COMPARISON OF THE EFFECTS OF ETOMIDATE AND THIOPENTONE ON INTRAOCULAR PRESSURE

The effects of etomidate and thiopentone on intracular pressurewere studied in 50 patients of either sex undergoing routinenon-ophthalmic surgery. Both drugs decreased intraocular pressuresignificantly. However, etomidate induced a significantly greaterdecrease in intraocular pressure than did thiopentone.     

LEPROMATOUS LEPROSY WITH EXTENSIVE TRUNCAL SEBORRHEIC KERATOSES AND ACRAL VERRUCA VULGARIS

A 37-year-old man came to us with asymptomatic dark colored warty iesions of 3V2 years' duration. The lesions started on the dorsa of the feet and hands and progressively increased in size and number to cover more than 60% of these areas. Later, they spread to other parts of the body. There was no history of sudden loss of weight or appetite, change in bowel habits, or of major illness in the past. The patient had not taken any medication. A general and systemic examination of the patient revealed no abnormality. On dermatological examination, hyperpigmented well-defined, verrucous papules and plaques of varying sizes were seen on the extremities, almost covering the dorsa of the hands and feet (Figs. 1–3). Small flattopped hyperpigmented papules with a smooth surface and “stuck-on” appearance were present on the trunk (Fig. 4). The rest of the body had scattered hyperpigmented papules and plaques, up to 2 × 2 cm in size with a minimally verrucous surface. The patient also had a shiny appearance of the face, infiltration of the ear lobes, with mild ichthyosis of the limbs. Examination of the peripheral nerves revealed bilateral thickening without tenderness or sensory loss. Slit smears for acid-fast bacilli from the earlobe and normal skin showed a bacteriological index of 5+ and 2+, respectively. A diagnosis of lepromatous leprosy with extensive verruca vulgaris and seborrheic keratoses was made. Biopsies of the normal-looking skin, the flat truncal lesions, and the verrucous lesions on the extremities were taken. Histopathologic examination of the trunk lesions showed hyperkeratosis and acanthosis with interwoven tracts of basaloid cells and horn cysts, indicative of the acanthotic type of seborrheic keratosis (Fig. 5). Below the epidermis there was a clear zone of dermis. A foamy macrophage granuloma was seen in the deeper dermis; M. leprae with Fite-Faraco staining was demonstrated. On histopathologic examination the acral lesions showed hyperkeratosis, acanthosis, and papillomatosis. The rete ridges were elongated and bent inwards and typical vacuolated cells were seen in some areas, indicative of verruca vulgaris (Fig. 6). The biopsy from a lesion on the arm revealed seborrheic keratosis and verruca vulgaris in continuity along the epidermis with a foamy macrophage granuloma in the lower dermis (Fig. 7). Mycobacterium leprae were demonstrable in all the sections. Thus, the histopathology of the lesions confirmed a diagnosis of lepromatous leprosy with acral verruca vulgaris and truncal seborrheic keratosis. The patient was further investigated and baseline parameters including urine and stool examination, hemogram, blood sugar, and renal and hepatic function tests revealed no abnormality. Keeping in mind the sign of Leser-Trelat, the patient was also investigated for any focus of malignancy. Gastroscopy, x-ray of the chest, and other tests were normal. The Mantoux and blood serology for H(v were negative. The patient was started on antileprosy treatment according to the WHO Multidrug Regimen and was also given a course of levamisole. Minimal response was noted. Eighteen months later the patient returned to the hospital and a 50% regression of the acral lesions was seen. A few lesions were also cauterized by electrocautery and the response was good.     

Holoprosencephaly (A Case Report)

We describe here a rare entity of Holoprosencephaly. The embryogenesis and the diagnostic aspects of this condition are highlighted.     

CT of Anterior Intervertebral Disc Herniation

Herniation of intervertebral disc usually occurs posterolaterally. A thorough review of the recent radiological literature revealed only a single case report of anterior intervertebral disc hernitation demonstrated by computed tomography (CT). We report another such case.     

Formalin toxicity in hydatid liver disease

Two cases of formalin toxicity developed within 5 to 10 minutes of the placement of packs soaked in formalin within hepatic hydatid cysts. Hypotension, severe tachycardia, postoperative anuria, tachypnoea, restlessness, unconsciousness and coma developed. There was no response to the treatment given. Treatment was continued for about 12 hours. The problems associated with the use of formalin are discussed.     

STAGING OF PROSTATE CANCER USING 3-DIMENSIONAL TRANSRECTAL ULTRASOUND IMAGES: A PILOT STUDY

PURPOSE: We used conventional transrectal ultrasound images for 3-dimensional (D) reconstruction of the prostate, and determined its value in staging clinically localized prostate cancer. MATERIALS AND METHODS: A total of 36 patients with newly diagnosed clinically localized prostate cancer were studied. All patients underwent conventional transrectal ultrasonography with 3-D reconstruction. Images were examined and analyzed blindly, and findings were compared to histopathological staging following radical prostatectomy. RESULTS: Pathological staging of specimens revealed 15 sites of extracapsular extension in 10 patients, of whom 8 had positive margins and 2 had seminal vesicle invasion. The 3-D imaging identified 12 sites of extracapsular extension in 9 patients with 80% sensitivity, 96% specificity and 90% positive predictive value. Of the 2 patients with seminal vesicle invasion 1 was identified correctly on 3-D images. Overall staging accuracy of 3-D imaging was 94%. CONCLUSIONS: The 3-D reconstruction of conventional transrectal ultrasonography imaging is superior to 2-D imaging for staging localized prostate cancer. However, this advantage relies entirely on the visibility of prostate cancer lesions on conventional ultrasonography. Further studies are warranted to evaluate this technology for the management of prostate cancer.