Diagnostic and prognostic utility of SF-1 in adrenal cortical tumours

Background and Aims: Superior imaging techniques have increased the recognition of adrenal pathology. Distinguishing benign from malignant adrenocortical tumors is not always easy. Several criteria and immunohistochemical markers have been discovered which help to differentiate between adrenocortical adenoma (ACA) and adrenocortical carcinoma (ACC). Our aim here was to evaluate the diagnostic and prognostic role of steroidogenic factor-1 (SF-1) in adult adrenocortical tumors (ACT) diagnosed using the Weiss criteria. In this cohort, we have also analyzed Ki67 and p53 expression and the extent of agreement between SF-1 and Ki-67. Methodology: This was a retrospective, observational study comprising 24 cases of adult ACT over 10 years. Immunohistochemical staining for SF-1, Ki67, and p53 was done in all the cases, and the results correlated with the morphological diagnosis made using Weiss criteria. Results: SF-1 was 100% sensitive and 80% specific as a marker of malignancy. Increased SF-1 expression correlated with worse survival. There was a moderate degree of agreement between Ki-67 labeling-index and SF-1 as a marker of malignancy with the kappa coefficient being 0.75. The sensitivity of p53 was lower than Ki67 in diagnosing ACC. Conclusion: In adult ACTs, SF-1 has diagnostic significance and prognostic implication. SF-1 is a crucial, dosage-dependent survival factor in ACC. There is a moderate extent of agreement between Ki-67 and SF-1 as a marker of malignancy.

Rhinoscleroma Revisited

ABSTRACT Rhinoscleroma (more appropriately 'scleroma') is a chronic, disfiguring inflammatory lesion that is rarely encountered in the present-day otolaryngology practice. The diagnosis often becomes difficult especially when it recurs and presents late with complications. This report illustrates the clinical and histologic features of rhinoscleroma in a defaulter patient who represents advanced-stage disease with orbital and intracranial extensions. Special emphasis has been provided on the computed tomography impressions such that the evolution of scleroma with time can be studied.

Awareness of diabetic retinopathy among physicians and optometrists in a district of West Bengal.

A cross sectional study was done to ascertain the current knowledge among physicians and optometrists regarding diabetic retinopathy in a district of West Bengal. We obtained response from 242 physicians and 36 optometrists working in government health units. The questionnaire comprised of three sections covering magnitude of problem, risk factors and management. The responses were analysed and graded. In different sections, knowledge of 74 - 78% physicians and 83 - 86% optometrists was graded as not acceptable. Existing lack of knowledge among physicians and optometrists regarding diabetic retinopathy needs correction.

A study on smoking habits among slum dwellers and the impact on health and economics.

To assess the impact on health from smoking with economic implications with major emphasis given to see whether passive smoking is an established outcome and if it is, how much additional burden of the disease is put on the smokers' families and consequently how much extra economic cost is put on such families, a study was conducted in a slum area of Howrah Municipal Corporation (HMC) on approximately 3000 families, which were randomly selected. Data was collected in relation to the socio-economic status, family members, housing with water and environmental sanitation, smoking habit, energy used for cooking, health awareness, follow-up of episodes of diseases of all ages, their remedial action taken and estimation of economic burden of the disease due to smoking (active and passive). There was a statistically significant difference in disease pattern between smokers' family and non-smokers' family especially with relation to chronic obstructive pulmonary disease, coronary heart disease, acute respiratory infections, common cold, hypertension and peptic ulcer (p<0.05). Also it was observed that with increasing years (1st, 2nd, 3rd years), the number of cases in each disease group gradually increased. This can be attributed to the effect of passive smoking especially when environmental conditions and socio-economic variants are same in both groups. Cost analysis of the illness episodes in the smokers' and non-smokers' families showed that there was a 3-fold difference in average annual expenditure between the families of the non-smokers and that of smokers and a 8-fold difference in work days lost. There was a 4-fold difference in annual expenditure on these diseases by the families. It is observed that when the total cost of smoking was included in the total expenditure, there was a 12-fold increase in annual expenditure between smokers' and non-smokers' families. The study conclusively proves that there are ill effects on health both from active and passive smoking. It is also demonstrated here that apart from economic implications due to direct smoking, the economic loss has been added to smokers' families due to passive smoking.

High resolution CT (HRCT) in miliary tuberculosis (MTB) of the lung: Correlation with pulmonary function tests & gas exchange parameters in north Indian patients.

