Malignant Sertoli cell tumor of the testis masquerading as seminoma with bone metastasis

Sex cord–stromal tumors of the testes are rare malignancies as compared to germ cell tumors. Pure Sertoli cell tumors are still rare representing <1% of testicular cancers and the malignant forms are too rare. Furthermore, the occurrence of metastasis in such cases is extremely rare with <30 cases reported in literature so far to the best of our knowledge. We present herein a case of malignant Sertoli cell tumor in a 48-year-old male who was initially misdiagnosed as seminoma based on histology and clinical presentation. Four months later, he presented with symptoms due to bony metastasis and found to have widespread metastatic disease which is a very rare presentation of Sertoli cell tumors. Diagnosis of sex cord–stromal tumor requires high index of suspicion as these tumors are most of the times misdiagnosed as germ cell tumors due to their rare incidence and atypical presentation leading to mismanagement. Timely diagnosis at an early stage can provide therapeutic benefit due to lack of well-defined treatment options at advanced stages.

Antimicrobial resistance in invasive and colonising Streptococcus pneumoniae in North India.

The present study was done to detect the antibiotic resistance in S. pneumoniae. One hundred twenty S. pneumoniae isolates from clinical specimens and 50 from nasopharyngeal sites were subjected to antimicrobial susceptibility testing by Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC) determination for penicillin and cefotaxime non-susceptible isolates. A total of 22 isolates (18.3%) from clinical sites and eight (16%) from nasopharyngeal sites showed decreased susceptibility to penicillin by oxacillin disk diffusion test. MICs of 26 of these resistant strains ranged from 0.12-1 microg/mL (intermediate resistance) by broth dilution and E test. Only four isolates, two from sputum and two from nasopharyngeal swabs, showed MIC of 2 microg/mL (complete resistance). However, MIC of two cefotaxime resistant isolates (by disk diffusion) was in the susceptible range (0.5 microg/mL). Highest antimicrobial resistance was seen to cotrimoxazole (55.2%) and tetracycline (61.2%). Antimicrobial resistance to cotrimoxazole and tetracycline was much more in clinical isolates than colonizing isolates. Multi-drug resistant phenotype was detected in 76.9% (20 of 26) of isolates that were intermediately sensitive to penicillin and 50% (2 of 4) of penicillin resistant isolates (co-resistant to tetracycline and cotrimoxazole). Routine screening for antibiotic susceptibility is recommended for clinical isolates of pneumococci. Strains with reduced susceptibility to penicillin should be subjected to MIC determination to detect relative resistance or true resistance as such strains are associated with increased virulence.The choice of antibiotics should be guided by the prevalence of local resistance patterns of pneumococci.

Isolated intraorbital metastasis in breast carcinoma.

We report a case of metastases to the eye, in a 30 year old lady with carcinoma breast leading to isolated metastatic involvement of the lateral rectus muscle with no evidence of metastases at any other site in the body after a follow up of one year after completion of chemotherapy.

Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi.

AIM: To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season. METHODS: Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001. RESULTS: Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies. CONCLUSIONS: This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.

A study of prevalence of health problems in asymptomatic elderly individuals in Delhi.

A survey was conducted in asymptomatic aged individuals (> or = 60 years) in The National Capital Territory of Delhi for the prevalence of major health problems like hypertension, diabetes mellitus and respiratory diseases. A total of 200 individuals (100 males and 100 females) were studied over a period of three months in 1998-99. Hypertension was defined as BP > or = 140/90 mmHg (JNC VI criteria), while diabetes mellitus was diagnosed if fasting whole blood sugar was 120 mg/dl or more (WHO criteria). Diagnosis of other health problems was based on relevant history and physical examination. Prevalence of hypertension in the study group was 32.5 per cent (more in males). Of these 18 per cent and 4.2 per cent had isolated systolic and diastolic hypertension, respectively. Prevalence of diabetes mellitus in the same population was 13.0 per cent. Both diseases were more prevalent in urban population. A high prevalence of respiratory disorders was observed (pulmonary tuberculosis 16 per cent, COPD 10 per cent, asthma 4.5 per cent). Cataract was present in 7.5 per cent while 1.5 per cent had symptoms of urinary tract infection. History of Jaundice was present in 3.5 per cent. Three per cent each had a history suggestive of IHD and TIA, respectively. Proteinuria and glycosuria was seen in 22.2 and 7.6 percent, respectively. A large percentage of the study group (34.4 per cent) had asymptomatic ECG abnormalities.

