A rare case report of Castleman's disease and review of literature

Castleman’s disease (CD) is a rare lymphoproliferative disorder, described for the first time by Castleman, et al. in 1954 in a single case then in 1956 in a group of 13 patients with localized benign lymphadenopathy. The incidence of CD is unknown and can occur at any age, however it is mainly reported in adults in the literature with a slight feminine predominance (60%). The majority of the previously reported cases of CD in the neck were of the hyaline vascular type and the most common sign was an asymptomatic neck mass. In the present case the patient is having unicentric CD and histologically it is Mixed Type. We are reporting this case because of its rarity.

Role of Ki 67 Labelling Index as an Adjunct to Histopathological Diagnosis for Grading of CNS Tumours

The Central Nervous System tumours are unique as they arise from specialized tissue. CNS tumours constitute a wide range of neoplasm that differs in their location, age distribution, extent of invasiveness, morphological features and tendency for progression. We wanted to evaluate the traditional morphological data with knowledge on the prognostication marker Ki 67 antibody in evaluating tumour grade and prognosis of CNS neoplasm.METHODSThis is a cross section study carried out between March 2015 and September 2016 in histopathology department of Dhiraj Hospital on 50 cases of CNS tumours. Immunolabelling of all biopsies was done by horse radish peroxidase technique using rabbit monoclonal antibody to Ki 67 (clone SP 6) (Thermo Scientific, USA). Ki 67 immune positive labelling index was obtained for each tumour and correlated with mitotic labelling index obtained by conventional morphological grading as per WHO 2007 classification.RESULTSIn our study of CNS tumours, all age groups were studied. The mean Ki 67 labelling index (LI) values +/-SD for WHO Grade I tumours were- meningiomas (10) 3.85 (+/1.97) %, schwannoma (3) -3.0 (+/-2.97) %, pituitary adenoma (1) 0.6, craniopharyngioma (1) -1.1% and ependymoma (6) 2.62 (+/-0.60) %. WHO Grade II tumours- atypical angiomatous meningioma (1) -2%, atypical mucinous meningioma (2) -6.15 (+/-1.06) %, gemistocytic astrocytoma (1) -12; pleomorphic xanthoastrocytoma (2) -4.3 (+/-0.99) %, astrocytoma grade ii (2) -3.3 (+/-0.71) %, oligodendroglioma grade ii (4) - 3.9 (+/-0.88) %. WHO grade III tumours- anaplastic astrocytomas (5) -6.82 (+/-2.17) %, anaplastic oligoastrocytoma grade iii (1) -10.8 %. who grade iv-glioblastomas (7) -18.44 (+/-3.97) %; medulloblastomas (1) 20%, metastatic tumour (3) -36 (+/- 22.16) %. In our study, the mean Ki 67 LI (± SD) values for grade II, III and IV glioma is as follows: 4.76 (+/-2.83) %, 7.48 (+/-2.53) % and 18.44 (3.97) % respectively.CONCLUSIONSThis study shows that Ki 67 LI serves as an essential clinical prognostic proliferation marker of particular importance in cases with lower grade histology of Grade II & Grade III astrocytomas, Grade II & Grade III oligodendrogliomas. Ki 67 LI is important in determining benign, atypical and malignant meningiomas, non-invasive and invasive pituitary adenomas.

Clinical spectrum of AKI in chronic liver diseases

Introduction: Acute kidney injury (AKI) is a heterogeneous syndrome of different aetiologies, and often multifactorial. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer. Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used. Result: 87% are males and 13 % are females. The most common cause of cirrhosis is alcoholic 77% followed by hepatitis Bvirus related 10%, unknown etiology 7%, hepatitis C 3%, NASH 2%, Wilson 1. The most common sign of decompensation of liver is jaundice 78% followedby ascites 70%, hepatic encephalopathy 37% and upper GI bleed 30%. Distribution of child class as a prognostic indicator showed the maximum no. ofpatients found in class C 56% followed by class B 34% and class A 10%. Conclusion: Acute kidney injury is very common in chronic liver disease patient in our hospital and majority of them have intrinsic cause of AKI

