A rare case report of large bilateral vulval elephantiasis

Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae

Mn II Catalyzed Periodate oxidation of N, N-dimethyl-p-toluidine -A Kinetic and Mechanistic Study

ABSTRACT One mol of N,N-dimethyl-p-toluidine(DMT) reacts with two moles of periodate during the initial part of reaction. The main reaction product is 4-methyl-1, 2-benzoquinone. The kinetics of the Mn II catalyzed periodate oxidation of DMT in acetone-water medium has been followed by monitoring the increase in the absorbance of reaction intermediate. Where kK 3 K 4 is the empirical composite rate constant, K w is ionic product of water, K 2 is acid dissociation constant of H 4 IO 6 -and K b is base dissociation constant of DMT. In agreement with the rate law the 1/k cat versus [H + ] plot passes through the minimum. Detailed molecular mechanism is given

Undertreated Breast Cancer in the Elderly

The effect of undertreatment with adjuvant hormonal therapy, chemotherapy, or radiation was studied in elderly women with breast cancer. A prospectively maintained database was used to identify women undergoing potentially curative surgery between 1978 and 2012. The presentation, pathologic findings, treatment, and outcomes of 382 women over 70 were compared to the findings in 2065 younger patients. Subsequently, conventionally treated and undertreated elderly patients were identified and their characteristics and outcomes were compared. Both young and old patients presented most frequently with mammographic findings, but older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Cancers of older patients were significantly more favorable than cancers in younger patients: smaller, with more infiltrating lobular, fewer ductal carcinoma in situ, and more frequently estrogen receptor positive and fewer were poorly differentiated. Elderly patients had less axillary sampling, fewer mastectomies, less adjuvant radiation therapy, and more hormonal therapy. Fifty-one percent of the 382 elderly patients were undertreated by conventional criteria. Undertreated patients were more frequently in situ, better differentiated, smaller, and more often estrogen receptor positive. Forty-four percent of the undertreated patients died during followup without disease recurrence. Despite undertreatment, local and distant disease-free survival was comparable to patients who were not undertreated

Painful OsPeroneum Syndrome Presenting as Lateral Plantar Foot Pain: A Case Report

The painful osperoneum syndrome (POPS) results from a wide spectrum of conditions, including fractures, diastases, and other causes. POPS can result in tenosynovitis or discontinuity of the peroneus longus tendon with a clinical presentation of pain in the lateral aspect of the midfoot. We report a rare case of painful Osperoneum syndrome (POPS) of 52 year-old man who had suffered from chronic pain on lateral foot after varus ankle injury and been treated successfully with surgical excision of the Osperoneum and preserved eroneuslongus tendon at a same time

Impact of the COVID-19 breast cancer screening hiatus on clinical stage and racial disparities in New York City

BACKGROUND: The impact of the COVID-19 mammography screening hiatus as well as of post-hiatus efforts promoting restoration of elective healthcare on breast cancer detection patterns and stage distribution is unknown. METHODS: Newly diagnosed breast cancer patients (2019-2021) at the New York Presbyterian (NYP) Hospital Network were analyzed. Chi-square and student\u27s t-test compared characteristics of patients presenting before and after the screening hiatus. RESULTS: A total of 2137 patients were analyzed. Frequency of screen-detected and early-stage breast cancer declined post-hiatus (59.7%), but returned to baseline (69.3%). Frequency of screen-detected breast cancer was lowest for African American (AA) (57.5%) and Medicaid patients pre-hiatus (57.2%), and this disparity was reduced post-hiatus (65.3% for AA and 63.2% for Medicaid). CONCLUSIONS: The return to baseline levels of screen-detected cancer, particularly among AA and Medicaid patients suggest that large-scale breast health education campaigns may be effective in resuming screening practices and in mitigating disparities