Methotrexate in childhood psoriasis

We treated childhood psoriasis with methotrexate (MTX) in seven children (4 boys, 3 girls) over 7.5 years. Their ages and duration of disease varied from 3.5 to 16 years (mean 12.14 yrs) and 4.8 months to 5 years (mean 2.2 yrs), respectively. Psoriatic erythroderma was seen in three patients, generalized pustular psoriasis in two, recalcitrant psoriasis and psoriatic arthropathy in one each. Pre-MTX liver biopsy performed in 4 children showed grade I changes. Methotrexate was given in a single weekly oral dose of 3.75 to 25 mg (mean 16.6 mg). The duration of treatment necessary to control the disease varied from 6 to 10 weeks (mean 7.9 wks). Total duration of MTX therapy was 31.2 to 46.4 weeks (mean 38.8 wks). Posttherapy disease-free interval ranged between 14.4 and 16.8 weeks (mean 15.5 wks). Follow-up after withdrawal of MTX was 16 to 28 weeks (mean 22.3 wks). Total cumulative MTX dose ranged from 390 to 960 mg (mean 683.6 mg). Side effects were nausea and vomiting in three patients.

Factors responsible for death in patients with pemphigus

The records of 10 patients who died with pemphigus have been examined for factors affecting and contributing to death. Early initiation of therapy, the age at onset of the disease, and the mode of administration of corticosteroids, conventional or in pulse form, did not affect the survival. The cutaneous involvement was extensive in all 10 patients; it ranged between 30-80%. Septicemia was the commonest event preceding death; in 4 cases, it was due to Staphylococcus aureus.

Spectrum of reticulate flexural and acral pigmentary disorders in northern India

Reticulate pigmentary disorders are rare in India. Only 15 cases of reticulate acropigmentation of Kitamura (RAPK) and 9 cases of Dowling-Degos disease (DDD) have been reported previously. To the best of our knowledge, there has been no earlier report of acropigmentation of Dohi. We herein describe 10 patients with various reticulate pigmentary abnormalities: 6 with RAPK, 2 with DDD, 1 with RAPK-DDD overlap, and 1 with acropigmentation of Dohi. Palmar pits and/or breaks in epidermal ridge pattern were absent in 2 of 6 patients with RAPK. A 23-year-old male patient had RAPK-DDD overlap. Periorbital pigmentation and pigmentation over the mucosal surface of the prepuce and corona of the glans penis were some unique features observed in this patient. His sister and mother had RAPK and DDD, respectively. We concluded that RAPK and DDD are varying manifestations of a single entity. Their presence in other family members probably depends on the degree of penetrance.

Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb

We have reviewed the results in 34 patients (39 operations) following simple excision of the trapezium for osteoarthritis of the basal joint of the thumb. The average age at operation was 57 years and the average follow-up was 6 years. All the patients were graded clinically and radiologically and were asked their opinion of the procedure. There was dramatic relief of pain following this procedure. Stability of the thumb was not compromised. When compared to the unoperated side, thumb length, thumb abduction and first web span were similar. There was a reduction in pinch strength (operated 8.1 k.p.a., non-operated 9.6 k.p.a.) and grip strength (operated 15.5 k.p.a., non-operated 19.5 k.p.a.) and an increase in MIP extension (operated 5.4 degrees, non-operated 2.9 degrees) following this procedure but the differences were not statistically significant. 11 patients (32%) had scar hyperaesthesia on testing but this was a clinical problem in two patients only (5%). Simple excision of the trapezium is a satisfactory procedure for the majority of patients with this disorder, but has a long post-operative rehabilitation period.

Sporotrichosis in north-west India

Twelve culture proven patients of sporotrichosis were seen over a period of 4 1/2 yr in the north-western region of this country. Most of the patients (75%) were from Himachal Pradesh, with slight female preponderance. The right upper limb was commonly (58.3%) involved; gardeners and housewives being the common sufferers. Localised lymphocutaneous variety was the commonest presentation (91.7%), except in one patient, where after initial involvement of the face, the lesion extended to the right upper limb and trunk. All but one patient responded to oral potassium iodide therapy; this patient with mixed infection of Sporothrix schenckii and Cladosporium species, required in addition, amphotericin B therapy.

Further experience with pemphigus in children

Seven children had pemphigus: six had pemphigus vulgaris and one pemphigus foliaceus. Four who had pemphigus vulgaris were administered dexamethasone pulses. Follow-up from six months to one year was uneventful; the disease was under control and there were no complications due to therapy. Our observations suggest that the clinical features, course, and principles of therapy for pemphigus in children are essentially the same as those in adults.

The modified Liverpool total elbow prosthesis

We present the results of the modified Liverpool total elbow joint replacement. The humeral component of the original prosthesis was modified because of a high incidence of loosening. 19 patients who had total elbow joint replacement for rheumatoid arthritis were reviewed 8 years after surgery. 14 patients had the modified prosthesis implanted. There was dramatic relief of pain and improvement in function following surgery. There was a reduced fixed flexion deformity and an increased range of movement with the modified prosthesis. None of the humeral components of the modified prosthesis have as yet required revision. In selected patients therefore, this operation is a predictably successful procedure. Our follow-up confirms the ability of the modified prosthesis to provide a pain-free, stable and mobile joint.

