Background: Psoriasis neurodermiformis (PN) and verrucous psoriasis (VP) are two distinct forms of psoriasis characterized by thickened plaques, whose proper description in most dermatologic texts is ...still lacking. Psoriasiform keratosis (PK) is a recently described clinical entity characterized by a solitary keratotic plaque whose microscopic findings simulate psoriasis. Aim: To compare and evaluate the clinical and histological profile of PN, VP and PK, and systematically characterize each of them. Settings and Design: This was a prospective, descriptive study done on a total of 51 patients, who were diagnosed with PN, VP and PK based on certain clinical criteria. The study was done at a teaching hospital in eastern India. Methods and Materials: The study was carried out on a total of 51 patients presenting with thickened psoriasiform plaques, who visited our outpatient department, over a period of 9 months. They were then carefully evaluated clinically (along with their demographic profile), followed by meticulous microscopic assessment. Each biopsy specimen was then categorically evaluated to enable a precise diagnostic conclusion. Statistical Analysis: As all values in our study were qualitative, they were expressed as numeric values and percentages. Results: Out of 51 patients, 18 were diagnosed as PN, 19 with VP and 14 with PK. PN demonstrated an equal gender distribution, whereas in VP and PK a male preponderance was apparent. History of past/present psoriasis was positive in only one patient diagnosed with VP. Intensity of pruritus was marked in 88.88%, 21.05% and 14.28% of patients with PN, VP and PK respectively. Dorsa of feet was the commonest site of involvement in PN and VP. In PK, the shin was the predominating site. VP presented clinically as mammillated, verrucous and crateriform phenotypes. PN and PK however, demonstrated single clinical patterns. Microscopically, none of the specimens satisfied all the 7 epidermal criteria set forth by Ackerman. In each slide Trozak's histologic psoriasiform numeric score was >10. Conclusion: PN, VP and PK are certainly not as rare as previously considered. Mammillated VP closely mimics PN clinically. Crateriform VP is an extremely rare phenotypic expression encountered. Histological findings of papillomatosis, buttressing and anastomosing rete ridges and a dense dermal lymphocytic infiltrate point more in favor toward VP. Detecting solitary keratotic plaques with a psoriasiform histology should allow clinicians to consider the possibility of PK.
Objective:
Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. ...We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time.
Methods:
A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B).
Results:
A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases.
Conclusion:
RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients.
Level of evidence:
Level 4.
Thalidomide was used in the late 1950s and early 1960s as a sedative for morning sickness in pregnant women. It resulted in thousands of babies being born with various congenital anomalies, such as ...phocomelia. Subsequently, the drug was banned for this indication. Most of the survivors have become thalidomide adults and now they are in their fifties. We report the first case of a robot-assisted radical prostatectomy in a 54-year-old male with prostate cancer and phocomelia as a result of thalidomide embryopathy. He presented with a PSA of 3.3 and was diagnosed with Gleason 3 + 4 prostate cancer. An extra peritoneal approach was chosen due to his body habitus and to avoid extreme Trendelenburg tilt. Side docking with the da Vinci robot was employed and the prostatectomy was carried out in the standard extra peritoneal fashion. At 6 months’ follow-up his PSA is unrecordable and he is voiding well with minimal urinary incontinence, requiring 1 pad/day. We aim to outline our approach and highlight the technical modifications in this rare physically disabling condition.
The extension of the Asian Elephant’s Elephas maximus range in the northern Western Ghats (Sahyadri) was observed since 2002. This colonization was marked by elephant crop raiding events in the ...newly colonized Sindhudurg District, where the local community had no experience of living with elephants. The present study was conducted to understand the spatiotemporal patterns of crop depredation (raiding) and to prioritize areas to inform future interventions on managing this ecological phenomenon turned conflict. Data on crop raiding between 2002 and 2015 was obtained from compensation records with the state forest department, and mapped at village scale. Subsequently, we used three indices of crop raiding, viz., Crop Raiding Frequency (CRF), Relative Crop Raiding Intensity (RCRI), and Crop Raiding Vulnerability Index (CRVI). Results show a gradual northern movement of elephants and of the crop raiding zone over the period of 2002–2015. The rankings provided by CRVI, identified villages in a narrow strip of foothills of the Sahyadri mountains as severely vulnerable. With sufficient long term data, CRVI would be a highly useful index for prioritization of villages for resolving human-elephant negative interactions; and other cases of human-wildlife interactions too.
