Lymphangiosarcoma of the arm presenting with lymphedema in a woman 16 years after mastectomy: a case report

Lymphangiosarcoma following breast cancer is a relatively rare entity, with around 300 cases so far reported worldwide. Affecting the long term survivors of breast cancer, lymphangiosarcoma (Stewart-Traves Syndrome) has a high mortality rate. Since lympedema following radical mastectomy or axillary clearance and radiotherapy seems to be the main predisposing factor, further research regarding modifications in the surgical technique of axillary nodes dissection as well as the development of new chemotherapeutic agents effective in lymphangiosarcoma are required

Comparison of different treatment modalities in advanced laryngeal hypopharyngeal squamous cell carcinoma

OBJECTIVE: To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2000 to December 2005. METHODOLOGY: Medical records of already treated stage-III and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. Cox proportional hazard regression was used to estimate the hazard ratio with 95 percent confidence interval for gender, age and tumour location. RESULTS: Sixty two percent of group-A and 49% patients of group-B were stage-III. In group-A, 40% patients received postoperative adjuvant therapy while in group-B, 45% received concomitant chemoradiation. Mean follow-up duration was 18.3 months. Mean recurrence time was 1369+193 days. In group-A, mean recurrence time was 2097+277 days. It was 399+/-68 days for group-B patients (p \u3c 0.001). The hazard ratio of recurrence in hypopharyngeal tumours was 1.5 times (95% CI 0.68, 3.30) as compared to tumours of larynx. The hazard ratio of recurrence was 1.98 times (95% CI 0.99, 3.95) when both larynx and hypopharynx were involved as compared to when tumour was localized to larynx only. No residual disease was noted at the completion of treatment in surgical group-A while 62% patients of the group-B had residual disease at the completion of treatment. Larynx was retained in only 25% patients in group-B. CONCLUSION: Statistically significant difference was noted in disease free outcome when stage-III and IV larynx hypopharynx cancer was managed surgically as compared to non-surgical management. Chances of retaining larynx are only 25% when managed non-surgically

Bullet-induced synovitis as a cause of secondary osteoarthritis of the hip joint: a case report and review of literature

Abstract BACKGROUND: With increasing prevalence of gunshot injuries we are seeing more patients with retained bullet fragments lodged in their bodies. Embedded lead bullets are usually considered inert after their kinetic energy has dissipated hence these are not removed routinely. However, exposure of any foreign body to synovial fluid may lead to rapid degradation and hence result in systemic absorption, causing local and systemic symptoms. We present the case of a thirty year old man who came to our out patient department with a history of progressive, severe hip pain ten years after a gun shot injury to his right hip. CONCLUSION: The common belief that intraarticular bullets should not be removed has no benefit and may result in unwanted long term complications

Choroidal neovascularization regression on fluorescein angiography after VEGF blockade.

BACKGROUND: Intravitreal vascular endothelial growth factor (VEGF) inhibitors stabilize vision in a majority of patients with neovascular age-related macular degeneration (AMD) and can improve vision in almost 40% of patients. However, some individuals who respond to anti-VEGF treatment still lose vision due to the formation of geographic atrophy (GA). While optical coherence tomography is often the primary imaging modality used, fluorescein angiography (FA) can provide useful information on GA development after choroidal neovascularization (CNV) regression. METHODS: A retrospective chart review was conducted to evaluate the changes seen on FA over a 47-month period for 3 patients with neovascular AMD treated with anti-VEGF inhibitors. RESULTS: All 3 patients were initially noted to have subfoveal CNV due to AMD at baseline; they were followed up monthly and treated on an as needed basis for at least 47 months with intravitreal VEGF inhibitors. All subjects had regression of their CNV lesions after VEGF blockade. Two subjects developed foveal atrophy. CONCLUSIONS: This case series depicts the changes on FA seen over a 4-year period and shows that GA can occur with regression of CNV after treatment with VEGF inhibitors

Morphology of the proximal femur in a Pakistani population

Purpose: To measure the morphology of the proximal femur in a Pakistani population. Methods: Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. Results: Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0-4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI,2.7). Conclusions: Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population

