Hematological changes following early ligation of splenic artery during splenectomy in shunt surgery for portal hypertension.

Objective and background data: Reduction in cellular elements of blood, secondary to hypersplenism is an established component of non-cirrhotic portal hypertension. Prior transfusion of blood or blood components is frequently required for safe surgical intervention. Due to thrombocytopenia, epidural catheter insertion for effective and durable analgesia is not possible. The aim of the present study was to objectively demonstrate the gain in blood components following early ligation of splenic artery for splenectomy in shunt surgery. Methods: From Jan 2008 to July 2010, 30 patients underwent elective proximal spleno renal shunt for portal hypertension, for various indications and were analyzed prospectively. We followed the standard protocol of ligating the splenic artery in situ, first in the lesser sac. Proximal spleno shunt was done . After the surgical procedure and before extubation, an epidural catheter was placed for effective and durable analgesia. 5ml of venous blood was drawn in the following order of sequence: prior to induction of anesthesia, immediately after the ligation of splenic artery, 30 minutes after ligation of splenic artery and 30 minutes after splenectomy. Samples were sent for complete hemogram and values were analyzed in respective order. Patients requiring transfusion of blood or blood components during surgery were excluded from the study. Results: 30 patients (M - 9, F- 21) with mean age of 29.4 years ( 11-60 years) were analyzed (NCPF- 20, EHPVO- 9, cirrhosis- 1). We objectively demonstrated a significant gain in RBCs (p=0.016) and platelets (p=0.000) using this standard protocol. As there were no intrinsic abnormalities in RBCs, red blood cell indices (MCV, MCH, MCHC) showed no changes as expected (p-0.9). Conclusion: By following this standard protocol, in addition to reduction in blood loss there was a significant gain in RBCs and platelets. This gain allows the surgeon to perform the surgical procedure safely and the anesthetist to secure an epidural catheter immediately after surgery for effective and durable analgesia without prior transfusion.

Isolated mesenteric fibromatosis.

Fibromatosis is a rare, locally aggressive but non-metastasising fibrous mass often associated with familial adenomatous polyposis in Gardner's Syndrome (GS). Although sporadic cases occur, unlike in GS, they are predominantly extra-abdominal. We report the case of a 40-year-old lady who underwent laparotomy for a large isolated abdominal mass three years after a Whipple's procedure for adenocarcinoma of the distal common bile duct. A spherical, football sized tumour was found in the jejunal mesentery. Resection of the tumour with jejunum was carried out. No metastasis was detected. This case is peculiar in that mesenteric fibromatosis occurred in a patient with prior history of periampullary carcinoma and without history of familial adenomatous polyposis.

P 53 and PCNA in Non Hodgkin's lymphoma--an immunohistochemical evaluation.

P 53 positivity and PCNA labelling index were studied in 50 cases of node based Non Hodgkin's lymphomas, P 53 positivity was observed in a spectrum of these disorders, suggesting that P 53 mutations play a role in the genesis of these tumours. P 53 positivity incresed from low through intermediate to high grade tumours and thus may be of prognostic value in these lesions. PCNA labelling index (LI) was higher in high grade tumours. P 53 and PCNA immunoreactivity showed a relationship in that PCNA LI was seen to be more than 30% in P 53 positive tumours. P 53 positivity appears to be related to the subtype and proliferation rate of NHL.

Study of association of Epstein Barr-virus with Hodgkin's disease.

Epstein Barr-Virus (EBV) is a lymphotropic herpes virus, well recognised for its oncogenic properties. In recent years substantial evidence has accumulated supporting a role for EBV in the pathogenesis of Hodgkin's disease. The epidemiologic and histologic features of Hodgkin's disease (HD) have long indicated a possible infective cause. Our study involves the detection of the EBV encoded latent membrane protein 1 (LMP-1) in 45 cases of Hodgkin's disease using immunohistochemical methods. In this study we detected LMP-1 positivity in the Reed-Sternberg and Hodgkin's cells in 31% of cases of HD. In mixed cellularity the positivity was 21.7% while nodular sclerosis exhibited positivity of 50% of the cases. The lymphocyte depletion subtype showed 100% positivity. All cases of lymphocyte predominance and the single unclassified case were negative for LMP. The demonstration of LMP-1 in Hodgkin's disease has important implications since it is one of the latent gene products which produces B Lymphocyte transformation.

Protein C levels in ischaemic heart disease.

Protein C is a circulating glycoprotein with anticoagulant properties. Functional and immunological levels of protein C were determined in 34 cases of ischaemic heart disease and 12 healthy age-matched controls. The sensitive colorimetric assay was used to determine the functional levels and ELISA for antigenic levels. Mean protein C activity and antigenic levels were found to be elevated in these patients as compared to controls. Protein C levels in the three individual subgroups-acute myocardial infarction, previous myocardial infarction and chronic stable angina pectoris-were also raised as compared to controls. The elevation was significant in the case of the acute myocardial infarction group. These results further support the hypothesis that the body synthesises increased amounts of protein C in ischaemic heart disease to compensate for the hypercoagulable state that exists in this disorder, thus playing a protective role.

Lectin binding patterns in benign and malignant lesions of the breast.

