Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms

Context: Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. Aim: The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. Materials and Methods: A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Results: Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Conclusion: Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

Thoracopagus: Autoptic and radiologic study of 2 cases

Conjoined twins are a very rare complication of monozygotic twinning, most common being thoracopagus. Here we report about two cases of thoracopagus male twins illustrating the autopsy details of one case and the prenatal magnetic resonance imaging (MRI) details of another case. While the first case was misdiagnosed as separate twins on antenatal USG, only to be later confirmed as thoracopagus twins after birth, the antenatal MRI done in the second case helped in accurate detection of thoracopagus twins. Bilateral peripheral cortical cysts with dysplasia was noted in one of the twins of the first case, which has not been reported earlier in conjoint thoracopagii. Early prenatal diagnosis of conjoined twins is essential for better counselling of parents regarding post natal surgical management or termination of pregnancy. Importance of prenatal MRI for accurate detection of these cases is thereby highlighted.

Post therapy Wilms tumour or ectopic immature renal tissue: A pathologist's diagnostic dilemma

Post chemotherapy Wilms Tumour (PCWT) is a diagnostic conundrum both for the clinician and the pathologist, in view of its morphological similarity with ectopic immature renal tissue (EIRT). However, due to their varying prognoses and different lines of management, it is important to distinguish between the two. Here, we discuss clinical presentation and pathology of a case of PCWT, arising in a horse shoe deformity of the kidney in a 5 year old girl. The discussion focuses on the pathogenesis of Extra Renal Wilms Tumour (ERWT) as well as its distinguishing morphological features and chemotherapy induced changes in Wilms tumour.

Focal nodular hyperplasia of the liver in children: A report of 2 cases

Focal nodular hyperplasia (FNH) is a benign non-neoplastic lesion of the liver usually found in adults. It is uncommon in children, comprising 2-10% of all pediatric liver tumours. In children, it can occur at all ages, with increased frequency between 6-10 years. We present two cases of FNH in childhood- the first being that of a 5-month-old infant, and the second in a 6-year-old boy. The possibility of congenital FNH had been excluded in the first case. The second case posed diagnostic difficulty initially and was wrongly treated for hepatoblastoma by neoadjuvant chemotherapy, but later correctly diagnosed to be FNH. Both the children are doing well on follow-up. Paediatric FNH though rare, should be kept in mind while dealing with a hepatic mass. Radiological features can be variable and needle sampling may not be sufficient to reach to a diagnosis. Histological examination with glutamine synthetase immunostaining should be performed in doubtful cases to differentiate FNH from other paediatric liver masses, as management differs.

Glomerulocystic disease, a rare cause of renal cysts in infants: A series of three cases

Glomerulocystic kidney disease (GCKD) is an uncommon type of cystic renal disease affecting children. It has both sporadic and familial occurrence and is characterized by cortical microcysts associated with dilatation of Bowman's spaces. In some instances, GCKD is an early manifestation of autosomal dominant polycystic kidney disease. Here, we present three cases of GCKD, two in infants and one in a perinatal postmortem. The first one is a case of GCKD with unilateral involvement, diagnosed on surgical biopsy. GCKD is a morphological expression of several hereditary and nonhereditary disorders that differ vastly in their management and long-term outcome. Hence, accurate morphological diagnosis of this entity is important for prognostication and genetic counseling.

Orchitis: An unusual presentation of polyarteritis nodosa

Polyarteritis nodosa (PAN), a systemic necrotizing vasculitis with multiorgan development, is generally restricted to the medium-sized muscular arteries. The varied initial clinical presentations of PAN can lead to a delayed diagnosis. We present the case of a middle-aged male patient who presented with an acute onset right-sided testicular pain as the initial clinical symptom with ischemic changes on ultrasonogram, thereby requiring orchiectomy. This was reported to be a case of tubercular epididymo-orchitis. On review, the biopsy revealed features of necrotizing arteritis as seen in PAN with fibrinoid necrosis and giant cells, thus highlighting the fact that vasculitis due to PAN may have a localized presentation at the time of diagnosis. PAN should be distinguished from other causes of epididymo-orchitis and other vasculitis lesions, the most common being tubercular etiology in the Asian population.

Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children.

