Xanthomatous hypophysitis: A rare case report with review of literature

Hypophysitis is classified into primary and secondary. Xanthomatous hypophysitis is one of the rare types of primary hypophysitis. A 55-year-old female presented with headache, vomiting, and blurring of vision. She also had endocrine dysfunction in the form of low serum T3, T4, and low cortisol levels. MRI scan showed a sellar expansile lesion suggestive of pituitary macroadenoma. Microscopy showed pituitary tissue replaced by inflammatory infiltrate made up of foamy histiocytes arranged in sheets along with lymphoplasmacytic infiltrate. Interspersed areas of fibrosis, hyalinization, few congested and sclerosed blood vessels were seen. Compressed residual pituitary tissue was identified at the periphery. Xanthomatous hypophysitis is a rare entity which can mimic as pituitary adenoma both clinically and radiologically. Accurate diagnosis at an early stage with postsurgical steroid therapy may help to prevent permanent pituitary damage.

Gum Arabic Enhances Paracellular Transport of Water in Amphibian Everted Small Intestinal Segments.

Gum Arabic (GA) is known for its proabsorbent activity in normal intestine as well as in animal models of diarrhea. The aim of the study was to find the effect of GA on intestinal transport of water and possible route of absorption in frog everted gut sacs. D-Mannitol was used as a marker of paracellular transport to find the route of absorption. Everted gut sacs (n=4,5) were placed in Ringer containing GA (2.5 g/L) with or without D-Mannitol (0.5 g/L), incubated for 1 hour and analysed for change in weights of the sacs and D-Mannitol uptake. There was significant increase in uptake of water and D-Mannitol in the presence of GA compared to controls (P<0.05).Gum Arabic improves water uptake by the intestinal mucosa, possibly by opening the paracellular pathways.

Acute effects of deep breathing for a short duration (2-10 minutes) on pulmonary functions in healthy young volunteers.

Breathing is the most vital function for maintenance of life. Slow and deep breathing is an integral part of Pranayama and it reduces dead space ventilation and renews air throughout the lungs. The reported beneficial effects of deep breathing as a part of either long term or short term practice of pranayama are well documented. However our knowledge about the effects of a few minutes’ of deep breathing on human ventilatory parameters is poor. In the present study, we examined the relationship between exposure to short duration of deep breathing and performance on Pulmonary Function Tests before and after the deep breathing. The study was conducted in a homogenous group of 12 volunteers containing 4 females and 8 males who were well trained in pulmonary function testing (PFT) before the start of the study. The volunteers performed deep breathing (DB) exercise for 2, 5 and 10 minutes at the rate of 6 breaths per minute under guidance, and the duration of DB exercise for that day was randomly selected for each group. PFT was done before and after the DB exercise. There was a significant (P<0.05) increase in vital capacity (VC) after 2 and 5 minutes’ DB exercise and a consistent improvement in tidal volume (TV) and minute ventilation (MV) after the DB exercise in all the three groups, though it wasn’t statistically significant. There was a significant (P<0.05) increase in forced vital capacity (FVC) after 2 minutes’ of DB exercise and a consistent increase in all the three groups in forced inspiratory vital capacity (FIVC) and peak inspiratory flow rate (PIFR), though this increase was not statistically significant. This shows that deep breathing exercise, even for a few minutes’ duration is beneficial for the lung functions.

An anomalous left external jugular vein draining into right subclavian vein: a case report

Knowledge of the varying drainage patterns of superficial veins of head & neck, in particular, jugular veins are not only important for anatomists but also for the surgeons operating at this level and to clinicians in general. The variations are important for interventional radiologists too who perform transjugular procedures, such as port implantations and the transjugular intrahepatic portosystemic shunt or selective venous samplings. Results of recent studies report that the superficial veins, especially the external jugular vein (EJV), is been increasingly utilized for cannulation to conduct diagnostic and therapeutic procedures. We report a very unusual presentation of external jugular vein on left side of an embalmed male cadáver. Embryological evaluations of the anomaly was done and compared with available literature which showed that the observed variation is rare.

