Utility of CD200 expression and CD20 antibody binding capacity in differentiating chronic lymphocytic leukemia from other chronic lymphoproliferative disorders

Background: Chronic lymphoproliferative disorders (CLPDs) are heterogeneous group of disorders with variable clinical presentations and outcomes. Therefore, accurate classification is crucial for treatment planning. At present, flow cytometry immunophenotyping (FCM-IPT) is a useful tool for diagnosing these diseases. However, overlapping immunophenotypes do exist. Recently, differential expression of CD200 and variation in number of CD20 antibody bound per cell (ABC) in different CLPDs has been reported. Materials and Methods: Seventy-seven CLPD cases were analyzed by FCM-IPT for CD200 expression, and Quantibrite bead was used to calculate CD20 ABC. Results: Variability in CD200 expression can help in the differentiation of chronic lymphocytic leukemia (CLL) and hairy cell leukemia (HCL) from other CLPDs. CD200 was brightly expressed in 100% CLL cases, having homogenous bright (2+) intensity. On the contrary, CD200 was uniformly negative in all Mantle cell lymphoma cases except 1, in which the intensity was dim, and the mean fluorescence intensity was significantly lower than CLL. Furthermore, all HCL cases showed bright expression of CD200, thereby making it useful in differentiation from other CLPD with villous lymphocytes. Evaluation of CD20 ABC showed that it differs among various CLPD and was significantly lowest in CLL and highest in HCL both on peripheral blood and bone marrow samples. Conclusion: Our results support the fact that CD200 can be added to routine CLPD panel as it is useful in subcategorizing them. However, inclusion of CD20 ABC to routine panel does not seem plausible but may be done for difficult diagnostic cases or where anti-CD20 therapy is planned.

The Use of Catlan's Appliance For Repaid Correction of Pseudo Class III Malocclusion.

In this case report, the use of a cemented lower anterior inclined bite plane (Catlan’s appliance) for the correction of a pseudo Class III malocclusion is shown in a growing child. The differential diagnosis of pseudo malocclusion and the advantages and disadvantages of the use of Catlan’s appliance are discussed.

Time Course of The Passage of An Ingested Brass Wire Separator Through The Gastrointestinal Tract.

Fixed Orthodontic Treatment involves the use of applinces with many metallic components. Some times appliance parts may go missing between appointments instead of and may be noticed during recall appointments. Ingestion of this parts is rare but if it happens it may be life threatening. Herewith a case of ingestion of metallic brass wire ligature and timely intervention is discussed.

The Use of 0.018" Special Plus Wire For Fabricating "Z-Springs" For Correction of Anterior Cross Bites.

Double helical cantilever springs of “Z-springs” are frequently used to correct one or two teeth anterior cross bites. Different wire sizes of round stainless steel wires have been suggested by various authors for the fabrication of these springs. The 0.018” Special Plus Australian wire is an excellent choice for the fabrication of the “Z-spring” because of it’s hardness and resilience. This case report shows the rapid resolution of a single tooth anterior cross bite of an upper central incisor using an appliance that incorporates such a “Z -spring”.

Detection of paroxysmal nocturnal hemoglobinuria-phenotype in patients with chronic lymphocytic leukemia and multiple myeloma.

Background : Paroxysmal nocturnal hemoglobinuria (PNH) results due to decrease or absence of glycosylphosphatidylinositol-anchored (GPI) molecules, such as CD55 and CD59, from the surface of the affected cells. PNH-phenotype has been described in various hematological disorders, mainly aplastic anemia and myelodysplastic syndromes; recently it has been reported in patients with lymphoproliferative syndromes and multiple myeloma (MM). Materials and Methods : We evaluated the presence of CD55 negative and/or CD59 negative red blood cell (RBC) populations in newly diagnosed treatment naive-54 chronic lymphocytic leukemia (CLL) and 29 MM patients by flow cytometry. Results : PNH-phenotype was not reported in any patient; however, RBC populations deficient in CD55 were detected in 16.66% (9/54) CLL and 6.89% (2/29) MM patients. Clinical presentation or the hematological parameters did not show any relationship with the presence of CD55 deficient RBC population. Conclusion : Our study showed absence of PNH-phenotype in patients with CLL and MM; however, isolated CD55 deficient RBC were identified in both CLL and MM. Larger prospective studies by other centers, including simultaneous analysis of granulocytes for the presence of PNH-phenotype, are needed to corroborate these findings and to work out the mechanisms and the significance of the existence of this phenotype in these patients.