Asthma attacks are serious respiratory problem that can be lethal when not treated appropriately. Till today the main stay of therapy is short acting ß2-agonist. Unfortunately in acute asthma episodes this is not enough to relieve the bronchospasm and reduce dyspnea. The shortcoming of ß2-agonist therapy has resulted in the use of a variety of other treatment in the management of acute asthma. The use of magnesium sulphate is one of the recent treatment options. This study was done to compare the efficacy of nebulized salbutamol with magnesium sulphate versus salbutamol with normal saline in the treatment of acute exacerbation of asthma in children. This randomized controlled trial was carried out among 60 patients with acute exacerbation of bronchial asthma fulfilling the inclusion criteria, admitted in the department of Paediatrics, Mymensingh Medical College Hospital over a period of one year from January 2009 to December 2009. They were distributed randomly, 30 patients received nebulized salbutamol (0.15mg/kg; minimum dose 2.5mg) with 2.0 ml of isotonic magnesium sulphate solution and another 30 patients received the same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. With single dose of nebulization in the magnesium sulphate with salbutamol group, by 20 minute almost all 26 (86.7%) patients achieved at least 60% of predicted PEFR. Within 20 minute from control group none could achieve 60% of predicted PEFR. After second dose of nebulization control group started achieving 60% of predicted value. Regarding response criteria, with second dose of nebulization, at 40 minute 16 (53.3%) patient from magnesium sulphate with salbutamol group showed good response (PEFR>70% predicted). But within the first 40 minutes, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulphate group showed good response but even at 60 minute, 5 (16.7%) patients in control group failed to be included as good responder. In conclusion, nebulization by isotonic magnesium sulphate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.

Caesarean Myomectomy is No Longer a Dreaded Job: a Case Control Study in Multiple Specialized Centre.

Removal of uterine myoma during caesarean section (CS) is not commonly done due to fear of severe haemorrhage which may lead to hysterectomy. Contradicting the previous belief many studies have been showing that myomectomy during caesarean section is a safe procedure without significant increase of risk. The objective of this study is to analyze the safety and clinical outcome of caesarean myomectomy. This is a prospective study carried out in different hospitals of Faridpur district, Bangladesh from 01.01.10 up to 31.12.12. Total 16 (study group) patients had undergone caesarean myomectomy. Operation time, peroperative blood loss, post operative complications and length of hospital staying was compared with that of 32 women (control group) with caesarean section alone. The result shows that peroperative blood loss was average 350±100 ml in study group which is 50 ml more than control group. Operation time was 20 minutes more and length of hospital staying was 1 day more than control group. There was no post partum haemorrhage, no hysterectomy was done at the time of CS and there was no maternal or perinatal mortality. So, caesarean myomectomy is safe and convenient to patient and cost effective without increasing any extra risk.

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d”7.8 mmol/l or d”140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (>7.8 mmol/l or >140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention.

The Metabolic Syndrome: Comparison of Newly Proposed IDF, Modified ATP III and WHO Criteria and their Agreements.

Background: Metabolic syndrome (MS) results from clustering of cardiovascular risk factors occurring in association with insulin resistance and obesity. With the increasing prevalence of obesity worldwide, MS is of keen interest in research. The disorder is defined in various ways, but one consolidated definition is needed to make studies comparable worldwide. The study was to determine the risk factors of metabolic syndrome in Bangladesh and comparison of newly proposed definition of International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the World Health Organization (WHO) criteria and their agreements. Materials and Methods: This was a cross sectional hospital based study. We randomly selected 229 participants. After obtaining informed written consent data collectors collected data by interview, clinical examination, anthropometric measurement and investigations. We calculated independent sample t-test means between to distinguish which risk factors were present in participants with and without MS, using SPSS v17. Results: The percentage of risk factors of MS among subjects according to different criteria was 72% of Modified ATP-III, 69% of IDF and 39% of WHO definition .In Modified NCEP ATP III when did independent sample t-test mean of BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, high density lipoprotein and triglyceride were present statistically significant difference between without MS and with MS (p<0.05). According to WHO criteria BMI, waist circumference, fasting blood glucose were statistically significant (p<0.05) and similarly fasting blood glucose & triglyceride were statistically significant difference between without MS and with MS (p<0.05) according to IDF criteria.ATP III and WHO criteria showed good agreement (k 0.56) compared to ATP III with IDF (k 0.31) and WHO with IDF (k 0.11) criteria. Conclusion: Metabolic syndrome is highly prevalent in Bangladesh. We detected the highest proportion of participants with MS using the ATP III definition, which emphasizes the predominant focus on the modified waist circumference for Asian participants. However, MS prevalence following WHO criteria in those with impaired glucose regulation is comparable with ATP III definition. Follow up study needed to examine the significance of MS following all definitions for the assessment of risk for diabetes and or cardiovascular disease.

Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention.

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction. Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development, Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN.

Cardiac Troponin-I And CK-MB for Risk Stratification in Acute Myocardial Infarction (First Attack): A Comparative Study.

Myocardial infarction is associated with release of two important enzymes. The enzymatic diagnosis is mainly based on the measurement of CK-MB and troponin-I. Cardiac troponin- I(cTnI) is known to have higher specificity and analytic sensitivity than CK-MB for detection of myocardial injury & risk stratification. These are used both as diagnostic and prognostic marker. This prospective observational study included 60 patients of 40-65 years age range, diagnosed as acute myocardial infarction. The mean ages were 50± 8 years and 53±8 years respectively. Male and female patients included were 86.7% and 13.3%; BMI was 25.3±1.5. The two important cardiac markers troponin-I and CK-MB were studied in 60 patients, admitted in the hospital with acute MI. Blood samples to estimate these markers were collected from the patients after admission at 6-9 hours, 9-24 hours and after 24 hours and their mean values with ±SD were calculated, evaluated and compared between the two groups of patients with low and high risk MI. The patients with low risk MI were those who recovered early and the high risk patients improved later in comparison to low risk group. Out of 60 patients, 37 had troponin-I level>1.5 ng /ml. Among them 29 developed high risk MI and 8 recovered earlier than high risk group. 23 patients had troponin-I <1.5 ng /ml, out of whom 10 were high and 13 were low risk. The difference of troponin-I levels between high and low risk groups of patients was statistically significant (p<0.01). On the other hand CK-MB level was >7 ng /ml in 33 patients. Out of them 22 patients developed high and 11 patients were low risk but 18 patients out of 27 who had CK-MB <7 ng /ml became high and 9 patients were low risk. The difference of outcome in respect to higher and lower values of CK-MB between the two groups was not statistically significant (p>0.05). Both troponin-I and CK-MB were estimated in all 60 patients on three occasions. The mean troponin-I levels were statistically significant between the high and the low risk groups on all occasions .On the contrary, the values of CK-MB were not statistically significant on two occasions but was significant (p < 0.01) on one occasion when it was estimated at 9 - 24 hour. Serum cTnI is better and more characteristic biomarker than CK-MB for risk prediction and prognosis evaluation in AMI patients.

Study Of Serum Lipid Profile In Pre-Eclampsia And Eclampsia.

The present study was designed to evaluate the association of lipid profile in pre- eclampsia and eclampsia. This case-control study was carried out in the department of biochemistry, M.A.G. Osmani Medical College, Sylhet, during July 2005 to June 2006. Total 100 study subjects were evaluated, 40 normotensive pregnant women (mean age 24.90 ± 4.04) as normal and 60 already diagnosed preeclamptic & eclamptic women (mean age 24.17 ± 4.90) as study group. Age range was 15-45 years, gestational age 24 weeks to term were included. Patients with pre-existing hypertension were excluded. Serum lipid profile (total lipids, cholesterol, triglycerides, HDL-cholesterol and LDLcholesterol) of hundred women with Pre-eclampsia and Eclampsia (n=60), normotensive women (n=40) were monitored. The preeclampsia was associated with a significant rise in triglyceride (225.6 ± 28.93 vs 165.6 ± 17.22) and fall in HDL cholesterol concentration (42.4 ± 9.29 vs 55.7 ± 7.11), while eclamptic women showed significant fall in HDL cholesterol (41.8 ± 8.79 vs 55.7 ± 7.11) and rise in LDL cholesterol (133.4 ± 11.75 vs 115.2 ± 10.72) as compared to normal pregnant women. Lipid metabolism plays a key role in the pathophysiology of Pre-eclampsia and Eclampsia. Increased triglycerides levels along with decreased HDL-cholesterol levels and delayed triglycerides clearance and high blood pressure are associated with development of preeclampsia and eclampsia. This association may be significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention or early diagnosis of the disorder.

Management of glaucoma with neuroprotective drug.

