Non-bullous variant of bullous pemphigoid: role of immunofluorescence in diagnosis

An elderly lady presented with persistent and unexplained excoriated lesions on trunk and limbs of 4 years' duration. No vesicles or bullae ever developed during the course of the disease. Histopathology showed nonspecific dermatitis. The diagnosis of bullous pemphigoid was confirmed by immunofluorescence. The patient responded well to topical steroids and dapsone.

Ischaemic complications after surgical resection of intracranial aspergilloma

A 32-year-old male presented with a paranasal sinus Aspergillus fungal infection. The nasal infection was cleared by endoscopic sinus surgery and the patient was treated with antifungal agents. The patient was otherwise healthy with no evidence of immunosuppresion. Five months later, the patient had to undergo excision of the left frontal intracranial infection for symptoms of raised intracranial pressure and seizures. Within 48hours of surgery, the patient developed basilar artery thrombosis with infarction of the cerebellum and midbrain. The patient succumbed to this vascular catastrophe, which developed at a site distal to that from surgery. The pathophysiology of ischaemic complications after surgical resection of intracranial aspergilloma is discussed.

Zoledronic acid induces antiproliferative and apoptotic effects in human pancreatic cancer cells in vitro

Bisphosphonates (BPs) are an emerging class of drugs mostly used in the palliative care of cancer patients. We investigated the in vitro activity of the most potent antiresorptive BP, zoledronic acid (ZOL), on the growth and survival of three human pancreatic cancer (PC) cell lines (BxPC-3, CFPAC-1 and PANC-1). Pancreatic cancer frequently has a dysregulated p21(ras) pathway and therefore appears to be a suitable target for BPs that interfere with the prenylation of small GTP-binding proteins such as p21(ras). We found that ZOL induces growth inhibition (IC(50):10-50 micro M) and apoptotic death of PC cells. The proapoptotic effect was correlated to cleavage/activation of caspase-9 and poly(ADP)-ribose polymerase, but not of caspase-3. Moreover, we studied the p21(ras) signalling in cells exposed to ZOL and detected a reduction of p21(ras) and Raf-1 content and functional downregulation of the terminal enzyme ERK/MAPkinase and of the pKB/Akt survival pathway. Finally, we observed that ZOL induces significant cytoskeletal rearrangements. In conclusion, we demonstrated that ZOL induces growth inhibition and apoptosis on PC cells and interferes with growth and survival pathways downstream to p21(ras). These findings might be relevant for expanding application of BPs in cancer treatment.

Pathological laughter as a presenting symptom of acoustic schwannoma: report of two cases

Two cases of acoustic schwannoma in a 48-year-old woman and 18-year-old male are reported. Both patients presented with an extremely unusual symptom of pathological laughter as a principal presenting symptom. Complete resection of the tumour via a retrosigmoid route resulted in an immediate resolution of pathological laughter.

Foot pump prophylaxis for deep venous thrombosis-rate of effective usage following knee and hip arthroplasty

We recorded the usage of foot pumps during the post-operative period in 29 patients undergoing knee or hip arthroplasty and made 621 recordings. Effective utilisation of foot pumps was seen in 37.2% of cases. There was a gradual reduction in correct utilisation with each day that passed post-operatively (day 1, 60.4%; day 2, 48.8%; day 3, 28.8%; day 4, 21.4%; day 5, 23%). This gradual reduction was statistically significant ( P=0.001) and mainly occurred between the second and third post-operative days. Effective usage was 60.2% overall at night and 36.4% during the day. Our results question the efficiency of foot pumps in deep venous thrombosis prophylaxis in the context of a true clinical setting.

BRCA1 expression modulates chemosensitivity of BRCA1-defective HCC1937 human breast cancer cells

Germline mutations of the tumour suppressor gene BRCA1 are involved in the predisposition and development of breast cancer and account for 20-45% of all hereditary cases. There is an increasing evidence that these tumours are characterised by a specific phenotype and pattern of gene expression. We have hypothesised that differences in chemosensitivity might parallel molecular heterogeneity of hereditary and sporadic breast tumours. To this end, we have investigated the chemosensitivity of the BRCA1-defective HCC1937 breast cancer cell line, and the BRCA1-competent MCF-7 (hormone-sensitive) and MDA-MB231 (hormone-insensitive) breast cancer cell lines using the MTT assay. The 50% inhibitory concentration (IC(50)) for the individual compounds were derived by interpolate plot analysis of the logarithmic scalar concentration curve after a 48 h exposure. HCC1937 cells were significantly (P<0.005) more sensitive to cisplatin (CDDP) (IC(50) : 30-40 microM) compared with MCF-7 (IC(50) : 60-70 microM) and MDA-MB231 (IC(50) : 90-100 microM) cells. On the other hand, BRCA1-defective breast cancer cells were significantly less sensitive to doxorubicin (Dox) (IC(50) : 45-50 microM) compared with MCF-7 (IC(50) : 1-5 microM) and MDA-MB231 (IC(50) : 5-10 microM) (P<0.02), as well as to paclitaxel (Tax) (IC(50) : >2 microM for HCC1937, 0.1-0.2 microM for MCF-7 and 0.01-0.02 microM for MDA-MB231) (P<0.001). Full-length BRCA1 cDNA transfection of BRCA1-defective HCC1937 cells led to the reconstituted expression of BRCA1 protein in HCC1937/(WT)BRCA1-derived cell clone, but did not reduce tumour cell growth in soft agar. BRCA1 reconstitution reverted the hypersensitivity to CDDP (P<0.02), and restored the sensitivity to Dox (P<0.05) and Tax (P<0.001), compared with parental HCC1937 cells. Taken together, our findings suggest a specific chemosensitivity profile of BRCA1-defective cells in vitro, which is dependent on BRCA1 protein expression, and suggest prospective preclinical and clinical investigation for the development of tailored therapeutical approaches in this setting.

