A stepwise approach to fine needle aspiration cytology of lymph nodes

The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

Projection of Infant Mortality Rate in Malaysia using R (Unjuran kadar kematian bayi di Malaysia menggunakan R) / Jurnal Sains Kesihatan Malaysia

@#Projecting future infant mortality rate (IMR) is an important subject in ensuring the stability of health in one nation or a specific region in general. Secondary data of IMR from December 1950 until December 2020 from United NationsWorld Population Prospects were used to project the trend of IMR in Malaysia up to 2023. In this study, five different forecasting models were adopted including Mean model, Naïve model, Autoregressive Integrated Moving Average (ARIMA) model, Exponential State Space model and Neural Network model. The results were analyzed using R programing and RStudio. The out-sample forecasts of mortality rates were evaluated using six error measures namely, Mean Error (ME), Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Percentage Error (MPE), Mean Absolute Percentage Error (MAPE) and Mean Absolute Scaled Error (MASE). Consequently, the keen analysis was focused on the trend and projection of infant mortality rate in the future using the most accurate model. The results showed that the “win” model for this study is ARIMA (0,2,0) model. The model provided a consistent estimate of IMR in relation to a similar decreasing pattern as shown by the original data and hence a reliable projection of IMR. The three ahead forecast values showed that IMR is likely to keep on continuously decreasing in the future. This study could become a guideline for human resource management and health care allocation planning. A forecast of IMR can help the implementation of interventions to reduce the burden of infant mortality within the target range.

Fatal invasive gastrointestinal fungal infection in three non-immunocompromised patients

The importance and frequency of invasive fungal infections in different organs, including the gastrointestinal tract, has increased due to excessive use of aggressive immunosuppressive and immunomodulatory drugs in malignant diseases and organ transplantations as well as increased infections with the human immunodeficiency virus [HIV]. Fungal infections in the small intestine or colon are usually part of a disseminated disease process and reach these organs through the bloodstream. Two of the patients were infants 10 and 15 days of age, while one was 23 years old. Patients presented with abdominal pain, intestinal obstruction, and rectal bleeding. Hirchsprung disease was suspected in the two infants. In the adult patient, the diagnosis was unclear. Mucormycosis was diagnosed in two out of three cases. It is imperative for clinicians to consider invasive mycosis in the differential diagnosis in patients of all ages with treatment-resistant severe abdominal pain, diarrhea and fever

Myocardial Revascularization utilizing interanl mammary arteries

Objective: To study myocardial revascularization with arterial grafts utilizing internal mammary arteries, with special reference to its morbidity and mortality and the results of internal mammary artery grafting in various ages and genders

Study Design: Retrospective study

Place and Duration of Study: National Institute of Cardiovascular Diseases [NICVD], from Mar 2012 to Feb 2013

Material and Methods: Patients with concomitant valve replacement, ventricular aneurysmectomy redo coronary bypass or other cardiac or ascending aortic procedures were excluded from this analysis. No patient was excluded for any other reason. The age range was 35 to 80 years. The statistical analysis for comparison of different proportions were carried out with the help of chi-square statistics, when the test is valid

Results: A total of 150 patients were studied during the year 2012-2013, out of which 135 were males and 15 were females. The ages ranged between 35-80 years. Majority of the patients in both groups were in the age range between 45-60 years. Far less were females 10 percent-15 patients as compared to male patients [90 percent - 135]. Out of these 18 percent had unstable and 5 percent had atypical angina. After surgery most of the patients in both the study groups experienced an equal degree of angina relief. Exertional dyspnea was present in 20 percent and palpitation in 5 percent of our patients

Conclusion: In this study conclude that internal mammary grafting does not increase morbidity, has lower mortality. Possibly no absolute contra - indications to the use of single, internal mammary artery there may be some relative contra-indication

The Influence Of Visual Art Therapy On Paediatric Dental Patient: A Pilot Study

Objective: This study examined the influence of visual art therapy techniques in reducing anxiety levelamong 4 to 6 years old paediatric dental patients.Methods: Eleven subjects were selected among 4 to 6 years old paediatric dental patients. The initialreaction towards dental procedure/treatment was evaluated using Frankl Behavior Rating Scale. Theanxiety level was assessed by using Malay-Modified Child Dental Anxiety Scale (MCDASf) to measurea child situational anxiety of pre- and post-treatment. Visual art making activities included free drawing,clay moulding and collage technique. The participant reaction to dental treatment was assessed by usingFrankl Behavioural Rating Scale for two subsequent independent visits in two weeks interval. Medianand Ordinal Test ranked the variables score of behavioural reaction towards dental treatment and anxietylevel.Results: Play-doh (PD) subjects could accept dental procedures more if compared to free drawing (FD)and storytelling by collage (ST) subjects, which has lower post treatment-median scores in Visit 1 andVisit 2, FD and ST subjects need more time to show positive attitude towards dental treatment.Conclusion: These findings suggest dental anxiety level of children aged 4 to 6 years old reduced afterthe art therapy and play-doh(clay-moulding technique) is the art making activity of choice among 4 to 6years old paediatric dental patients.

