Neuropathic Pain due to Fibromatosis: Does Anticancer Treatment Help?

Desmoid fibromatosis, although histologically benign, infiltrates local structures. The involvement of neural structures can lead to difficult neuropathic pain and the escalating use of analgesics. We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration. As the tumor was locally invasive and unresectable, he was treated with radiation therapy and oral tamoxifen. On follow-up, there was significant pain relief, sustained reduction in the tumor size, and reduced analgesic requirement. Antineoplastic treatments like local radiation therapy and targeted systemic therapy with hormones or other agents can be considered in the management of selected unresectable desmoid fibromatosis to improve symptom control and reduce polypharmacy.

Microbial contamination of tooth brushes and their decontamination

With the dawn of the new century, dentistry has seen a new face in the fields of diagnosis, treatment and prevention. Twenty one children were asked to brush their teeth for five days. The brushes were put in Robertson's Cooked Meat broth and cultured. Growth of Streptococcus Mutans were seen. These brushes were then placed in disinfectants such as 0.2% chlorhexidine gluconate (Gp I), 1% sodium hypochlorite(Gp II) and water (Gp III) for 24 hrs and then cultured. Disappearance of growth of microorganisms was seen in Gp I and Gp II and remnants of growth seen in Gp III. It can be concluded that the use of disinfectant is a must for every individual at regular intervals.

HAIR-AN syndrome: a multisystem challenge

HAIR-AN syndrome is an acronym for an unusual multisystem disorder in women that consists of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). The precipitating abnormality is thought to be insulin resistance, with a secondary increase in insulin levels and subsequent overproduction of androgens in the ovaries. Long periods of hyperinsulinism and, some suspect, hyperandrogenism can result in the cutaneous manifestation of acanthosis nigricans. Patients are often concerned about the physical manifestations of this disorder, including virilization and acanthosis nigricans, and may be less aware of systemic problems. Physicians should assess women with these problems for an underlying endocrine abnormality. Although a treatment regimen for the HAIR-AN syndrome has not been established, antiandrogen therapy and weight loss are useful.

Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis

Monosymptomatic hypochondriacal psychoses such as delusions of parasitosis are often difficult to treat. For the past two decades, pimozide has been considered the drug of choice. Although a few controlled studies have been done to support the efficacy of pimozide, the recommendation of treatment of choice is largely based on case reports. Pimozide has significant side effects, including cardiac and extrapyramidal abnormalities, which are of most concern in the treatment of the elderly. Although pimozide does appear to be effective in some cases of somatic delusional disorders, newer antipsychotics such as risperidone have also been shown to be beneficial in treating this perplexing cluster of disorders. Risperidone is generally considered safer than pimozide and should be considered as first-line therapy for monosymptomatic hypochondriacal psychoses.

The management of neuropathic pain in cancer: clinical guidelines for the use of adjuvant analgesics

Neuropathic pain is seen in a third of cancer patients and is not always responsive to traditional analgesics. We describe practical guidelines for the use antidepressants and anticonvulsants as adjuvant analgesics in such situations. Newer adjuvant analgesics, interventional procedures and options for the management of pain emergencies, are also briefly outlined.

Cutaneous T-cell lymphoma presenting as benign dermatoses

Cutaneous T-cell lymphoma, also known as mycosis fungoides, is a malignancy of the T helper (CD4+) cells. Diagnosis is difficult early in the course of this disease because it mimics several benign skin disorders, including eczema, psoriasis and contact dermatitis. Cutaneous T-cell lymphoma is also difficult to identify histologically, and multiple biopsies may be necessary to confirm the diagnosis. Treatment may require a combination of topical and systemic agents. Patients with limited skin disease have a good prognosis, but the prognosis is less hopeful in those with extracutaneous involvement. As the disease progresses, the normal T-cell population is eliminated, and the patient becomes significantly immunosuppressed. Infection is the primary cause of mortality in patients with cutaneous T-cell lymphoma.

Contact urticaria to the MCU-2A/P gas mask

A case of contact urticaria to the silicone rubber in the MCU-2A/P gas mask is presented. Contact urticaria is a type I hypersensitivity reaction mediated by immunoglobulin E that usually manifests as localized erythema, edema, pruritus, and urticarial plaques. It can also cause systemic reactions, including anaphylaxis. Allergic reactions to silicone rubber have been increasingly reported and are of importance in medical and military personnel. The implication of such a diagnosis in an active duty military member is significant because the individual cannot be worldwide-qualified. The correct diagnosis of allergic skin reactions to personal protective gear is critical to maintaining a strong fighting force and protecting military personnel from potentially life-threatening allergic reactions.

Herpes zoster in a 7-month-old infant: a case report and review

Herpes zoster (HZ) is a cutaneous viral infection of the skin that presents in a dermatomal distribution. It represents reactivation of herpes varicella zoster virus that has continued to exist in a latent form in the neurons of the posterior root ganglia. Although it is rare to see HZ in children, cases have been reported after exposure to varicella zoster in utero or during the first months of life. We present a case of HZ in a healthy 7-month-old girl who had had chickenpox at age 4 months.

The lines and grooves of the face: a suggested nomenclature

The lines and grooves of the face commonly recognized and used by plastic surgeons, biological anthropologists, forensic medicine specialists, artists, and others are described. Proper Latin anatomical names for them are suggested. It is hoped that eventually these will be adopted by those who use them and published by the International Anatomical Nomenclature Committee.