Acetabular morphometry and prevalence of hip dysplasia in the South Asian population

We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints) was studied. There were 136 males (54.4%) and 114 females (45.6%). Mean age of our study population was 38 years (15-78 years). The average center edge angle was 35.5±6.6° standard deviation (SD), acetabular angle was 37.76±4.37°, depth to width ratio was 0.31±4.6°, roof obliquity was 10.6±6.2°, extrusion index was 0.1±5.8, lateral subluxation 8.9±2.7 mm, and peak to edge distance 17±3.98 mm. There was significant influence (p\u3c0.05) of age in all angles except depth to width ratio. A total of seven hip joints (1.4%) were dysplastic with CE angle \u3c25° while four of the seven hips were severely dysplastic with CE angle \u3c20°. In the dysplastic group there was significant correlation (p\u3c0.05) of CE angle with acetabular angle, depth to width ratio, extrusion index and peak to edge distance. Prevalence of hip dysplasia was found to be very low in our population. These results are consistent with the findings of studies carried out in other Asian countries

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

<p>Abstract</p> <p>Background & Purpose</p> <p>Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery.</p> <p>Methodology</p> <p>This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5%) knees (group-I) had received tranexamic acid (by surgeon preference) while the remaining fifty-two patients with 66 (51.5%) knees (group-II) had did not received any tranexamic acid either pre- or post-operatively.</p> <p>Results</p> <p>The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral) and 2695 ml (bilateral). In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral) and 1.94 gm/dl (bilateral), with a mean drainage of 826 ml (unilateral) and 1288 ml (bilateral) (p-value < 0.001).</p> <p>Interpretation</p> <p>Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.</p

Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics.

Diabetes and its microvascular complications in patients poses a significant challenge and constitutes a major health problem. When it comes to manifestations in the eye, each case of diabetic retinopathy (DR) is unique, in terms of the phenotype, genotype, and, more importantly, the therapeutic response. It is therefore important to identify factors that distinguish one patient from another. Personalized therapy in DR is a new trend aimed at achieving maximum therapeutic response in patients by identifying genotypic and phenotypic factors that may result in less than optimal response to conventional therapy, and consequently, lead to poorer outcome. With advances in the identification of these genetic markers, such as gene polymorphisms and human leucocyte antigen associations, as well as development of drugs that can target their effects, the future of personalized medicine in DR is promising. In this comprehensive review, data from various studies have been analyzed to present what has been achieved in the field of pharmacogenomics thus far. An insight into future research is also provided

Retinal optical coherence tomography manifestations of intraocular lymphoma.

PURPOSE: Primary central nervous system lymphoma (PCNSL) is a rare disease. The index report describes a patient with intraocular lymphoma secondary to recurrent PCNSL and corresponding retinal findings on spectral domain optical coherence tomography (SD-OCT). METHODS: Case report. RESULTS: OCT changes were documented and correlated with the clinical course of intraocular lymphoma progression in the index patient. The OCT changes, manifested as hyperreflective material accumulation in the intraretinal and subretinal pigment epithelial spaces, were caused by lymphomatous infiltration. CONCLUSION: SD-OCT can be useful in diagnosing and monitoring the progression or regression of intraocular lymphoma with retinal involvement

Retinal optical coherence tomography manifestations of intraocular lymphoma

PURPOSE: Primary central nervous system lymphoma (PCNSL) is a rare disease. The index report describes a patient with intraocular lymphoma secondary to recurrent PCNSL and corresponding retinal findings on spectral domain optical coherence tomography (SD-OCT). METHODS: Case report. RESULTS: OCT changes were documented and correlated with the clinical course of intraocular lymphoma progression in the index patient. The OCT changes, manifested as hyperreflective material accumulation in the intraretinal and subretinal pigment epithelial spaces, were caused by lymphomatous infiltration. CONCLUSION: SD-OCT can be useful in diagnosing and monitoring the progression or regression of intraocular lymphoma with retinal involvement