El conocimiento de los diferentes patrones de drenaje de las venas superficiales de la cabeza y cuello, en particular, las venas yugulares no sólo son importantes para anatomistas, sino también para los cirujanos que operan a este nivel y para los médicos en general. Las variaciones son importantes también para los radiólogos intervencionistas, quienes realizan procedimientos transyugulares, así como implantaciones portales y portosistémicas transyugulares intrahepáticas o derivación venosa selectiva. Resultados de estudios recientes informan que la venas superficiales, especialmente la vena yugular externa, es cada vez más utilizada para la canulación en diagnósticos y procedimientos terapéuticos. Se reporta una muy inusual variación anatómica de la vena yugular externa del lado izquierdo, presente en un cadáver embalsamado de sexo masculino. Fueron realizadas evaluaciones embriológicas de la anomalía y se compararon con la literatura mostrando que se trata de una variación rara.

Effect of Phyllanthus niruri Linn. treatment on liver, kidney and testes in CCl4 induced hepatotoxic rats.

Phyllanthus niruri extract is extensively used in treating liver ailments. Effects of aqueous extract of P. niruri on liver, kidney and testes of CCl4 induced hepatotoxic rats were studied. High levels of malondialdehyde (MDA) were observed in the CCl4 test group with significant reduction of MDA levels in all groups on P. niruri extract administration. Highest levels of glutathione (GSH) were found in P. niruri group. Activities of alanine transaminase, aspartate transaminase and alkaline phosphatase enzymes were significantly reduced in the curative group (P. niruri treatment after CCl4 injection). Histopathology of liver showed lesser degree of inflammation in all P. niruri treated groups while the renal and seminiferous tubules showed eosinophilic protein casts with signs of tubular damage and degeneration. Testes also showed decreased amount of mature spermatozoa. The results suggest that P. niruri has anti-oxidant and hepato-protective activity with associated deleterious effects on kidney and testes.

International standards for tuberculosis care: relevance and implications for laboratory professionals.

On World Tuberculosis (TB) Day 2006, the International Standards for Tuberculosis Care (ISTC) was officially released and widely endorsed by several agencies and organizations. The ISTC release was the culmination of a year long global effort to develop and set internationally acceptable, evidence-based standards for tuberculosis care. The ISTC describes a widely endorsed level of care that all practitioners, public and private, should seek to achieve in managing individuals who have or are suspected of having, TB and is intended to facilitate the effective engagement of all healthcare providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative and extra-pulmonary TB, TB caused by drug-resistant Mycobacterium tuberculosis and TB/HIV coinfection. In this article, we present the ISTC, with a special focus on the diagnostic standards and describe their implications and relevance for laboratory professionals in India and worldwide. Laboratory professionals play a critical role in ensuring that all the standards are actually met by providing high quality laboratory services for smear microscopy, culture and drug susceptibility testing and other services such as testing for HIV infection. In fact, if the ISTC is widely followed, it can be expected that there will be a greater need and demand for quality assured laboratory services and this will have obvious implications for all laboratories in terms of work load, requirement for resources and trained personnel and organization of quality assurance systems.

Safety and radiosensitizing efficacy of sanazole (AK 2123) in oropharyngeal cancers: randomized controlled double blind clinical trial.

