A study of unusual pacemaker infection by mycobacterium tuberculosis in Indian patients.

BACKGROUND: The expanding clinical indications of cardiac rhythm management have led to an increased use of pacemaker implantation which is associated with increased incidence of pacemaker infections. Staphylococcus aureus and epidermidis account for the vast majority of pacemaker infections. Pacemaker infection due to Mycobacterium tuberculosis (M. tuberculosis) is very rare, only few cases having been reported till date. METHODS: We describe here a study of three patients of pacemaker pocket infection with M. tuberculosis. CONCLUSION: The possibility of mycobacterial pacemaker infection should always be kept in mind in patients with delayed pacemaker infection.

A Method to Measure Oil Penetration into Hair and Correlation to Tensile Strength.

Aim: The aim of this study is to identify a new method to measure oil penetration into hair, compare penetration ability of two types of oil: Type 3 hair oil and coconut oil into the hair shaft and explore its correlation to a physical property of hair, tensile strength. Materials and Methods: The study utilizes the measurements of two parameters, thickness, and cohesive force to define penetration of oil. The hypothesis was that an increase in hair fiber thickness along with reduction in cohesive force would indicate higher penetration of oil into the hair strand. The tensile strength of hair was then determined by measuring the behavior of treated hair strands while an axial stretching load was applied. Results: In experiment of hair thickness measurement, there was a significant increase in the hair fiber thickness post oil application in both the test oils as compared to baseline (untreated control). However, this increase was higher in hair swatches treated with Type 3 hair oil. For cohesive force measurement, significantly lower force was required for hair swatches treated with Type 3 hair oil when compared to coconut oil. For tensile strength, both test oils exhibited increase versus baseline but increase in tensile strength was significantly more with type 3 hair oil when compared to coconut oil. Conclusions: The present study shows that conjoint assessment of hair thickness and cohesive force post oil application can be a suitable method to indicate the extent of oil penetration into the hair. Overall, the study indicated the positive influence of oil penetration on hair strength.

A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection.

OBJECTIVES: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative? MATERIALS AND METHODS: This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated. RESULTS: In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively. CONCLUSION: We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks.

Primary aneurysmal bone cyst of coronoid process.

BACKGROUND: Aneurysmal bone cysts are relatively uncommon in the facial skeleton. These usually affect the mandible but origin from the coronoid process is even rarer. To the best of our knowledge, this is the first reported case of a coronoid process aneurysmal bone cyst presenting as temporal fossa swelling. CASE PRESENTATION: A 17 year old boy presented with a progressively increasing swelling in the left temporal region developed over the previous 8 months. An expansile lytic cystic lesion originating from the coronoid process of the left mandible and extending into the infratemporal and temporal fossa regions was found on CT scan. It was removed by a superior approach to the infratemporal fossa. CONCLUSION: Aneurysmal bone cyst of the coronoid process can attain enormous dimensions until the temporal region is also involved. A superior approach to the infratemporal fossa is a reasonable approach for such cases, providing wide exposure and access to all parts of the lesion and ensuring better control and complete excision.

Dieulafoy disease of the stomach presenting as mass lesion--a case report.

Dieulafoy disease is a rare cause of severe gastrointestinal haemorrhage. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. It is characterized by severe bleeding from a minute submucosal arteriole that bleeds through a punctate erosion in an otherwise normal mucosa. We describe a 55 year old patient of severe upper gastrointestinal bleeding caused by a gastric Dieulafoy disease, presenting as a mass lesion in the stomach, diagnosed clinically and radiologically as gastrointestinal stromal tumour. Increased awareness and early endoscopy are important for accurate diagnosis.

Metaplastic Carcinoma of Breast with Extensive Chondroid Differentiation: A Case Report with Review of Literature.

Metaplastic carcinoma of breast (MBC) is a rare and aggressive type of invasive breast cancer. As it encompasses a variety of distinct histopathologic designations, diagnostic challenges abound. We present a case report of metaplastic carcinoma with extensive chondroid differentiation. This case merits presentation because of its rarity and difficulty to diagnose, especially if the tumour is composed mainly of sarcomatous elements. Standard chemotherapy regimes are ineffective against MBC. The prognosis of MBC is poor in comparison to classical invasive breast cancer. Data focusing on MBC is limited due to its rare incidence.

Mucinous Cystadenocarcinoma Co-Existing with Mature Cystic Teratoma : A Rare Case Report.

Co-existence of mucinous cystadenocarcinoma with mature cystic teratoma in the same ovary is very rare. We report a case in a 48-year-old female who presented with left abdominal mass. CT scan revealed a heterogeneous enhancing left ovarian mass lesion. Clinical diagnosis of complex ovarian cyst was made, later underwent laparotomy and histologically diagnosed as mucinous cystadenocarcinoma (grade 2) co-existing with benign cystic teratoma, stage Ia (FIGO) of the left ovary. Six months after surgery, the patient is doing well without any recurrence or metastasis. Hence, histopathological examination plays a significant role in accurate diagnosis and management of the patient. So, we should be aware of these rare co-existent tumours and meticulous dissection should be done to look for any synchronous tumours or malignant areas; since management and prognosis will vary significantly depending upon the microscopic type and stage.

Malignant peripheral nerve sheath tumor of the occipital region: case report.

OBJECTIVE: A rare case of a malignant peripheral nerve sheath tumor of the occipital region is presented. The role of postoperative radiotherapy in such cases is reviewed. CLINICAL PRESENTATION: A 36-year-old man presented with a small spongy swelling in the posterior aspect of the cranium since childhood. The swelling gradually increased for 2 years and then rapidly over the next 7 months. There were no associated symptoms of headache, vomiting, vertigo, focal weakness, or visual impairment. INTERVENTION: A small occipital craniectomy for total excision of the tumor was attempted. However, as a result of intracranial extension to the transverse sinus, the tumor could not be completely excised. Local radiotherapy to a dose of 59.4 Gy in 33 fractions over 6.5 weeks was delivered to the residual microscopic disease in the posterior part of the cranium. The patient has been followed up regularly for the past 28 months and continues to remain asymptomatic. CONCLUSION: An aggressive malignant peripheral nerve sheath tumor of an atypical site such as the scalp, in which complete surgery may not always be possible, could benefit from postoperative radiotherapy. A dose of approximately 60 Gy could be effectively delivered with a satisfactory outcome.