Monoclonal gammopathy in prostate carcinoma: a case report and review of literature.

BACKGROUND: Monoclonal gammopathy is commonly associated with plasma cell dyscrasia. However, monoclonal gammopathy without bone marrow plasmacytosis in prostate carcinoma has rarely been reported. The association between the two conditions is not clearly established. CASE PRESENTATION: We report a case of metastatic prostate carcinoma in a 65-year-old Indian man with the unusual phenomenon of monoclonal band in gamma globulin region without evidence of bone marrow plasmacytosis. CONCLUSIONS: Monoclonal gammopathy in solid tumor has seldom been reported. This case report highlights the rare association of monoclonal gammopathy with malignant prostatic carcinoma. Therefore, while investigating a case such as this, in an elderly male patient, we should always keep a lookout for any solid tumor foci after excluding multiple myeloma.

An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India.

BACKGROUND: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. MATERIALS AND METHODS: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded. RESULTS: Six hundred and eighty (680) diabetic patients were examined, there were (64.8%) male and (35.1%) were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503) out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13) (41%) Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61%) showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67%) had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control. CONCLUSION: Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values.

A case of dyskeratosis congenita with primary amenorrhea and adenocarcinoma of stomach.

Dyskeratosis congenita (DC) is a rare disease characterized by hyperpigmentation, nail dystrophy and mucous membrane abnormality. Commonly occurring in males, the patients die young usually due to bone marrow suppression. Malignancies of various descriptions have been reported in this disease, the commonest being solid tumors of head/neck (squamous cell carcinoma). We report the case of a female patient with DC, who presented to us with severe wasting and primary amenorrhea and died of carcinoma stomach in our hospital 3 weeks later.

Homocysteine and cerebrovascular accidents.

Hyperhomocysteinaemia is rapidly emerging as an important risk factor for coronary artery disease, possibly because of its propensity to accelerate atherosclerosis. Whether it is also a risk factor for cerebrovascular accidents (CVA) is a matter of debate till now, as there are conflicting results of the various prospective studies. The present study was performed to correlate the levels of plasma homocysteine levels with that of ischaemic and haemorrhagic CVA. Forty-two cases of CVA were randomly selected over a period of one year, and their risk factors were assessed. It was observed that serum homocysteine levels were significantly raised in those with intracerebral infarcts when compared to those with intracerebral haemorrhage, although homocysteine levels didn't prove to be prognostically significant.

A study on dyslipidaemia in subclinical hypothyroidism.

Subclinical hypothyroidism is characterised by elevated serum thyroid stimulating hormone (TSH) concentrations in association with normal free thyroid hormones. The aim of the study was to evaluate the prevalence and pattern of serum lipid alterations in patients with stable subclinical hypothyroidism in comparison to age- as well as sex-matched euthyroid group and also subgroup analysis between them in regard to age of presentation, sex, antithyroperoxidase (anti TPO) positivity, and TSH value. In this study, 100 patients of SCH were recruited, age ranged 17-68 years, majority (78%) being females, presenting mainly with non-specific symptoms and compared with 52 euthyroid control regarding lipid parameters. Of the subclinical hypothyroidism patients, only 10% had goitre and anti TPO was positive in 52% cases. Serum lipoprotein (a) above the age of 20 years, and total cholesterol, triglyceride and low density liporpotein cholesterol in the age group of 40-50 years were significantly elevated. In addition, total cholesterol, triglyceride and low density lipoprotein cholesterol levels in anti TPO positive cases and serum triglyceride and low density lipoprotein cholesterol in anti TPO negative patients showed statistically significant higher levels. In males only lipoprotein (a), but in females total cholesterol, triglyceride, low density lipoprotein cholesterol and liproprotein (a)--all were significantly elevated.

Rheumatological problems in diabetes mellitus.

Major complications of diabetes mellitus--classified as microvascular and macrovascular, are more or less well understood. But musculoskeletal syndromes of diabetes are not rare and they are a major cause of morbidity. Musculoskeletal pain is a universal experience. Soft tissue rheumatism such as rotator cuff lesion of the shoulder, carpal tunnel syndrome and stenosing tenosynovitis are more common in subjects with diabetes mellitus. Articular musculoskeletal disorders also occur more frequently in diabetes mellitus. Careful history and physical examination are essential in reaching a specific diagnosis. Unnecessary investigations are expensive, may cause anxiety to the patients and if taken out of clinical context, lead to over-diagnosis and over-treatment. This article briefly covers the association between musculoskeletal disorders and diabetes mellitus.