Hemorrhagic Skin Nodules and Plaques: A Diagnostic Clue to Underlying Primary Plasma Cell Leukemia.

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with 'choked' blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.

Clinical and histopathological changes in palatal mucosa following two treatment modalities in patients wearing maxillary complete dentures with suction cup.

AIM: The aim of the study was to determine the clinical and histopathological effect on palatal hyperplasia caused by suction cups by different methods of management used for recovery of abused tissues. MATERIALS AND METHODS: A total of 35 subjects agreed for biopsy procedure, from 50 patients who gave consent for the study. Out of the 35 subjects, 20 were randomly selected for treatment with discontinuation of denture (Group I) and 15 selected for denture relined with tissue conditioner (COE-comfort) (Group II). Punch biopsy procedure was performed on these patients to study the histopathology of the lesion before the two modalities of treatment was administered on them. RESULTS: Inflammation caused by suction cup decreased considerably by both the treatment modalities, i.e., the use of tissue conditioner as well as discontinuation of denture (tissue rest) for a period of 2 weeks. CONCLUSION: It was concluded that wearing denture day and night considerably increased the severity of inflammatory papillary hyperplasia of palate. Healing was better with tissue conditioner when compared with tissue rest.

Bar and sleeve attachment: a report of two cases.

Patients with the anterior defects either due to trauma, congenital or pathological can be treated with conventional removable or fixed partial denture. The lost soft tissue structures are not replaced by the conventional treatment option. Andrews bridge is combination of both removable and fixed partial denture and fulfills all the requirements like phonetics, hygiene, aesthetics and comfort. This article describes the bar and sleeve attachment as the best treatment option in these types of defects and restores the patients satisfaction.

Phage typing in dermatitis cruris pustulosa et atrophicans: does staphylococcal carrier status have a role?

BACKGROUND: Dermatitis cruris pustulosa et atrophicans (DCPA) is a form of chronic folliculitis of the legs with a multifactorial etiopathogenesis, seen primarily in tropical countries. Staphylococcus aureus has been isolated from the pustules in earlier studies, although the organisms isolated have not been further characterized. MATERIALS AND METHODS: Patients with DCPA, who attended the Dermatology outpatient clinic at JIPMER, Pondicherry, India, during the study period (December 2006-June 2008) were included. Pus from the lesions as well as swabs from carrier sites (nares, axillae, and gluteal fold) were cultured. Staphylococcus aureus isolates were subjected to phage typing at the National Staphylococcal Phage Typing Center, Department of Microbiology, Maulana Azad Medical College, New Delhi, India. RESULTS: Thirty-seven patients were included in the study. Pus from the folliculitic lesions grew S. aureus in 32 (86.49%) patients. Based on the comparison of antibiotic sensitivity patterns, isolates from pus and carrier sites were found to be similar in 15 patients. Phage typing established the organism to be identical in five of these patients. CONCLUSIONS: Characterization of S. aureus in DCPA shows that there is no specific phage type that is uniformly responsible for the lesions in most patients. However, in view of the unclear etiology of this condition, the pathogenicity of a staphylococcal carrier state in individual patients needs to be addressed.

Comparison of efficacy of sodium hypochlorite with sodium perborate in removal of stains from heat-cured clear acrylic resin.

Acrylic resin bases of removable dentures attract stains and odor-producing organic and inorganic deposits. The use of chemical denture cleanser soaks is the most popular method of denture cleansing. This study was undertaken to compare the efficacy of two different denture cleansers--sodium perborate (Clinsodent) and sodium hypochlorite (VI-Clean)--in removing tea, coffee, turmeric and tobacco (paan) stains from heat-cured clear acrylic resins. Distilled water was used as a control. Both Clinsodent and VI-Clean were found to be the least effective in removing coffee stains and best for removing turmeric stain. It is necessary that the dental professional be aware of these results to ensure that denture wearers know how to select the appropriate denture cleanser.

Psychosocial impact of cicatricial alopecias.

