Glandular-type inverted papilloma of urinary bladder – Report of a unique case with immunohistochemistry

Inverted papilloma of urothelium is a rare benign tumour accounting for 1–2% of all the urothelial lesions. Morphologically, these are of two main subtypes – trabecular and glandular, of which the former subtype is most frequently encountered compared to the latter. The glandular subtype closely mimics cystitis glandularis and urothelial carcinoma with inverted growth pattern. We discuss a case of a 27-year-old male presenting with hematuria. On cystoscopy, he was found to have a bladder mass which was diagnosed as glandular-type of inverted papilloma on histopathology. The image illustrates the histopathology for easy identification and early diagnosis of this rare entity.

Lobster-claw syndrome.

Lobster-Claw syndrome is a rare autosomal dominant, hand-foot malformation with Oro-dental features. This is a rare condition and from the available reports so far, cases being reported are less than 1%. Most reports have focused on the hand-foot deformity of this syndrome. This paper highlights the typical Oro-dental features associated with this syndrome such as retained deciduous teeth, hypodontia and variation in crown size, arch length and arch width.

Comparative analysis of monoclonal antibody based enzyme immunoassay, modified genome electrophoresis & electron microscopy procedures for rotavirus diagnosis from faecal specimens.

BACKGROUND & OBJECTIVES: Reliable and rapid diagnosis of rotavirus infection is necessary for patient management. Several newly introduced commercial enzyme immunoassays (ELISAs) have been evaluated using direct electron microscopy (DEM) with or without direct ultracentrifugation as the standard reference method, and have shown varying results. METHODS: In the present study we compared the diagnostic efficacy of the three methods viz., monoclonal antibody (MAb) ELISA, modified polyacrylamide gel electrophoresis (PAGE) and DEM without ultracentrifugation in the detection of rotaviruses from 211 stool specimens. The data were analysed by two latent class model (2LC) in the absence of a gold standard reference method. RESULTS: Rotavirus was detected in 42 specimens by MAb-ELISA; in 40 specimens by PAGE and in 33 specimens by DEM. The estimates of sensitivities and specificities of the three methods were analysed by 2LC method. The analysis revealed no significant variation among the three methods. However, DEM was found with a comparatively lesser sensitivity over the other two methods. INTERPRETATION & CONCLUSIONS: Though DEM was found to be relatively less sensitive than the other two methods, the differences were not significant, and all the three methods were highly specific. Moreover, DEM has the additional advantage of detecting non-group A and other gastroenteritis viruses. The findings suggest the use of highly sensitive and specific MAb-ELISA and PAGE in parallel to detect group A, non-group A and atypical rotavirus infection in the population.

Effect of bed time intermediate acting insulin in NIDDM subjects refractory to a combination of sulphonylureas and biguanides.

The effect of a single dose of intermediate acting (Lente) insulin given subcutaneously at 9.00 P.M. in 22 NIDDM subjects refractory to a combination of Sulphonylureas and Biguanides was analysed. Euglycemia was achieved and maintained during the study period of three months with a mean insulin requirement of 14.22 +/- 5.98 units/day. Plasma FFA, Total cholesterol, triglyceride and VLDL-cholesterol also showed significant reduction. The level of FFA modulates hepatic glucose production, which in turn correlates positively with the fasting blood glucose. The therapeutic modality of bed time Lente Insulin based on physiological principles is an effective way of achieving glycemic control in NIDDM subjects who have become non-responsive to oral hypoglycemic agents.

Subcutaneous insulin pulse therapy.

Subcutaneous Insulin Pulse Therapy (SIPT) consists of administration of small doses of regular insulin hourly or two hourly in the subcutaneous tissue of anterior abdominal wall through a scalp vein needle. Fifteen Non-Insulin Dependent Diabetes Mellitus (NIDDM) subjects, 8 males and 7 females with mean ages 58 +/- 8.7 years and mean duration of diabetes 11.7 +/- 9.1 years and mean BMI 25.2 +/- 5.64 were admitted for elective surgery. Glycemic control was attempted preoperatively with multiple pre-meal doses of Actrapid MC with a single injection of Monotard MC at bed time. The mean fasting plasma glucose in the 15 subjects with this insulin regimen was 321.28 +/- 69.32 mgm% and the insulin requirement per day was 106.87 +/- 35.77 units. The subjects were put on SIPT for 48 to 72 hours. During SIPT the mean fasting plasma glucose dropped to 123.2 +/- 74.11 mgm% and this marked decline in fasting plasma glucose value was statistically significant (P < .05). The insulin requirement during SIPT was 96.42 +/- 31.36 units, similar to the previous regimen (NS). The subjects were switched back to conventional insulin therapy after SIPT during which period the mean fasting plasma glucose was 125.82 +/- 34.50 mgm% and this value was again significantly lower than the pre SIPT fasting plasma glucose value (P < .05). Insulin requirement during conventional insulin therapy after SIPT was reduced to 71 +/- 21.89 units/day. This dose was significantly lower than the insulin dose administered during SIPT (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Keloids and diabetes in a family.

An interesting familial association of keloids with diabetes mellitus in three successive generations is reported. Keloids did not develop if the injection site was changed to the anterior abdominal wall.