Utility of gamma-glutamyl transpeptidase and mean corpuscular volume in alcoholic liver disease.

The present study was designed to establish the role of Gamma-glutamyl transpeptidase (gamma-GT) and mean corpuscular volume (MCV) in alcoholic liver disease (ALD). Serum gamma-GT, total and direct bilirubin, albumin, total protein, AST, ALT and ALP were assayed by standard methods in a clinical chemistry autoanalyser. MCV, Hb, PCV and RBC were measured by an automated cell counter. Activity of gamma-GT and MCV levels were significantly higher in the patients with ALD compared to controls. A gamma-GT level of > or = 25 U/l was found to be significantly associated with ALD. MCV level > or = 100 fl/l showed a significant association with ALD. An AST to ALT ratio > 1 was found in 92% of the patients. None of the patients showed an ALT level > or = 300 IU/l. The degree of AST elevation in the patients with ALD was higher (3.7 times) then ALT (3.2 times). A gamma-GT level > or = 25 IU/L and an MCV level > or = 100 fl/l stand as markers of heavy alcohol consumption in this study. An AST to ALT ratio > 1 was present in most of the patients with ALD. The degree of elevation of AST was higher than ALT in the patients with ALD.

Primary liposarcoma of the omentum: a case report and review of the literature.

A case of round cell liposarcoma of omentum in a 45-year-old man is reported. The patient presented with abdominal pain, swelling and fever of 4-month duration. Abdominal ultrasonography and computed tomogram confirmed the presence of an abdominal mass, but the omental origin of the tumour was revealed only on laparotomy. In addition to the main tumour mass, multiple nodules were present in the omentum. The tumour was excised with omentum. Histopathology of the tumour revealed a round cell liposarcoma. The patient expired 9 months after operation. Eight other cases of liposarcoma of omentum reported in English literature are reviewed.

Lymphatic leishmaniasis--first case report from Nepal.

We report a case of exclusive involvement of lymph node in leishmaniasis presenting as generalized lymphadenopathy. The diagnosis of lymphatic leishmaniasis was confirmed by the presence of Leishmania donovani body in fine needle aspiration cytology, positive direct agglutination test and anti-rK39 antibodies. The bone marrow aspiration was negative for Leishmania donovani body. This is the first case of lymphatic leishmaniasis reported from Nepal.

Cutaneous metastatic adenocarcinoma.

A 55-year-old male presented with asymptomatic nodules and plaques on his scalp and pubic region of 2 months' duration. He was having productive cough, haemoptysis, chest pain, anorexia and weight loss and receiving antitubercular treatment for these symptoms for last 3 months. Clinical diagnosis of cutaneous metastatic disease was made. Chest x-ray revealed multiple coin shaped shadows on both sides with pleural effusion. Routine investigations were normal except for anemia and hyperuricemia. Biopsy of skin nodules showed features of metastatic adenocarcinoma. Features and significance of cutaneous metastases are discussed.

Cystic granulosa cell tumor of the ovary--a case report.

A case of cystic granulosa cell tumor of ovary in a 32 year old woman is described. The patient presented with abdominal mass without any signs and symptoms of hyperestrinism and virilization. Ultrasonographically and grossly a diagnosis of benign cystadenoma was considered. Histopathology confirmed the diagnosis of cystic granulasa cell tumor.

An incidental case of breast cysticercosis associated with fibroadenoma.

It is unusual for cysticercosis to occur in the substance of the breast. Only a few cases have been described in the literature. We report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 35 year old Nepali woman. The patient had no discernible evidence of cysticercosis in the other organs.

Lymphangiectatic fibrolipomatous polyp of the palatine tonsil.

A rare benign polypoid tumor of the right palatine tonsil is described in a 23 year old male. It contained dilated lymphatic channels surrounded by fibrous tissue and foci of mature fat. The features of this lesion add support to the hypothesis that benign tumors of tonsil may be hamartomas of tonsil rather than true neoplasms. The differential diagnosis of polypoid lesions of the tonsil is discussed.

Congenital infantile fibrosarcoma of the upper extremity.

Congenital-infantile fibrosarcoma is an unusual childhood tumor that occurs mainly in children under 5 years of age. More than 300 cases have been reported in the literature so far, very few of them at birth. A distinction must be made between it and its adult counterpart because of differences in their clinical behaviour. We report here a case of congenital fibrosarcoma in a 4-day-old female infant.

Hydatid cyst presenting as a breast lump.

We report a 33-year-old woman who presented with a breast lump which, on pathological examination, was found to be a hydatid cyst. There was no evidence of any coexistent lesion elsewhere. To our knowledge, this represents the first case of hydatid disease of the breast reported from Nepal.

Quality assurance programme in haematology at a teaching hospital in the eastern region of Nepal.

Quality assurance in haematology laboratory is intended to ensure the reliability of the laboratory tests. A quality assurance programme has two main aspects, namely, internal quality control and external quality assessment. A two year experience of quality assurance in haematology laboratory at B.P. Koirala Institute of Health Sciences, Nepal, is presented here. As a part of internal quality control, test results in the laboratory were scrutinized before release on a daily basis. Inconsistent result were checked for the given values with control material. In addition, the laboratory is a participant of the 'External Haematology Quality Assurance Programme' conducted by WHO regional reference centre at AIIMS, New Delhi, India. Variations related to errors in manual and autopipetting, calibration and inter-observer differences have been noted from time to time and rectified. The programme has helped us to deliver quality service in haematology laboratory at BPKIHS.