ABSTRACT
Background: The gallbladder is a surgically important organ of the body which may be affected by a variety of pathological processes, which are often, under appreciated. It has a wide spectrum of diseases ranging from congenital anomalies, gallstones and its complications, non-inflammatory, inflammatory to the neoplastic lesions. Gallbladder pathology is a frequent source of patient complaint, presenting as acute or chronic right upper quadrant pain, jaundice, or dyspepsia. Gallstones are the commonest pathology of biliary system causing morbidity and mortality. Absolute diagnosis of the premalignant and malignant lesions is possible only after histopathologic examination of the specimen, as pre-operative imaging techniques fail to identify the lesions. Aims and objectives: To study the histomorphology of various gall bladder lesions, to determine the age and sex distribution of the lesions and to ascertain the frequency of abnormalities. Materials and methods: This was a prospective study conducted at Gandhi Hospital, Hyderabad for a period of 1.5 years, i.e. from December 2014 to May 2016. A total of 170 cholecystectomies were received, (including both conventional and laparoscopic types of surgeries) from Department of General Surgery. After gross examination, representative bits were taken and submitted to routine processing, paraffin embedding, cutting and staining. Sections were stained with conventional hematoxylin and eosin and were analyzed. Results: In the present study, various types of lesions were identified and categorized as follows. Congenital anomaly (a single case of Duplication) was noted. Chronic cholecystitis (79), Chronic Cholecystitis with Cholelithiasis (59), Gangrene (13), Gangrene with perforation (3), Empyema (2), Xanthogranulomatous Cholecystitis (3), Adenomyosis (4), Follicular Cholecystitis (1), N. Sreemani Kumari, Annapurna Sireesha, Shyamala Srujana, O. Shravan Kumar. Cholecystectomies – A 1.5 year histopathological study. IAIM, 2016; 3(9): 134-139. Page 135 Cholesterolosis (1), Eosinophilic Cholecystitis (1), Porcelain gall bladder (1), Mucocele (1), and Carcinoma (1). Conclusion: Biliary disorders affect considerable portion of the population. 90% biliary diseases are attributed to cholecystitis. All cholecystectomies should be subjected to histopathological examination in order not to miss the spectrum of gall bladder lesions and their significance.
ABSTRACT
Cancer of stomach remains the major cause of mortality worldwide despite a marked decline in the incidence of gastric carcinoma in the industrialized nations. Gastric cancer is the end result of multifactorial, multigenetic, multistep process. The knowledge of the factors that influence gastric carcinogenesis is determinant for the development of strategies effective for prevention and treatment. Our study emphasizes upon the role of p53 as a prognostic indicator of gastric carcinoma. 50 cases of gastric biopsies were taken at random over a period of 4 years, and p53 expression of these lesions was studied. Gastric carcinoma cases were followed and the TNM staging was assessed. In our study, p53 expression was associated with younger age group, increased depth of invasion and lymph node metastasis, thereby indicating that p53 is a prognostic indicator for gastric carcinoma.
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Neonatal septicemia is defined as a bacterial infection documented by a positive blood culture in the first 4 weeks of life. The clinical symptoms and signs are non specific and vague. So it is important to make diagnosis and to start treatment as early as possible to prevent serious morbidity and mortality caused by non-treatment or late treatment of septicemia. This study was conducted for a period of 3 years. 200 neonates under the age of 28 days were studied to find out hematological parameters including sepsis screen, hematological scoring system and serum procalcitonin levels in neonates suspicious of sepsis. We concluded that, though blood culture is a gold standard for the diagnosis of sepsis, combined use of sepsis markers increases the diagnostic accuracy in suspected cases and simultaneously prevents over treatment of clinically suspicious cases.
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Acute appendicitis is a common surgical emergency. Appendix continues to be the major chunk of surgical specimens received in Pathology laboratory. However, pathogenesis of appendicitis remains poorly understood. Obstruction and inflammation is implied in pathogenesis of acute appendicitis. Presently there is increasing evidence of involvement of enteric nervous system in immune regulation and in inflammatory responses. The present study combines routine histopathology and immunohistochemistry to study the role of mast cells and enteric nervous system in pathophysiology of acute appendicitis. We have done a prospective study for a period of one and half years from January 2014 to July 2015. Appendicectomy specimens from patients who are clinically diagnosed as acute appendicitis were included in study group as cases. Appendix specimens removed at Forensic autopsies were used as controls. Study was conducted on total 138 appendix specimens of which 118 were surgically removed from patients with acute appendicitis, taken as study group. 20 specimens from Forensic autopsy, were used as comparison group (normal control group). We found a consistent increase in mast cell and neuronal counts along with prominence of ganglion cells in specimens with acute appendicitis compared to the control group.