Glaucoma is an optic neuropathy characterized by progressive loss of retinal ganglion cells (RGCs). Death of ganglion cells is not always only pressure dependent mechanism but also have several pressure independent mechanism that establish a cascade of changes that ultimately leads to cell death. Neuro- protection is a process that attempt to preserve the cells that were spared during initial insult, but are still vulnerable to damage. Although not yet available, a neuroprotective agent would be great use that rescue neurons already compromised or that promote regrowth of axonal or dendritic connection to restore function. This review based on literature, giving the idea of varies mechanism of RGC death delineated by research and discussed some pharmacological agent believed to have a neuroprotective role in glaucoma.

A study to evaluate the efficacy and safety of oral fluconazole in the treatment of tinea versicolor.

In our study of 6 month of pityriasis versicolor patient in skin department of Mymensingh Medical College Hospital outdoor, most of the patient was of age 16-25 years (63.33%), 20% was of age 26-35 years and 16.67% was of 36-45 years. Age distribution among male patient maximum (66.67%) was of 16-25 years and among females the maximum 50% was also of 16-25 years. Mostly was male (80%) and 20% was female only 20% of the patient has got the positive family history whereas 80% with no family history of the disease, which indicates that there is no hereditary predilection. Of the patient 66.67% was unmarried and 33.33% was married. Late adolescence & early adult age groups are predominantly affected. Small children & elderly adults are infected only in unusual circumstances, such as prolonged occlusion or immunosuppresion. Prevalence reported to be as high as 50% in the humid, hot environment of Western Samoa & on low as 11.1% in the colder temperature of Sweden. About sex distribution of patients 20% were female. The study shows that majority of patients were male (20%).

Effect of Ocimum Sanctum Linn (Tulsi) on body weight and some biochemical parameters in restraint stressed albino rats.

Background: With the increased trend of urbanization of our society, the incidence of various stress related diseases are increasing day by day. People under chronic stress often tends to seek relief through drugs, which may have side effects. But some natural supplements called adaptogen, can be more beneficial in reducing symptoms of stress. Objective: The present animal model experimental study was designed to observe the effects of restraint stress on body weight, serum ALT, AST, Glucose, Cholesterol and their modifications by Ocimum sanctum Linn (tulsi) pretreatment which is an Ayurvedic adaptogen and has a long history of therapeutic use. Study design: For this purpose, 30 albino rats aged 90 to 120 days were included in this study. Twenty rats of experimental group were further subdivided into two groups. One group consisted of 10 rats exposed to one hour restraint stress daily for 7 days and 10 rats of the second group were pretreated with tulsi for 7 days before exposure to stress in the same way. 10 non stressed , non pretreated rats were taken into control group.This study was undertaken in the laboratory of the Department of Physiology,BSMMU during the period from July 2003 to June 2004. Methods: The body weight of all control rats were recorded daily in the morning. Body weight of the experimental rats were recorded just before exposure to stress. After completing the experiment , the animals were sacrificed and blood was collected . Serum glucose, cholesterol and ALT,ASTwere determined by standard laboratory technique. Data were compared among the groups and the results were statistically analyzed using unpaired student t’ test. Results : The body weight in untreated stressed group was significantly lower (p<0.001) than those of the control group and tulsi pretreated group. Serum levels of glucose, cholesterol, aminotrasferases (ALT and AST) were significantly higher (p<0.001) in stressed group than those of control . Again in Tulsi treated group all these biochemical parameters were significantly lower (p<0.001) than those of stressed group. This restraint stress-induced changes in body weight and biochemical parameters may be due to hypophagia, altered secretion of various metabolic hormones and neurotransmitters, changes in membrane permeability & hypovolaemia resulting from stress induced secretion of corticosterone and epinephrine through hypothalamo-pituitary adrenal axis activation. Conclusion: Prevention of stress induced changes in biochemical parameter by tulsi pre treatment indicates its anti stressor effect.

Unusual presentation of progressive systemic sclerosis.