BACKGROUND & OBJECTIVE: High resolution computed tomography (HRCT) scans are known to be helpful in early diagnosis and management of patients with miliary tuberculosis (MTB). We made an attempt in this study to identify patterns of pulmonary MTB on HRCT and to correlate the HRCT disease extent with pulmonary function tests (PFT) and gas exchange analysis (GEA). METHODS: A total of 16 non-HIV patients with MTB underwent HRCT of the chest, PFT and GEA. All the investigations in these patients were completed within 20 days of presentation. Evidence of TB was diagnosed by biopsy from lymph nodes (3/16), organ biopsy [skin, liver, bone marrow and lung (transbronchial) (6/16)]. In one patient fundoscopy revealed choroid tubercles. In 6 patients, diagnosis was confirmed by clinical/radiological improvement following anti-tuberculosis therapy. Radiological patterns of involvement on HRCT of the lungs were studied and disease extent was estimated in each case by consensus between two radiologists using specially devised visual scoring system. Disease extent was correlated with PFT and GEA. Spearman rank correlation was used for statistical analysis. RESULTS: Findings on HRCT in MTB included miliary nodularity (16/16), alveolar lesions such as ground glass attenuation and/or consolidation (5/16), lymphadenopathy (8/16), peribronchovascular interstitial thickening (1/16), emphysema (1/16), pleural pathology (2/16), and pericardial effusion (2/16). A significant correlation was noted between disease extent score and forced vital capacity (FVC) (r = -0.76; P=0.003), forced expiratory volume in one second (FEV(1))(r = -0.74; P = 0.005), total lung capacity (TLC) (r = -0.66; P = 0.037), oxygen saturation in arterial blood (SaO(2)) (r = -0.69, P = 0.01), diffusion capacity of the lung (DLco) (r = -0.8; P = 0.02). INTERPRETATION & CONCLUSION: Our findings showed that HRCT reliably diagnosed MTB, and thus could help in predicting derangement of pulmonary function tests and GEA in these patients.

Prevalence of thalassaemia trait in the state of West Bengal.

From three districts namely, Burdwan, Midnapur (undivided) and 24-Parganas North of the state of West Bengal, a total of 2045 blood samples were drawn to test for the presence or absence of thalassaemia trait. Out of the total samples, 621 samples were from general population, 807 from focus group (Muslims and ST/SC), 370 from antenatal mothers and 247 from relatives of cases. The blood samples were first subjected to screening test ie, red cell indices and the presence of trait was confirmed by gel-electrophoresis of the samples positive in screening test. Results showed that thalassaemia trait is prevalent in the population of the state in the magnitude of 11.25%. It is mostly prevalent in close relatives of cases (thalassaemia major) in the magnitude of 55.26%, followed by scheduled tribe (29.87%) and among the Muslim population it was predominantly more. General population has a prevalence of 3.6% (males) and 5.95% in antenatal mothers. High prevalence rate is associated with illiterates (19.23%) than literates (5.55%). Highest prevalence rate ie, 20.47% (overall prevalence) is associated with age group between 0-9 years. The findings of the study are considered to be very valuable as far as future action programme is considered to reduce the prevalence rate of thalassaemia trait in the community. The action programmes like intensive counselling and IEC maybe instituted to the groups, which show high prevalence rate rather than general population to make the programme not only cost-effective but cost-efficient as well.

Idiopathic pulmonary haemosiderosis: two case reports.

Idiopathic pulmonary haemosiderosis (IPH) is a rare disorder and is characterised by the occurrence of episodes of diffuse alveolar haemorrhage (DAH). The patients usually present with a history of recurrent haemoptysis, anaemia and alveolar opacities on chest radiograph. The radiographic features are very characteristic and reveal alveolar opacities in middle and lower zones with selective sparing of the upper zones. An extensive diagnostic work-up is needed to exclude other causes of DAH. We report two cases of idiopathic pulmonary haemosiderosis who responded well to treatment with oral glucocorticoids.

Deaf child--a general practitioner's responsibility.

The power of a child's speaking language never develops if he is deaf. Deafness persists if it is not detected early. Childhood deafness is either congenital or acquired. At birth, doctors or attendants can detect deafness by arousing the baby with sudden loud noise. At 4 months onwards mothers and doctors can detect deafness. The baby at this age can turn its head or eyes towards the source of the sound. By 12 months to 2 years of age it is very difficult to detect deafness. By the age of 3 years children again become co-operative and it becomes easier to detect deafness. Children should always be screened for deafness while being admitted to nursery classes. In school going age ie, 5 years onwards loss of tests can be employed to detect deafness. If a child is suspected be deaf, a general practitioner's responsibility is to refer him to an ENT specialist earlier. Any child whose mother believes her child is deaf should be given due attention. Otitis media with effusion, enlarged adenoid, chronic suppurative otitis media, recurrent otitis media are some diseases to be carefully looked into by the general practitioners. Now-a-days cochlear implantation surgery is gaining popularity to give hearing to deaf child. Moreover regular screening for deafness should be included school heath programme.

Aortic aneurysm and dissection: evaluation with spiral CT angiography.

The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm, aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aortic aneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findings were compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; and surgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation of aortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhanced CT axial images and those of angiography in the form of 3D reformatted images.