Clinicohaematological profile in chronic renal failure.

OBJECTIVE: Aim of the study was to observe the clinicohaematological profile, bone marrow and serum iron indices of patients with chronic renal failure. METHOD: A total of 27 patients of chronic renal failure were selected, irrespective of their age, sex, clinical profile and etiology. These patients were not on dialysis, haematinics or erythropoietin therapy. They underwent series of biochemical and haematological investigation including bone marrow aspiration and also estimation of serum iron indices. RESULTS: The commonest cause of chronic renal failure in study group was diabetes mellitus (20%), glomerulonephritis (8%). Fifty percent of the patients on first presentation were in end-stage renal disease. Most patients presented with features of anaemia (94%), uraemia (63%) and fluid overload (96%). Severity of anaemia was correlating with degree of azotemia. Sixty percent of the patients had microcytic hypochromic anaemia, five percent had macrocytic anaemia while 30% had normocytic normochromic anaemia. The reticulocyte count was high in 46% of the patients. RDW-CV of greater than 14 was observed in 67%. Thrombocytopaenia was found in 52% of the patients. Leucocyte count was within normal range in 75%. In differential leucocyte count and absolute eosinophil count was high in 32% of the subject. In bone marrow examination 61% of the patients had normal bone marrow cellularity, 75% were having erythroid hyperplasia. Fifty seven percent of the cases had bone marrow iron store of zero, 37.8% had normal bone marrow iron store, 6.5% had increased bone marrow iron store. Serum ferritin was low in 62% and serum iron was below normal in 74% of the patients. CONCLUSION: Majority (65%) of patient had microcytic hypochronic anaemia because of iron deficiency and 33% of patient had parasitic infestation.

Detection of tubercle bacilli in sputum: application of sodium hypochlorite concentration method.

Tuberculosis has emerged as the leading cause of death due to single infectious agent. Sputum microscopy forms mainstay of diagnosis as it is most reliable, specific and objective method available especially in developing countries. However, this method is hampered by lack of sensitivity. Liquefaction and concentration of sputum before Ziehl Neelsen staining improves yield and also makes examination of smears rapid and convenient. A total of 304 sputum samples were studied by direct staining and after sodium hypochlorite treatment and centrifugation. Direct smears stained with Auramine-Phenol were also examined. Use of sodium hypochlorite method increased the number of positive samples from 52 to 96. No false positives were detected by either method. The method is simple as the only extra reagent required is sodium hypochlorite that is easily available. Additional advantage is that sodium hypochlorite, being a potent disinfectant, reduces the risk of laboratory acquired infections.

Plasma cortisol response to 1 microgram adrenocorticotropin at 0800 h & 1600 h in healthy subjects.

BACKGROUND & OBJECTIVES: Cortisol response to 250 micrograms adrenocorticotropin (ACTH) exhibits no circadian variation. Information on the circadian variation, if any, in cortisol response to 1 microgram ACTH, which is considered as a physiological dose is not available. As the 1 microgram ACTH stimulation test is projected as an outpatients procedure with no time constraint, this information is very important. Hence, this study was designed to assess whether any circadian variability exists in cortisol response to 1 microgram ACTH in healthy subjects. METHODS: Thirty six healthy volunteers (23 male and 13 female) with mean age of 32.2 +/- 9.0 yr were consecutively studied after obtaining informed consent. On day 1, prestimulated and stimulated plasma cortisol samples were collected at 0800 h and, at 30 and 60 min following an intravenous bolus of 1 microgram ACTH, and on day 3, plasma cortisol samples were similarly collected at 1600 h. Cortisol estimation was done by a sensitive and specific radioimmunoassay. Stimulated plasma cortisol of 500 nmol/1 or more was defined as a normal response. RESULTS: The prestimulated and peak cortisol levels at 0800 h (377.5 +/- 93.3 and 729.1 +/- 183.2 nmol/l) were higher (P < 0.001 and P < 0.01) than those at 1600 h (230.1 +/- 75.7 and 665.8 +/- 138.6 nmol/l). However, a stimulated cortisol response of 500 nmol/l or more was observed at both 0800 h and 1600 h in all subjects at 30 min but not at 60 min. The [symbol: see text] (peak-basal) response was higher at 1600 h than that at 0800 h (432.8 +/- 136.8 vs 351.5 +/- 177.3, P < 0.01). INTERPRETATION & CONCLUSION: The demonstration of normal cortisol response to 1 microgram ACTH both at 0800 h and 1600 h suggests that the test can be performed at any time of the day.

