Gallbladder Mucosal Changes Associated with Chronic Cholecystitis and Their Relationship with Carcinoma Gallbladder.

384 cholecystectomy specimens were examined during a period of one year from Oct 2005 to Oct 2006, in the department of Pathology, ASCOMS, Sidhra. Jammu, for studying the histological patterns of chronic cholecystitis, the frequency of associated mucosal changes, the age related incidence and the relationship of carcinoma with various mucosal changes. Majority of patients presented in the fourth decade of life. The youngest patient was 16 years and the oldest 78 years of age. Acute and chronic inflammatory lesions were associated with ulceration in 13.02%, mucosal hyperplasia in 25.26% and antral metaplasia in 53.40%. Intestinal metaplasia constituted 9.11%, cholesterolosis was seen in 12.25%, dysplasia in 3.64% and neoplasia in 0.78% of cases. All the cases of carcinoma were associated with gallstones. Histological continuity between epithelial changes was seen in 35 cases. 8 cases had continuity of antral metaplasia, intestinal metaplasia and dysplasia. 2 cases showed continuity of intestinal metaplasia with dysplasia and carcinoma and 1 case showed continuity of dysplasia with carcinoma.It is inferred that antral metaplasia, intestinal metaplasia, dysplasia and carcinoma have an inter-relationship. There is a significant higher incidence of carcinoma gallbladder in patients who harbor gallstones for longer period. Histopathological examination is thus important in every case of cholecystectomy for identifying metaplasia, dysplasia and carcinoma.

Dual kidney transplantation--a solution for less than ideal brain dead donors.

For renal transplantation, an elderly cadaver donor is often rejected because of the relatively poor long-term graft survival. Considering that a number of potential recipients are waiting for a renal transplant, dual kidney transplantation would be a more appropriate approach in this situation. We report one such case with a successful outcome.

Bilateral renal angiomyolipomas in association with end stage renal disease without features of tuberous sclerosis.

We report a case of end stage renal disease in association with bilateral renal angiomyolipomas (RAML). There were no features suggestive of tubercous sclerosis (TS). Renal angiomyolipomas were detected incidentally, patient being asymptomatic for the same. She is being evaluated for live related kidney transplant.

Severe acute renal failure in malaria.

BACKGROUND: We have noticed a recent rise in the incidence and severity of acute renal failure (ARF) in malaria. AIM: To study the incidence, severity and outcome of ARF in malaria. SETTING and DESIGN: It is a retrospective analysis of data of one year from a tertiary medical centre in a metropolitan city. MATERIALS AND METHODS: Patients with ARF and smear positive malaria were evaluated. STATISTICAL ANALYSIS: Results were expressed as mean, range and standard deviation. RESULTS: Out of 402 detected smear positive malaria, 24 had ARF. Eighteen were of the age group 21-40 years. Plasmodium falciparum (PF) was detected in 16, Plasmodium vivax in three, and mixed infection in five. Non-oliguric ARF was seen in 14. Eighteen showed severe ARF (Serum creatinine >5 mg%). Twenty-two patients needed dialysis. Prolonged ARF lasting for 2-6 weeks was seen in eight. Seventeen patients recovered completely, while seven showed fatal combination of disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), severe ARF and PF malaria. No response was seen to chloroquine and artesunate given alone and twenty patients required quinine. CONCLUSION: ARF necessitating dialysis was seen in 92% of patients with ARF in malaria. PF infection, severe ARF, DIC and ARDS were poor prognostic factors. Resistance was noted to both chloroquine and artesunate.