Diagnostic usefulness of triple biopsies (Skin, Muscle and Nerve) in clinically suspected cases of vasculitis in a tertiary care hospital in Gujarat

Introduction: The term vasculitis refers to a heterogeneous group of diseases, all characterized by inflammation and destruction of blood vessel walls leading to ischemic, thrombotic, and hemorrhagic damage to tissues of central and peripheral nervous system. The main indication for triple biopsy (skin, muscle and nerve) is to rule out peripheral vasculitis neuropathy. However, the drawback is that any systemic inflammatory process may show changes in a skin biopsy and hence these changes need to be interpreted with caution. The aim of this study is to establish the diagnostic yield and the usefulness of the triple biopsies in clinically suspected cases of vasculitis. Material and Methods: The present study was conducted in the Department of General Pathology, SBKS MI & RC, Vadodara over a period of one year (1/1/2022 to 31/12/2022). All the clinically suspected cases of vasculitis received at OPD were included in the study. Any case with either muscle, nerve or skin biopsy reported as inadequate were excluded from the study. Results: On evaluation the usefulness of triple biopsies for vasculitis, we found a very low diagnostic yield with only 3.3% of peripheral nerve biopsy and 0.8% of muscle and nerve biopsy showed definite vasculitis. In case of suspected peripheral/systemic vasculitic neuropathy, nerve biopsy was sufficient in the majority of case and has the diagnostic armamentarium for the evaluation of vasculitis. Conclusion: In conclusion, nerve biopsies provide the best yield for the diagnosis of vasculitis, as opposed to muscle and skin biopsies. The role of triple biopsies as a routine protocol for the evaluation of vasculitis is questionable.

A rare case report of Castleman's disease and review of literature

Castleman’s disease (CD) is a rare lymphoproliferative disorder, described for the first time by Castleman, et al. in 1954 in a single case then in 1956 in a group of 13 patients with localized benign lymphadenopathy. The incidence of CD is unknown and can occur at any age, however it is mainly reported in adults in the literature with a slight feminine predominance (60%). The majority of the previously reported cases of CD in the neck were of the hyaline vascular type and the most common sign was an asymptomatic neck mass. In the present case the patient is having unicentric CD and histologically it is Mixed Type. We are reporting this case because of its rarity.

Comparative Evaluation of Pre-operative Antibiotic Prophylaxis in the Prevention of Surgical Site Infections: A Prospective Study.

Introduction: One of the most important causes of post-operative morbidity is surgical site infection (SSI) in planned cases. It accounts nearly 65-80% of all cases and the most common nosocomial infection in our population accounting for 38%. Previous to the use of prophylactic antibiotic, the incidence of SSI was more, which has been drastically reduced the incidence of SSI. Aim: This study was conducted to know the need for antibiotic prophylaxis in clean, clean-contaminated surgical wounds and whether prophylactic antibiotic is itself suffi cient to minimize SSI. Materials and Methods: A 300 patients admitted between January 2013 and December 2014 in SBKSMI and RC, Vadodara, Gujarat were selected for our study, which were clean or clean-contaminated surgeries done under meticulous surgical technique. Results: The present study showed that there is no need for prophylactic antibiotics in cases of clean surgeries. Conclusion: The incidence of SSI depends on various factors such as old age (20.51%), anemia (20.51%), diabetes mellitus (15.38%), and prolonged duration of surgery more than 2 h (80%) and obesity (25.64%) are present.

Analytic Study of Chest Injury.

Background: Trauma is one of the leading causes of morbidity and mortality worldwide. Chest trauma constitutes about 10-15% of all cases and is responsible for 25% of deaths as a result of trauma. It is a major problem for India, where there is a very high incidence of vehicular accidents (6% of global vehicular accidents), along with crime and riots. In spite of that very few studies have been documented that assess the prevalence and management of these events. Hence, this retrospective study was carried out to determine the magnitude and management of patients with chest trauma in rural setup. Methods: A study of 100 cases of chest trauma admitted in Dhiraj Hospital, from May 2010 to September 2012 was carried out. The data collected included the patient’s demographic profi le; mode, type and severity of chest injuries, management scheme and outcome. Results: Of 100 patients who sustain chest trauma, 76% of cases were due to vehicular accident. Of 100 patients 64% had rib fractures, 17% had fl ail chest, 12% had pneumothorax, 24% had hemothorax, and 5% had hemopneumothorax and 24% had extra-thoracic injury. In 33% water seal intercostals tube insertion was done and 17% of patients having fl ail chest were treated with intermittent positive pressure ventilation. Conclusions: The present study reveals that the trauma commonly seen in young males was motor vehicle accident. The outcome and prognosis for the majority of patients of blunt chest trauma are excellent. Most require no invasive therapy or, at most intercostals chest drainage tube insertion.

Case of pulmonary pneumocytoma: A probable cytological diagnosis with histopathological confirmation.

Pneumocytoma is a rare benign tumor of the lung that usually presents as a solitary pulmonary nodule. It is believed to arise from the primitive undifferentiated respiratory epithelium. We report a case of pulmonary pneumocytoma that was suspected on needle aspiration smears and confi rmed histologically. This case describes the cytological features of pneumocytoma that are rarely described in textbooks.