A rare case of giant mediastino-pleural lipoma.

Lipomas are common benign neoplastic mesenchymal tumours arising from adipose tissue anywhere in the body. Giant intra-thoracic lipoma extending across the anterior mediastinum into bilateral pleural spaces causing compression of the underlying lung resulting in respiratory embarrassment is rarely seen and reported. Giant lipomas of thorax require surgical excision as they continue to grow and cause compressive symptoms.

Clinical Characteristics and Remedy Profiles of Patients with COVID-19: A Retrospective Cohort Study.

OBJECTIVE: The aim of the study was to identify indicated homeopathic remedies based on the clinical characteristics of coronavirus disease 2019 (COVID-19) patients in India. METHODS: In this retrospective, cohort study, confirmed COVID-19 patients admitted at a COVID Health Centre in New Delhi between April 29 and June 17, 2020 were given conventional and homeopathic treatment. Patients were grouped into mild, moderate or severe categories of disease. Their symptomatologic profiles were analyzed to identify indicated homeopathic medicines. RESULTS: A total of 196 COVID-19 patients were admitted. One hundred and seventy-eight patients had mild symptoms; eighteen patients had moderate symptoms; no patients with severe symptoms were included as they were referred to tertiary care centers with ventilatory support. The mean age of patients with mild symptoms was significantly lower (38.6 years; standard deviation or SD ± 15.8) compared with patients in the moderate category (66.0 years; SD ± 9.09). The most important symptoms identified were fever (43.4%), cough (47.4%), sore throat (29.6%), headache (18.4%), myalgia (17.9%), fatigue (16.8%), chest discomfort (13.8%), chills (12.6%), shortness of breath (11.2%) and loss of taste (10.2%). Twenty-eight homeopathic medicines were prescribed, the most frequently indicated being Bryonia alba (33.3%), Arsenicum album (18.1%), Pulsatilla nigricans (13.8%), Nux vomica (8%), Rhus toxicodendron (7.2%) and Gelsemium sempervirens (5.8%), in 30C potency. CONCLUSION: Data from the current study reveal that Arsenicum album, Bryonia alba, Pulsatilla nigricans, Nux vomica, Rhus toxicodendron and Gelsemium sempervirens are the most frequently indicated homeopathic medicines. A randomized controlled clinical trial based on this finding is the next step.

Percutaneous core needle biopsy in the diagnosis of lung lesions: An experience on 280 consecutive cases from a university hospital in southern India.

CONTEXT: Percutaneous needle biopsy of lung (PCNBL) is advantageous over bronchoscopic biopsies to obtain adequate sample for peripheral lung lesions. OBJECTIVE: The objective was to evaluate the diagnostic yield of image-guided PCNBL in the diagnosis of lung lesions and to classify lung carcinomas as per the recently proposed International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society/European Respiratory Society classification for small biopsies modified and adopted by the World Health Organization, 2015. MATERIALS AND METHODS: A total of 280 image-guided PCNBL were analyzed. The radiological findings and routine hematoxylin and eosin (H&E)-stained sections along with immunohistochemistry (IHC) were analyzed in all the cases. Molecular testing was done depending on tissue diagnosis and availability. RESULTS: Majority (81%) were diagnosed as malignant lesions, with adenocarcinoma (ADC) being the most common. More than 70% were diagnosed on H&E morphology alone, with thirty cases requiring IHC to categorize as ADC. Nearly 60% were categorized as squamous cell carcinoma on morphology alone and the rest required IHC. Though TTF1 showed higher sensitivity than napsin A, the latter is more specific. Both p63 and p40 were found to be highly sensitive for squamous cell carcinoma, but p40 was more specific than p63. Epidermal growth factor receptor could be evaluated on 94.4% of ADC samples, indicating good yield for molecular testing. CONCLUSION: PCNBL yields adequate sampling for tissue diagnosis and ancillary testing with minimal complications. The use of IHC markers reduces the number of non-small-cell not otherwise specified cases significantly.

An Unusual Cause of Mediastinal Mass and Chylothorax.

Mediastinal masses are commonly encountered in clinical practice. The commonly encountered anterior mediastinal masses include those of thymic or thyroid origin, teratomas, and lymphoma. Establishing the diagnosis by histopathology is essential considering the wide range of differential diagnosis and to exclude malignancies. Here, we present an unusual case of large mediastinal mass with chylothorax in a young immunocompetent female.

Invasive mucinous adenocarcinoma of the lung in a 19-year-old female.