A rare case of mature teratoma of testis in 55 years old male patient

Background: Laparoscopic surgeries being minimally invasive surgeries are associated with a relatively minor surgical trauma. Excessive pain, nausea and vomiting and fatigue will delay the discharge. Bupivacaine and Ropivacaine, the long acting Local Anaesthetics when given intraperitoneally provide effective pain relief when the pain peaks within 4-6 hours of surgery. Aim: To compare the efficacy of intraperitoneally nebulised Ropivacaine 0.75% and Bupivacaine 0.5% for postoperative analgesia in Laparoscopic surgeries. Materials and methods: This study was a double blinded randomised controlled trial in ASA grade I and II patients” was conducted in 60 patients of both sexes, of age group 20-45 years. They were randomly divided into two groups of 30 patients each: Group R (Ropivacaine) – received intraperitoneal nebulization of Ropivacaine 0.75% 4 ml (30 mg) after the placement of umbilical port and Sreedevi Porika, T. Venkata Naga Lakshmi. Intraperitoneal nebulization of ropivacaine 0.75% vs intraperitoneal nebulization of bupivacaine 0.5% for post-operative analgesia in laparoscopic surgeries: Prospective double blinded randomised controlled trial. IAIM, 2018; 5(9): 105-117. Page 106 Group B (Bupivacaine) – received intra peritoneal nebulization of Bupivacaine 0.5% 4 ml (20 mg) after the placement of umbilical port. Results: There was no significant difference in age and weight between the two groups. Intraoperatively statistically significant differences were observed SBP - At 15 and 30 min post nebulization and at extubation. No significant differences were observed with respect to DBP and HR. Postoperatively DBP and HR differences were found to be statistically significant at 4th post-operative hour. There were no statistically significant differences in SBP and MAP between both the groups. Dynamic VAS scores were statistically significant at extubation and in first 6 hours and not significant at 24 hours between both the groups. Static VAS scores were not statistically significant at all times compared between both the groups. Mean Time for first rescue analgesic requirement was 8.23+0.511 hours in group R vs.7.59+0.52 in group B and was statistically significant (p=0.0001). Mean total rescue analgesic required was 95+33.3 mg Diclofenac in group R vs. 112.6+38.4 in group B with 26% of group R requiring 2 nd dose of rescue analgesic and 50% of patients in group B required 2 nd dose and was not statistically significant. Mean time for unassisted ambulation was 12.8+0.61 hours in group R vs.13.16+0.6 hours in group B which was not statistically significant (p=0.52). Conclusion: From the present study, it is concluded that both Bupivacaine and Ropivacaine are safe and similarly efficacious in reducing postoperative pain following intra-peritoneal nebulization in laparoscopic surgeries.

A case report of Ameloblastoma in 36 years old female patient

Ameloblastoma is benign odontogenic tumor of epithelial origin which is often aggressive and it originates from remnants of the dental lamina and dental organ (odontogenic epithelium). It is generally a painless and slow growing tumor causing expansion of the cortical bone and infiltration of the soft tissues. Its incidence peak is in the third and fourth decade of life and it is most common in black individuals. The ratio of ameloblastoma of the mandible to maxilla is 5 to 1, with higher sensitivity in the mandible. Here we are reporting the case of Ameloblastoma in 36 years old female patient and we are able to find and document the typical histopathological features of Ameloblastoma.

Multiple myeloma in 33 years old male patient – A case report.

Multiple myeloma is a condition of malignant plasma cell proliferation derived from a single B-cell lineage. These cells produce monoclonal immunoglobulins, most commonly either immunoglobulin G (IgG) or immunoglobulin A (IgA). The peak incidence of MM is in the seventh decade, whereas, it is a rare entity in young patients. Here we are presenting a case report of 33 years old male patient with diagnosis of Multiple myeloma WHERE are able to find and document the classical features of Multiple myeloma. Increased level of β2 microglobulin, serum creatinine, IL-6, IL-2 and plasmablastic type myeloma cells suggest poor prognosis of mm patients.

Hypoglycemia due to 3b-Hydroxysteroid Dehydrogenase type II Deficiency in a Newborn.

