Peripheral neuropathy and the role of nerve biopsy: A revisit

Background: Nerve biopsy has been widely used to investigate patients with peripheral neuropathy and in many centers, it is still a part of the diagnostic armamentarium. In this study, the histopathological spectrum of the nerve biopsies received is being revisited to analyze the various clinical and pathologic features and also to assess their relevance. Materials and Methods: Retrospective analysis of the data retrieved was done for 74 cases of nerve biopsies. Results: On the basis of the data and histopathological features, broad diagnoses were obtained in 52 cases and further categorized into biopsies being supportive for patient management (including acute and chronic axonopathies and demyelinating neuropathies) and biopsies considered essential for patient management (including vasculitic neuropathies, leprous neuropathies, hereditary neuropathies, and chronic inflammatory demyelinating neuropathies). Nine nerve biopsies did not show any abnormal histopathological features, while 13 nerve biopsies were found to be inadequate for diagnosis, both these groups were categorized as noncontributory. Conclusion: With advanced nerve conduction studies available, nerve biopsy is losing its relevance. However, in our experience, nerve biopsy did complement the clinical findings and nerve conduction studies, with which a close correlation is required to make the histopathology of nerve biopsy more relevant in terms of guiding further specific workup and management.

Integrated positron emission tomography/computed tomography fusion imaging: an emerging gold standard in lung cancer.

Positron emission tomography (PET) has emerged as an important diagnostic tool in the management of lung cancers. Although PET is sensitive in detection of lung cancer, but FDG (2-deoxy-2- 18 fluro-D-glucose) is not tumor specific and may accumulate in a variety of nonmalignant conditions occasionally giving false positive result. Addition of CT to PET improves specificity foremost, but also sensitivity in tumor imaging. Thus, PET/CT fusion images are a more accurate test than either of its individual components and are probably also better than side-by-side viewing of images from both modalities. PET/CT fusion images are useful in differentiating between malignant and benign disease, fibrosis and recurrence, staging and in changing patient management to more appropriate therapy. With analysis and discussion it appears that PET/ CT fusion images have the potential to dramatically improve our ability to manage the patients with lung cancer and is contributing to our understanding of cancer cell biology and in development of new therapies.

Maternal knowledge regarding breast feeding and weaning practices.

The study assessed the knowledge of mothers of the high income group of urban Baroda, related to breast feeding and weaning. Forty mothers with children aged 4 to 18 months were studied. Knowledge and practices regarding breast feeding and weaning were assessed using pretested questionnaires. Results indicated that only half the mothers breast fed their babies on the first day. Breast feeding was stopped when the child was 3-6 months; top feeding and solid supplements were initiated at 4-6 months. Mainly commercial baby foods were used for weaning. Most mothers avoided 'dals' for the child because these were believed to be difficult to digest and produced gas in the child's stomach. Fifty percent of the mothers were not in favour of feeding the sick child with small frequent meals.

A simple field test for identification of night-blindness.

A simple and replicable field test to measure dark adaptation time has been developed. It required a darkened room with a 5 watt bulb covered with a piece of black cloth, a spherical white object of 22 cm diameter suspended vertically from a horizontal string, a stool, a black curtain, a Maxwell electronic photographic flash unit and a stop-watch. The spherical object behind the closed curtain was hung 1.5 m away from the subject either to his left or right, or in the centre of the room. The seated subject was then exposed to 3 consecutive flashes, the curtain drawn, and the time taken to identify the position of the object was noted on the stop-watch. The test was conducted for 3 consecutive days on non-night blind young adult girls (n = 46) of the high income group (PC); underprivileged school-age children (n = 44) with a positive history of night-blindness (NB), and their age/sex pair-matched (n = 44) non-night-blind controls (NNB). The NB group had a significantly higher mean dark adaptation time as compared to the NNB and PC groups (14.9 sec vs 11.9 and 11.3 sec respectively). The mean serum vitamin A levels of NB, NNB and PC groups (15.8, 17.5 and 29.5 micrograms/dl respectively) were correlated with the dark adaptation times.