En-plaque ventricular ependymoma

An extremely unusual case demonstrating rare behaviour of an ependymoma is presented. The tumour spread in an en-plaque fashion and involved the ependymal lining of the entire ventricular system. The patient, a 56-year-old male, presented with symptoms of raised intracranial pressure and truncal ataxia. The management issues are analyzed on the basis of a brief literature survey.

Lipoma in the region of the jugular foramen

A 22-year-old girl presented with a gradually progressive loss of hearing in the left ear and ipsilateral facial paresis. Investigations revealed a lipoma in the region of the jugular foramen. Conservative resection of the tumor resulted in improvement in facial paresis. The treatment options in such cases are discussed in this report.

Laparoscopy in diagnosis and management of urinary incontinence caused by small ectopic dysplastic kidney

We describe a case of urinary incontinence which was caused by a small ectopic dysplastic kidney where all preoperative investigations including ultrasound, intravenous urography, micturating cystourethrogram, technetium-99m ((99m)TC) diethylenetriamine penta-acetic acid renal scan, spiral CT scan and angiography failed to reveal the offending kidney. Only a (99m)Tc dimercaptosuccinic acid scan suggested the presence of a small left kidney located in the iliac region. The patient underwent laparoscopy and the offending kidney was identified and excised.

Malignant paraganglioma of the urinary bladder. A case report

Paraganglioma (pheochromocytoma) is probably the most fascinating of all tumors as it can present with a wide range of clinical manifestations. Paraganglioma of the urinary bladder is one of the rare tumors and constitute less than 10% of all bladder tumors. The common presentation of paraganglioma of the urinary bladder is painless haematuria, headache, palpitation and anxiety. Malignancy is uncommon and no histological feature is characteristic of malignancy. Invasion of adjacent organs or metastasis to the lymph nodes is the only criteria to suggest malignancy. In the presence of proven metastasis radical cystectomy with pelvic lymphadenectomy is recommended. In the present case the tumor was arising from anterior wall of the bladder away from the bladder neck and that in a large capacity bladder it was possible to get a wide margin for partial cystectomy along with bilateral pelvic lymphadenectomy without violating the oncological principles. At a follow up of two years there is no evidence of recurrence of tumor.

Carcinoma urinary bladder presenting as acute abdomen

Bladder perforation presenting as acute peritonitis is a rare and dramatic event in the course of carcinoma urinary bladder. We present one such case and discuss the presentation, management and brief follow-up.

Cranial vault Salmonella osteomyelitis leading to extradural abscess - a case report

A case of rarely encountered Salmonella typhi osteomyelitis of left occipital bone leading to extradural abscess, is reported. The causative organism was not suspected until the culture report was obtained. The patient responded promptly to surgical drainage and antibiotic therapy.

Cholesterol granuloma in the middle fossa presenting 30 years after surgery for chronic otitis media: a case report

A massive left subtemporal extradural cholesterol granuloma in a 45 year old male patient is reported. The lesion communicated with the petrous temporal bone and was diagnosed after it became symptomatic 30 years following surgery for left chronic otitis media. The case is analysed and the literature on the subject is reviewed.

Multicystic acoustic neurinoma: report of two cases

A report of two unusual and remarkably similar cases of multicystic acoustic neurinoma in 46 and 60 year old patients is presented. The clinical presentation mimicked a regular acoustic neurinoma. The tumours in each case were similar in their radiological appearance. The entire tumour had a honeycomb appearance with well defined and multiple cysts. Each cyst contained xanthochromic fluid. Like in any other cystic acoustic neurinoma, the presence of multiple cysts made internal decompression of the tumour relatively easy but the dissection of the tumour from the adjoining cranial nerves was difficult. The pathogenesis of multiple cysts is analyzed and the literature on this subject is briefly reviewed.

Cavernous sinus thrombosis and air embolism following surgery for acoustic neurinoma: a case report

A 55 year old male patient was operated on for a massive and vascular acoustic neurinoma in a sitting position. The tumor was completely excised. Post-operatively, the patient developed irritability and clinical features suggestive of contralateral cavernous sinus thrombosis. CT scan showed air within the dural walls of the cavernous sinus on the side of surgery. However, there was no radiological evidence of cavernous sinus thrombosis on the contralateral side. Cavernous sinus thrombosis as a post-surgery complication has not been reported. Air within the dural confines of the cavernous sinus has also not been observed or radiologically recorded in the literature.

Patellar instability following total knee replacement -- the dangers of constant design evolution

Patellar instability following total knee replacement although infrequent can cause disabling symptoms. We report a case of symptomatic patellar instability caused by insertion of left femoral component into a right knee. We highlight that all members of the surgical and theatre team need to be familiar both with the implant equipment and of any recent design modifications, particularly if they have been used to using one system for a long time, in order to prevent surgical errors. In addition this possibility should be born in mind by surgeons looking for causes of post-operative patellar instability.