Epithelioid Sarcoma of the hand is a rare, high grade soft tissue sarcoma. It accounts for less than 1% of soft tissue sarcoma. It is often misdiagnosed and is a great mimicker of multiple diseases due to its deceptively harmless appearances during the initial stages of the disease.
We are presenting a case of a 24-year-old gentleman presented to our centre with history of nodular swelling and pus discharge over radial side of left wrist for 3 months. He was diagnosed with osteomyelitis of left radial styloid and treated with 6 weeks of antibiotic after wound debridement. He presented to us 2 months later with worsening wound over surgical site for which he underwent wound debridement and another 6 weeks course of antibiotics. Patient presented to us 2 weeks later with complaint of swelling and bleeding from operative site. On examination we noted a wound measuring 3x3 cm with friable granulation tissues over radial aspect of left wrist and multiple nodular lesions over left palm with haemoserous discharges. X ray of left wrist showed juxta-articular osteopenia with focal bone lysis. Patient underwent wound debridement and intraoperative histopathological sample sent came back as Grade 3 epithelioid sarcoma. Patient underwent above elbow amputation with postoperative radiotherapy after 3 months being treated for osteomyelitis of radial styloid.
This case should alert treating surgeons to include soft tissue sarcoma as differential diagnosis of harmless looking, occasional painful firm nodules localised on the hand and wrist region of young adults especially when there are osteolytic changes in x-rays.
Rhabdomyolysis is a clinical condition of potentially life threatening destruction of skeletal muscles caused by diverse mechanisms including drug and toxins. Opioid is one of the encountered drug which cause rhabdomyolysis in association with renal failure. Paraparesis is one of the important feature of rhabdomyolysis which usually occur due to dyselectrolytemia (secondary hyperkalemic periodic paralysis) recovers completely on normalization of electrolyte, we are presenting a case of opioid induced rhabdomyolysis who develop paraparesis even with normal electrolyte which later on diagnosed as acute sensory motor axonal neuropathy.
In Sri Lanka WHO estimates 3.1% of the population to have alcohol used disorder and predicts that nearly 50% of them can present with alcohol withdrawal syndrome.
We describe a 51 year old male with the back ground history of alcohol abuse for 20 years duration and series of adverse life events facilitating him to develop severe alcohol used disorder and depression. When he presented to us, he exhibited features of major depression with suicidal thoughts and evidence of alcohol withdrawal syndrome according to DSM V criteria. He also had minor cognitive impairment according to MMSE.
After two months of inward treatments, he continued to have disturbing Lilliputian hallucinations, tremors and sleep disturbances which made us to diagnose him having protracted alcohol withdrawal syndrome after considering the other possibilities like major depression with psychotic symptoms, lewy body dementia and psychotic disorder with mood symptoms. His cognitive impairment can be explained by reduced attention and concentration together with low literacy, therefore the diagnosis of pseudo dementia secondary to depression was made.
This case illustrated us the multi-faceted presentations of alcohol used disorder which ultimately posing significant burden to the patient, family, society and also to the free health care system in the country.
Habits are defined as acquired, repetitive, involuntary and body focused, stereotyped motor acts. Tics have the same attributes, but are characterised by muscle spasm additionally. So far, the emphasis in the literature is that the habits are acquired. There is no reference in the literature as to the habits being transmitted genetically. Whereas in the case of tics, some like, Tourette Syndrome (TS), are accepted to have genetic basis Habits are harmless. But some are self - destructive Out of the group of the four destructive habits, like trichotillomania (TTM), bruxism, scabiomania or skin pulling (SP) and onychophagia, TTM, along with chronic persistent motor tics, persistent vocal tics and combined motor and vocal tics like TS, are grouped together, as habit disorders by the American Psychiatry Association (APA) Statistical Manual of Mental Disorders classification, 4th edition (DMS 4). Virginia Commission recommends inclusion of SP also under habit disorders. Other authors include all the four destructive habits under the habit disorders. It is also accepted that habits are related to behavioural patterns and that the behavioural patterns are genetically determined. Thus an indirect link is established between the habits and heredity, through behaviours. The author presents in this article, a benign, ‘nose rubbing habit’ being transmitted through 6 generations in a family tree. Unique to the pattern of inheritance, 100 % desendents in some generations (generations 1,2 and 3) with involvement of both males and females, without any skip generations, is seen .Very early onset is recorded at the age as low as 2 years and as high as 6 years belonging to the in the 6th generation. This is the first of it’s kind reported in literature that a benign habit is shown to run in a family, across 6 generations. This is contrary to the popular belief, that habits are always acquired. If it is so, what is it that irrefutably transmitted through 6 generations in this case? Mitochondrial gene (mtDNA) transmission, involving recombinant maternal and paternal mtDNA, is suggested, by inference and after eliminating the other Mendalean and non Mendalean types of inheritance. Of course, the main intended focus of the article is to highlight the transmission of a habit- trait (?) genetically. As a possible explanation of this observed phenomena only, the tentative inheritance pattern is suggested. The matter is open for discussion by the concerned fraternity.
The present case study describe the pulmonary tuberculosis and intercostal zona complicating abusive corticosteroid therapy. Corticosteroids have changed the history and prognosis of most inflammatory diseases by the effectiveness and speed of their action. Far from being a universal panacea, the abusive and long-term use of these powerful anti-inflammatory agents with immunosuppressive effect, exposes to severe complications, some of which, namely opportunistic infections, are serious. A case showed 59-year-old patient with a history of long-term systemic corticosteroid therapy based on dexamethasone established for an acute orchiepididymitis and with no notion of tuberculous contagion found, who had consulted at the Gloria Medical Union Clinic for chronic cough, vespero-nocturnal fever and painful rashes. The clinical examination found bilateral pulmonary condensation, a vesicular band rash lesion, metameric from front to back and hyperesthesic resting on an erythematous background, located in the lower third disengaging on the right hemithorax on an erythematous background, surmounted by embedded vesicles under the skin and grouped in clusters in places without going beyond the left contralateral hemithorax to the midline. Compliance with the indications and close monitoring of patients on corticosteroid therapy will, as far as possible, avoid them.
