Pleomorphic adenoma of the upper lip

This case report describes a rare and unusual lesion found in a 33-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 3 cm in diameter, almost obstructing the nares and characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented.

Presentation and clinical course of Wolfram (DIDMOAD) syndrome from North India

AIMS

Wolfram syndrome, also known as DIDMOAD, is a relatively rare inherited neurodegenerative disorder, first evident in childhood as an association of juvenile-onset diabetes mellitus and optic atrophy, followed by diabetes insipidus and deafness. The aim of the study was to examine the clinical profile of patients with DIDMOAD syndrome presenting to a tertiary care hospital in north India.

METHODS

Clinical presentation of juvenile-onset diabetes mellitus fulfilling the diagnosis of Wolfram syndrome was studied using a prepared standardized form.

RESULTS

Subjects with juvenile-onset non-autoimmune diabetes mellitus attending the diabetic clinic at a tertiary care centre in north India were followed for 10 years and a diagnosis of fully developed Wolfram syndrome was confirmed in seven individuals. The series consisted of five male and two female patients with a mean age of 17.5 ±7.34 years. Two subjects had consanguinity and none had any other family member affected. Optic atrophy was present in all, sensorineural hearing loss in 4/7, central diabetes insipidus in 4/7 and nephrogenic diabetes insipidus in 2/7 subjects. The new associations found were: spastic myoclonus, short stature with pancreatic malabsorption, nephrogenic diabetes insipidus, cyanotic heart disease and choledocholithiasis with cholangitis. Genetic analysis revealed mutation in exon 8 of the WFS1 gene in all the cases studied.

CONCLUSIONS

The present clinical series of Wolfram syndrome reveals a varied clinical presentation of the syndrome and some new associations.

Applying patient centered approach in management of pulmonary tuberculosis: A case report from Malaysia

A 24 year university student with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti tuberculosis drugs and was treated with chlorpheniramine (4mg) tablet. Patient missed twenty eight doses of anti tuberculosis drugs in continuation phase claiming that he was very busy in his studies and assignments. Upon questioning he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking prescribed medicines. His treatment was stopped based on clinical improvement, although he did not complete six months therapy. Two major reasons; false perception of being completely cured and side effects associated with anti TB drugs might be responsible for non adherence. Non sedative anti histamines like fexofenadine, citrizine or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such lifestyle. Patient had not completed full course of chemotherapy, which is preliminary requirement for a case to be classified as "cure" and "treatment completed". Moreover, patient had not defaulted for two consecutive months. Therefore, according to WHO treatment outcome categories, this patient can neither be classified as "cure" or "treatment completed" nor as "defaulter". Further elaboration of WHO treatment outcome categories is required for adequate classification of patients with similar characteristics. Likelihood of non adherence can be significantly reduced by applying the WHO recommended "Patient Centered Approach" strategy. Close friend, class mate or family member can be selected as treatment supporter to ensure adherence to treatment.

Degeneration of the extensor muscle group in a surgical low back and leg pain population

The spinal muscles have received great attention in low back pain (LBP) with suggestions of a de-conditioning syndrome. It is not known whether it is a long or short term consequence of LBP. This study explored the cross section area (CSA) and muscle quality of the spinal extensor group in LBP patients referred to a spinal clinic. MRI scans of 100 annoymised patients were retrospectively reviewed; sagittal and transverse (from levels L3-5) images were archived and analysed to determine CSA and levels of fat infiltration of the extensor muscle groups. Forty six patients had spinal stenosis (28 males, 18 females, mean age 66 ± 14.2 years) and 54 had a disc prolapse (28 males, 26 females, mean age 50 ± 12.9 years). CSA was significantly smaller in the stenotics at both L3/4 and L4/5. Patients presenting with leg pain and a disc herniation had a significantly smaller CSA (p < 0.01) at L3/4 and L4/5 levels. Fat infiltration was present in both groups but was significantly greater in the stenotic group (p < 0.01) and was present at a similar degree at all spinal levels. Multiple regression analysis confirmed that reduced CSA was linked to leg pain (p < 0.01) and age was linked with fat infiltration (p < 0.01). Future work should explore the extent of such changes in an age and sex matched control population with no current back pain or sciatica.

Physiological changes in scalp, facial and body hair after the menopause: a cross-sectional population-based study of subjective changes

BACKGROUND

Significant changes in scalp, facial and body hair occur after the menopause. These can have a significant negative impact on self-esteem and are also potential markers of endocrine or metabolic diseases. Knowledge of postmenopausal hair changes is important for clinicians to distinguish between normal physiological change and those that require further medical investigation.

OBJECTIVES

To assess the subjective experience of scalp, facial and body hair change in a large cohort of normal postmenopausal females.

METHODS

Postmenopausal females aged 45 years or over of northern European origin completed a questionnaire detailing scalp, facial and body hair changes following the menopause. Women with a history of thyroid disease, oophorectomy or premature menopause were excluded from the study. The Mann-Whitney U-test and the χ(2) test were used to assess the correlation between scalp, facial and body hair changes with age.

RESULTS

Diffuse generalized hair loss was the most common form of scalp hair loss, reported by 26% of women. Frontal hair loss was reported by 9% of women. Facial hair gain was cited by 39% of females with the chin being the most frequent site for new growth (32% of women). Body hair loss was significantly correlated with older age (P < 0·001) and was most frequent at androgen-sensitive sites. We noted two patterns: (i) diffuse hair loss in which diffuse generalized scalp hair loss was significantly correlated with body hair loss and increasing age (P < 0·05); and (ii) frontal hair loss which was associated with higher facial hair scores and relatively younger age (P < 0·05) compared with women with diffuse hair loss.

CONCLUSIONS

This is the first comprehensive study of the subjective hair changes in postmenopausal women. This study demonstrates two distinct patterns of hair change relating to age, which may reflect different underlying pathophysiological mechanisms and are of relevance to the medical management of these women as well as being possible predictors of health outcomes.