Testicular embryonal cell carcinoma presenting as haemoptysis and skin nodules.

Embryonal cell carcinoma affects young males in the prime of their life with majority of tumours already having metastasised at the time of diagnosis. Subcutaneous metastasis from embryonal carcinoma is rare and is associated with widespread disease and poor prognosis. We report a case of 22-year-old male who presented with haemoptysis and skin nodules. Fine needle aspiration cytology of skin nodules and the lung lesion led to the diognosis of testicular embryonal cell carcinoma.

Mandibular canal variant: a case report.

The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal.

Endobronchial leiomyoma.

Two rare cases of endobronchial leiomyoma are presented. Both cases presented with suppuration and destruction of ipsilateral lung. The diagnosis was confirmed by biopsy and pneumonectomy performed. The world literature of previously reported twenty two cases is reviewed and salient features elaborated. The tendency to treat such cases with antitubercular drugs in a country were tuberculosis is endemic should be deplored.

Severe community-acquired legionella pneumonia: treatment, complications and outcome.

Legionella pneumophila is the second most common cause of severe community-acquired pneumonia requiring treatment with intermittent positive pressure ventilation. The prognosis of this condition and its complications have not been well documented. Erythromycin is the first-line antibiotic of choice based on clinical experience. Rifampicin has been recommended as an additional agent, though clinical experience has not been reported. We have retrospectively examined 30 cases of severe community-acquired legionella pneumonia. The mean age of the patients was 53 years, 24 were male and eight died (27%, mean age 57 years). During admission 26 patients received erythromycin (eight died) and 15 received rifampicin in addition (five died); four received neither drug and survived. Mean duration of intermittent positive pressure ventilation was 15.9 days for survivors and 14.1 days for fatal cases. Acute renal failure requiring dialysis developed in 13 (43%), of whom five died (38%). Positive inotropic drugs were used in 10 patients and of these six died. Jaundice occurred in 11 patients and was significantly more common (p = 0.028) in patients who received rifampicin (60%) than in those who did not (17%). Excess bilirubin was largely conjugated when measured and there was no consistent hepatitic or obstructive change in the liver enzymes. Severe community-acquired legionella pneumonia has a relatively good outcome with a mortality of 27%, though prolonged intermittent positive pressure ventilation may be required. Acute renal failure is common but reversible in survivors, and jaundice is more common in those who receive rifampicin.

Pulp calcifications in primary teeth.

One hundred and twenty primary maxillary and mandibular extracted teeth were collected to study the occurrence and nature of pulp calcifications. The teeth were serially sectioned, stained with hematoxylin and eosin, examined by light microscope. Pulp calcifications were observed in 31 (25.8%) teeth. Two types of pulp calcifications were noticed i.e., diffuse calcifications and free/attached type denticles. The occurrence of pulp calcification appears identical in all teeth except in the first primary molar which is statistically not significant (P greater than 0.05). The low prevalence of pulp calcifications in the primary teeth support the view that pulp calcification increases as the age advances.

Corneal epithelial cell migration in humans: 'hurricane and blizzard keratopathy'.

Replicative turnover of the corneal epithelium is believed to occur from a population of stem cells located at the corneo-scleral limbus. During the healing of corneal epithelial wounds, sheets of epithelial cells move centripetally from the limbus and circumferentially along the limbus to cover the defect. A whorled or vortex pattern, similar to that seen in cornea verticillata, has been reported to occur on the corneal surface as an effect of topical steroid medication, during the healing of grafted corneas. This condition has been termed 'hurricane keratopathy'. We have noted this appearance in 6 patients who did not have corneal grafts. In all our patients the whorled pattern was best visible on fluorescein staining. This feature differentiates 'hurricane keratopathy' from cornea verticillata secondary to deposition of substances in corneal epithelial cells. Further, in all our patients the vortex was clockwise. Examination of illustrations of 'hurricane keratopathy' and cornea verticillata reported in the literature reveals that the whorled pattern is almost always clockwise. We believe that this specific pattern is likely to be due to the effect of the electromagnetic fields of the eye on the migrating epithelial cells and present a theory to explain this phenomenon. In 3 eyes of 2 other patients with chronic epitheliopathies we observed a random distribution of cells that did not conform to any specific pattern. We have termed this condition 'blizzard keratopathy'.