BACKGROUND: Cicatricial alopecias have a significant impact on the psychological status, quality of life, and social interaction of those suffering from it. Till date, limited or no data have been available regarding the psychosocial and quality of life aspects of cicatricial alopecias. AIMS: To assess the psychosocial impact of cicatricial alopecias. MATERIALS AND METHODS: Thirty patients fulfilling the criteria for cicatricial alopecia irrespective of their age and sex were included in the study. Psychosocial assessment was carried out in 23 patients who were capable of responding to the questionnaire, using an adopted and suitably modified version of Women's Androgenetic Alopecia Quality of Life Questionnaire. RESULTS: We observed that 73.9% of our patients with cicatricial alopecias had moderate to severe psychosocial impact due to their hair loss. Patients of younger age group and with inactive disease, suffered from greater psychosocial impact of the disease. Patients with slight hair loss also had considerable psychological distress. The chronicity of disease duration did not seem to reduce the psychosocial impact of the disease. Both married and unmarried patients suffered equally from the psychosocial impact of the disease. CONCLUSION: The management of cicatricial alopecias needs a holistic approach. In addition to laying an emphasis on early diagnosis aided by clinco-pathological correlation, to prevent irreversible hair loss, the psychosocial impact of the disease should also be taken into consideration and addressed by the treating dermatologist.

Dermatitis cruris pustulosa et atrophicans revisited: our experience with 37 patients in south India.

BACKGROUND: Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, with a number of unique features such as its peculiar symmetric localization to legs, extreme chronicity, resistance to therapy, and inevitable alopecia and atrophy. METHODS: All patients with DCPA, attending the Dermatology Outpatient Department at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, from December 2006 to June 2008 were included. Parameters recorded were detailed history and examination, hemogram, erythrocyte sedimentation rate, random blood sugar, skin biopsy and cultures from pus and carrier sites (nares, axillae and gluteal fold). RESULTS: 37 patients were studied (35 males and 2 females). Sixteen patients (43.24%) belonged to the 21-30 year-old age group. The disease most commonly began on the legs (81.1%). Majority (78.38%) had a disease duration of less than 5 years. Itching was the most common symptom (89.19%), followed by bleeding and scaling, with no significant systemic symptoms. The lower limbs were involved in all patients. Eleven patients (29.73%) had involvement of other sites--beard, axillae, chest, moustache, abdomen, and eyebrows. Pustules, papules, and scaling were seen in all patients, followed by wiry roughness, atrophy, alopecia, and pigmentation. Aggravating factors included use of full-length synthetic trousers, occupational exposure to potential irritants, and season (summer). Pus culture from the folliculitic lesions grew Staphylococcus aureus in 32 (86.49%) patients. Twenty one patients (56.75%) were carriers of S. aureus in one or more sites. CONCLUSION: DCPA is a chronic folliculitis of the legs, with a multifactorial etiopathogenesis, in which staphylococcal carrier status may be a new potential pathogenetic factor.

Dermatitis cruris pustulosa et atrophicans.

Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, primarily affecting the lower limbs. It is characterized by symmetrical follicular pustules of both legs, with cutaneous edema, resulting in alopecia, atrophy and scarring. It was first described by Clarke, from West Nigeria, in 1952 and well illustrated in his book "Skin diseases in the African," under the initial label of "Nigerian shin disease." Subsequently, it was described in India as well, in 1964, and continues to be a problem in dermatology clinics across the country. It is predominantly a disease of men and has a high prevalence in some geographical regions; up to 3-4% in Madras, South India. Some unique features that distinguish DCPA from banal pustular folliculitis include its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the involved skin, with little postinflammatory hyper- or hypopigmentation. Further, even in the presence of extensive lesions, there are no systemic features. Coagulase-positive Staphylococcus aureus is known to have a role in the etiology of DCPA, but the exact etiopathogenesis still needs to be elucidated. Immunological postulates such as hypergammaglobulinemia have been put forward to explain the chronicity of the condition. A number of therapeutic agents have been tried in various studies, including cotrimoxazole, psoralen with ultraviolet A (PUVA) therapy, ciprofloxacin, pentoxifylline, rifampicin, dapsone, minocycline and mupirocin (topical) with variable success rates. Although a well-recognized entity in dermatology clinics in tropical countries, DCPA has received little attention in the dermatological literature and has only a few studies to its credit. Its unique clinical picture, unclear etiopathogenesis and resistance to therapy afford a vast scope for further investigation and study.

