Immunohistochemical detection of axillary lymph node micrometastases in breast cancer patients: Increasing the accuracy of detection and decreasing labor intensive serial sectioning.

Background: The histological detection of axillary lymph node tumor metastases in cases of breast carcinoma is of major prognostic significance, but may be difficult when metastases are of microscopic size. The micrometastases can be detected either by immunohistochemistry (IHC) or serial sectioning. Aims: We investigated whether immunohistochemical techniques and serial sectioning can increase the accuracy of metastatic detection and compared the efficacy of both. Materials and Methods: Thirty cases of breast carcinoma were studied in all of whom the axillary lymph nodes had been reported as free of metastases. Blocks from these cases were serially sectioned and stained with hematoxylin and eosin and a single section was stained with monoclonal antibody to cytokeratin AE1/AE3 and epithelial membrane antigen. The positivity for micrometastases was correlated with size, number, grade and histological type of primary tumor, lymph node size and number. Results and Conclusion: In 5/30 previously unsuspected cases, micrometastases were revealed by IHC and in 1/30 by serial sectioning. These findings suggested that serial sectioning is a labor intensive, time consuming and impractical procedure. Micrometastases were more frequently detected with age of patient >50 years, Grade 2/3 tumor, tumor size >5 cm and more than one primary tumor. Immunohistochemical analysis can be recommended as a routine procedure or an adjunct to routine histological procedures for the correct staging of breast carcinoma and use of adjuvant chemotherapy, especially in the high risk group.

Primary intraosseous meningioma.

Primary intraosseous meningioma of the skull is an uncommon lesion often confused preoperatively with a primary bone tumor of the skull. We report this rare tumor in a 19-year-old male who was radiographically diagnosed as osteoid osteoma.

A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients.

Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.

Dilacerated unerupted central incisor: A case report.

Dilaceration of permanent successors is one of the most common complications of trauma to the deciduous teeth. It is advisable to keep these patients under observation post-trauma and to consult an orthodontist at an early stage to prevent unfavorable sequelae. Presented here is a typical case of dilaceration.

Music distraction - Its efficacy in management of anxious pediatric dental patients.

Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham's picture test, Venham's anxiety rating scale, pulse rate, and oxygen saturation during different treatment visits. The values were statistically analyzed and it was concluded that audio distraction did decrease the anxiety level in pediatric dental patients, but not to a very significant level.

Strangulated femoral hernia presenting as parietal wall emphysema.

Surgical emphysema of abdominal and thoracic wall, along with features of intestinal obstruction, has not been reported as a complication of strangulated femoral hernia. We report a 31-year-old woman with such a presentation.

Gastric teratoma.

Gastric teratoma accounts for less than 1% of all teratomas occurring in children, usually males. These tumors may be benign or malignant and complete excision of the tumor in either case carries a good prognosis. This rare case is an addition to the few cases of gastric teratomas in females reported in world literature and presenting as an exophytic & endophytic growth.

Single stage removal of right pulmonary and hepatic hydatid cysts.

A case of hydatid disease of lung and liver is described. The patient was investigated because of a circumscribed shadow in the right lung on chest skiagram. Another cystic shadow was picked up in the right lobe of liver on ultrasound examination. Both the cysts in right lung and liver were removed simultaneously through a right thoracophrenotomy. Emphasis is being laid on the utilization of single stage thoracotomy as an operative procedure of choice for hydatid cysts of right lung and liver.