Cardiovascular involvement in systemic lupus erythematosus: an autopsy study of 27 patients in India.

BACKGROUND: Although cardiovascular disease (CVD) is recognized as a leading cause of death in patients with systemic lupus erythematosus (SLE) in western countries, there is hardly any data regarding Indian subjects with SLE. AIMS: To determine the incidence of cardiac abnormalities and vascular lesions at autopsy and to assess their contribution to the mortality in patients with SLE. SETTINGS AND DESIGN: Retrospective retrieval of reports of autopsies performed on 35 patients with SLE over a 11 year period and analysis of 27 cases with cardiac and/or vascular lesions. MATERIALS AND METHODS: Gross and microscopic features in 27 autopsies were analyzed with special attention to the heart and the vasculature of all organs. Findings were correlated with clinical features and ante-mortem investigations. Their contribution towards mortality was assessed. RESULTS: Valvar lesions were the commonest cardiac lesions noted with non-bacterial thrombotic endocarditis in nine (33.33%), valvar thickening in two (7.41%), Libman-Sacks endocarditis and infective endocarditis in one (3.70%) each. Myocarditis and myocardial scarring were seen in 10 (37.03%) and seven (25.92%) cases, respectively. Fibrinous pericarditis was noted in seven (25.92%). Thromboses/embolism, vasculitis and severe coronary atherosclerosis were seen in nine (33.33%), five (18.52%) and one (3.70%) subjects, respectively. Renal disease [13, 48.14%] and cardiovascular manifestations [8, 29.62%] were the leading causes of death in our patient population. CONCLUSION: CVD contributes significantly to the mortality in patients with SLE in India. It is second only to renal disease in this regard.

Sino-nasal epithelial tumours: a pathological study of 69 cases.

BACKGROUND: Epithelial neoplasms are uncommon lesions affecting the sino-nasal tract. There are hardly any reports in the Indian literature. AIM: To study the incidence, mode of presentation and histological types of sino-nasal epithelial tumours in the surgical pathology material. SETTING AND DESIGN: Retrospective retrieval of all sino-nasal tumours and analysis of epithelial tumours. MATERIALS AND METHODS: All sino-nasal epithelial tumours, biopsied or surgically excised over a period of ten years, were studied. The tumours were classified as benign or malignant. The histology was correlated with the clinical presentation and investigations. RESULTS: In ten years, there were 120 sino-nasal tumours representing 0.14% of all the surgical specimens received. Sixty-nine epithelial tumours (59.2%) outnumbered the non-epithelial tumours and were diagnosed on the basis of histopathology. Twenty were benign and 49 malignant; occurring predominantly in males. Benign lesions included four squamous papillomas and 16 inverted papillomas, with recurrence in three inverted papillomas (21%). Squamous cell carcinomas were the commonest among malignant tumours and four of these were associated with inverted or cylindrical cell papilloma. The second most frequent malignant tumour was adenoid cystic carcinoma with eight cases. Other rare types included the variants of squamous carcinoma, adenocarcinomas of the non-enteric type, muco-epidermoid carcinoma and undifferentiated carcinomas. CONCLUSION: Sino-nasal epithelial tumours are rare lesions, with male preponderance. Inverted papillomas and squamous cell carcinomas are the most frequent neoplasms.