Mature ovarian teratoma with gliomatosis peritonei--a case report.

Gliomatosis peritonei (GP), a rare condition related to ovarian teratomas, is characterized by miliary implants of mature glial tissues on the peritoneum or omentum. We report herein a case of mature teratoma of the ovary with GP with imaging features and pathological correlation.

Lymphangioleiomyomatosis: a rare cause of breathlessness.

A 24-year-old female presented with complaints of cough with scanty expectoration, breathlessness on exertion and chest pain for the last three years. These symptoms had appeared during the 12th week of her third pregnancy. She was given anti-tuberculosis treatment at another hospital for nine months without any improvement in symptoms. Four years ago she had been diagnosed to have leprosy of borderline variety for which she had received treatment. On examination, she was tachypnoeic with a respiratory rate of 33 breaths per minute. She had clubbing and small, discrete and firm lymph nodes in the anterior cervical region. Chest examination revealed wheezing with bibasilar end-inspiratory crepitations.

Tracheobronchial amyloidosis masquerading as bronchial asthma.

A case of localized tracheobronchial primary amyloidosis masquerading as "bronchial asthma" is presented. Computed tomography of the chest and fiberoptic bronchoscopy image are included. Tracheobronchial primary amyloidosis is a rare, but potentially curable cause of airway obstruction mimicking asthma.

Effect of arsenic on cell growth of the cellular slime mould, Dictyostelium discoideum.

The growing D. discoideum cells were killed in a dose-dependent manner when exposed to 100 and 140 ppm of arsenic (As2O3) at mid-log phase for 20 min. Reduced plaque sizes and changed cell and colony morphologies were observed in the treated cells. Endocytotic functions (both phagocytosis and pinocytosis) were also inhibited in the treated cells. Arsenic treated cell showed a lower DNA and protein synthetic activities. These findings are discussed in relation to known mechanism of action of the heavy metal on growth-related cellular functions.

X-linked Charcot-Marie-Tooth disease with myokymia: report of a family.

The clinical and electrophysiologic profiles of two brothers suffering from Charcot-Marie-Tooth disease are presented. Both had widespread muscle twitching in the legs which showed electrophysiologic features of myokymia. Pedigree analysis suggested an x-linked recessive form of inheritance. This appears to be the first report of an Indian family with x-linked Charcot-Marie-Tooth disease.

Isolated extra-cranial internal carotid artery aneurysm in a young adult with Eale's disease.

A young male patient, a known case of Eale's disease presented with a large isolated aneurysm of the extra-cranial part of internal carotid artery. Detailed investigation failed to establish the etiology of the aneurysm, and it is possible that the underlying pathology may be the same as that of Eale's disease. Eale's disease is an idiopathic vascular disease of the peripheral retina and we hypothesize that aneurysm in this patient may be associated with Eale's disease of the eye.

Damodar river pollution and health hazards.

Damodar river is one of the most polluted rivers in this country. Chemical pollution and bacteriological pollution, both are high--leading to rising trend in different industrial health hazards in the Damodar basin.

Sleep disordered breathing in chronic obstructive pulmonary disease.

We prospectively studied sleep disordered breathing in 50 consecutive patients (39 males) with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure (CRF) (n=33) and without CRF (n=17) by performing polysomnography. Patients with CRF had a lower mean nocturnal oxygen saturation (SaO2 %) (88.6+/-6.7 vs. 96.3+/-0.8; p=0.0001) and a lower minimal nocturnal SaO2 (73.6+/-12.0 vs. 84.3+/-7.3; p=0.002) compared to those without CRF, suggesting that patients with CRF tend to have more severe drops in nocturnal SaO2. Patients with CRF also had a lower FEV1 (% predicted) (p=0.01) and PEFR (% predicted) (p=0.031) compared to those without CRF suggesting an indirect relation to the oxygen saturation. Other pulmonary functions were comparable between both the groups. Among patients with and without CRF, the total sleep time (minutes); the rapid eye movement (REM) stage (% of total sleep time); the non-rapid eye movement (NREM) stage (% of total sleep time) were comparable (p=NS). Only three of the 50 patients with COPD had a significant (>5) apnea-hypopnea index (AHI) (total no. of apneas + total no. of hypopneas/ total sleep time [(hours) = AHI] and these three patients had a mean BMI = 27.7 which was higher than the mean BMI of the whole group (21.1). The AHI was comparable in patients with and without respiratory failure. Multiple regression analysis revealed a positive correlation between AHI and the neck circumference (r=0.41; p=0.005) and BMI (r=0.31; p=NS). There was a small but statistically insignificant negative correlation between AHI and neck length (r= -0.28; p=NS). We conclude that, BMI per se contributes to the AHI and nocturnal desaturation in patients with COPD.