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Background There is a constant search for an ideal treatment for vitiligo. Platelet-rich plasma (PRP) is a novel modality for treating stable vitiligo. Presently, literature regarding the efficacy of combining either PRP or platelet-poor plasma (PPP) with psoralen+sunlight (PUVASOL) in vitiligo does not exist. Objective This study compares the safety and efficacy of combining PUVASOL with either PRP or PPP against PUVASOL alone in patients with stable nonsegmental vitiligo. Patients and methods This prospective, open-labeled, comparative study was done in 20 patients with stable nonsegmental vitiligo, each having at least three vitiligo patches of similar shape and size. All the patients received PUVASOL as standard treatment modality. PRP or PPP was injected into two separate study patches as an adjuvant treatment with PUVASOL; however, the third patch acted as a control and was treated by PUVASOL alone. These patients were followed up for 4 weeks after the end of four treatment sessions. Results Compared with control areas (exposed to PUVASOL only), statistically significant more repigmentation was seen in areas treated with a platelet preparation (either PRP or PPP) along with PUVASOL. However, there was no significant difference between PRP and PPP arm (P=0.824) as per qualitative and quantitative assessment. Conclusion Addition of a platelet preparation (either PRP or PPP) had an additive beneficial effect on the response of PUVASOL therapy in patients with stable vitiligo at the study end point of 16 weeks. However, PRP and PPP showed comparable efficacy at the study end point in terms of repigmentation when used in conjunction with PUVASOL.

Introduction: Short penile length is a commonly encountered problem in clinical practice. Detection of abnormal stretched penile length (SPL) warrants appropriate endocrine evaluation. Ethnicity-specific SPL data are required to detect these abnormalities. There is a dearth of such data in India. This study aims to establish normative values of SPL in boys from West Bengal. Materials and Methods: This is a cross-sectional study. SPL, testicular volume (TV), height/length, and weight were measured in 460 boys aged 1 to 13 years from the schools located at urban, suburban, and rural areas in the state of West Bengal, India. Similar data were collected from 36 healthy neonates within 1–3 days of full-term delivery at IPGME and R and SSKM Hospital, Kolkata, West Bengal, India. Results: The 5th percentile, median, and 95th percentile of SPL were 1.7, 2.0, and 2.7 cm for neonates; 3.5, 4.4, and 6.4 cm for the children aged 1 Y–2 Y 11 M; 4.0, 5.5, and 7.0 cm for the age group 3 Y–4 Y 11 M; 4.2, 6.0, and 7.2 cm for the age group 5 Y–6 Y 11 M; 4.3, 6.0, and 7.6 cm for the age group 7 Y–8 Y 11 M; 4.4, 6.5, and 9.0 cm for the age group 9 Y–10 Y 11 M; and 4.8, 7.0, and 11.0 cm for the age group 11 Y–12 Y 11 M, respectively. SPL showed significant positive correlation with TV [r = 0.365, P < 0.0005] and height of the children [r = 0.516, P < 0.0005], but not with BMI. Conclusion: Our study provides normative data of SPL in neonate and children aged 1 to 13 years from the eastern part of India. SPL value correlated positively with TV and height of children.

Testicular metastasis from a solid malignancy of the distant organ is a rare entity and prostate, gastrointestinal tract, lungs, skin, and kidneys are the common primaries. Gastric carcinoma with testicular metastasis is an extremely rare entity with only few cases reported in the literature. Most of the testicular metastases are unilateral. Synchronous bilateral testicular metastasis is an extremely rare situation in gastric primary. We report a first case of synchronous bilateral testicular metastasis in a treated case of gastric carcinoma in India.

Acral metastasis is rare in incidence with poor prognosis due to presence of widespread metastases during presentation. Lung is the most common primary for acral metastases followed by breast and kidney. Acrometastasis with head and neck primary is an extremely rare situation with only few cases reported in the literature. Here, we present a case of acral metastases in a 40-year-old male. The patient was previously diagnosed as a case of squamous cell carcinoma of gingivobuccal sulcus on the left side, and for which, he had undergone radical surgery followed by adjuvant concurrent chemoradiation 6 months back. The patient had local recurrence with multiple metastatic pleural nodules during diagnosis of acral metastasis. The patient was treated with one cycle of palliative chemotherapy followed by amputation of the metastatic finger. However, after 2 months of treatment, the patient was died due to the disease progression.

