Primary Angiosarcoma of Breast: a Case Series of Rare Disease.

Primary angiosarcoma of breast (PAB) is a very rare disease and it accounts for only 0.05% of all malignant breast tumors. We present the clinical radiological and pathological features, treatment given, and outcome of this rare disease in our institute in a period of 5 years, aiming at contributing to the knowledge of prognostic factors of this rare disease. We report a case of PAB treated at our hospital along with 2 more cases of PAB we found on retrospective analysis. The basic criterion for inclusion in the study was the presence of histopathologically confirmed primary angiosarcoma of the breast: graded into low (G1, G2) and high (G3) grades. Surgeons must be aware about its high systemic metastatic potential, atypical presentation, and diffuse nature of infiltration so that it will be diagnosed early, and undergo a margin negative excision with reconstruction after a proper metastatic evaluation.

Paraneoplastic Manifestation of Primary Squamous Cell Cancer of the Thyroid Gland.

Paraneoplastic manifestation (PNM) of cancers is a non-metastatic, non-invasive systemic effect of malignancies due to chemokines and hormones produced by the primary neoplasm. Squamous cell cancers (SCCs) are known to present with PNM. Primary SCC of thyroid accounts for <1% of all thyroid malignancies and carries a very poor prognosis. We present a rare case of SCC arising from the thyroid gland who presented with fever, leukemoid reaction and hypercalcemia as part of PNM. A 67-year-old male patient presented with two months history of intermittent high-grade fever, weakness, loss of weight and appetite. Examination revealed a large (~10 cm) hard swelling over the right side of the neck. Investigations revealed neutrophilic leukocytosis, elevated C-reactive protein (CRP) and procalcitonin and hypercalcemia with a normal thyroid-stimulating hormone (TSH). The fever workup was negative for infection. Fine-needle aspiration cytology (FNAC) and core biopsy of the thyroid mass revealed malignant cells with squamous differentiation. An extensive search for possible other primary was ruled out by triple endoscopy. The combination of fever, neutrophilic leukocytosis, hypercalcemia and squamous malignancy was consistent with a diagnosis of PNM of SCC. A fluorodeoxyglucose-positron emission tomography (FDG-PET) CT scan showed a heterogeneously enhancing mass lesion in the right lobe of the thyroid with some retrosternal extension. He underwent total thyroidectomy with bilateral central compartment neck dissection. Final histopathology revealed moderately differentiated SCC of the thyroid. Concurrent chemoradiation was given. Despite continued chemotherapy, he succumbed to illness within six months of diagnosis. Primary SCC of thyroid (PSCCT) is a rare malignancy. It is a highly aggressive tumor having a poor prognosis with a median survival time of about 9-12 months and less clearly defined therapy due to its rarity. Paraneoplastic manifestation of PSCCT is known. As fever, leukemoid reaction and hypercalcemia can be a paraneoplastic manifestation, one should think of PSCCT.

The artificial iris - Analysis of various implantation techniques after ocular trauma.

PURPOSE: The aim of this study is to analyze the outcome of various techniques for a custom-made iris prosthesis implantation as part of reconstructive anterior segment surgery following traumatic aniridia. METHODS: This retrospective interventional study was done for 6 eyes that received an artificial iris as secondary reconstructive measure for photophobia and unsatisfactory vision following initial globe repair. Different implantation techniques were employed. These included simple sulcus implantation, implantation of a composite (iris prosthesis with attached intraocular lens) implant, and combinations with phacoemulsification, vitrectomy, and penetrating keratoplasty. RESULTS: In all cases, the artificial iris was implanted successfully. In the follow-up period (1-48 months), postoperative complications included rhegmatogenous retinal detachment, prolonged intraocular inflammation, and corneal transplant decompensation due to graft rejection. There was no case of secondary glaucoma. Complications could be managed successfully. All patients showed improved best-corrected visual acuity and were satisfied with functional and cosmetic results. CONCLUSION: This case series highlights the different implantation techniques for reconstruction of the anterior segment after ocular trauma. The versatility of the custom-made iris implant accounts for a wide range of applications and the foldable material reduces the need for large incisions in the already traumatized eye.

