A case report of 29 year old male patient with breast carcinoma: diagnosed on fine needle aspiration cytology

Breast cancer has been considered a female dominated disease. Carcinoma of male breast is a rare disease representing 1% of all breast cancers and less than 1 % of all cancers in men. The mean age at presentation is mainly in sixties. We here present a case of male breast cancer presented at very young age of 29 years, diagnosed on fine needle aspiration which was confirmed later on histopathological examination.

A study of cervical Papanicolaou smears examination in patients with abnormal vaginal discharge

Background: Reproductive tract infection represents major public health problem in developing countries. Cervical infections are common problems among women of reproductive age and associated with clinical complaints of vaginal discharge. Pap smear is a screening test to diagnose various abnormal pathology of cervix. Aims and objectives of this study was to identify various causes of vaginal discharge and frequency of various pathogenic microorganisms in cervical smear.Methods: This was hospital based descriptive study carried out on 300 female patients who attended obstetrics and gynecology clinic at tertiary care hospital with compliant of vaginal discharge. Cervical smear samples were collected, conventional smears were prepared by trained technical staff and stained using Papanicolaou (Pap) technique.Results: The most common age group affected with vaginal discharge was 26 to 35 years with 115 cases. The most common associated symptom was lower abdominal pain seen in 75 cases. Most frequent findings on per speculum examination was thick whitish discharge in 186 cases and the most common pathogenic organism found was Bacterial Vaginosis (BV) in 177 cases.Conclusions: The study emphasizes the need for educating women of rural community to raise the awareness for cervical Pap screening.

Erdheim-Chester disease with multisystemic involvement: a diagnostic challenge

Erdheim–Chester disease (ECD) is a rare, non-inherited, non- Langerhans form of histiocytosis of unknown origin, first described in 1930. This entity is defined by a mononuclear infiltrate consisting of lipid laden, foamy histiocytes that stain positively for CD68. Individuals affected by this disease are typically adults between their 4th and 6th decades of life. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(−) histiocytes are identified within a biopsy specimen with aid of clinical and radiological data. Here we present a rare case of Erdheim-Chester disease in a 46 year male patient based on clinical data, radiological data, histopathological and immunohistochemistry findings.

Comparison of automated flowcytometric reticulocyte analysis with manual reticulocyte count

Background: Reticulocytes are young or immature red blood cells released from bone marrow and that contain remanants of ribonucleic acid (RNA) and ribosomes. Reticulocyte count (RC) is the index of erythropoietic activity within bone marrow. The reticulocyte counting methods at clinical laboratories are currently divided into manual and automated.Methods: A total of 500 samples of study cases were processed by manual method using New Methylene Blue (NMB) and automated method based on flowcytometry by PENTRA XLR HORIBA hematology analyzer. All quality control parameters were evaluated and values obtained by both methods were compared using various statistical methods.Results: Automated hematology analyzer provides excellent precision and linearity with no significant carryover. On comparing manual and automated RC method good method correlation was found (correlation coefficient r-0.865), however individual case wise percent deviation between manual and automated RC and CRC varied significantly. In addition within run precision calculated for automated RC differed significantly from manual count. The mean of difference between duplicate readings (150 samples) of manual and automated RC (<5%) were 0.3 and 0.01 respectively while 6.3 and 0.15 respectively for >5% RC. Thus, automated method was found to be more precise than the manual RC.Conclusions: The manual count method for RC associated with significant imprecision compared to flowcytometric method mostly based on interobserver variation and the smaller number of cell being counted. In contrast, the automated method is rapid, easy to operate, count higher number of cells with precise measurement.

Prevalence, SeroconversionAnd Risk Factors Of Hepatitis B And C Infection In Haemodialysis Patients At District Hospital Of Mehsana.

Background& Objective: Hepatitis B and Hepatitis C are significant problems in the management of haemodialysis patients.We aimed to investigate the incidence and prevalence of HBV and HCV infection in the hemodialysis patients as well as risk factors for infection.Methodology:All adult patients receiving maintenance hemodialysis (n=150) in District hospital, Mehsana were studied between June 2014 to October 2015. Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was performed at initiation of dialysis and every 3 monthly thereafter. Patients who were sero-negative for HBV and HCV were followed up for 1 year to detect sero-conversions.Results: The prevalence and seroconversion rates were 11.33% and 4.66% in HBV patients and 14% and 6% in HCV patients respectively. There was a significant correlation of the prevalence and seroconversion of HCV and HBV with number of blood transfusion and duration of heamodialysis.Conclusion:Patients on maintenance hemodialysis have a high incidence and prevalence of HCV infection and lower rates of HBV infection in this study. The factors associated with HBV and HCV infection are highly suggestive of nosocomial transmission withinhemodialysis units. Strict infection control measures are required.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method.

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Role of squash smear technique in intraoperative diagnosis of CNS tunmors.

Background: Neurosurgical practice frequently requires intraoperative consultation to optimize surgical procedure. Frozen section and Squash smear cytology can offer the same. As brain tissue is friable & predisposed to show ice crystal artefacts, frozen section is often difficult to interpret. Squash smear examination provides good cytological details to offer diagnosis in most cases except where anatomical correlation is needed. Present study was undertaken to evaluate the efficacy of Squash smear in absence of frozen section facility. Aims & Objective: To evaluate the value of Squash smear cytology for rapid intraoperative diagnosis in CNS lesions and its correlation with final histomorphological diagnosis. Material and Methods: Total 35 case of CNS tumours were examined by squash smear technique for cytomorphological analysis followed by histomorphological correlation on paraffin section. Results: Complete correlation with histomorphological findings was observed in 82.35% of cases. Complete correlation was observed more with glial neoplasm. Conclusion: Squash smear preparation proved to be a simple, inexpensive and rapid technique for intraoperative consultation of CNS tumours and can be effectively utilized as a diagnostic tool for intraoperative diagnosis in absence of frozen section facility.

Transoesophageal echocardiography and central line insertion.

We investigated the potential utility of transoesophageal echocardiography (TOE) in facilitating central venous catheter (CVC) insertion in patients undergoing cardiac surgery. Thirty five patients undergoing elective cardiac surgery and CVC insertion were prospectively included in the observational, single-centre clinical investigation. Following induction of general anaesthesia and tracheal intubation, the TOE probe was inserted and the bicaval view obtained prior to CVC insertion (site at discretion of the anaesthesiologist). Prospectively collected data included site and sequence of CVC insertion attempts, information regarding ease of guidewire insertion, whether or not guidewire was visualized via TOE, and other pertinent information. In 1 patient, the TOE bicaval view could not be readily obtained because of right atrial (RA) distortion. In 31 patients, the TOE bicaval view was obtained and CVC access was successful at the site of first choice (guidewire visualized in all). Three patients had noteworthy CVC insertions. In one, CVC insertion was difficult despite visualization ofguidewire in the RA. In another, multiple guidewire insertions met with substantial resistance and without visualization of guidewire in the RA. One patient was found to have an unanticipated large mobile superior vena cava thrombus that extended into the RA, which changed clinical management by prompting initial CVC insertion into the femoral vein (potentially avoiding morbidity associated with thrombus dislodgement). Our prospective observational clinical study indicates that routine use of TOE during CVC insertion may help avoid potential complications associated with this intervention. If both CVC insertion and TOE are going to be used in the same patient, the benefits of TOE should be maximized by routine visualization of the bicaval view during guidewire insertion.