized lepromatous patients, often suffering from many ulcerations on their limbs due to physical and thermal trauma, but not developing clinical tetanus, were studied. Sera from 40 such patients with no history of immunization against tetanus, 35 unimmunized matched controls and 12 immunized controls were tested for the presence of tetanus antitoxin by the passive haemagglutination technique. 45% of patients, 17% of controls and all the immunized patients showed adequate serum antibody levels. Eight of the 22 leprosy patients, with no detectable antitoxin on their sera, were immunized with a single dose of tetanus toxoid and all showed sero-conversion four weeks later. 2-Mercaptoethanol (2ME) treatment of these sera showed both IgM and IgG classes of specific antibody in all groups but the level of mature antibody of IgC class was higher in the immunized group. Neutralization test further confirmed the presence of protective antibodies in these sera.

Leprosy.

Leprosy is a chronic infectious disorder, presumptively caused by Mycobacterium leprae. This article reviews the epidemiology, etiopathogenesis, classification, clinical features, reactions, diagnosis, and treatment of the disease.

Cutaneous tuberculosis.

Tuberculosis has been a well-known affliction of mankind since antiquity. This article reviews the etiopathogenesis, clinical features, diagnosis, differential diagnosis, and treatment of the disease.

Leprosy in children: correlation of clinical, histopathological, bacteriological and immunological parameters.

The study of leprosy in children has indicated an incidence of 10% amongst leprosy patients attending the clinic. The duration of the disease was usually less than 2 years. The expression of leprosy in this group was either a macule and/or a plaque. Classification was, therefore, different and conforms to indeterminate (I), borderline tuberculoid (BT) and borderline (BB) leprosy. Only occasionally were other clinical variants seen. The bacteriology was largely unproductive by slit-skin smears. The lepromin (Mitsuda) responses were positive in BT and unpredictable in BB patients. Epicutaneous responses to sensitization with dinitrochlorobenzene (DNCB) paralleled responses to lepromin. Microscopic pathology was of very little help. The correlation of these parameters was only 50-60% indicating that the diagnosis of leprosy should primarily be based on clinical features.

Soluble interleukin-2 receptors: levels in leprosy, and during and after type 1 (lepra) and type 2 (ENL) reactions.

Twenty-five patients with Type 1 (lepra) and Type 2 (ENL) reactions, were assayed for SIL-2R in serum--before and after treatment for their acute condition--and the results were compared with 10 normal healthy adults and 20 patients of leprosy per se. Classification of each subject into different leprosy groups, and into various types and subtypes of reactions, was done according to standard criteria, prior to inclusion into the study. Detailed statistical evaluation of the data revealed significantly higher levels of SIL-2R in all leprosy patients, as compared to normal controls, with higher levels in the multibacillary groups as compared to the paucibacillary group. SIL-2Rs appeared higher in Type 1 upgrading reaction than in other forms of reaction, though this was not statistically significant. There was no significant change in levels following treatment and clinical remission.

Itraconazole versus terbinafine in the management of onychomycosis: an overview.

Ever since the introduction of itraconazole and terbinafine in the management of onychomycosis, there has been a revival of interest in the latter. In order to comprehend the intricate emerging scenario, an endeavor has been made to form a distinct outline in the shape of an overview on several of their facets. The review, therefore, envisages forming and facilitating instant decision-making.

Determination of length of human long bones of hands from their fragments.

In cases of fragment/broken long bones, it becomes difficult to measure the length of bones for the purpose of calculation of total height (stature) of the individual with the help of magnification factors. An attempt has been made to devise a method of calculating the bones length from fragments on three long bones of the upper extremity.

Determination of length of human upper limb long bones from their fragments.

It is impossible to measure directly the length of fragmentary or broken long bones. It is in order to calculate the height (stature) of the individual, using magnification factors. An attempt has been made to devise a method of calculating the length from such fragments for the three long bones of the upper limb.

Pseudoelephantiasis of the penis following donovanosis.

Pseudoelephantiasis of the penis, an unusual sequel of longstanding donovanosis with otherwise characteristics clinical expression, is reported in a young man. The diagnosis was confirmed by the demonstration of Donovan bodies in Giemsa stained tissue smears and tissue sections.

Significance of antibodies to phenolic glycolipid-I in leprosy diagnosis.

A gelatin particle agglutination assay for the detection of anti PGL-I antibodies in 40 clinically diagnosed and variously classified groups of leprosy cases revealed elevated PGL-I antibody titers in 85% of cases. In contrast, the slit-skin smear examination was positive in only 30% of cases. It was further observed that, out of 28 cases with Bacteriological Index (B.I.) zero, 22 cases (78.5%) had significant levels of PGL-I antibodies. There was no case in which the slit skin smear was positive and the PGL-I antibody titer was not significant. The elevated titers of PGL-I antibody better correlated (84%) with histopathological findings than did B.I. Thus it was concluded that estimation of PGL-I antibody titer is a better supplement to clinical diagnosis than B.I. Significant levels of PGL-I antibody were seen in 85% of cases who had no earlier chemotherapy or were treated for less than 2 months. Similar findings were observed in 12 patients who were on MDT for more than 5 months but for less than 2 years. In order to determine the significance of anti PGL-I antibodies in monitoring the response of patients to chemotherapy, a longer follow up with a greater number of cases should be contemplated.

Inoculation lupus vulgaris.

An 11-years-old girl with lupus vulgaris on the right buttock following inoculation is described. The diagnosis was formed by the history, morphological characteristics, Mantoux test, histopathology, and was supported by an affirmative response to short course intensive chemotherapy (6 months). This route of infection acquires special significance with the worldwide-spread of HIV infection.

Tuberous sclerosis and spina bifida occulta.

An interesting occurrence of tuberous sclerosis and spina bifida occulta is described, highlighting their unique and previously undescribed association in a 5-year-old boy.