A female 38 years old, housewife, presented to the Department of Dermatology and Venereology, Mymensingh Medical College Hospital (MMCH) on 08.04.07 with the complaints of i) pain and reduced movement of hand, knee, shoulder and neck joints for 1 year and 9 months ii) tightness of skin over face, neck, limbs and trunk for 1 year and 6 months iii) patchy depigmentation over same areas for 1 year and 3 months iv) deformity of hands with flexion contractures for 6 months and v) dysphagia to solid food for 3 months. She had no complaints of Raynaud's phenomenon. On general examination, she was ill looking, anemic and nutritionally poor. Examination of integumentary system showed smooth, shiny, thick, hard and hidebound skin with pigmentary alteration of 'salt and pepper' appearance over fingers, hands, limbs, face, neck and trunk. Hands appear claw like but more on the right side than the left and there were no other obvious changes suggestive of digital ischaemia (atrophy, ulceration, scarring, gangrene etc). Face has got suggestive features of scleroderma. Examination of the respiratory system showed restriction of chest movement and reduced expansibility of chest wall. No other abnormality was found on examination of other systems. Laboratory investigations showed histopathology typical of scleroderma. X-ray of hands and feet showed suggestive changes, lung function test-showed restrictive lung disease. Barium swallow x-ray of esophagus in supine position showed mild dilation of lower oesophagus. But serology was non-reactive (negative ANA, Negative RA test, Negative VDRL). So, she was diagnosed as a case of progressive systemic sclerosis (PSS) with some atypicality.

Comparative study of lung functions in women working in different fibre industries.

A cross sectional work has been done on Bangladeshi females, working in different fibre industries, to study the effect of exposure to fibre dust on pulmonary functions. The ventilatory capacities were measured by VMI ventilometer in 653 apparently healthy women (160, 162 and 167 were jute, textile and garment industry workers, respectively). For the controls 164 females were recruited who never worked in any fibre industry. The observed FVC, FEV1 and PEFR were lower in all groups of fibre industry workers than those of the control. Among the industry workers, the jute mill workers had the lowest ventilatory capacities and garment industry workers had the highest values. The jute and textile mill workers had also significantly lower FEV1 and PEFR than those of garment industry workers. The FEV1 and PEFR were significantly lower in jute mill workers than those of textile ill workers. The low ventilatory capacities were almost proportionate with the length of service of the workers. Thus, the present study indicates that the fibre dust, on regular exposure for longer duration, may limit the lung functions.

Effects of Surgical Stress on Serum Cortisol Level: A Comparative Study between Elective and Emergency Surgery.

The study was designed to observe the effects of surgical stress on serum level of cortisol in patients undergoing surgical treatment and to find out any differences in hormonal response between elective and emergency surgical procedures. A total number of 60 male subjects aged between 18 and 45 years were included in the study. Of them, 20 were healthy control (Group I), 20 underwent elective surgical treatment (Group II) and emergency surgical interventions were applied in rest 20 subjects (Group III). Study Groups were further divided into subgroups A (preoperative samples were collected 1- hour before operation), B (postoperative samples were collected 1-hour after the end of the operation) and C (postoperative samples were collected 24-hours after operation).Serum cortisol level was estimated by invitro-immunolytic test.Statistical analysis was done by paired, unpaired ‘t’ test and regression analysis. The preoperative mean serum cortisol concentration in elective surgical cases was almost similar to that of healthy control. On the contrary, in the emergency surgical cases, a significantly increased mean cortisol level were observed (I vs IIIA and IIA vs IIIA; P < 0.05). The serum cortisol concentrations were increased both in elective and emergency surgical cases after operations but the magnitude of rise was more marked in emergency group of patients (IIB vs IIIB; P < 0.05). Therefore, this study reveals that surgical intervention causes increase in serum cortisol which is more marked in emergency procedure.

Simultaneous occurrence of multiple types of cutaneous tuberculosis (TVC and PNT) with internal organ tuberculosis (PTB).

A 40 years old male patient of poor socioeconomic condition presented with a well circumscribed rough surfaced and fissured, verrucous plaque on left axilla and a similar lesion on right foot- which were clinically diagnosed as tuberculosis verrucosa cutis. He also had necrotic papular eruption with varioliform scarring in some lesions on upper back clinically diagnosed as papulonecrotic tuberculid. He had fever and cough and mild weight loss suspicious of pulmonary tuberculosis. On investigation ESR was raised, mild anaemia was present, MT was strongly positive, chest x-ray was suggestive of tuberculosis. So, he was diagnosed as a case of simultaneous occurrence of tuberculosis verrucosa cutis (TVC) with papulonecrotic tuberculid (PNT) with pulmonary tuberculosis (PTB). Standard anti tuberculosis chemotherapy already started to offer cure of all lesions.