Physical processes controlling the diurnal cycle of convective storms in the Western Ghats.

Diurnal variation of convective storms (CSs) during monsoon season and associated physical mechanisms are significantly important for accurate forecast of short-time and extreme precipitation. The diurnal cycle of CSs is investigated using ground-based X-band radar, Tropical Rainfall Measuring Mission Precipitation Radar, and reanalysis data during the summer monsoon (June-September of 2014) over complex mountain terrain of Western Ghats, India. Diurnally, CSs show a bimodal distribution in the coastal areas, but this bimodality became weak along the upslope regions and on the mountain top. The first occurrence mode of CSs is in the afternoon-evening hours, while the second peak is in the early-morning hours. The diurnal cycle's intensity varies with location, such that it reaches maximum in the afternoon-evening hours and early morning on the mountain top and coastal areas, respectively. Two possible mechanisms are proposed for the observed diurnal variation in CSs (a) the radiative cooling effect and (b) the surface wind convergence induced by the interaction between land-sea breeze, local topography and large-scale monsoon winds. It is also observed that the CSs developed on the mountain top during afternoon-evening hours are deeper than those along the coast. The higher moisture in the lower- and mid-troposphere, higher instability and strong upward motion facilitate deeper CSs during afternoon-evening hours.

Fumaric acid incorporated Ag/agar-agar hybrid hydrogel: A multifunctional avenue to tackle wound healing.

Wound and its treatment is one of the major health concerns throughout the globe. Various extrinsic and intrinsic factors can influence the dynamics of healing mechanism. One such extrinsic factor is moist environment in wound healing. The advantages of optimum hydration in wound healing are enhanced autolytic debridement, angiogenesis and accelerated cell proliferation and collagen formation. But hydrated wounds often end up with patient's uncomfortability, associated infection, and tissue lipid peroxidation. Healing process prefers antimicrobial, anti-inflammatory and optimum moist microenvironment. Here, we have synthesized fumaric acid incorporated agar-silver hydrogel (AA-Ag-FA); characterized by UV-Visible spectroscopy, FTIR spectroscopy and TEM. The surface morphology is evaluated through SEM. The size of the silver nanoparticles (Ag NPs) was found to be 10-15 nm. The hydrogel shows potential antibacterial effect against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa which are predominantly responsible for wound infection. The gel shows reasonable antioxidant property evaluated through 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. Topical application of the gel on the wound site heals the wound at much faster rate even compared to standard (Mega heal, Composition: Colloidal silver 32 ppm hydrogel) gel. Histological analysis reveals better tissue proliferation (i.e. epithelialization), more granulation tissue formation, neovascularisation, fibroblast and mature collagen bundles. The lipid peroxidation of wound tissue estimated through malondialdehyde (MDA) assay was found to be reasonably less when treated with AA-Ag-FA hydrogel compared to standard (Mega heal). Cytotoxicity of the samples tested through MTT assay and live-dead cell staining shows its nontoxic biocompatibility nature. In our hydrogel scaffold, the bio-degradable agar-agar provides the moist environment; the Ag NPs inside the gel acts as bactericidal agent and fumaric acid facilities the antioxidant and angiogenesis path implicitly.

Crouzon syndrome - A rare case report.

Crouzon syndrome is the most common syndrome among the craniosynostosis group. Crouzon syndrome accounts for about 4.8% of all of them. It commonly has autosomal dominant inheritance with complete penetrance and variable expressivity from subtle to severe forms and characterized by craniosynostosis, exophthalmos, and hypoplastic maxilla with relative mandibular prognathism. Mutation of the fibroblast growth factor receptor-2 gene is responsible for the occurrence of this rare genetic disorder. Our paper reports the diagnosis of this rare syndrome in a young female patient based on clinical and radiographical features. Prompt and timely management of the syndrome has enabled this patient to lead a normal life despite the syndrome.

Florid Osseous Dysplasia-Report of Two Cases and Review of Literature.