Radioprotective effect of growth radiation and growth hormone hormone [somatotrophin] on irradiated long bones of young albino rats

To evaluate possible effects of Growth hormone in ameliorating the harmful effects of radiation on growing long bones of young albino rats. Experimental study. This study was carried out at Department of Anatomy, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC] Karachi from January 2009 to June 2009. 30 litters of 10 days of age of albino rats were taken for this study. They were divided into three groups: Group A [Control],Group B[Irradiated] was given 5Gy gamma radiation and Group C was given radiation and injection somatotrophin [Growth hormone]. Each Group was further subdivided into two sub Groups according to their respective time period of treatment i-e., 2 and 4 weeks respectively. Their weight was observed weekly. Animals were sacrificed by etheranasthesia. Dissection was done and the long bones i,e., humerus and femur were taken out and their length and width measured by digital caliper. A significant decrease in weight was noted and there was significant decrease in length and width of long bones in irradiated sub Groups B as compared to control Group A. There was significant increase in weight, length and width in long bones of irradiated and somatotrophin treated sub Groups of C as compared to irradiated sub Groups of B. Irradiation causes severe bone growth retardation. Growth hormone protects the bone injury and reverses the damage

No Detection of Simian Virus 40 in Malignant Mesothelioma in Korea

BACKGROUND: Simian virus 40 (SV40), a polyomavirus, was discovered as a contaminant of a human polio vaccine in the 1960s. It is known that malignant mesothelioma (MM) is associated with SV40, and that the virus works as a cofactor to the carcinogenetic effects of asbestos. However, the reports about the correlation between SV40 and MM have not been consistent. The purpose of this study is to identify SV40 in MM tissue in Korea through detection of SV40 protein and DNA. METHODS: We analyzed 62 cases of available paraffin-blocks enrolled through the Korean Malignant Mesothelioma Surveillance System and performed immunohistochemistry for SV40 protein and real-time polymerase chain reaction (PCR) for SV40 DNA. RESULTS: Of 62 total cases, 40 had disease involving the pleura (64.5%), and 29 (46.8%) were found to be of the epithelioid subtype. Immunostaining demonstrated that all examined tissues were negative for SV40 protein. Sufficient DNA was extracted for real-time PCR analysis from 36 cases. Quantitative PCR of these samples showed no increase in SV40 transcript compared to the negative controls. CONCLUSIONS: SV40 is not associated with the development of MM in Korea.

Primary Thymic Mucinous Adenocarcinoma: A Case Report

Primary thymic mucinous adenocarcinoma is an extremely rare aggressive subtype of thymic carcinoma. With a review of literatures, only nine cases have been reported up to present. A 36-year-old woman was admitted for further evaluation and treatment of a mediastinal mass. The patient had no medical history of cancer. The clinicoradiological examination disclosed no tumor elsewhere. After the surgical excision of mediastinal mass, it was grossly a round semi-solid mass with mucin-filled cystic areas. Microscopically solid areas showed cords, small nests and dilated glands infiltrating the fibrotic parenchyma, while the cystic areas were lined by mucinous epithelium with tumor cells floating in extracellular-mucin pools. Some cystic walls underwent malignant transformation of the benign thymic epithelium. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK20, CD5, and CDX-2, and negative for thyroid transcription factor-1. In conclusion, the mucinous thymic adenocarcinoma should be recognized as a separate histopathological entity and considered in the differential diagnosis of mediastinal carcinomas.

Functional Adrenocortical Oncocytoma: A Case Report of Rare Neoplasm of Uncertain Malignant Potential

Adrenocortical oncocytoma is a rare adrenal neoplasm with only 25 cases having been reported in the English medical literature, of which only seven were functional tumors. Since these adrenal tumors are usually nonfunctional, they are mostly incidentally detected, and most of them are benign. Herein, we report on a rare case of a functional adrenocortical oncocytoma of an uncertain malignant potential and this tumor was located in the left adrenal gland in a 59-year-old woman who presented with hypertension. The tumor size was large with foci of necrosis in the cut surface and it exclusively had oncocytic histologic features.

Fulminant Epstein-Barr Virus-associated T-cell Lymphoproliferative Disorder in an Immunocompetent Middle-aged Man Presenting with Chronic Diarrhea and Gastrointestinal Bleeding

The World Health Organization (WHO) recently defined systemic Epstein-Barr virus (EBV)-positive T-cell lymphoproliferative disorders (LPD) of childhood as a life-threatening illness. However, this rare disease has not been extensively studied. Here we report a case of systemic EBV-positive T-cell LPD in a previously healthy middle-aged man with a chief complaint of chronic diarrhea. The initial colon biopsy showed focal infiltration of EBV-positive small lymphocytes without any atypia. However, the disease rapidly progressed and the patient required a total colectomy due to severe gastrointestinal bleeding. Three and half months after admission, the patient died from a complication of disseminated intravascular coagulation. The resected colon showed diffuse infiltration of EBV-positive atypical lymphocytes with ischemic change. Most atypical lymphocytes were CD3+ or CD5+. The monoclonality of EBV was demonstrated by sequence variation analysis of the latent membrane protein 1 (LMP1) gene in the colectomy specimen as well as in the initial biopsy.

Two Cases of Pyoderma Gangrenosum Associated with Recurrent Ulcerative Colitis / 대한소화기내시경학회지

Pyoderma gangrenosum (PG) begins with a painful, erythematous skin lesion followed by pustule formation and rapid ulceration in which an erythematous border surrounds a sterile, necrotic center. In most patients, symptoms of ulcerative colitis precede PG, and exacerbations of the bowel disease frequently correlate with worsening of the skin lesions. As PG is not commonly encountered by clinicians, the diagnosis of such lesions is not always straightforward. This case emphasizes the importance of detailed history taking and the consideration of PG as a differential diagnosis of such lesions in patients with a background of related systemic disease. The prognosis of PG is generally good. But, early aggressive therapy can minimize severe complications, and maintenance treatment may prevent some devastating consequences. We report two cases of PG that developed on the entire body and on an anterior chest wall abscess with ulcerative colitis, which improved with corticosteroid and cyclosporine.