Background: 3β-hydroxysteroid dehydrogenase type II deficiency results in decreased production of all three groups of adrenal steroids. Recurrent hypoglycemia as a presenting feature of this disorder has not been reported earlier. Case characteristics: A genotypically and phenotypically normal female newborn delivered by in-vitro fertilization presenting with recurrent hypoglycemia. Primary adrenal insufficiency with insignificant mineralocorticoid deficiency and slightly elevated levels of 17-hydro-xyprogesterone, dehydroepiandrosterone sulphate and testosterone. Outcome: Successfully managed only with corticosteroid replacement. Message: Congenital adrenal hyperplasia can rarely cause recurrent hypoglycemia in newborns.

A novel method of plasmid isolation using laundry detergent.

Since the discovery of plasmid, various methods have been developed to isolate plasmid DNA. All the methods have one common and important target of isolating plasmid DNA of high quality and quantity in less time. These methods are not completely safe because of use of toxic chemicals compounds. The developed protocol for plasmid extraction is based on the alkaline lysis method of plasmid preparation (extraction at pH 8.0) with slight modifications. Cell lysis reagent sodium dodecyl sulfate is replaced by lipase enzyme present in laundry detergent. A good plasmid preparation can be made, which is well suited for subsequent molecular biology applications. By taking safety measures on count, contaminants like, RNA and protein can be completely avoided with maximized plasmid yield. The resultant plasmid quality and quantity can be well comparable to other prevalent methods.

Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test.

Background: Colposcopic evaluation and guided biopsy is an important diagnostic step and standard of management for abnormal cytology smears in developed countries. Aim: The present study evaluates the performance of colposcopy vs conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology as a secondary test modality to triage women found positive on primary screening by visual inspection with 5% acetic acid (VIA). Settings and Design: Colposcopy and directed biopsy were performed after primary screening for cervical cancer in an urban hospital cancer screening clinic between January 2000 and June 2005, in Mumbai, India. Materials and Methods: Healthy women (8863) in the age group of 35-65 years participated in the cervical cancer early detection program in the hospital and community cancer screening clinics in Mumbai. Women found positive on the primary screening test by VIA underwent diagnostic evaluation by Pap smear cytology and colposcopy evaluation with directed biopsies. Statistical Analysis: Accuracy parameters and their 95% confidence intervals were calculated using 2 Χ 2 tables and standard formulae. Results: The test range of sensitivity of colposcopy for the detection of histologically confirmed cervical intraepithelial neoplasia grade 1+ (CIN1+) or CIN2+ was 58.0-74.7% and that of specificity was 57.5-92.9%. The sensitivity and specificity of cytology to detect CIN2+ was 57.4% and 99.4%, respectively. Conclusion: Colposcopy is a good sensitive test for the detection of CIN and can be considered as a secondary testing tool to triage women found positive on VIA.

Childhood cancer survivors--living beyond cure.

Advances in diagnosis and treatment along with improved supportive care have contributed to the current survival rates for pediatric malignancies. Recent concept of a truly "cured child" in pediatric oncology envisages not only a biological cure of the disease but a child on par with peers in growth and development physically and in achievements and aspirations, both mentally and emotionally. Because of the young age of these survivors and their potential for longevity, the delayed consequences of therapy may have a serious impact on their lives and family at large than do the acute complications of the cytotoxic therapies that they had experienced. Though figures from India are not available, it has been estimated that, in USA, the prevalence of childhood cancer survivors is expected to increase from 1 in 900 persons among young adults to 1:250 persons by 2010. Although this constitutes a remarkable medical achievement, the late morbidity in this growing survivor population has become an area for concern. It is estimated that 50% of the survivors are likely to develop disabilities that alter the quality of life.

Courses of substance use and schizophrenia in the dual-diagnosis patients: is there a relationship?