Florid osseous dysplasia is a rare benign fibro-osseous multiquadrant dysplastic lesion confined to the alveolar process of jaws, generally asymptomatic and usually detected incidentally during radiologic examination and requires no treatment unless symptomatic or cosmetically concerning. In this article, we present two rare cases of florid osseous dysplasia in Indian women with their clinical, radiographic and histologic findings and a brief review of literature. The first case was asymptomatic and the lesion was detected during routine radiographic examination and required no treatment whereas, the second case presented with features of osteomyelitis. Based on the clinical findings, the case was diagnosed as chronic suppurative osteomyelitis, but, after radiologic examination, diagnosis of florid osseous dysplasia with secondary osteomyelitis was made. Besides diagnostic challenge, management of the lesion is difficult due to poor vascularity. In our case, antibiotic prophylaxis along with surgical debridement and sequestrectomy was done with regular recall visits.

Community acquired pneumonia and cardiac diseases: a fatal association.

BACKGROUND: Community acquired pneumonia (CAP) remains a common disease condition attributing to a significant mortality and morbidity worldwide. Acute cardiac events (ACEs) are one of the most life-threatening complications in patients with severe pneumonia. METHODS: Retrospective study of burden of ACE in 105 patients admitted with CAP. RESULTS: Twenty-five patients with (CURB-65) score ranging between 0 - 2 did not require intensive care unit (ICU) admission and were admitted in the ward and high dependency unit. Of these, 12 developed ACE and 4 required to be shifted to the ICU for further management. Eighty patients with a CURB-65 score of greater than 3 were admitted to the ICU. Of the patients admitted to the ICU, 10 with ACE died; 2 patients without ACE also died. CONCLUSIONS: Our observations suggest that ACE constitute an important cause of morbidity and mortality in patients with CAP requiring hospitalisition.

Incidence of chronic thrombo-embolic pulmonary hypertension following acute pulmonary thrombo-embolism: an Indian perspective.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) remains a severe disabling disease causing a significant amount of mortality and morbidity worldwide. The incidence and severity of this condition is quite obscure. The initial inciting event, the reason of progression, the natural history of the disease and the predictors of adverse outcomes are not yet adequately clarified. From the Indian subcontinent, data regarding this disease is limited. But with the advent of the multi-detector computed tomography, the understanding of this disease is gradually improving. As most of the available data suggests, acute pulmonary embolism (PE) as the main initial trigger leading to CTEPH, we prospectively analysed all patients being admitted in our hospital with acute PE and followed them over a period of one-and-a-half years to determine the incidence of CTEPH in this group. This is just an attempt to increase the awareness about the disease pattern and determine the rate of progression, risk factors of poor outcome, so that early detection and prompt treatment can benefit the patient care.

Do NiTi instruments show defects before separation? Defects caused by torsional fatigue in hand and rotary nickel-titanium (NiTi) instruments which lead to failure during clinical use.

AIMS: Visual and microscopic evaluation of defects caused by torsional fatigue in hand and rotary nickel titanium (NiTi) instruments. MATERIALS AND METHODS: Ninety-six NiTi greater taper instruments which were routinely used for root canal treatment only in anterior teeth were selected for the study. The files taken include ProTaper for hand use, ProTaper Rotary files and Endowave rotary files. After every use, the files were observed visually and microscopically (Stereomicroscope at 10×) to evaluate the defects caused by torsional fatigue. Scoring was given according to a new classification formulated which gives an indication of the severity of the defect or damage. STATISTICAL ANALYSIS: Data was statistically analyzed using KruskallWallis and Mann-Whitney U test. RESULTS: Number of files showing defects were more under stereomicroscope than visual examination. But, the difference in the evaluation methods was not statistically significant. The different types of defects observed were bent instrument, straightening/stretching of twist contour and partial reverse twisting. Endowave files showed maximum number of defects followed by ProTaper for hand use and least in ProTaper Rotary. CONCLUSION: Visible defects due to torsional fatigue do occur in NiTi instruments after clinical use. Both visual and microscopic examinations were efficient in detecting defects caused due to torsional fatigue. This study emphasizes that all files should be observed for any visible defects before and after every instrumentation cycle to minimize the risk of instrument separation and failure of endodontic therapy.

