Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria

INTRODUCTION AND IMPORTANCE

Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant.

CASE PRESENTATION

A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence.

CLINICAL DISCUSSION

Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint.

CONCLUSION

Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.

Evaluating the efficacy of surgical excision and topical dimethyl sulphoxide (DMSO) in the treatment of equine cutaneous pythiosis

BACKGROUND

Cutaneous pythiosis in horses is a chronic ulcerative granulomatous disease caused by the oomycete Pythium insidiosum.

AIMS

The objective of the present study was to evaluate the response of cutaneous pythiosis in horses to surgical excision and topical dimethyl sulphoxide (DMSO).

METHODS

Thirty horses were presented clinically with pruritus, fistulae discharging serosanguineous fluid, and output kunkers in different body areas (limb, abdomen, neck, and face). The clinical diagnosis was confirmed by isolation of the causative agent and histopathology. All animals were treated by surgical excision alone, or surgical excision followed by topical DMSO. The healing process was monitored every week macroscopically to evaluate the response to treatment until complete recovery.

RESULTS

The existence of Pythium insidiosum was confirmed in all cases. Histologically, affected horses were characterized by granulation tissue with abundant eosinophils. The size of wounds and the clinical features of pythiosis lesions decreased more after surgical debridement with DMSO application than surgical excision alone. The cutaneous pythiosis lesions were completely recovered at 35 ± 7 and 60 ± 5 days after the surgical excision with topical DMSO and surgical excision alone, respectively.

CONCLUSION

The combination of surgical excision and topical DMSO is found an effective treatment for cutaneous pythiosis in horses.

Relationship between Helicobacter pylori infection and gastric atrophy and the stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence: results from the FINBAR case-control study

OBJECTIVE

A number of studies have shown an inverse association between infection with Helicobacter pylori and oesophageal adenocarcinoma (OAC). The mechanism of the apparent protection against OAC by H pylori infection and, in particular, the role of gastric atrophy is disputed. The relationship between all stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence and H pylori infection and gastric atrophy was explored.

METHODS

A case-control study involving 260 population controls, 227 OAC, 224 Barrett's oesophagus (BO) and 230 reflux oesophagitis (RO) patients recruited within Ireland was carried out. H pylori and CagA (cytotoxin-associated gene product A) infection was diagnosed serologically by western blot, and pepsinogen I and II levels were measured by enzyme immunoassay. Gastric atrophy was defined as a pepsinogen I/II ratio of <3.

RESULTS

H pylori seropositivity was inversely associated with OAC, BO and RO; adjusted ORs (95% CIs), 0.49 (0.31 to 0.76), 0.35 (0.22 to 0.56) and 0.42 (0.27 to 0.65), respectively. Gastric atrophy was uncommon (5.3% of all subjects), but was inversely associated with non-junctional OAC, BO and RO; adjusted ORs (95% CIs), 0.34 (0.10 to 1.24), 0.23 (0.05 to 0.96) and 0.27 (0.08 to 0.88), respectively. Inverse associations between H pylori and the disease states remained in gastric atrophy-negative patients.

CONCLUSION

H pylori infection and gastric atrophy are associated with a reduced risk of OAC, BO and RO. While use of the pepsinogen I/II ratio as a marker for gastric atrophy has limitations, these data suggest that although gastric atrophy is involved it may not fully explain the inverse associations observed with H pylori infection.

Electroencephalography and computerized transaxial tomography in epilepsy diagnosis

Over a 6-month period 89 patients with epileptic seizures were systematically examined by EEGs and CT. Forty-two percent of all cases showed pathological findings in CT compared to 89% with abnormal EEGs. CT is very useful in identifying organic lesions in the epileptic patient. CT identified 11 cases of supratentorial tumour which were correctly localized by EEG. In patients with seizures after trauma or encephalitis the EEG abnormalities were more than could be detected by CT. The EEG and CT findings in cerebrovascular disorders, alcoholism and other diseases are discussed. A remarkable result is the relatively high percentage of hydrocephalus (23%) in the group of cryptogenic epilepsy. Positive EEG findings as to epilepsy could be seen in 62% of the cases.

Combined activation of the EEG with brietal and pentetrazol

A group of 101 activations with Brietal and Pentetrazol are reported. Although Brietal proved to be of value in the investigation of all forms of epilepsy, with 55% positive results, there remained groups of patients in whom there was still a call for greater diagnostic precision. Pentetrazol was tried in 21 of these patients with 66% positive activation. It was found that the two agents together were successful in 72% of the patients. Both also add valuable negative evidence in suspected functional fits.