STUDY ON THE EFFECT OF BRASS AND COPPER ELECTRODES DURING ELECTRIC DISCHARGE MACHINING OF INCONEL 718 USING NANO PARTICLES MIXED DIELECTRIC FLUID.

Electrical Discharge Machine (EDM) parameters have a significant influence on machining characteristic like material removal rate (MMR) and tool wear rate (TWR). Inconel 718, which is widely used in the Medical, Marine, Architectural and food processing industries, is used as a work material. The tool electrode materials used are brass and copper. Experiments are conducted using face centered central composite design to determine the effects of process parameters like current rate, pulse on time, pulse off time and concentration of titanium carbide nano particle in dielectric fiuid. Based upon the experimental outcomes, the effect of brass and copper electrodes during electric discharge machining of Inconel 718 using nano particles mixed dielectric fiuid was investigated.

Biphasic squamoid alveolar renal cell carcinoma: A rare entity with an even rarer presentation as cutaneous metastases – A case report

Biphasic squamoid alveolar renal cell carcinoma (BSARCC) is a newly emerging distinct and rare morphologic variant of renal cell carcinoma (RCC). Morphological, immunohistochemical, and molecular data have shown that BSARCC is closely related to papillary RCC type 1. We report a case of Biphasic squamoid alveolar renal cell carcinoma with a rare presentation as cutaneous metastases. This variant tends to show an aggressive behavior. Hence, accurate histopathological diagnosis can help in effective treatment and for close follow-up of the patients.

Role of CTLA4 immunohistochemistry in the diagnosis of colon cancers

Background: There are a wide range of diagnostic markers for colorectal cancers like detection of mutated KRAS, TP53, and APC genes. However, genetic and immunological factors have also been attributed to the cancer prognosis. The present study was carried out to evaluate the expression of CTLA-4 in colorectal cancers. Methods: This cross-sectional study was carried out among 30 resected specimens of colorectal cancer. Paraffin blocks were made on samples from tumor areas along with adjacent normal areas. Immunohistochemistry for CTLA-4 was done on the sections along with controls. Gross findings were recorded from the blocks. Blocks with section containing normal epithelium and tumor were chosen for immunohistochemistry. Results: Overexpression of CTLA-4 was observed in 43.3% of the tumors. There was a significantly high tumor infiltration among those specimens showing overexpression of CTLA-4. The observed difference was statistically significant (P < 0.05). On comparing the grade of the tumor with intensity of CTLA4 uptake, it was observed that majority of the well-differentiated tumors (66.7%) had an intensity of 1+ whereas majority of the poorly differentiated tumors had an intensity of 3+ (66.7%). Conclusion: The present study has demonstrated overexpression of CTLA-4 in colorectal cancer specimens, and also highlighted the potential scope for anti-CTLA-4 agents like Ipilimumab in cancer therapy. The need for further evaluation to examine five-year survival with such immunotherapies is essential to document candid therapeutic recommendations for colorectal cancers.

Imaging and pathological discordance amongst the plethora of breast lesions in breast biopsies

Introduction: Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis. Materials and Methods: This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed. Results: A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%. Discussion: The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions. Conclusion: In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Cystic hypersecretory carcinoma with invasion: Case series on a rare variant of carcinoma breast

Background: Cystic Hypersecretory Carcinoma (CHC) is a rare subset of breast carcinoma. It is part of a spectrum of cystic hypersecretory lesions which includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situ and CHC with invasion. Approximately 65 cases of cystic hypersecretory lesions have been reported; most of them were CHC in situ and only 19 cases of CHC with invasion have been reported so far. Case Presentation: We are reporting 2 cases of 47 and 62 year old women with a palpable breast mass for 6 and 1 month duration respectively. Trucut biopsy was carried out for both which showed high grade ductal carcinoma in situ with microinvasion in the first patient and the latter showed a tiny focus of invasive carcinoma. Simple mastectomy and modified radical mastectomy (MRM) were done for the respective cases; both showed dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells that showed variable degrees of proliferation, atypia and in situ carcinoma. There were foci of invasion in both cases and hence a morphological diagnosis of CHC with invasion was made. Conclusion: Owing to a smaller number of reported cases, little is known about the biological behavior, prognosis and molecular profile of cystic hypersecretory carcinoma.

