Microinvasive squamous cell carcinoma of uterine cervix with superficial spread to endometrium: a rare case report

Microinvasive squamous cell carcinoma of uterine cervix is defined as carcinoma with invasion of less than 5 mm penetration of the stroma. The spread to uterine corpus occurs rarely, but on lateral spread it involves parametrium and deep myometrium via lymphatic dissemination. Less than 30 cases are reported in literature of superficial spread of microinvasive carcinoma of cervix. We report a case of microinvasive squamous cell carcinoma of cervix with metastasis to uterine corpus due to superficial spread

Pemphigus vulgaris in pregnancy with transient neonatal pemphigus - can psychological stress be culprit?

Pemphigus vulgaris (PV) is a rare life threatening, autoimmune bullous disease affecting mucous membrane and skin. Pregnancy and emotional stress may be the possible triggering factors for PV. It is a very rare phenomenon with less than 27 cases of pregnancy induced PV and only 9 cases of neonatal pemphigus reported in literature. The lesions may appear transient in neonate which resolve spontaneously over 2-3 weeks. We hereby, report a case of 26-year-old female who developed PV in second trimester of pregnancy with peripartum depression, which was managed by intravenous, oral and topical steroids and selective-serotonin reuptake inhibitor (SSRI). Furthermore, the development of transient neonatal pemphigus raises the possibility of genetic linkage from maternal to fetal transmission

Pediatric spinal infections

The infections of the spinal axis in children are rare when compared with adults. They encompass a large spectrum of diseases ranging from relatively benign diskitis to spinal osteomyleitis and to the rapidly progressive, rare, and potentially devastating spinal epidural, subdural, and intramedullary spinal cord infections. We present a comprehensive review of the literature pertaining to these uncommon entities, in light of our experience from northern India. The most prevalent pediatric spinal infection in Indian scenario is tuberculosis, where an extradural involvement is more common than intradural. The craniovertebral junction is not an uncommon site of involvement in children of our milieu. The majority of pyogenic infections of pediatric spine are associated with congenital neuro-ectodermal defects such as congenital dermal sinus. The clinico-radiological findings of various spinal infections commonly overlap. Hence the endemicity of certain pathogens should be given due consideration, while considering the differential diagnosis. However, early suspicion, rapid diagnosis, and prompt treatment are the key factors in avoiding neurological morbidity and deformity in a growing child

Hemisection: A conservative approach

Hemisection denotes the removal of compromised root and the associated crown portion with the loss of periodontal attachment and is performed to maintain the original tooth structure and attain the fixed prosthesis. The success rate of such procedure is high. The present case report demonstrates the successful management of hemisection of 46 with occlusal rehabilitation. It was a conservative approach aiming to retain as much original tooth structure as possible against the option of extraction of the natural tooth

Giant Occipitocervical Encephalocele

Encephaloceles are cranial defects in which sac contains herniating brain, which is often gliotic. Congenitally, this defect may extend into posterior elements of cervical vertebrae and leads to occipitocervical encephalocele. When the size of this sac is larger than head size, they are termed as giant. Very young age and associated congenital anomalies in these patients pose significant challenges in diagnostic, anesthetic, and surgical techniques. We share a case of giant occipitocervical encephalocele managed at our institute and discuss about its management issues with review of literature

Rare Case of Sellar and Suprasellar Metastasis from Ewing’s Sarcoma of Tibia

We hereby report a case of metastatic Ewing’s sarcoma presenting with rapid-onset total ophthalmoplegia, optic atrophy, and right temporal hemianopia. Comprehensive ophthalmic and neurological evaluation with targeted radioimaging revealed a tumor mass centered over the sella, compressing optic chiasma, extending to involve the left cavernous sinus and the left orbital apex. Whole-body imaging revealed the evidence of multifocal lung and mediastinal metastasis with focal lytic defect in the left femoral head. Histopathological evaluation of transnasal punch biopsy from the nasopharyngeal extension of the tumor revealed small round-cell tumor with strong CD99 positivity, supporting the diagnosis of Ewing’s sarcoma. Rapid, aggressive extensions of the metastatic tumor into vital structures despite the initiation of chemoradiation of the extensive intracranial tumor led to unexpected demise of the patient. Our case is an unusual case of Ewing’s sarcoma metastasis manifesting as a sellar mass and mimicking a pituitary adenoma radiologically, with a rapid progression within 2 weeks to cause massive extension of tumor into suprasellar, infrasellar, and left parasellar area, indicative of highly malignant nature of the tumor