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Background: Soft tissue sarcomas are uncommon malignant mesenchymal tumours, of unknown etiology, accounting for less than 1% of the all the malignant neoplasms, with a median age of occurrence at 65 years, having male preponderance, 3/4th of them occurring in the deep soft tissues, especially thigh, with median diameter of 9 cm. 2/3rd of them metastasizing to the lung. Sarcomas need thorough evaluation by radiology to assess the extent, depth and neurovascular involvement. Morphology has to be correlated with histochemistry and immunohistochemistry. Aim: To study the prevalence, in relation to age, sex, site and size. To correlate histopathological findings with immunohistochemistry marker studies at our institution, studying and comparing with changing overviews and evolving literature. Materials and methods: All the soft tissue mass specimens submitted to the Department of Pathology, Gandhi Hospital, Hyderabad, from January 2011 to December 2015, were subjected to routine processing and those cases on histopathology, suspected to be sarcomas were included in the study, analyzed with ancillary techniques to arrive at final diagnosis. Results: A total of 40 sarcomas were encountered out of 20460, histopathology biopsy load at Gandhi Hospital, Hyderabad, constituting an incidence rate of 2%. Majority of the tumours were seen in the age groups of 40-49 years and 60-69 (20% each) with male preponderance (67.5%), occurring mostly in the trunk region (50%), with average size of 10 cm and constituting 0.6% of cancer incidence. Liposarcoma was the commonest soft tissue sarcoma in the present study. Conclusion: Liposarcoma was the commonest soft tissue sarcoma in the present study followed by Undifferentiated Pleomorphic sarcoma and Leiomyosarcoma. Most of the tumors presented with N. Sreemani Kumari, Shyamala Srujana, O. Shravan Kumar. 5 years study of soft tissue sarcomas at Gandhi Hospital, Hyderabad - A tertiary care centre. IAIM, 2016; 3(7): 334-344. Page 335 mass lesion, pressure symptoms and incidentally detected on imageology. FNAC was not very helpful in present study. Prediction of the course of the disease was difficult as most of the patients were referred to cancer institutions in the city, for further management.
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Background: Perimenopausal bleeding is one of the commonest conditions for which patients come to the gynecological outpatient department. The prevalence increases with age peaking just before menopause. Anovulatory cycles causing excessive, uncontrolled and prolonged bleeding, irrespective of the etiology, are the commonest cause for such bleeding in the perimenopausal women. Perimenopause is 2-8 years proceeding and 1 year after menopause. It occurs in women between the ages of 40 to 50 years. Aim: To evaluate the histomorphological profile of Endometrial Biopsies of 200 women with perimenopausal bleeding coming to the Gynaecological outpatient Department Gandhi Hospital, from January to December, 2015. Materials and methods: Endometrial curettings were obtained from 200 women clinically diagnosed to have perimenopausal bleeding. The curettings were fixed in 10% formalin, which were then processed. The slides were stained with Haematoxylin and Eosin (H&E) and their histomorphological pattern was noted. Results: Out of a total of 387 cases with dysfunctional uterine bleeding (DUB), 200 cases had perimenopausal bleeding. Most of the patients were between 46 to 50 years of age. The most important cause of perimenopausal bleeding was proliferative endometrium seen in 85 cases, followed by secretory endometrium in 49 cases. We had 36 cases of fibroids, 16 cases of simple hyperplasia, 5 cases of endometrial polyps, 4 cases of complex hyperplasia without atypia, 3 cases of complex hyperplasia with atypia and 2 cases of endometrial carcinoma. Conclusion: Perimenopausal bleeding is common between the ages of 40 to 50 years, with a peak in the ages between 46 to 50 years. Though the commonest histomorphological profile of the endometrial curettings obtained from such patients was proliferative phase, there were cases of hyperplasia’s both simple and complex with atypia. There were 2 cases of endometrial carcinomas.
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Background: The evaluation of data of prevalence of Transfusion Transmitted Infections (TTIS) among blood donors permits an assessment of infections in donor population and consequently the safety of collected donations. It also gives an idea of the epidemiology of these infections in the community. Aim: To find out the seroprevalence of transfusion transmissible infections, namely HIV, HBV and HCV, among voluntary and replacement donors, coming to the Department of Transfusion Medicine at Gandhi Hospital. Materials and methods: Total of 16,872 units of blood were collected from voluntary and replacement donors during the study period from January 2014 to December 2015. All blood samples were screened for (HIV) Human Immuno deficiency Virus, (HBV) Hepatitis B Virus and (HCV) Hepatitis C Virus. Results: out of the total of 16,872 units of blood donors, replacement donors were (91.6%) more compared to voluntary donors (8.4%). The seroprevalence of TTI was 1.85% in total donors. The seroprevalence of HIV was 0.18% in total donors. No voluntary donor was found to be reactive for HIV. The seroprevalence for HbsAg was more in replacement donors (1.58%) as compared to voluntary donors (0.04%). The seroprevalence of HCV was 0.10% and no voluntary donors were reactive. Conclusion: The prevalence of TTI was more in replacement donors when compared to voluntary donors. Hence, more emphasis should be given to motivation of voluntary donors.