Is there a need for antibiotic cover in clean surgery like laparoscopic cholecystectomy: a prospective study

Background: Even with a low post-operative infection complication rate in elective laparoscopic cholecystectomy (LC), most surgeons use prophylactic antibiotics out of habit. This prospective study was done to analyze the need for such prophylaxis in cases of elective LC.Methods: 135 successive patients undergoing elective LC were included in the study. Patients were randomized into 3 groups. Group A (n=45) cases received 3 doses of injection ceftriaxone in the post op period, group B (n=48) cases received a single dose of injection ceftriaxone at the time of induction of anesthesia, and group C (n=42) cases did not receive any antibiotic pre or post operatively. Post-operative infectious complications between three groups were compared.Results: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, duration of surgery and hospital stay. Intraoperative spillage of bile [6.7% (A): 4.6% (B): 5.2% (C)] did not increase infectious complications.Conclusions: Routine use of prophylactic antibiotic in a clean, uncomplicated cases of laparoscopic cholecystectomy is not required. One dose of ceftriaxone at the time of induction or 3 doses of injection ceftriaxone post operatively following elective LC even in the urban Indian setting should be abandoned as it neither reduces the rate of surgical site infection but also contributes to adverse reactions, drug resistance, and unnecessary financial burden.

Trichoblastic carcinoma arising in trichoepithelioma in Brooke–Spiegler syndrome

Brooke–Spiegler syndrome (BSS) is a rare autosomal dominant disease characterized by the development of multiple cutaneous adnexal neoplasms namely cylindroma, trichoepithelioma and spiradenoma. The neoplasms associated with this syndrome are generally benign, but rarely they may undergo malignant transformation. A 63-year-old male presented with an ulcerated nodular lesion over glabella and multiple asymptomatic nodular lesions over face, scalp, chest and limbs. His father, grandfather and paternal cousins had history of similar lesions. Histopathological examination revealed trichoblastic carcinoma arising from trichoepithelioma over glabella and cylindroma on the chest. With these findings we arrived at a diagnosis of BSS with malignant transformation of trichoepithelioma. Trichoblastic carcinoma arising in trichoepithelioma in a patient with BSS is extremely rare with only a single case reported in literature.

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Recombinant factor VIIa in a case of pontine hemorrhage.

A 59-year-old lady presented with hypertensive hemorrhage involving the pons. Since she presented within 3 hours of onset of the stroke, recombinant factor VIIa was administered. From a state of altered sensorium there was a rapid recovery of consciousness followed by gradual improvement in limb weakness. Serial CT scans of the brain revealed no further expansion of the hematoma. The hematoma progressively resolved. Recombinant factor VIIa could be an attractive therapeutic option in treating hemorrhages at critical sites like brainstem where expansion of hematoma could be fatal.

An association of Alternaria alternata and Scopulariopsis brevicaulis in cutaneous phaeohyphomycosis.

Rare molds are increasingly emerging as a cause of deep and invasive fungal infections. We report here a rare case of cutaneous phaeohyphomycosis of the lower limbs due to Alternaria alternata associated with extra-ungual localization of Scopulariopsis brevicaulis. Diagnosis was made based on repeated, direct, microscopic mycological and histological examinations. The study revealed hyphae and fungal cells in a granulomatous dermal infiltrate. Identification of the molds was based on macroscopic appearance on culture of samples from the lesions on Sabouraud's dextrose agar and microscopic appearance on Lactophenol cotton blue following slide culture.

Genetic and metabolic diversity of pink-pigmented facultative methylotrophs in phyllosphere of tropical plants

Diversity of Pink-Pigmented Facultative Methylotrophs (PPFMs) in phyllosphere of cotton, maize and sunflower was determined based on differential carbon-substrate utilization profile and Random Amplified Polymorphic DNA data. Results indicate that six diversified groups of PPFMs are found in these crops. Sunflower and maize phyllosphere harbor four different groups of methylobacteria while cotton has only two groups.

A diversidade de microrganismos metilotróficos facultativos pigmentados (PPFMs) na filosfera de algodão, milho e girassol foi determinada baseada no perfil diferencial de utilização de substratos de carbono e em dados de RAPD. Os resultados indicaram a existência de seis grupos diferentes de PPFMs nessas plantas. As filosferas de girassol e milho apresentaram quatro grupos diferentes de metilobactérias enquanto a de algodão apresentou apenas dois grupos.

