Role of peak expiratory flow rate and chest radiography in children above 5 years of age with acute asthma

Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78'14.36, which improved significantly to 67.13'14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ' 4.11 and 96.96'2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.

Cytomorphology of subcutaneous panniculitic T-cell lymphoma (SPTCL)--a case report.

T cell lymphomas account for approximately 60% of cutaneous lymphomas. The annual incidence of cutaneous lymphoma is estimated to be from 0.5 to 1 per 1,00,000 persons per year. We present one case of cutaneous lymphoma, an eighteen year old male who presented with multiple swellings all over the body of one month duration. On examination, multiple, subcutaneous, mobile, non tender nodules were seen ranging from 0.5 cm to 5 cm in diameter. FNAC revealed non-Hodgkin's lymphoma morphologically in favour of cutaneous T-cell lymphoma. A biopsy and immunohistochemistry confirmed SPTCL.

Mast cell profile in uterine cervix.

Mast cell profile was studied in 50 neoplastic and 50 non-neoplastic conditions of the uterine cervix. The mean number of mast cells decreased to 44.8 in chronic cervicitis with ulceration, whereas the highest number of mast cells was observed in cervical polyp with a mean of 250. The mean number of mast cells was also higher in papillary endocervicitis (102.57) and chronic cervicitis (103.8). Mast cells were found in close proximity to the cervical glands and around blood vessels in non-neoplastic lesions. Mast cell count in carcinoma of cervix ranged from 0 to 210 per 10 HPF with a mean of 48.08. When the invasion by tumour was extensive the total count of mast cells was lower when compared to minimal invasion. The distribution of mast cells was found to be around the tumour deposits. Comparison of mast cell densities in neoplastic and non-neoplastic conditions revealed an increase in chronic inflammatory processes, while in cancers there was diminution in number or total absence of mast cells. There is no conclusive correlation between the age of the patients and the density of mast cells. An inverse relationship existed between the mast cell population and degree of anaplasia as well as of mitotic figures.

Study of mast cells in non-neoplastic skin lesions.

Sixty non-neoplastic skin lesions were studied for mast cells by toluidine blue stain. The highest numbers of mast cells were seen in the viral infections of the skin (50/mm2) and lowest number of mast cells in congenital diseases (17/mm2). Out of the cutaneous bacterial infections, highest numbers of mast cells were seen in leprosy (44/mm2) while in lupus vulgaris they were much less (37/mm2). In leprosy cases it was observed that as the lesions moved from indeterminate to both polar tuberculoid and lepromatous, the mast cell count increased. It could therefore be summarised that periodic follow-up of indeterminate and borderline lesions for mast cell count might help in predicting stability of lesions. In non-infectious squamous and papular lesions the mean mast cell count was 39/mm2. The highest numbers of mast cells in the non-infectious vesicular and bullous lesions were in bullous pemhigoid (57/mm2) and lowest in dermatitis (38/mm2).

Connective tissue stromal changes in tumours and tumour-like lesions of the breast.

Between June 1994 and December 1995, one hundred and fifteen tumours and tumour-like lesions of the breast were studied in the Department of Pathology, Kasturba Medical College, Mangalore. Neoplasms constituted 80.9% and tumour like lesions accounted for 19.13%. Among the tumours, 51.6% were benign and 48.4% were malignant. Tumour-like lesions included the entire spectrum of fibrocystic disease. Tumours were common between 2nd and 8th decades while tumour-like lesions were uncommon above 6th decade. Whereas benign tumours exhibited ground substance, collagen and reticulin fibres in varying amounts, tumour-like lesions and carcinoma showed more of collagen fibres and less of ground substance. Elastosis and lymphoplasmacytic infiltrate were prominent features in carcinomas rather than in benign lesions.