Expression of p53 and bcl2 in squamous cell carcinoma of head and neck

Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth-most common malignancy worldwide. Despite advances in radiotherapy and surgical treatment, survival rates have not changed significantly in the last 40 years. Molecular markers are currently being identified that can determine prognosis preoperatively by routine tumor biopsy, lead- ing to improved management of HNSCC patients. Aim: The aim of the present study was to demonstrate the expression of p53 and bcl2 proteins in squamous cell carcinoma of head and neck (HNSCC) and to correlate the expression of p53 and bcl2 with clinical staging (AJCC) and WHO histological grading of SCC. Materials and methods: The study population comprised 50 cases of HNSCC. Tissue sections from these cases were subjected to hematoxylin and eosin (H and E) and immunohistochemical (IHC) staining using p53 and bcl2, and a comparative analysis of the results was performed. Cases of colon carcinoma and benign lymphoid hyperplasia were used as positive controls for p53 and bcl2, respectively. Results: Positivity for p53 was recorded in 30 cases (30/50), while positivity for bcl2 was recorded in 44 cases (44/50). Positivity for p53+/bcl2+ coexpression was seen in 28 cases (28/50). The frequency of p53 expression was associated with tumor histologic grade (p=0.02), increasing lymph node involvement (p=0.01), and clinical stage (p=0.038). The frequency of bcl2 expression was associated with histological grade (p=0.02) and increasing lymph node involvement (p=0.028), but not with clinical stage (p=0.242). Moreover, the combined p53+/bcl2+ expression was significantly associated with histo- logical grade (p=0.02) and lymph node involvement (p=0.01). Conclusion: Study of p53 and bcl2 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness and survival rates. [Arch Clin Exp Surg 2016; 5(3.000): 160-168

Use of Marker Computed Tomography as a Navigational Tool for Performing Minicraniotomies

We want to highlight a simple technique for performing smaller craniotomies, using a marker computed tomography scan, which does not require any special equipment, training or cost and is not time-consuming. Pictorial description of two such cases have been provided

Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports

Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs. Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome. Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome. Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome

Effects of antihypertensive agents on the quality of life in diabetic hypertensive patients: A prospective study

Background: Diabetes mellitus is a chronic noncommunicable disease, and hypertension (HT) is the most common comorbidity which affects their quality of life (QoL). Aim: The aim of the study was to assess the effects of antihypertensive agents (viz., amlodipine, ramipril, telmisartan, and ramipril with telmisartan) on the blood pressure (BP) and QoL. Methodology: It was an open-labeled prospective intention-to-treat study done in diabetic hypertensive patients (CTRI/2016/10/007340). Patients were randomly assigned antihypertensive agents, namely, amlodipine, ramipril, telmisartan, and a combination of ramipril with telmisartan (RT) in four groups. They were evaluated for BP, blood sugar level, and QoL at baseline and 24th week. Results: After 24 weeks of therapy, systolic BP (SBP) and diastolic BP (DBP) were significantly reduced in all groups. In amlodipine, there was a mean percentage fall of SBP by 15.85% (confidence interval [CI]: 21.38–28.13) and DBP by 11.22% (CI: 8.41–12.70); in ramipril – 14.4% (CI: 18.61–25.15) and 12.4% (CI 8.88–13.99); telmisartan – 18.4% (CI: 24.89–10.79) and 14.6% (CI 10.79–16.24); and in RT group, SBP 17.7% (CI: 23.38–29.18) and DBP 12.4% (CI: 9.05–13.02). QoL score increased by 30.56% (CI: 14.30–10.90), 30.94% (CI: 14.21–10.68), 28.07% (CI: 14.89–11.20), and 28.84% (CI: 15.49–11.77), in respective groups (P 0.05). Conclusion: Amlodipine, ramipril, telmisartan, and a combination of RT are equally effective to improve BP and QoL among diabetic hypertensive patients. However, amlodipine and telmisartan lacked in dry cough and more tolerable than the ramipril and RT therapy. Henceforth, amlodipine and telmisartan are better choice to control HT among DM patients