A comparison of stress distribution and flexion among various designs of bar attachments for implant overdentures: a three dimensional finite element analysis.

CONTEXT: Bar overdentures are popular choices among clinicians worldwide but configurations that provide an optimal biomechanical distribution of stress are still debatable. AIMS: To compare the stresses and elastic flexion between implant supported bar overdentures in various configurations using finite element analysis. SETTINGS AND DESIGN: A CAT scan of a human mandible was used to generate an anatomically accurate mechanical model. MATERIALS AND METHODS: Three models with bars and clips in three different configurations were constructed. Model 1 had a single bar connecting two implants, Model 2 had three bars connecting all the four implants, and Model 3 had two bars connecting the medial and distal implants on the sides only. The models were loaded under static conditions with 100N load distributed at the approximate position of the clip. The mandibular boundary conditions were modeled considering the real geometry of its muscle supporting system. Maximum von Mises stress at the level of the bar and at the bone implant interface were compared in all three models. The flexion of mandible and the bar was also compared qualitatively. STATISTICAL ANALYSIS USED: The analyses were accomplished using the ANSYS software program and were processed by a personal computer. Stress on these models was analyzed after loading conditions. RESULTS: Qualitative comparisons showed that stress at the level of the bar and at the bone implant interface were in the following order: Model 1> Model 3> Model 2. The flexion of the mandible and the bar were in the following order: Model 2 > Model 1 > Model 3. CONCLUSIONS: Four implant bar systems connected by bars on the sides only is a better choice than two implant bar systems and four implant bar systems with bars connecting all four implants.

Quality of life in psoriasis: a study from south India.

BACKGROUND: Psoriasis can have a profound impact on a patient's quality of life. Very few Indian studies have examined this aspect of Indian patients of psoriasis. AIMS: This study was conducted to assess the clinical severity, as well as physical and psychosocial disability, and stress incurred and to analyze their interrelationship in psoriasis patients aged more than 18 years. METHODS: This hospital-based cross-sectional study was conducted in the Department of Dermatology, JIPMER, Pondicherry, India. Clinical severity, physical and psychosocial morbidity, and the stress incurred were measured using psoriasis area severity index (PASI), psoriasis disability index (PDI), and psoriasis life stress inventory (PLSI) respectively, the latter two of which were suitably modified and translated into the local language, viz., Tamil. Appropriate tests were conducted using SPSS for Windows (Release 7.5.1) statistical software. RESULTS: Fifty patients (34 males, 16 females) were included in the study. The clinical PASI scores correlated significantly with the overall physical disability (PDI), individual aspects of the PDI (except the treatment-related activities), and the measurement of stress incurred (PLSI). A PASI score of more than 18 delineated a subgroup of patients with higher overall physical disability and higher stress rating. Among the physical and psychosocial factors investigated, daily activities, employment, and treatment were reported to be affected the most. Psoriasis sufferers are also most likely to feel self-conscious, be disturbed / inconvenienced by the shedding of the skin, live in a constant fear of relapse, and avoid social interactions. CONCLUSIONS: The present study provides compelling evidence that psoriasis affects the quality of life, and it highlights the importance of adopting a multidimensional assessment of psoriasis.

A Yellow Discoloration of Cooked Cured Meat Products - Isolation and Characterization of the Causative Organism.

An organism has been isolated in pure culture that is capable of causing a yellow discoloration on a cooked cured meat substrate under aerobic and anaerobic conditions. This organism has subsequently been identified as a member of the genus Streptococcus . The characteristics were such that a tentative identification as Streptococcus faecium , sub-species casseliflavus was made. The organism is extremely heat resistant and could survive a heat processing of 71.1°C for 20 min. The yellow discoloration on a vacuum packaged luncheon style meat takes 3 to 4 wk to become apparent under refrigerated storage. The pigment was extracted and separated by thin layer chromatography (TLC). The evidence points to the compound being carotenoid in nature.