Lung cancers commonly occur in the sixth to eighth decades of life. They are extremely uncommon in first two decades of life. We describe the clinical, radiological, and pathological findings in a 19-year-old female diagnosed with an invasive mucinous adenocarcinoma that was initially mistaken and treated as tuberculosis. This case is being presented to emphasize inclusion of this entity in the differential diagnosis of multifocal consolidations and nodules that do not resolve or persist after treatment, and also to create awareness of the occurrence of lung cancers in young patients.

Primary Ciliary Dyskinesia and Situs Ambiguus: A Rare Association.

Primary ciliary dyskinesia (PCD) is a rare disorder with impaired ciliary function resulting in a spectrum of clinical manifestations of varying severity. PCD affects approximately one in every 20,000 individuals with a reported prevalence between 1:4000 and 1:50,000. Due to its nonspecific clinical features, the condition is usually diagnosed late in its course, unless situs inversus (SI) or organ laterality defects are discovered at imaging. A small subset of patients with PCD display associated organ laterality defects, different from the classical SI totalis. We present here, the clinical and imaging findings in a young female with PCD along with left-sided isomerism, a variant of heterotaxy syndromes.

Pilomatricoma: An unusual cause of lump in a male breast.

We present the case of a 48-year-old man who presented with a painless, progressively increasing lump in the left breast. The mammographic and sonographic appearance of the lesion was suspicious for malignancy. Fine needle aspiration cytology and histopathologic examination confirmed the diagnosis of pilomatricoma. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:209-211, 2018.

A 66-Year-Old Man With Mediastinal Mass and Dyspnea.

A 66-year-old man presented with dry cough and shortness of breath on exertion of 6 months' duration. There were no complaints of fever and hemoptysis. His history was significant for recurrent episodes of respiratory tract infections over the previous 4 years. He had also had episodes of recurrent otitis media and pus discharge from the left ear for 3 years, with progressive loss of hearing. There was no history of recurrent skin infections or diarrhea. He was treated symptomatically with antibiotics by local general practitioners. He was a nonsmoker and did not drink alcohol, and there was no history of environmental or occupational exposure. He had been known to have diabetes for 10 years. He had negative results for the presence of HIV and hepatitis B surface antigen.

Changing trends in acquired syphilis at a Tertiary Care Center of North India.

INTRODUCTION: Prevalence and pattern of acquired syphilis are changing in India in recent years because of good laboratory diagnosis and treatment, but it still remains a major public health problem with significant regional variations. AIM: To study the changing trend of acquired syphilis in a Tertiary Care Center of North India. SUBJECTS AND METHODS: Retrospective analysis of all the cases of sexually transmitted infections (STIs) registered in the Skin and VD Department of PGIMS, Rohtak from January 2008 to December 2012 was done. Complete epidemiological, clinical, and investigational data were recorded and analyzed for changing trends in prevalence, pattern and clinical presentations of syphilis. OBSERVATION: Total of 1462 cases attended the STI clinic from January 2008 to December 2012. A total of 124 patients were venereal diseases research laboratory reactive, of which 33 (2.25%) were false positive cases, and Treponema pallidum hemagglutination was reactive in 91 cases (6.22%). Totally, 91 (6.22%) cases were diagnosed as syphilis. Of 91 cases, 78 (85.71%) were males and 13 (14.29%) were females. Primary syphilis was diagnosed in 21 (13.08%), secondary in 38 (41.76%), and latent in 32 (35.16%) patients. 4 (10.53%) of the secondary syphilis were having asymptomatic rash, 14 (36.84%) had condyloma lata and 17 (44.74%) had genital ulcer with cutaneous rash. Mixed infection was detected in 7 patients. 8 (8.79%) were human immunodeficiency virus positive. CONCLUSION: Although our study indicates a decreasing trend in the prevalence of syphilis in last 5 years, there is a rise in latent syphilis as compared to primary syphilis demanding steps to increase awareness among general population.

Evaluation of oral methotrexate in the treatment of systemic sclerosis.