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Background: Estimation of low density lipoprotein cholesterol (LDL-C) is crucial in management of coronary artery disease patients. There are many homogenous assays currently available for the estimation of serum LDL-C. Most clinical laboratories determine LDL-C (mg/dl) by Friedewald’s formula (FF). Recently Anandaraja and colleagues have derived a new formula for calculating LDLC. This formula needs to be evaluated before it is extensively applied in diagnosis. Aim: The aim of this study was to compare the results obtained by direct homogenous assay for LDLC to those obtained by Friedewald’s and Anandaraja’s formulas with the assumption that the results obtained by direct assay are the most accurate. Materials and methods: We measured Lipid profile (TC, TG, HDL-C, D-LDL-C) by direct homogenous method in 715 fasting samples. Simultaneously Friedewald’s and Anandaraja’s formulas were also used for calculation of LDL-C (FF-LDL-C and AR-LDL-C, respectively). Results: The mean LDL-C levels were 117.78 ± 13.797, 115.51 ± 12.854 and 112.93 ± 11.671 mg/dl for D-LDL-C, FF-LDL-C and AR-LDL-C respectively. There was a statistically significant difference between the results (P ˂ 0.001) obtained by calculation formulas compared to the measured LDL-C. There was underestimation of LDL-C by 2.27 mg/dl and 4.85 mg/dl by Friedewald’s and Sridevi V, Vinit Anand, Mahendrappa S.K. Comparison of Friedewald’s and Anandaraja’s formula with direct estimation of low-density lipoprotein cholesterol in Shivamogga population. IAIM, 2016; 3(7): 120-131. Page 121 Anandaraja’s formulas respectively. In this study, the Pearson’s correlation between FF-LDL-C and D-LDL-C was 0.881 and that between AR-LDL-C and D-LDL-C was 0.880. Bland–Altman graphs showed a definite agreement between mean and differences of the calculation formulas and direct LDL-C with 95% of values lying with in ±2 SD limits. Conclusion: The results of our study showed that FF is better in agreement with D-LDL-C than Anandaraja’s formula for estimation of LDL-C by calculation though both lead to its underestimation.
ABSTRACT
Introduction: Adrenal gland is a bipartite endocrine gland divided into cortex and medulla. As their developments are different, a wide range of tumours are encountered. We have presented here adrenal tumors of varied histomorphology, in one year study from August 2013 to July 2014, at Gandhi Hospital, Hyderabad. Aim and objectives: To study the spectrum of adrenal tumors diagnosed at Gandhi hospital for over a period of one year, correlation with clinical features and an overview of the pit falls encountered. Materials and methods: All the adrenal gland specimens submitted to the Department of Pathology, Gandhi Hospital, Hyderabad, from August 2013 to July 2014 were included in the study. These specimens were subjected to routine processing and ancillary techniques were used to arrive at final diagnosis.
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Background: Hemoglobinopathies are genetically acquired diseases. When present in new-born and in children they need to be treated and can be life threatening many a times. In the adults they can be asymptomatic and can manifest as disease during stress. They may present with other signs and symptoms not related to hemoglobinopathies. Aim: To perform Hemoglobin (Hb) Electrophoresis to detect Hemoglobinopathies in patients not presenting with hematological problems coming to the Medical OPD at Gandhi Hospital. Materials and methods: 3 ml Ethylene Diamine Tetra Acetic Acid (EDTA) whole blood was collected from cubital fossa from patients and Hb Electrophoresis was carried out on BIORAD - D10 Results: Hb Electrophoresis of a total of 464 patients were carried out over a period of six months (July to December 2015) and14 cases of Sickle Cell Trait, 16 cases of Thalassemia Trait, 1 case of Hb E trait , 1 case of sickle cell disease and 1 case of sickle cell disease with low Hb A2 levels were identified. Conclusion: Hemoglobinopathies can present themselves in the adults without symptoms related to red blood cell disorders. So when Patients present themselves with other symptoms and are not being relieved of their complaints by the conventional treatment, Hb Electrophoresis can help in identifying the hemoglobinopathies, especially when the Hb is normal or near normal for that age and sex of the patient.
ABSTRACT
Hydatid disease is a zoonotic infection caused by Echinococcus granulosus, which belongs to phylum Platyhelminthes. It is endemic in many parts of the world including India. Though Hydatid disease commonly occurs in liver and lung no organ or tissue is immune in the body. When it presents in unusual sites Hydatid disease often poses a diagnostic challenge. A high index of suspicion, comprehensive radio imaging investigations are often required to evaluate these cases. In the study we have conducted for 4 years, we reported a total no of 7 Hydatid cases that presented at unusual sites. Most common rare presentation in our study was renal hydatid disease, 3 cases; and one each in pancreas, Spleen, peritoneum and pelvis.