Acute lymphoblastic leukemia presenting as breast mass.

We present here a 34 years female who presented with bilateral breast lumps as the initial manifestation of acute lymphoblastic leukemia. She was treated with consolidation chemotherapy and showed good response.

Growth hormone therapy.

Growth hormone therapy with rhGH (recombinant human growth hormone) has been recommended for treatment of GH deficient short stature in children, repeated hypoglycemias in infancy and early childhood due to GH deficiency, short stature accompanying chronic renal failure prior to renal transplantation and Turner's syndrome. It is now increasingly recommended to adults with GH deficiency following pituitary tumour surgery or irradiation or idiopathic hypopituitarism. There are other indications for its use where evidence for protein catabolism is very strong such as burns injury. The end points of GH therapy in children include achievement of desirable adult height or a growth rate velocity of < 2.5 cm/year. In adults GH deficiency, GH therapy is intended for improvement of general well being, body composition and metabolic markers of GH function.

Cortisol response to arginine-vasopressin does not compare with cortisol response to insulin-hypoglycemia in pituitary tumors.

Timed cortisol responses to insulin-hypoglycemia (IH) and arginine-vasopressin (AVP) were compared in 16 patients with pituitary tumors and six healthy controls. Serum cortisol was estimated by a specific and sensitive radioimmunoassay as per the WHO protocol. The basal cortisol (AM) was normal (> 290 nmol/l) in 9 patients and low in seven. With IH peak cortisol response was normal (> 550 nmol/l) in 10 patients, 8 of whom had normal and 2 had low basal (AM) cortisol. In contrast AVP evoked normal cortisol responses in only 5 of these patients, all of whom had normal basal (AM) cortisol and none had low basal (AM) cortisol. The data indicate lower sensitivity for AVP stimulation test (50%) and favour IH as the standard cortisol stimulation test in patients with pituitary tumors awaiting surgery.

Serum and cerebrospinal fluid concentrations of rifampicin at two dose levels in children with tuberculous meningitis.

Twenty patients of tuberculous meningitis (TBM) in age group of 6 months to 10 years included in the study were divided into two groups of 10 patients each. Rifampicin was administered in dosage of 10 mg and 7.5 mg/kg bw to each patient of groups I and II respectively. Drug concentrations in serum and CSF of these patients were measured by a microbiological tube dilution method using a strain of Sarcina lutea. In group I mean serum and CSF concentration was 3.84 micrograms/ml and 0.178 microgram/ml respectively, while in group II it was 2.16 micrograms/ml and 0.206 microgram/ml respectively. These concentrations were many times higher than the MIC against Mycobacterium tuberculosis. Mean percentage penetration of rifampicin in CSF was 5 and 10% in group I and II respectively. We recommend similar studies in large number of children before advocating the therapy with low dose of rifampicin in TBM.

Anaerobic flora in endodontic infections.

Microbiological and clinical data from 56 patients with endodontic infections were evaluated. Samples were collected using autoclaved paper points. Specimens were processed for isolation of aerobic and anaerobic bacteria. Antimicrobial sensitivity and resistance profiles of the recovered isolates was also performed. Forty nine positive cultures (87.5%) were obtained from the 56 consecutive necrotic root canal systems which were sampled. A total of 69 aerobic bacteria and 21 anaerobic bacteria were recovered. Aerobic bacteria were isolated from 35 patients (72%), anaerobic bacteria from 3 (6%) and mixed aerobic and anaerobic bacteria from 11 patients (22%). The most common aerobic isolate was Klebsiella pneumoniae. The predominant anaerobic isolate was Bacteroides species. One isolate was recovered from 25 patients (51%) whereas in the remaining 24 patients (49%) more than 1 isolate were recovered. These data illustrate the polymicrobial nature of endodontic infections in half the patients studied and the role of anaerobic bacteria in a quarter of them.