Study of deaths in industrial areas around Aurangabad city.

We retrospectively studied the death cases brought for medico-legal post-mortem examination at mortuary, Government Medical College, Aurangabad in last one year i.e. 2010. All the cases from these areas (Police station MIDC Waluj, MIDC Cidco, MIDC Chikhalthana, and MIDC Paithan, etc.) were included in the study and the results are analyzed. Deaths from industrial areas accounted for 6.85% of total autopsies. It is observed that the most common cause of death in industrial area is road traffic accident probably due to higher frequency of transportation. Males outnumbered the females and they suffered injuries most in their fourth decade of life. Maximum incidences occurred in the month of October, that too on Friday between times 12:00 pm to 6:00 pm. Maximum cases were accidental in manner and brought dead to Government Medical College, Aurangabad. The most common cause of death was vehicular accidents involving head. This is the first time such a study has been carried out locally. The proportion of accidental deaths in industrial areas relative to that of non industrial area may be attributed to the poor enforcement of safety measures in these areas.

Accidental ligature strangulation with avulsion of scalp.

With its relatively small diameter, lack of bony shielding and close association of the airway, spinal cord and major vessels, the human neck is uniquely vulnerable to life threatening injuries. Strangulation is a constriction of the neck by a ligature without suspension of the body, the constricting force being applied directly to the ligature. In this paper, we present case of a 25 years old woman who was accidentally strangled when her one end of saree was entrapped in moving crop thresher during separating grains from dry crops in the field. She was immediately brought to the hospital where she was declared dead. Complete and meticulous autopsy was done and cause of death given as accidental ligature strangulation. This phenomenon is unusual and highlights the hazards of working with such conditions leading to such unfortunate machinery incidences and safety measures to be taken while working with such machines.

Suicide: An important exit of life.

The “Medico-legal study of suicidal death” was undertaken in the Department of Forensic Medicine and Toxicology at Govt. Medical College, Aurangabad for a period of 6 months. Two hundred cases are included. These cases were studied and analyzed on the basis of age, sex, marital status, methods and cause of suicide. Male outnumbered the female with majority in age group of 19-32 years, married and commonest cause was insanity in males and dowry in females.

Change in tissue thromboplastin content of brain following trauma.

BACKGROUND: Tissue thromboplastin (TTP) is an integral membrane protein contributing to coagulopathy after trauma of brain, which is a rich source of TTP. AIMS: A study was undertaken to establish the TTP content of various areas of normal brain and estimate the changes in TTP activity of brain in response to varying degrees of trauma. MATERIALS AND METHODS: Samples from different areas of brain of ten cadavers were used as controls and they were compared with contused brain tissue obtained after surgery in 25 head injury (HI) patients of varying severity. RESULTS: In the study group, the TTP activity of the frontal, parietal, and temporal lobes after HI was significantly raised in contrast to that of the control group. The TTP activity was also significantly higher in the severe HI patients than those having moderate HI. The mode of injury and the time lapse after HI had no significant bearing on the TTP activity. Subjects above 40 years of age demonstrated a higher mean TTP activity after HI, though it was not statistically significant. CONCLUSION: The study provides quantitative data on TTP activity of normal brain and highlights the role of TTP in coagulopathy following HI through its increased activity after HI, more so in the severe HI group.

Celiac disease presenting as iron-deficiency anemia in northern India.

