Comparing retrograde urethrography readings with intraoperative findings in urethral stricture

Background: Urethral strictures are relatively common in men with most patients acquiring the disease due to injury or infection. The present study was conducted to assess the accuracy of retrograde urethrography (RGU) in diagnosing urethral strictures in patients presenting with lower urinary tract symptoms.Methods: All male patients presenting with lower urinary tract symptoms and referred for retrograde urethrogram to the Department of Radiodiagnosis, Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from November 2018 till January 2019 were included. The parameters of RGU were compared with intra-operative findings as gold standard to calculate the operating characteristics of RGU.Results: The present study included 42 patients, mean age 54.9±11.2 years. Grade I urethral stricture was observed in 42.8% and 26% had grade II stricture. Bulbar stricture was the most common location. The common presenting complaints were increased frequency (50%) and dribbling micturition (40.4%). Approximately one tenth of all patients had a history of trauma. RGU was 100% sensitive and 66.7% specific in detecting strictures of less than 2 cm. Overall accuracy of RGU in detecting urethral strictures of less than 2 cm was 83.3%.Conclusions: RGU is a reliable means for establishing the diagnosis of a suspected urethral stricture and also provides accurate staging information with regard to stricture number, length, location, and coexistent urethral pathology.

Analysis of frozen section in correlation with surgical pathology diagnosis

Background: Frozen section (FS) is a rapid diagnostic procedure performed on tissues obtained intraoperatively. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metastasis, and identifying small structures. But it bears many disadvantages and limitations, the most of which is the danger of incorrect diagnosis. Therefore, it is critical to determine efficiency of frozen section performance periodically.  This study was performed to determine accuracy of frozen section by correlating the intra-operative frozen section diagnosis with final diagnosis on permanent sections.Methods: In this retrospective study, authors compared the results of frozen section with their final permanent section diagnosis in Government Medical College and Hospital, Aurangabad, Maharashtra, India during January 2017 to December 2018.Results: Study comprises 83 patients, of which 73 were female and 10 were male. Out of 83 cases, the diagnosis of 76 cases was concordant with conventional histopathology diagnosis while seven were discordant. This gave overall accuracy rate of 91.57% and discordant rate of 8.43%. The overall sensitivity was 85.71% and specificity was 97.92%. The positive predictive and negative predictive value was 96.77% and 90.38% respectively.Conclusions: The accuracy, sensitivity, specificity of frozen section diagnosis in this study  are comparable with most international quality control statistics for frozen sections. The results suggest that the correlation of intra-operative frozen section diagnosis with the final histopathological diagnosis on permanent sections forms an integral part of quality assurance activities in the surgical pathology laboratory and specific measures should be taken to reduce the number of discrepancies.

Role of neurosonography in neonates with clinically suspected intracranial pathology

Background: Preterm neonates have a higher mortality and morbidity because of their greater risk for intracranial hemorrhage (ICH), hypoxic ischemic encephalopathy(HIE) which can lead to poor neurodevelopmental outcomes. The present study was conducted to evaluate neonates with clinically suspected intracranial pathology by neurosonography.Methods: Included neonates were those with clinically suspected intracranial pathology admitted to neonatal intensive care unit of the Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from October 2018 till December 2018. First cranial neurosonography was done between first and third day, second between 7th and 10th day of birth. HIE also known as Periventricular leukomalacia (PVL) grading was done using the De Varies et al, grading. Severity of ICH was graded according to Papile and Burstein classification(1978).Results: Of the total 60 neonates, 61.7% were preterm and rest at term. Mean APGAR score at 1 minute was 8.6 (range 5 to 10) and at 5 minutes was 9.58 (range 8 to 10). Mean ventricular index at the first assessment was 26.78% and 26.89% at the second assessment. Grade 1 HIE was found in 17 neonates on first assessment, and two had grade 2 HIE. Second assessment revealed grade 1 HIE in 20 neonates and grade 2 in two. First assessment revealed two neonates with grade 1 and grade 2 ICH, out of which one grade 2 ICH worsened to grade 3. Two neonates were found to have corpus callosal agenesis.Conclusions: Transcranial neurosonography stands as an excellent and reliable investigation of choice for neonates to detect HIE,ICH and intracranial congenital anomalies.

Effectiveness of transabdominal ultrasonography in assessing benign versus malignant nature of prostatomegaly

Background: Benign prostatic hyperplasia is closely related with ageing. The present study was conducted to assess the ability of transabdominal ultrasonography in diagnosing benign and/or malignant hypertrophy of the prostate.Methods: An observational study was done in the Department of Radiology, Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli, Maharashtra, India of patients who had prostatomegaly on transabdominal ultrasound examination and underwent histopathological confirmation of the lesions from 1 October 2018 till 31 December 2018. The prostate gland was assessed for volume, echotexture, morphology, focal lesions and median lobe.Results: Out of 155 patient’s benign prostatic disease was diagnosed in 116 patients, while malignancy was detected in the rest of the 39 cases. Prostate specific antigen levels were significantly higher among malignant cases (18.39±7.44 ng/ml) as compared to that of benign cases (7.51±3.22 ng/ml), p value <0.01. Benign lesions were predominantly inner glandular, while malignant cases were mainly peripheral. Moderate vascularity was found in 76.9% of the malignant cases. Focal vascular asymmetry was found in 74.4% of the malignant cases and only 12% of the benign cases. Sensitivity of transabdominal ultrasonography in diagnosing malignant prostatic lesions was 94.8%, specificity was 75% with an overall accuracy of using transabdominal ultrasonography in the diagnosis of malignant prostatic lesions in this study population was 80%.Conclusions: Transabdominal ultrasound evaluation of prostate is a simple, economical, non-invasive technique of choice due to its high accuracy in detecting size, nature of pathology as benign or malignant with fair accuracy.