Recurrent venous thrombosis with factor V Leiden mutation.

A patient who presented with recurrent venous thrombosis is reported. Following an episode of spontaneous deep vein thrombosis of the lower limb he was started on oral anticoagulant therapy, which he discontinued. He presented with cerebral venous thrombosis and improved partially with anticoagulant therapy. Evaluation for hypercoagulable states revealed factor V Leiden mutation by polymerized chain reaction method. Long-term anticoagulation has been planned. Evaluation for factor V Leiden mutation is always warranted in patients presenting with spontaneous thrombosis, especially if there is recurrent thrombosis.

Cardiac involvement in Wilson's disease--an electrocardiographic observation.

BACKGROUND: Wilson's disease is known for its protean manifestations; however electrocardiographic abnormalities have not received much attention. AIM: To evaluate the various electrocardiographic (ECG) changes in patients with Wilson's disease. METHOD: The resting ECGs of 50 patients with Wilson's disease were systematically analyzed independently by three observers after excluding other causes that could induce ECG abnormalities. RESULT: Fifteen patients had at least one abnormality in the ECG. Sinus tachycardia was seen in eight and sinus bradycardia in six. Other abnormalities included: bifid P wave (1), ST elevation (2), ST depression (2), T inversion (4), ventricular premature contraction - VPC (1) and prominent U waves (1). QRS axis, PR interval, QRS complex, R/S amplitude ratio and QT interval were normal in all. Ventricular premature beats were not recorded in any. None had features of ventricular hypertrophy. There was no statistically significant difference in ECG abnormalities with reference to age, gender, duration of illness or treatment, serum copper or ceruloplasmin, and severity of neurological impairment. CONCLUSION: ECG abnormalities are not uncommon in Wilson's disease and are presumably related to an underlying cardiomyopathy due to deposition of copper in heart.

Bacteriological profile of cholera in Tamil Nadu (1980-2001).

BACKGROUND & OBJECTIVE: In addition to Vibrio cholerae O1, a recently emerged non-O1 serotype, V. cholerae O139 has also been found to be responsible for epidemics of cholera. In the context of the changing etiology of cholera, the occurrence of different serotypes, biotypes and phage types of V. cholerae in Tamil Nadu is presented. METHODS: Between 1980 and 2001, 26,502 stool/rectal swabs from patients suspected to have cholera were processed for the presence of V. cholerae at the King Institute of Preventive Medicine, Chennai (Madras), Tamil Nadu. Serotypes, biotypes and phage types (Basu & Mukerjee and new phage typing method) of the isolates were determined. Antimicrobial susceptibility determination was included from 1997 onwards. RESULTS: Of the 26,502 stool/rectal swabs tested, 6035 (22.8%) specimens yielded V. cholerae. 4,046 (67%) of them were O1 serotype; followed by 1529 (25.3%) O139 serotype and 448 (7.4%) non-O1 serotypes other than O139 were encountered. Twelve specimens yielded rough strains of V. cholerae. All V. cholerae O1 were the biotype ElTor and the predominant serotype was Ogawa (95.9%). After the initial explosive epidemic by O139 serotype in late 1992 and early 1993 occurrence of this serotype had declined. Resurgence of this new serotype was observed in 1997. O1 domination was observed during 1995 and 1996. The new phage typing scheme for V. cholerae O1 was able to differentiate the isolates into 22 types, type 27 (68.2%) being the predominant one followed by type 26 (12.3%). In Basu & Mukerjee scheme, the isolates were clustered between two types--type 2 (34%) and type 4 (61%). Further, about 5 per cent of them were untypeable. All but a few of the isolates irrespective of serotype, were susceptible to chloramphenicol, tetracycline, gentamicin and ciprofloxacin. 97 per cent of the O1 strains and 48.9 per cent of the O139 strains were resistant to cotrimoxazole. INTERPRETATION & CONCLUSION: V. cholerae O139 might have the ability to survive during interepidemic periods. Both V. cholerae O1 and O139--the two serotypes with epidemic potential seem to be firmly established in this region. This situation warrants constant surveillance.