Oropharynx is an important site of cancer in India. Global comparison indicates higher incidences in India. Radiotherapy remains an important treatment modality. Efforts to improve loco-regional treatment and prolong survival are areas of focus. Radiosensitizers in hypoxic tumors have shown promise. AIM: To study the safety and radiosensitizing efficacy of sanazole in oropharyngeal squamous cell carcinoma (stage T2-4, N0-3, M0) as phase-II double blind controlled trial in patients treated with conventional radiotherapy. SETTINGS AND DESIGN: Single institutional, randomized, double-blind, placebo-controlled trial. MATERIALS AND METHODS: Group 1 (control; n = 23) received normal saline infusion, group 2 (test; n = 23) received sanazole biweekly 1.25 g intravenous infusion 15 minutes before radiotherapy. Surrogate end points of efficacy were tumor and nodal size; safety parameters were mucositis, salivary and skin reactions, dysphagia, vomiting, dysgeusia and neurological deficit. Investigators blinded to the trial evaluated patients, weekly during treatment for six weeks and thereafter monthly for three months. STATISTICAL METHODS: Non-parametric, Friedman's, Chi square, Mann-Whitney U tests. RESULTS: In the test, 15 (65%) patients had complete response, five (22%) partial/no response, two (9%) died, one (4%) lost to follow up. In the control, five (22%) patients had complete response, 16 (70%) partial/no response, one (4%) died, one (4%) lost to follow up. Short-term loco-regional response was better in the test (DF = 3, 95% Confidence Interval 0.418, 0.452, P = 0.0048). In the test group significant vomiting and one case of grade 3 neurological deficit was observed. CONCLUSION: The study validates the usefulness of sanazole for initial loco-regional control in oropharyngeal cancers.

Alternatives to the tuberculin skin test: interferon-gamma assays in the diagnosis of mycobacterium tuberculosis infection.

For nearly a century, there were no alternatives to the tuberculin skin test (TST) for diagnosing latent tuberculosis infection. Because of advances in immunology and genomics, for the first time, an alternative has emerged in the form of T cell based interferon-g (IFN-gamma) assays, a new generation of in vitro tests of cellular immunity. These assays measure cell mediated immune response by quantifying IFN-gamma released by T cells in response to stimulation by Mycobacterium tuberculosis antigens. Although early versions of IFN-gamma assays used purified protein derivative (PPD) as the stimulating antigen, newer versions use antigens that are significantly more specific to M. tuberculosis. These specific antigens include ESAT-6 and CFP-10. These proteins, encoded by genes located within the region of difference 1 (RD1) segment of the M. tuberculosis genome, are more specific to M. tuberculosis than PPD because they are not shared with any BCG substrains or several nontuberculous mycobacterial species. A review of current evidence on the performance of IFN-gamma assays and TST suggests that both the TST and IFN-gamma assays have advantages and limitations, and both tests appear to be useful at this time. The emergence of IFN-gamma assays is a much anticipated, welcome development that has, for the first time, increased the choice of tests available for diagnosing latent tuberculosis infection. Because both tests have their strengths and limitations, the decision to select one over the other will depend on the population, the goal of testing, and the resources available. To fully evaluate the utility of IFN-gamma assays in high burden countries such as India, long-term cohort studies are needed to determine the association between positive IFN-gamma results and the subsequent risk of active disease.

Preclinical evaluation of the antidiabetic effect of Eugenia jambolana seed powder in streptozotocin-diabetic rats

The world is facing an explosive increase in the incidence of diabetes mellitus and cost-effective complementary therapies are needed. The effects of Eugenia jambolana, a household remedy for diabetes, were studied. Streptozotocin diabetic female albino Wistar rats weighing 150-200 g (N = 6) were fed E. jambolana seed powder (250, 500 or 1000 mg/kg) for 15 days. Diabetic rats fed 500 and 1000 mg/kg seed powder showed an increase in body weight on day 20 in relation to day 5 (6 ± 4.7, 9 ± 7.8 vs diabetic control -16 ± 7.1 g, P < 0.001), a decrease in fasting blood glucose (75 ± 11.9, 123 ± 14.4 vs diabetic control -34 ± 12.1 mg/dl, P < 0.001), a difference in post-treatment fasting and peak blood glucose (38 ± 11.9, 36 ± 14.2 vs diabetic control 78 ± 11.9 mg/dl, P < 0.001), and a difference in liver glycogen (50 ± 6.8, 52 ± 7.5 vs normal control 90 ± 6.6 æg/g of liver tissue, P < 0.001). Tri-terpenoids, tannins, gallic acid, and oxalic acid were the chemical constituents detected in E. jambolana seed. The best results were obtained with an oral dose of 500 mg/kg. Subacute toxicity studies with a single administration of 2.5 and 5.0 g/kg seed powder showed no mortality or abnormality. These data on the antidiabetic effect of E. jambolana seed are adequate for approval of phase 2 clinical trials to evaluate this seed powder as complementary therapy in type 2 and type 1 diabetes.

Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study.

BACKGROUND: Hypothyroidism is a common, potentially treatable endocrine disorder. Since hypothyroidism is not always associated with the signs and symptoms typically attributed to it, the diagnosis is often missed. Conversely, patients with typical signs and symptoms may not have the disease when laboratory tests are performed. AIMS: We aimed to determine the accuracy of physical examination in the diagnosis of hypothyroidism. SETTING AND DESIGN: Prospective, hospital-based, cross-sectional diagnostic study. MATERIAL AND METHODS: Consecutive outpatients from the medicine department were screened and an independent comparison of physical signs (coarse skin, puffy face, slow movements, bradycardia, pretibial oedema and ankle reflex) against thyroid hormone assay (TSH and FT4) was performed. STATISTICAL ANALYSIS: Diagnostic accuracy was measured as sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and positive and negative predictive values. RESULTS: Of the 1450 patients screened, 130 patients (102 women and 28 men) underwent both clinical examination and thyroid function tests. Twenty-three patients (18%) were diagnosed to have hypothyroidism by thyroid hormone assays. No single sign could easily discriminate a euthyroid from a hypothyroid patient (range of positive likelihood ratio (LR+) 1.0 to 3.88; range of negative likelihood ratio (LR-): 0.42 to 1.0). No physical sign generated a likelihood ratio large enough to increase the post-test probability significantly. The combination of signs that had the highest likelihood ratios (coarse skin, bradycardia and delayed ankle reflex) was associated with modest accuracy (LR+ 3.75; LR- 0.48). CONCLUSION: Clinicians cannot rely exclusively on physical examination to confirm or rule out hypothyroidism. Patients with suspected hypothyroidism require a diagnostic workup that includes thyroid hormone assays.

Primary squamous cell carcinoma of caecum.

Proximal to the anal canal, carcinomas composed in whole or in part of squamous epithelium are distinctly uncommon, accounting for 0.1 per cent of all colorectal carcinomas. Pure squamous cell carcinoma of the colorectum are extremely rare. Here we report a case of primary squamous cell carcinoma of the caecum in a 55 year old lady from South India.

Fine Needle Aspiration cytology versus Fine Needle Sampling without aspiration. A prospective study of 200 cases.

In the present prospective study of 200 patients with superficial swelling of various sites, FNS followed by FNA were performed. Fifteen cases were excluded due to inadequate material. In the 80 lymph node cases, FNS was diagnostic in 85% cases as compared to FNA in 87.5%. The diagnostic accuracy was higher for FNA (87.5%) than for FNS (81.25%). However FNS smears were much superior qualitatively than FNA smears and for the diagnosis of malignant conditions FNS was found to be much better. Regarding the 68 thyroid swellings, FNS obtained a diagnosis in 82.4% cases while FNA got it in 77.9%. The diagnostic accuracy with FNS (89%) was much better compared to FNA (75%). Of the 27 breast cases FNS yielded diagnostic material in 70.38% cases while FNA was diagnostic in 85.19%, thus establishing definite superiority. However FNS seemed to be better for diagnosing malignant lesions while FNA appeared better for diagnosing benign ones. In the 5 salivary gland lesions and 5 miscellaneous lesions both FNS and FNA fared equally well. On the whole FNS technique was much more patient friendly and gave high class "text book" quality smears while FNA smears gave quantitatively more adequate material. Both the techniques therefore would be complementary to each other.