Clinicopathological study of skin tumours

Background: Skin cancers are relatively uncommon malignancies worldwide, but the incidence of skin cancers has progressively increased over the last few decades. The distinction between benign and malignant neoplasm are more difficult to define when they appear in skin than when found elsewhere and histopathological examination is frequently required to establish a definitive diagnosis. Diagnosis of any skin tumours can be done by correlating clinical features and histological features. The aim and objective were to study age-sex wise distribution, clinical presentation and histopathological spectrum of various skin tumours.Methods: This is a retrospective study of three years conducted in the Department of Pathology, Government Medical College, Aurangabad, India from December 2015 to December 2018. Specimens received from Department of Dermatology were fixed in formalin and after adequately processing the sections were stained routinely with H and E stain and properly evaluated for histopathological examination. This study includes tumors of epidermis along with melanogenic tumors and skin appendageal tumors. The data collected was tabulated, analysed and compared to other similar studies.Results: The study consists of 130 cases. The ratio of male to female was 1.24:1. Head and neck region (48.46%) was the most common site observed where skin lesions were present followed by extremities (37.69%). Most of the malignant tumours were presented with non-healing ulcers (30.76%) and Noduloulcerative lesions (20.33%). Out of 130 cases, 83 (63.84%) were benign whereas 47 (36.15%) were malignant tumour. According to WHO classification, keratinocytic tumour 55 (42.30%) was the most common tumour type in the present study. Skin adnexal tumours and melanocytic tumours were observed in 54 (41.53%) and 21 (16.15%) respectively.Conclusions: The skin is a complex organ. Because of complexity of skin, a wide range of diseases can develop from the skin. The majority of benign neoplasms are from skin adnexal group whereas most common malignant neoplasm were from keratinocytic group. Skin adnexal tumors can occur anywhere in the body, however head and neck region constitute the most common site. Skin adnexal tumours are clinically often misdiagnosed, so histopathological examination remains gold standard for their correct diagnosis and for their differentiation between benign and malignant neoplasm.

Clinicopathological study of testicular lesions

Background: Testis is affected by both neoplastic and non neoplastic conditions. Non neoplastic lesions of the testis include epididymo-orchitis, testicular atrophy, undescended testis, testicular abscess etc. Testicular tumors are relatively rare. They constitute the 4th most common cause of death from neoplasia in the young males. This study was undertaken to study the histopathological spectrum, age wise distribution and clinical symptoms of testicular lesions.Methods: This is a retrospective study of three years conducted in the department of pathology, Aurangabad from June 2015 to May 2018. It included all the orchidectomy specimens received from the department of surgery and excluded the orchidectomy specimens sent for infertility and prostatic carcinoma. A detail clinical history was taken. Histopathological examination was done after routine processing and staining with H and E. The data collected was tabulated, analysed and compared to other similar studies.Results: We studied 70 cases. Non neoplastic testicular lesions were 57 and 13 were neoplastic. Non neoplastic testicular lesions were more common than the neoplastic ones. Non neoplastic testicular lesions presented most commonly in the 2nd decade. Most common non neoplastic lesion was epididymo-orchitis followed by torsion, atrophy and testicular abscess. Most common neoplasm was malignant mixed germ cell tumor. Most of the patients of neoplasms presented in the 3rd decade. The most common complaint was testicular swelling and pain.Conclusions: Majority of testicular lesions are non neoplastic. Neoplastic lesions are rare. Non neoplastic lesions mimic neoplastic ones clinically, as testicular swelling is the most common complaint. So histopathological diagnosis is necessary for an accurate diagnosis of testicular lesions.

Outcome of application of primary versus secondary Illizarov's fixator in open tibial shaft fractures / 世界急诊医学杂志（英文）

@#BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov''s fi xator application as a treatment method for type Ⅲ open tibial fractures in terms of non-union and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type Ⅲ tibial fractures were treated with Illizarov''s apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov''s application, primary (n=28) and secondary (n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100％ in the primary group and more than 95％ in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov''s fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov''s fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: A clinical study.

Objectives: The objective of this study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared with ultrasonography. Study Design: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained Sonologist, which was considered as the gold standard assessment. Results: Digital panoramic radiographs had a sensitivity of 76% and specificity of 98.66% in determining CCAAP. There was a high level of agreement between diagnoses, with a kappa value of 0.8. Conclusion: To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting CCAAP. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Presentation of retinoblastoma in pregnancy.

A 22-year-old female in her third trimester of pregnancy was referred to our department for sudden loss of vision with a painful blind eye. It was diagnosed as retinoblastoma clinically and radiologically. Histopathology and immunohistochemistry confirmed the diagnosis. This case is one of its kind because retinoblastoma occurring during pregnancy had not been reported in literature so far.

Stabilisation of some of the protein synthesis components in the thermophilic fungus, Humicola lanuginosa.

The thermal stabilities of tRNA from the thermophilic fungus, Humicola lanuginose were compared with that from the mesophilic yeast, Candida utilis, by measuring the increase in the optical density with temperature. tRNAs from both the species were stable in the presence of millimolar quantities of magnesium chloride upto 50°C, the optimum growth temperature of the fungus. Aminoacyl tRNA synthetases were maximally active at 40°C under the in vitro assay conditions. They were fractionated and one species of valine tRNA synthetase was purified to homogeneity. The purified enzyme was protected against inactivation to varying degrees when preincubated with the substrates valine, tRNA and ATP as well as spermine. Protein turnover studies showed that the rate of turnover was higher at higher temperatures. It was concluded from these results that the protein synthesizing machinery of this fungus has no intrinsic stability but it is stabilised by intracellular factors. Higher rate of protein turnover also plays a role for growth at higher temperature.