Homology modeling and QSAR analysis of 1,3,4-thiadiazole and 1,3,4-triazole derivatives as carbonic anhydrase inhibitors.

Carbonic anhydrase (CA) inhibitors are very interesting target for designing anticancer (hypoxic) and antiglaucoma drugs. In the present study, a 3D homology modeling of human carbonic anhydrase-IX (hCA-IX) isozyme, based upon the crystal structure of murine CA-XIVA (PDB CODE 1RJ5) was performed, as no experimental 3D structures are available. A homology model of hCA-IX was developed and validated. To explore the responsible physicochemical properties of 1,3,4-thiadiazole and 1,3,4-triazole derivatives for carbonic anhydrase inhibition, a quantitative structure activity relationship (QSAR) study was performed having hCA-II and hCA-IX inhibitory activity respectively. In hCA-II and hCA-IX inhibitory activities, four significant models with good correlations (> or = 0.945 & > or = 0.926) were obtained; two models (models 1 and 3) were selected based on statistical criterion. The QSAR study revealed that in case of hCA-II, overall increase in size and volume of molecule, introduction of electropositive surfaces might increase the inhibitory activity, whereas in case of hCA-IX, decreasing the hydrophobicity and introduction of electron releasing substituents might increase the hCA-IX inhibitory activity.

Nimesulide-modified gum karaya solid mixtures: preparation, characterization, and formulation development.

Solid mixtures of nimesulide (NS) and modified gum karaya (MGK) were prepared to improve the dissolution rate of NS. The effect of drug-carrier ratio on dissolution rate of NS was investigated by preparing the solid mixtures of different ratios by cogrinding method. Solid mixtures were also prepared by physical mixing, kneading, and solid dispersion techniques to study the influence of method of preparation. Differential Scanning Calorimetry (DSC), X-ray Diffraction (XRD), and equilibrium solubility studies were performed to explain the results of in vitro dissolution rate studies. It was clearly evident from the results that the NS dissolution rate was dependent on the concentration of MGK in the solid mixtures, and optimum weight ratio was found to be 1:4 (NS:MGK). Though the dissolution rate of NS from all solid mixtures prepared by different methods improved significantly, maximum improvement in dissolution rate was observed with solid dispersions. The order of methods basing on their effect on dissolution efficiency is solid dispersion > kneading > cogrinding > physical mixing > pure NS. Tablets of pure drug and solid mixtures (1:4 w/w, NS:MGK) were prepared. Though the best results from the dissolution test were obtained for the tablets containing solid dispersions, tablets containing cogrinding mixture were found to be suitable, from a practical point of view, for commercialization.

Studies on the applicability of tamarind kernel powder as a carrier in the dissolution enhancement of poorly water soluble drug, celecoxib.

In the present investigation, tamarind kernel powder (TP) was evaluated for its suitability as a carrier to improve the dissolution rate of poorly water-soluble drug, celecoxib (CC). The influence of polysaccharide concentration and method of preparation of solid mixtures on dissolution rate was investigated. Solid mixtures of CC and TP were prepared in different ratios (1:1, 1:4 & 1:9 w/w, CC:TP) using co-grinding technique to test the effect of polysac-charide concentration. Four different methods namely (i) physical mixing method (ii) co-grinding method (iii) kneading method and (iv) solvent deposition method were used to assess the effect of method of preparation. Solid mixtures were characterized by Differential Scanning Calorimetry (DSC), X-ray Diffraction (XRD) studies and solubility studies. Dissolution rate of CC was increased as the TP concentration increased and optimum weight ratio was found to be 1:4 (CC:TP). It was found that method of preparation of solid mixtures significantly effected the dissolution rate of CC from solid mixtures. The order of products basing on dissolution efficency is solvent deposition > co-grinding > kneading > physical mixing > pure CC. Among all the methods, though the solvent deposition technique improved the dissolution rate to maximum, co-grinding technique was found to be suitable from practical point of view and commercialization.