Background: High dose oral prednisolone (100 mg/day) in Graves′ orbitopathy (GO) is limited by lesser response, and greater side-effects compared to intravenous (iv) methylprednisolone. Low dose oral prednisolone has not been evaluated in GO. This study aimed to evaluate the safety and efficacy of low dose oral prednisolone in GO. Materials and Methods: A total of 114 consecutive GO patients were screened of which 65 patients with previously untreated moderate-severe GO, clinical activity score (CAS) >2, without co-morbid states were randomized into treatment Group-A (iv methylprednisolone 0.5 g for 3 days/month for 4 months) and Group-B (oral prednisolone 1 mg/kg/day for 6 weeks then tapered stopped), and followed-up. Thirty-one patients in each group with at least 1-year follow-up were analyzed. Responders were defined as improvement in ≥ 1 major response criteria or ≥ 2 minor response criteria. The trial is registered at ctri.nic.in (CTRI/2013/12/004264). Results: At 1-year, 27/31 (87.10%) patients were responders in Group-A compared to 17/31 (54.84%) in Group-B (P = 0.005). There was a greater improvement in CAS score in patients of Group-A as compared to Group-B (P < 0.001). Responders (n = 44) had significantly higher baseline intra-ocular pressures and left eye proptosis as compared to nonresponders. Cox-regression revealed baseline T 4 levels, diplopia, and smoking history were predictive of remission. Low dose prednisolone was well tolerated, and the occurrence of adverse events were comparable in both groups. Conclusions: Low dose oral prednisolone is inferior to iv pulse methylprednisolone in managing GO, having a comparable side-effect profile. It can be a safe second line alternative in patients intolerant to pulse iv methylprednisolone.

Thyroid associated orbitopathy, although seen most commonly with thyrotoxicosis, is also known to occur in primary hypothyroidism. Myasthenia gravis is an autoimmune condition with an established association with autoimmune thyroid disease. We report the case of a patient who presented with recent onset unilateral ptosis that was fatigable with a history of proptosis since a year. On examination, she had a goiter, bilateral proptosis, restriction of upward gaze and adduction both eyes and normal pupils. Investigations revealed primary hypothyroidism with anti-thyroid peroxidase positive and anti-acetylcholine receptor antibody positive. Computerized tomography orbit showed thickening of medial and inferior rectus characteristic of thyroid orbitopathy. A diagnosis of primary hypothyroidism with thyroid orbitopathy with ocular myasthenia gravis was made. Patient is on Levothyroxine and anticholinesterase medications and is on follow-up. We present this case to highlight that the presence of ptosis in a patient with thyroid orbitopathy should alert the clinician to the possible coexistence of myasthenia gravis.

Germ cell tumors may lead to incomplete isosexual male precocity and are commonly located in the pineal gland. Germinomas of the basal ganglia are almost always unilateral and precocious puberty is a rare manifestation in them. We report a 9.5-year-old boy who presented with incomplete isosexual precocity due to bilateral basal ganglia germinoma.

Thyroid hormone resistance (THR) is a rare disorder with a prevalence of 1:40,000 and is commonly due to mutation in thyroid receptor β-isoform. Goiter is the most common presenting feature in patients of THR (66-95%) followed by behavioral abnormalities (60%). Severe mental retardation and short stature are uncommon. We present three patients of THR, all of whom presented with short stature and goiter. Patient-1 had attention deficit hyperkinetic disorder with severe mental retardation (IQ-52). Patient-2 presented with bleeding and non-palpable purpura and was diagnosed to have immune thrombocytopenic purpura (ITP). This is the first report of ITP in a patient of THR. Patient-3 in contrast had normal intelligence and presented with only short stature and goiter. Patients-1 and 2 had tachycardia which improved with propranolol. Propranolol can be a useful agent in the management of thyrotoxic symptoms in THR patients when thyroid hormone analogues are not available. Unlike previously reported case series of THR, short stature and goiter were the universal presenting features in our patients, probably reflecting the fact that such patients are more likely to seek medical care.

Objective: To present a rare case of gigantism. Case Report: A 25-year-old lady presented with increased statural growth and enlarged body parts noticed since the age of 14 years, primary amenorrhea, and frontal headache for the last 2 years. She has also been suffering from non-inflammatory low back pain with progressive kyphosis and pain in the knees, ankles, and elbows for the last 5 years. There was no history of visual disturbance, vomiting, galactorrhoea, cold intolerance. She had no siblings. Family history was non-contributory. Blood pressure was normal. Height 221 cm, weight 138 kg, body mass index (BMI)28. There was coarsening of facial features along with frontal bossing and prognathism, large hands and feet, and small goitre. Patient had severe kyphosis and osteoarthritis of knees. Confrontation perimetry suggested bitemporal hemianopia. Breast and pubic hair were of Tanner stage 1. Serum insulin like growth factor-1 (IGF1) was 703 ng/ml with all glucose suppressedgrowth hormone (GH)values of >40 ng/ml. Prolactin was 174 ng/ml. Basal serum Lutenising Hormone (LH), follicle stimulating Hormone (FSH) was low. Oral glucose tolerance test (OGTT), liver and renal function tests, basal cortisol and thyroid profile, Calcium, phosphorus and Intact Parathyroid hormone (iPTH) were normal. Computed tomographyscan of brain showed large pituitary macroadenoma. Automated perimetry confirmed bitemporal hemianopia. A diagnosis of gigantism due to GH secreting pituitary macroadenoma with hypogonadotrophichypogonadism was made. Debulking pituitary surgery followed by somatostatin analogue therapy with gonadal steroid replacement had been planned, but the patient refused further treatment.