BACKGROUND: Treatment of scleroderma is difficult and currently no treatment can induce complete remission of the disease. OBJECTIVE: To evaluate weekly oral methotrexate in the treatment of Indian patients with systemic sclerosis. METHODS: Thirty-three patients with systemic sclerosis presenting to the department of dermatology (outpatients) who satisfied the inclusion criteria were enrolled into the study. All cases were admitted into the dermatology ward for detailed evaluation. A detailed history and physical examination, including assessment of disease severity by Rodnan skin scoring, was carried out. Baseline investigations included complete blood counts, blood glucose, serum electrolytes, renal function test, liver function tests, urine examination (albumin, sugar, microscopic examination, 24-h protein), ANA, chest X-ray, Barium swallow, pulmonary function test, electrocardiogram (ECG), HRCT of chest, and 4-mm punch skin biopsy from dorsum of the hand. All the patients were treated with oral methotrexate (15 mg/week) for 6 months, following standard guidelines. RESULTS: The patients included 29 (87.9%) females and four (12.1%) males with a mean age of 31.45 +/- 8.76 years. The mean duration of disease was 5.6 +/- 4.5 years (range 2 months to 15 years). All the patients had binding down of skin, 31 (93.9%) had Raynaud's phenomenon, 31 (93.9%) had pigmentary change, 21 (63.6%) had hand contractures, 17 (51.5%) had fingertip ulcers, 15 (45.5%) had dyspnoea, 14 (42.4%) had restricted mouth opening, 13 (39.4%) had telangiectasia, 11 (33.3%) had fingertip resorption, eight (24.2%) had joint complaints, six (18.2%) had dysphagia, and one (3.03%) had gangrene. On laboratory investigation ANA was positive in 29 (87.9%) patients, dsDNA was raised in only four (12.1%), baseline chest X-ray was abnormal in 18 (54.5%), HRCT was abnormal in 27 (81.8%), abnormal PFT in 32 (96.9%), abnormal ECG in five (15.2%), and barium swallow abnormality in 19 (57.5%) patients. Twenty-five patients completed the 6-month follow up. There was subjective improvement in binding down (80%), Raynaud's phenomenon (96%), fingertip ulceration (88.8%), hyperpigmentation (77.2%) and dyspnoea (45.5%). The objective parameters showed statistically significant improvement in mouth openingm, but improvement of skin score, lung function (chest radiograph, PFT, HRCT), and dysphagia was not significant at the 6-month follow up. In eight patients, treatment was continued for 1 year of methotrexate, which showed statistically significant improvement in skin score. CONCLUSION: It was concluded that methotrexate for 6 months only provides subjective improvement, and further studies after 1 year of treatment with methotrexate are recommended.

Impact of 24-h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: defining the gold standard.

BACKGROUND AND AIMS: The tests that are currently available for the diagnosis of gastroesophageal reflux disease (GERD) lack the desired diagnostic accuracy. To date, only pH monitoring has been shown to have a good sensitivity and specificity, but recent studies have failed to confirm this. Thus there is a need to find a test with acceptable sensitivity and specificity for diagnosing GERD. The present study aimed to find a single test or a combination of tests that could serve as a gold standard for the diagnosis of GERD and to identify an evidence-based diagnostic work-up for GERD in clinical and research settings. METHODS: A prospectively conducted masked study was carried out in which 109 GERD patients were recruited on the basis of symptom score evaluation (heartburn and/or regurgitation). After informed consent was given, the patients underwent various tests, including esophagogastroduodenoscopy with biopsy from the lower esophageal mucosa during the first visit, followed by omeprazole challenge test (OCT), radionuclide scintigraphy, barium swallow and finally 24-h esophageal pH monitoring. A positive concordance of three or more tests was taken as the gold standard. RESULTS: The results of all six tests were available for 70 patients. As a single diagnostic test, pH testing had the best combination of sensitivity and specificity (Youden's J = 0.69). Even in cases of endoscopy-negative reflux disease, pH monitoring was the most sensitive and specific test (93.3% and 90.4%, respectively; J = 0.83). OCT, endoscopy and histopathology also had good sensitivity (84.4%, 64.4%, 82.2%, respectively). A combination of OCT, endoscopy and histopathology achieved a sensitivity of 100%. CONCLUSIONS: A combination of OCT, endoscopy and histology will identify all cases of GERD. As these investigations are easily available, they should form the diagnostic work-up in clinical situations. 24-h esophageal pH testing, despite being the gold standard, has no utility in routine clinical settings and hence its availability should be limited to tertiary care settings.

Imaging in intersex disorders.

BACKGROUND: Evaluation of the gonads and internal genital structures is an essential component for evaluation of patients presenting with ambiguous genitalia. Ultrasonography (US) and magnetic resonance imaging (MRI) are the two preferred modalities. OBJECTIVE: To compare US and MRI in patients with intersex for localization of gonads and internal genitalia. PATIENTS AND METHODS: Ten patients with proven intersex disorders were included in the study. Findings from US and MRI were corroborated by those from surgery/laparoscopy. RESULTS: For evaluation of the gonads, MRI was found to be marginally more sensitive than US. For internal genital structures, both modalities were found to be equally sensitive and specific with no false positive results. CONCLUSION: US still remains the modality of choice for screening patients with intersex disorders. MRI is helpful in cases with equivocal US findings.