The binding patterns of a panel of eight lectins were studied in twenty eight breast lesions, consisting of ten cases of fibroadenoma, three cases of cystosarcoma phyllodes, five cases of fibrocystic disease and ten cases of infiltrating duct carcinoma by light microscopy. The eight lectins viz. PNA, WGA, RCA, SBA, UEA I, LTA, LCA and Con A were tested on paraffin sections using the Avidin Biotin Peroxidase Complex technique. PNA, RCA and UEA I showed a consistent positivity in benign and malignant lesions. The binding was localised mainly along the apices of mammary ductal epithelial cells in the benign lesions. In contrast, the malignant cells showed a considerable variation in staining patterns like diffuse cytoplasmic, membranous, and vacuolar. No definite correlation was seen between the intensity of binding and the histological grade in infiltrating duct carcinoma except in the case of Con A which was seen to bind more intensely to poorly differentiated tumours. The diagnostic significance of these patterns have been discussed.

Diagnostic parameters of vascular neoplasms by immunohistochemistry.

Immunohistochemical identification of Factor VIII-related antigen and Ulex Europaeus A-I lectin as endothelial markers were studied in a series of 103 cases, comprising of benign and malignant vascular tumours, and few undifferentiated sarcomas. The results are correlated with that of others in this area and emphasizes the utility of these markers in surgical pathological diagnosis, especially to confirm the difficult diagnosis of angiosarcoma from other poorly differentiated sarcomas.

Studies on serum and tissue lipid fractions in Bengal gram induced retardation of experimental atherosclerosis.

Serum and tissue lipid levels were studied in rabbits in whom egg yolk was used to induce atherosclerosis and Bengal gram was supplemented in the diet as a lipodiatic agent. Monthly serological and tissue studies were done to assess the levels of total cholesterol, triglycerides and phospholipids and it was found that egg yolk feeding leads to statistically significant increases in all these fractions in the serum, liver, adrenals, heart and aorta. Bengal gram supplementation of the diet led to flattening of the atherosclerotic plaques and showed statistically significant decline in the organs with the exception of the kidney. This study confirms the lipodiatic effect of the bengal gram and its beneficial effect on the atherosclerotic plaque.

Serum lipid and lipoprotein fractions in bengal gram and biochanin A induced alterations in atherosclerosis.

Serum lipids and lipoproteins were studied in rabbits fed on egg yolk supplemented diet to induce hypercholesterolemia. Bengal gram and synthetically pure isoflavone Biochanin A have been used as lipodiatic agents in this study. Rabbits were divided into four groups: Group A were fed on egg yolk supplement alone to form the positive control group, Group B were fed with 40 gms of overnight soaked bengal gram (Cicer arietinum), Group C were fed with 50 mgs of Biochanin A fortnightly, Group D was negative control group fed on pelleted laboratory feed. Serum samples were taken every month and total cholesterol, triglycerides and HDL cholesterol were estimated. The other lipoproteins like LDL cholesterol and VLDL cholesterol were obtained by calculations. The Group B and C showed a significant decrease of their lipids and lipoprotein in comparison to Group A thereby indicating the lipodiatic effect of these two substances. However, HDL cholesterol showed an increase in these two groups thereby proving that an increased HDL cholesterol has a protective effect on the atherosclerotic process.

Cell marker studies in undifferentiated soft tissue sarcoma.

100 cases of undifferentiated soft tissue sarcomas were studied using cell markers by immunoperoxidase technique with DAB as substrate. Vimentin, Desmin, Myoglobin, Actin, Keratin, Epithelial Membrane Antigen, S-100 protein, F VIII R Ag, A1 Antitrypsin, A1 Antichymotrypsin, Collagen-IV and UEA-1 lectin were used as markers. Fibrosarcoma was consistently positive for Vimentin and Collagen-IV. The undifferentiated Rhabdomyosarcoma showed strong and consistent positivity for Vimentin Actin and Myoglobin. Desmin positivity was the hallmark of leiomyosarcoma, whereas the malignant schwannomas were identified by their S-100 positivity. This marker along with A1AT and A1ACT reactivity was of great use in the identification of malignant fibrous histiocytoma. Angiosarcoma/malignant haemangioendothelioma could be identified with great accuracy by their strong positivity for F VIII RAg and UEA-1 lectin. Other miscellaneous sarcomas also could be identified by their specific reactivity to the markers used. We consider immunohistochemistry to be an important and essential adjunct to routine stains in the diagnosis of undifferentiated soft tissue sarcomas.

Histological and functional correlation of thyroid carcinoma by immunohistochemistry.

40 cases of thyroid carcinoma comprising of 22 follicular, 11 papillary, 4 medullary, 2 anaplastic and 1 medullary carcinoma with focal areas of papillary differentiation were selected for this immunohistochemical study for the presence of thyroglobulin, calcitonin and somatostatin. As per the functional classification recommended by Otto L Jungberg, 22 cases were well differentiated, 13 were of intermediate differentiation with 3 poorly differentiated cases. 2 cases of anaplastic carcinoma were negative for all the 3 markers. Correlation between functional classification and histological pattern show 77% of the well differentiated type to be of follicular pattern with the rest consisting of papillary carcinoma. In the intermediate type 38.4% were follicular carcinoma, 15.3% medullary carcinoma and the rest, papillary carcinoma. Poorly differentiated type consisted of 2 medullary carcinomas. Contrary to previous reports, functional differentiation did not always correlate with histological pattern.