BACKGROUND: Interrelationship of schizophrenia and substance use is complex and multifactorial. Examining the influence of various psychoactive substances on course of patients with pure dual-diagnosis schizophrenia may help to solve this riddle. AIM: To examine the relationship of the courses of substance use and schizophrenic symptomatology in substance abusing "dual-diagnosis" patients with schizophrenia. SETTINGS AND DESIGN: Outpatient Deaddiction and Treatment Center of a tertiary care hospital with a retrospective design. METHODS and MATERIAL: Twenty-two substance abusing dual-diagnosis patients with schizophrenia were investigated regarding the course of substance use (abuse/dependence, use, non-use) and that of schizophrenia (psychotic, non-psychotic, in remission). A graphical representation of course of schizophrenia and substance abuse was made and their relationship studied by superimposition of respective graphs. STATISTICS: The Friedman two-way analysis of variance of ranks was applied to see the relationship between time spent by patients while on and off various substances. RESULTS: In five cases, the onset of schizophrenia preceded the onset of substance use. In seven out of 22 subjects, the schizophrenic exacerbation was clearly preceded by increase in substance abuse in the preceding two-twelve months. In none of the subjects decrease in substance use led to a decrease or increase in schizophrenic symptoms. CONCLUSIONS: Although substance use disorder preceded the onset of schizophrenic illness in the majority, and increase in substance abuse preceded schizophrenic exacerbation in one-third of dual-diagnosis patients, overall there was no evidence that the course of substance use was associated with that of schizophrenia after both disorders were diagnosed.

Immunological identification of two female-specific proteins from the plasma of Indian freshwater murrel, Channa punctatus (Bloch).

Existence of a non-phosphorylated female-specific protein (FS II), in addition to phosphorylated vitellogenin (FS I), in the plasma of murrel by exogenous administration of estradiol-17beta is reported. Polyspecific rabbit antibodies were raised against estrogen-inducible murrel plasma proteins. This antiserum was absorbed with normal male serum in order to obtain female-specific antiserum (FSAS). Radial immunodiffusion studies suggested that both the proteins (FS I and FS II) were present in the plasma of E2-treated and normal vitellogenic females and in the ovarian homogenate from gravid females, but absent in normal male plasma. Autoradiographic experiments demonstrated that phosphorus moiety was attached with FS I only. Further, immunoelectrophoretic analysis and peptide maps supported the observation that FS I and FS II were discrete, unrelated female-specific proteins.

Purification of vitellogenin from the plasma of Indian freshwater murrel, Channa punctatus (Bloch) by different methods: a comparative study.

Plasma from estrogenized, [32P] NaH2PO4-injected murrel, Channa punctatus was collected in the presence of proteolytic inhibitors and subjected to different separation procedures singly or in combination, viz., gel filtration chromatography on Ultrogel AcA 34, ion-exchange chromatography on DEAE sephacel, or selective precipitation with dimethylformamide or with Mg2+: EDTA in order to isolate vitellogenin from other plasma proteins. The results show that chromatography on Ultrogel or DEAE sephacel yields intact vitellogenin whereas prior precipitation with DMF or with Mg2+: EDTA results in either co-precipitation of other plasma proteins or in the cleavage of phosvitin-like material from the native vitellogenin molecule.

Radiotherapy in carcinoma cervix.

The techniques of radiation treatment of cervical cancer with radium evolved empirically. During the last few decades a lot of technological breakthrough has occurred in the field of brachytherapy mainly due to revolutionary changes brought by computerisation. The difficulties encountered during intracavitary insertions and the practical problems have been discussed. The complications following acute and late reactions have also been discussed.

Profile of heroin addicts in Nagaland, India.

A total of 395 drug addicts from Nagaland, India during 1992-1993 were studied. Of these, 331 (83.8%) were primary abusers of heroin. Mean age of the group was 21.8 years +/- SD 3.84. Of these 5.2% were females. The majority were unmarried (92.1%) and 52% had completed 10 years of schooling. Drug-related school dropout rate was 72.8%. Unemployment was predominant (90.3%) in the group, of which most were never employed. Christianity was the main religion (90.9%) of the group. The mean age at first use of heroin was 17.6 years +/- SD 3.68. The mean duration of dependence on heroin was 4.4 years +/- SD 2.8. Heroin was injected by 80.9% subjects. Friends were the main source of introduction. Concurrent use of tranquilizers and codeine containing cough syrups was prevalent in the event of a short supply of heroin. The involvement of young, unemployed, unmarried persons in heroin addiction; widespread prevalence of the injection route and needle sharing; chronicity of heroin dependence; paucity of specialized treatment avenues and proximity to the Golden Triangle facilitating illicit traffic, have contributed to emergence of heroin addiction as a major public health problem in Nagaland.