BACKGROUND: Adult celiac disease is infrequent in India. Iron-deficiency anemia as its presenting manifestation is still rarer. METHODS: We investigated patients with refractory iron-deficiency anemia attending the hematology clinic of a tertiary-care hospital for celiac disease. The diagnosis of celiac disease was based on histology, serology and response to treatment. RESULTS: Of 19 patients with refractory iron-deficiency anemia seen from April 1998 to March 2000, 11 were diagnosed to have celiac disease. Four of these had abnormal D-xylose test and 3 had fat malabsorption. All 11 patients responded to gluten-free diet with improvement in hematological parameters. CONCLUSION: Patients with refractory iron-deficiency anemia of unknown cause should be investigated for subclinical celiac disease.

Acute erythroleukemia (AML-M6)--a study of clinicohematological, morphological and dysplastic features in 10 cases.

Acute erythroleukemia is a relatively rare form of acute myelogenous leukemia. In the present study we analysed ten cases of acute erythroleukemia. All the patients were anemic and nine were thrombocytopenic at the time of diagnosis. Peripheral blood showed blasts in nine cases. Dyserythropoiesis was seen in all the cases whereas dysmegakaryopoiesis was seen in five cases. Dysplasia in the granulocytic series was seen in five cases. Based on the overall features this study concludes that acute erythroleukemia is associated with dysplasia of variable degree.

Cryptococcal prostatitis in a patient with chronic lymphocytic leukemia.

Cryptococcosis is a systemic mycosis usually affecting patients of immunodeficiency i.e. transplants recipients, patients on chemotherapy for neoplastic diseases and in those suffering from human immunodeficiency virus infection. We report a 52-year old male suffering from chronic lymphocytic leukemia (CLL) on chemotherapy who presented with fever and features of prostatism. Cryptococcus neoformans infection (CN) was diagnosed on aspiration of a prostatic nodule. Subsequent investigations revealed a disseminated involvement by cryptococcus. The case represents an unusual presentation of disseminated cryptococcosis.

Paterson-Kelly syndrome and celiac disease--a rare combination.

Paterson-Kelly syndrome is characterized by an association of iron deficiency with dysphagia. We describe a patient with this syndrome who was later diagnosed to have celiac disease.

Pulmonary functions in Indian sportsmen playing different sports.

Regular exercise has proved to be beneficial for the human body and the lungs are no exception. The present study was undertaken to assess the relation between the quality of exercise performed and the quantitative effect of these exercises on the lungs. Pulmonary function tests of sportsmen engaged in various sports were compared with each other and with that of the controls. Players playing football (n=18), hockey (n=19), volleyball (n=20), swimming (n=20) and basketball (n=18) were chosen for this study. Medical students (n=20) were chosen as controls. The parameters taken into account in this study were forced vital capacity (FVC), forced expiratory volume (FEV-1), and peak expiratory flow rate (PEFR). The results indicate that all the sportspersons had a higher values of lung functions compared to the controls. Among the various groups of players chosen for this study, the swimmers showed the maximum increase in their lung functions.

Histological and clinical evolution patterns of chronic myelocytic leukemia.

Trephine biopsies of 101 chronic myelocytic leukaemia (CML) patients were analysed to study the relationship between initial and subsequent histological features vis-a-vis clinical behaviour of the disease. The patients with blast crisis at presentation were excluded. At diagnosis 62 (61.4%) patients revealed granulocytic-megakaryocytic (gran-meg) proliferation whereas granulocytic (gran) proliferation was found in 39 (38.6%) patients. Gran pattern at diagnosis was associated with shorter survival and early evolution into blast crisis (36.8%) in 12 months, although the difference in the total incidence of blast crisis between the two histological groups was not statistically significant. Myelofibrosis was detected in more number of cases on follow up (89.1%) as compared to the initial biopsies (80.2%). However myelofibrosis did not correlate with initial cellular composition, overall survival or the phase of CML (P > 0.05). Transition from one histological type to another was observed in 15 out of 60 (25%) cases while remaining in the chronic phase.