No abstract

Itraconazole is not only an effective and safe therapy for controlling exacerbations of SD but may also be used as maintenance therapy to prevent disease recurrence.

Background:Few studies have examined the effect of seborrheic dermatitis (SD) and/or its consequent therapy on a patient’s quality of life. Itraconazole has been suggested as an effective therapy for severe SD but its impact on Quality of Life (QoL) in these patients has never been studied before.Objective:The study aimed to verify the efficacy of the itraconazole on the quality of life in patients with moderate to severe SD.Methods:A randomized, double-blind, placebo controlled trial was planned to describe the effect of SD per se on QoL and to determine the impact of oral itraconazole or placebo on QoL of SD patients. Sixty-eight patients with moderate to severe SD participated in the study to receive either itraconazole or placebo. Dermatology Life Quality Index was used to evaluate their quality of life before and after treatment. Itraconazole 200 mg/daily or placebo was prescribed for one week and then the first two days of every month for the following three months. Fifty-seven patients completed the study.Results:Significant improvement was observed in QoL of both itraconazole and placebo groups, but itraconazole group showed significantly higher improvement as compared to placebo (p=0.001). QoL was impaired significantly with high disease severity (p=0.002) and facial involvement (p=0.017).Conclusions:Itraconazole significantly improves the QoL in patients with moderate to severe SD.

Background. Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. In 50 to 70% of cases, the initial manifestations of pemphigus vulgaris are oral lesions which may be followed by skin lesions. But it is unusual for the disease to present with initial and solitary persistent lower lip lesions without progression to any other location. Main Observations. We report a 41-year-old woman with dry crusted lesions only on the lower lip, clinically resembling actinic cheilitis and erosive lichen planus, but histopathological evaluation showed unexpected results of suprabasal acantholysis and cleft compatible with pemphigus vulgaris. We treated her with intralesional triamcinolone 10 mg/mL for 2 sessions and 2 g cellcept daily. Patient showed excellent response and lesions resolved completely within 2 months. In one-year follow-up, there was no evidence of relapse or any additional lesion on the other sites. Conclusion. Cheilitis may be the initial and sole manifestation of pemphigus vulgaris. Localized and solitary lesions of pemphigus vulgaris can be treated and controlled without systemic corticosteroids.

Hair transplantation (HT) is a relatively safe surgery and is associated with very few complications. Recipient site necrosis (RSN) is a rare but potentially devastating complication of HT. This adverse event can impact the cosmetic and psychological outcome for the patient and can have medicolegal implications for the surgeon. Hence, the surgeon should be familiar with this complication, its preventive measures, and management techniques. Necrosis occurs as a result of vascular injury. Circulation in the scalp is marginal and without perforating veins in any event; moreover, vascularization is further diminished in patients with Androgenetic Alopecia (AGA). 1 RSN usually appears in the central scalp, that is, the least vascularized area of the scalp but it can also occur elsewhere. Typically, it arises when an increased number of recipient grafts are utilized and de-vascularization of the scalp occurs as a result of dense splitting of recipient skin. 2 Transection in any vessel of supragaleal plexus due to deep slitting can also lead to necrosis.

Vascular abnormalities associated with neurofibromatosis type 1 are well described in the literature, however, arteriovenous malformation is a very rare finding in neurofibromatosis type 1. We report the case of an 11-year-old girl who presented with a soft mass on the right flank. Provisional diagnosis of plexiform neurofibroma was made on the basis of clinical and histological observations. Because the lesion was warm on palpation, imaging studies were performed to evaluate further and arteriovenous malformation was detected underlying the plexiform neurofibroma. This report emphasizes the importance of careful examination and proper investigations of the plexiform neurofibroma prior to treatment strategies to avoid future complications. The rarity of plexiform neurofibroma in association with arteriovenous malformation at the same site was also highlighted in this report.

Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (40 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between November 2010 to October 2011. SPLC was performed using X-cone with 5 and 10 mm extra-long (50 cm) telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were postoperative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction with body image and operating time. The mean VAS scores for pain at rest in MPLC group were higher on day 0 (SPLC 3.38 versus MPLC 4.80, p0.0001). VAS on coughing/straining was also significantly higher in MPLC group on day 0(SPLC 3.98 versus MPLC 6.48, p0.0001).VAS on postoperative day 1 was significantly higher in MPLC group (SPLC 2.25 versus MPLC 3.80, p0.000). Number and nature of surgical complications was statistically insignificant. Post-operative resumption of normal activity was earlier in SPLC group (SPLC 7.08, MPLC 10.83, p0.0001). Patient assessed cosmesis and satisfaction with body image scores on likert index (SPLC 5 in 100% versus MPLC 3 in 82.5% and 3 in 7.50%) indicating better cosmesis and greater patient satisfaction in SPLC. SPLC took longer to perform (87.63min versus 58 min in MPLC). Additional laparoscopic device (Alligator, 2.3 mm grasper) was used for retraction of gall bladder in 6 patients and 5mm right subcostal port in SPLC. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.

for a period of one year. Aim of the study was to see the effects of surgeries of benign prostatic hyperplasia (TURP and open prostatectomy) on the urodynamic parameters and to statistically analyze and compare the urodynamic outcome of two surgeries. Patients selected for study were those undergoing either transurethral resection of prostate (TURP) or open prostatectomy for benign prostatic hyperplasia (BPH), whereas those excluded from the study were patients with nervous system disorders, unstable/overactive bladder, obstructive symptoms due to causes other than BPH and those who were not fit for general anaesthesia. Forty patients with prostate >50 grams, who fulfilled the inclusion criteria, were randomly and equally selected to undergo either transurethral resection of prostate (TURP) or open prostatectomy. Preoperative urodynamic study of the patients was done. Repeat urodynamic study of the patients was done at 3 weeks and 3 months after surgery. Then the differences in the preoperative and postoperative urodynamics were evaluated in two groups of patients. The mean maximum flow rate (in ml/sec) was more in TURP group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in open prostatectomy group at 3 months postoperatively and the difference was statistically significant (p = 0.01).The mean average flow rate (in ml/sec) was more in TURP group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in open prostatectomy group at 3 months postoperatively and the difference was statistically significant (p = 0.008). The mean maximum detrusor pressure (in cm H2O) was more in open prostatectomy group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in TURP group at 3 months postoperatively and the difference was statistically significant (p = 0.0001). Open prostatectomy is an acceptable operation for the prostate size >50 grams. Higher peak flow rate improvement, average flow rate improvement and less detrusor pressure was evident in patients treated with open prostatectomy group. Open prostatectomy is a better procedure than transurethral resection of prostate as per as the udoynamic outcome is taken into consideration.