Is a diagnostic lumbar puncture indicated in intraocular retinoblastoma?

Background: Lumbar puncture (LP) is frequently performed in patients with advanced intraocular retinoblastoma. However, this may not be necessary in a significant proportion of patients. Materials and Methods: A file review of patients who were diagnosed with retinoblastoma over a 13-year-period was performed. Patients who underwent LP as part of staging were included in the study. Results: The study included 223 patients. One-third had bilateral retinoblastoma. The grouping was C, D, and E in 4 (2.9%), 41 (29.9%), and 92 (67.2%) patients, respectively. The stage was 0, I, II, III, and IV in 14 (6.3), 123 (55.2%), 13 (5.8%), 70 (31.4%), and 3 (1.3%) patients, respectively. Eight (3.6%) patients had a positive cerebrospinal fluid (CSF) cytology. None of the patients with intraocular disease and 7 (10%) patients with extraocular disease had a positive CSF. Conclusions: A diagnostic CSF is not indicated in patients with intraocular retinoblastoma.

Multiplex polymerase chain reaction using insertion sequence 6110 (IS6110) and mycobacterial protein fraction from BCG of Rm 0.64 in electrophoresis target genes for diagnosis of tuberculous lymphadenitis.

Purpose: Tubercular lymphadenitis (TBLA) is a common manifestations of extrapulmonary tuberculosis (EPTB) accounting for 30-40% of cases. Prompt diagnosis and timely initiation of anti-tubercular therapy (ATT) is the key for successful clinical outcome. This study was carried out to evaluate multiplex polymerase chain reaction (MPCR) using MPB64 and IS6110, and compare with the conventional methods for rapid diagnosis of TBLA. Materials and Methods: In our study, lymph node fine-needle aspirates of patients were evaluated for TBLA. They were classified as Group I: TBLA group, divided into (a) Confirmed TBLA cases (n0 = 80): Culture/smear-positive or cytological examination showing presence of epithelioid cell granuloma with or without multinucleate giant cell and caseation necrosis with presence of AFB, and (b) suspected TBLA cases ( n = 30): Culture/smear-negative and cytological examination showing presence of epithelioid cell granuloma and response to ATT and Group II (Control) (n = 25): Patients of lymphadenopathy confirmed to be caused by other diseases such as sarcoidosis, lymphoma, etc., All samples were subjected to conventional tests and MPCR. For MPCR we used Mycobacterium tuberculosis-specific deoxyribonucleic acid sequences specific for the MPB64 and IS6110 region. Results: In the confirmed TBLA group, Ziehl-Neelsen (ZN) smear, cytology, culture, and MPCR positivity was 30%, 70%, 26.3%, and 91.3% respectively. In the suspected TBLA group, smear and culture were negative, and sensitivity of cytology and MPCR was 73.3% and 86.6%, respectively. In the control group all tests were found to be negative, thus giving a specificity of 100% to all the tests in the study. Conclusion: In conclusion, techniques like MPCR with high sensitivity and specificity can play an important role in rapid diagnosis of TBLA.

Evaluation of impression smear in the diagnosis of fungal keratitis.

PURPOSE: To evaluate and compare impression smear with the conventional mechanical corneal scraping by potassium hydroxide (KOH) method in the diagnosis of fungal keratitis. MATERIALS AND METHODS: Fifty consecutive cases of clinically suspected fungal keratitis were included. Under topical anesthesia, impression smear was obtained from the lesion, followed by the conventional mechanical scraping and both were transferred to sterile glass slides. The slides were examined under direct microscopy with KOH 10% wet mount. Impression smear KOH was compared with the scraping KOH and culture. RESULTS: The KOH smear was positive in 36 (72%) patients with impression smear technique and positive in 35 (70%) patients from corneal scrapings. Sensitivity of impression smear technique as compared to scraping was 97.14%, specificity 92.86%, positive predictive value 94.4%, negative predictive value 92.86%, false positive rate 5.56%, false negative rate 7.14% and accuracy was 94%. As compared to culture, the sensitivity was 100%, specificity 46.67%, positive predictive value 55.56%, negative predictive value 100%, false positive rate 53.33%, false negative rate 0% and accuracy was 68%. CONCLUSION: Impression smear KOH examination is comparable to conventional mechanical corneal scraping KOH examination in making a tentative diagnosis of fungal keratitis and can be accurately relied upon for initiating anti-fungal therapy.

Transendoscopic fine needle aspiration cytology in the diagnosis of hepatocellular carcinoma.

This report describes the use of transendoscopic fine needle aspiration cytology in the diagnosis of three cases of hepatocellular carcinoma who had presented with large nodular liver and mass impression on the left border of the stomach at endoscopy. Using a 21G, 1.0 cm needle catheter, transendoscopic fine needle aspiration was done under direct endoscopic vision. The aspirate confirmed the diagnosis of hepatocellular carcinoma in all of them.

Teratocarcinoma presenting with duodenal metastases diagnosed on endoscopic fine needle aspiration.

Upper gastrointestinal bleed as the first symptom of metastatic testicular tumors is rare. We describe a 17-year-old man who presented with upper gastrointestinal bleed; endoscopic fine needle aspiration cytology from a duodenal mass suggested germ cell tumor, which was later confirmed on histology of the testis.

T cell rich and histiocyte rich B cell lymphoma--a case report.