Some observations on patients from two leprosy colonies in north India attending a city clinic

Fifty-eight patients (26 males - mean age 52.5 years, 32 females - mean age 58.5 years) from two different leprosy colonies (Ambala and Jagadhari) were studied. Maximum number of the patients (48.4%) belonged to Uttar Pradesh. The clinical diagnosis was LLp:41(70.7%), LLs:14(24.2%), LL-burnt-out, BB-BL and BT: one each (1.7%). Mean duration of disabilities/deformities in these patients was 21.5 years. A peculiar myokymic movement of periorbital muscles was observed in 20 patients (34.5%). While dapsone monotherapy was continued in 55 patients, MDT (WHO-multibacillary regimen) was started in three patients. Vocational advice was given to 23 patients; and 35 (60.4%) patients were declared as "destitutes".

Cutaneous sarcoidosis masquerading as relapsed borderline tuberculoid leprosy?

A patient with cutaneous sarcoidosis is presented. The patient was diagnosed initially as borderline tuberculoid leprosy downgrading to borderline lepromatous leprosy and received a full 2 years of World Health Organization multibacillary drug treatment (MDT). Bilateral hilar lymphadenopathy on chest X-ray and cutaneous anergy manifested by negative Mantoux, candidin and trichophytin skin tests suggested the diagnosis of sarcoidosis. Histopathology confirmed this diagnosis. The subcutaneous nodule seen in this patient is a rare type of cutaneous sarcoidosis.

Correlation between bone age and Risser's sign in adolescent idiopathic scoliosis

Skeletal maturity in 86 girls with adolescent idiopathic scoliosis was determined by assessing their bone age at the hand and wrist and by the development of their iliac (Risser's sign) and ischial apophyses. The two methods were compared and a statistically significant correlation was noted, signifying that the development of the iliac and ischial apophyses is a sensitive parameter for assessing skeletal maturity in these patients. The iliac apophysis is visible on routine follow-up radiographs of these patients, so using this criterion results in a reduction of roentgen ray exposure to the patient and significant financial savings. A more sensitive method of assessing the development of the iliac and ischial apophyses is suggested.

Rupture of the symphysis pubis during labor

Two cases of spontaneous rupture of the symphysis pubis (SP) during delivery are reported. The separations were associated with considerable pain, swelling, and tenderness over the symphysis pubis and were confirmed roentgenographically. Both patients were treated conservatively with bed rest, mostly in the lateral decubitus position, within pelvic binders. Immobilization was discontinued when they were pain free. The SP separations remained in reduced positions. The patients were essentially asymptomatic and walked normally. Conservative treatment followed by early mobilization is adequate treatment for SP separations.

Role of tear secretory IgA in hard contact lens-related changes in the tarsal conjunctiva

The role of tear secretory IgA in contact lens-related conjunctival changes was investigated in 40 subjects (80 eyes) who wore polymethyl methacrylate (PMMA) contact lenses and 10 subjects (20 eyes) who did not wear contact lenses. The eyes in the contact lens group had significantly higher tear IgA levels than the control eyes (p < 0.05). We were not able to demonstrate a relation between increased IgA levels and the presence of symptoms or duration of contact lens wear. Increased IgA levels were correlated to papilla formation in the contact lens group. A rise in tear IgA levels seems to be the first abnormal change related to papilla formation in patients who wear PMMA contact lenses.

Role of bacterial flora in the pathogenesis & management of atopic dermatitis

The carriage state of Staphylococcus aureus and its role in the pathogenesis and management of atopic dermatitis were evaluated in 50 patients, aged 3 months to 12 yr. An equal number of age and sex matched controls were also studied. The positivity of Staph.aureus in patients with atopic dermatitis was 50 per cent from eczematous skin, 34 per cent from anterior nares and 26 per cent from normal skin. In controls, the comparative figures were 14 per cent from anterior nares and 10 per cent from normal skin. After institution of oral erythromycin or cloxacillin therapy (according to sensitivity), the colony counts dropped to 18 per cent from eczematous skin, 14 per cent from anterior nares and 8 per cent from normal skin after one week and to zero after 3 wk. This was associated with significant clinical improvement. The results of this study suggest that Staph. aureus aggravates the eczematous process in patients with atopic dermatitis and antibiotics decrease the severity and are useful in long term prognosis of the disease.

Posterior mediastinal teratoma

A patient with benign posterior mediastinal teratoma which is a rare site for teratomas is reported. Chest skiagram and CT of the thorax established the diagnosis. Complete removal of the mass was not possible on surgery as it was adherent to the pericardium and the esophagus. The patient remained asymptomatic one year after the surgery. There was no evidence of recurrence of the tumor.

Failed lumbar spinal surgery

Failures and poor results of 160 patients after lumbar spinal surgery between 1980 and 1984 were analysed retrospectively. A self-rated questionnaire carried out 12 months after operation revealed 20 poor results; these occurred most commonly after multiple operations, decompression and fusion as compared to disc excision. The commonest cause was failure to recognise abnormal pain behaviour before operation. A more careful preoperative assessment should reduce the incidence of failure.

Cytodiagnosis of granulocytic sarcoma presenting as superior vena cava syndrome in acute myeloblastic leukemia. A case report

We describe a rare case of acute myeloblastic leukemia presenting with superior vena cava syndrome due to a mediastinal granulocytic sarcoma. The morphologic diagnosis of granulocytic sarcoma was obtained from computed tomography-guided fine needle aspiration cytology. This is the second such case described in the world literature.