We report one case of Non Hodgkin's Lymphoma which was classified as Histiocyte Rich B cell lymphoma on immunocytochemistry. The diagnosis was difficult on fine needle aspiration cytology and routine histopathological examination as the infiltrate was composed of reactive lymphocytes and numerous histiocytes obscuring the lymphoma cell population. The neoplastic cells were positive for CD20(L26-A Pan B marker) and negative for CD15(Leu M1), CD3(Ber H2) and pan T cell markers. The histiocytes were positive for CD3(UCHL-1). The patient had a rapid downhill course and died. The autopsy showed infiltration in the axillary, cervical, mesenteric, para aortic, peri pancreatic and hilar lymph nodes. The liver, spleen, bone marrow and kidney also showed lymphomatous infiltration.

Ectopic pregnancy presenting as lower gastro-intestinal hemorrhage.

A patient with ruptured tubal pregnancy presenting with lower gastrointestinal bleed is described. Colonoscopy and other investigations were not helpful; laparotomy was diagnosis as well as therapeutic.

Fluoroscopic transbronchial fine needle aspiration for diagnosis of peripheral pulmonary nodules.

Transbronchial fine needle aspiration (TBNA) was performed under fluoroscopic guidance in 21 patients with either solitary (15 patients) or multiple (6 patients) peripherally located nodules. Good aspirate could be obtained in 16 patients (76.1%). Ten were confirmed to be malignant and 2 turned out to be tubercular. Nonspecific benign inflammatory aspirate was obtained in the other four. There were no significant complications. TBNA is thus an effective, safe and quick method for diagnosis of solitary/multiple pulmonary nodules.

Fine needle aspiration biopsy of pancreas.

Percutaneous fine needle aspiration biopsy (FNAB) were performed in 22 cases of pancreatic lesions. FNAB was done with the help of ultrasonographic guidance in 14 cases and intraoperatively in 2 cases. In rest of the cases it was done without any radiological guidance. Diagnosis was confirmed either by histopathology or exploratory laparotomy by follow-up data in rest of the cases. There was no false positive or negative diagnosis. Nuclear crowding, nuclear enlargement and prominent nucleoli were the important cytological criteria for pancreatic adenocarcinoma. Cytology smears of the islet cell tumour show round to oval monomorphic cells with central to eccentric nuclei and fine reddish granulations in cytoplasm. There was no complication following aspiration. Thus FNAB of pancreas is a relatively safe, reliable and quick technique which can be performed under ultrasound guidance.

Bronchoalveolar lavage--cellular characteristics in patients with idiopathic pulmonary fibrosis and sarcoidosis.

Bronchoalveolar lavage (BAL) was carried out in 30 patients of idiopathic pulmonary fibrosis (IPF), 10 patients of sarcoidosis and 10 normal subjects who served as controls. The total cell counts were higher both in the IPF (24.8 x 10(5)/ml) and sarcoidosis (19.3 x 10(5)/ml) as compared to the normal controls (9.8 x 10(5)/ml). The difference was statistically significant in both the groups (p less than 0.001 and less than 0.05 respectively). Patients with IPF showed a predominant polymorphonuclear response although the lymphocytes were also increased whereas patients of sarcoidosis had a lymphocytic response in the BAL fluid. In 6 patients with IPF the study was repeated after 6 weeks of steroid therapy and a decrease in the total cell count and polymorphonuclear cells (%) was noted.

Fine needle aspiration cytology of intrathoracic lesions--a repraisal.

FNAC was performed in 186 cases. Inadequate material was obtained in 41 cases. A definite diagnosis of malignancy could be made in 120 cases. In five cases a diagnosis "suspicious" of malignancy could be made. No serious complication was encountered with the technique. FNAC is of definite help in diagnosing the intra thoracic lesion whether malignant or inflammatory in nature. It also avoids unnecessary thoracotomy for diagnostic purposes.

AIDS in India: a report of three cases with review of literatures.

Sera from 3500 individuals including patients of non-Hodgkin's lymphoma, patients with sexually transmitted diseases, leprosy, jail inmates, healthy laboratory workers and patients on hemodialysis were screened for antibodies against human immunodeficiency virus (HIV) as a sero surveillance exercise of one of the centers set up by the India Council of Medical Research at the Postgraduate Institute of Medical Education & Research, Candigarh. Three individuals were found to be strongly positive by ELISA using the Wellcozyme kit, with no background noise in the population studies. These three patients were also evaluated by the Western blot technique and showed strong antibody reaction to all the major gene products. It was also possible to ascertain the approximate incubation period of infection in a case who rapidly developed full blown AIDS and died of wasting syndrome. Comprehensive data of 14 cases was also collected from all the centers in India and in every case one could trace the contact outside India. None of the 3 cases studied at our center had Kaposi's sarcoma. These observations could be important landmarks in the epidemiology of AIDS in India.

Leprosy, liver and jaundice.

Nine patients of leprosy, 5 BL and 4 LL who developed jaundice during the course of disease were investigated. Two LL patients developed jaundice during ENL reaction. There was slight hepatomegaly in 5 patients and moderate splenomegaly in 3 only. There was significant alterations in liver enzymes and serum bilirubin in all patients. The abnormalities of the enzymes levels persisted for abnormally long periods even when the serum bilirubin had come down and the patients had become asymptomatic. Blood for HBsAg and anti-HAV IgM was negative in all the patients except one in whom HBsAg was positive. Drugs could not be implicated as the cause of jaundice, all patients maintained recovery even after restarting antileprosy drugs. The possibility of non A, non B viruses producing hepatitis during the course of disease is brought out. Course of prolonged jaundice in leprosy is compared with other diseases which could result in a similar situation.