Castleman Disease: A Rare and Intriguing Malady: A Case Series

Castleman disease (CD), first described by Benjamin Castleman as angiofollicular mediastinal lymph杗ode hyperplasia, is a rare benign lymphoproliferative disorder with varied modes of presentation. Its common presentation within the mediastinum misleads the clinician and merits special attention since it is essentially a diagnosis of exclusion. We are sharing our experience with three patients, within a relatively short period of 2 years. All three presented with a mediastinal mass, however, each of them came with an entirely different clinical scenario and diagnosis. All three were successfully operated and Castleman disease [hyaline杤ascular (HV) type] was diagnosed only after the final histopathology.

Prevalence of hypertension and its associated risk factors in rural community of Barabanki

Background: Hypertension is one of the most important non-communicable diseases. Although high blood pressure is a recognized risk factor for cardiovascular disease, the prevalence of hypertension still remains unclear for most populations. The objectives of the study were to estimate the prevalence of hypertension in rural area of Faizabad and to identify the associated risk factors for hypertension.Methods: This community-based cross sectional study was carried out among 300 adults from a randomly selected village in rural health training centre, Safdarganj who were aged 18 years and above over a period of 3 months from March 2019 to May 2019. Participants were interviewed and examined for the assessment of socio-demographic detail, behavioral and lifestyle risk factors of hypertension. Template generated in MS excel sheet and analysis was done on SPSS software.Results: Among 300 study participants, 45.3% were male and 54.7% were female. The prevalence of hypertension was observed to be 10.33%. It was found to be more common in males. Prevalence increased as the age increased. The prevalence of hypertension was high among obese and those consuming more than 2 spoons of salt every day.Conclusions: Prevalence of hypertension is different in different parts of the country. Higher age, male sex, tobacco use, obesity, less physical activity and high salt intake are significantly associated with hypertension.

A Study Of Ossicle At Asterion In Western U.P. Of North Indian Crania.

Background: Studies of non metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance. Methodology: Total of 28 north Indian human crania of western U.P. was studied for the incidence of Ossicle at Asterion a cranial variant. Results: Ossicle at Asterion was found in 4 (14.2%) of total human crania. Conclusion: The presence of Ossicle at Asterion found to be of considerable regional and racial significance.

Unilateral Superficial Brachial Artery With High Origin Of Profunda Brachii Artery.

Abstracts: Variations of the axillary artery have been frequently observed during routine anatomy dissection classes. These variations of vascular system are of considerable significance for surgical and radiological procedures. Accurate knowledge of these variations is desirable as well as essential as they may be mistaken for veins that may lead to formation of gangrene and even loss of hand during surgical procedures. Reported here is one such case of A unilateral superficial brachial artery with a high origin of Profunda Brachii artery (PBA) as observed during routine dissection class of medical students at Rohilkhand Medical College, Bareilly, India.

Incidence of bregmatic bone in north Indian skulls.

Background and objective: Studies of non-meteric cranial variants have been a field of considerable interest to research workers specially because of their racial and regional importance. Supernumerary ossicles (or Wormian bones) of the cranial vault are formations associated with insufficient rate of suture closure. It was reported that there exists racial variability among the incidence of these bones. Material and methods: Studies of fifty north Indian skulls of Rohilkhand Medical College Bareilly and Shri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, U.P. were studied for the incidence of Bregmatic bone cranial variant. Results: In our study the incidence of bregmatic bone was 4%, which was higher than reported elsewhere. Conclusion: The findings are discussed in the light of available literature and are of considerable racial and regional significance. We believe that the knowledge of bregmatic bone is of importance to the neuroanatomists, neurosurgeons, radiologists, anthropologists, paediatricians and morphologists.

A study of mastoid foramen in adult north Indian crania.

Background: Non metric cranial variants have always been a topic of considerable interest for research workers, as they possess racial, regional and sex dimorphic differences. These variants are also of anthropometric, genetic, morphological and forensic importance. Material and methods: 71 skulls from north indian region were studied for one of such variant, absence of mastoid foramen and presence of multiple mastoid foramen. Results: Incidence of absent mastoid foramen is 7.04 %, while bilateral incidence of absent mastoid foramen is only 1.4 %, however unilaterally mastoid foramen is absent in 5.63 %. (2.8 % on right side and 2.8 % on left side). Incidence of multiple mastoid foramina is 12.67 %, out of this it is bilateral in 8.45 %, however unilaterally it is present in 4.22 %. ( 1.40 % on right side and 2.81 % on left side).Conclusions: Findings are discussed and compared with other global studies and are found to be of considerable racial and regional significance. Knowledge of this variant is valuable in some neurosurgical and otolaryngeal procedures.

A study of metopic suture in adult north Indian skulls.

Background:- Studies of non metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance. Material and Methods:- Total of 40 north Indian skulls of U.P. were studied for the incidence of metopism, a cranial variant in the present study. Results:- Metopism was found in 2(5%) of total of human skulls. Conclusion:-The presence of Metopic suture found to be of considerable regional and racial significance and it simulates fracture of frontal bone, therefore its presence should be properly ruled out in X-rays.

Epidemiology of soft tissue sarcomas in Karachi South, Pakistan (1995-7).

INTRODUCTION: The present study was conducted with the objective of examining epidemiological characteristics of soft tissue sarcomas (STSs) in Karachi. PATIENTS AND METHODS: Epidemiological data of 96 (63 male and 33 female) incident STS cases registered at Karachi Cancer Registry (KCR) for Karachi South (KS), from 1st January 1995 to 31st December 1997, were reviewed. RESULTS: The age standardized rate (ASR) world per 100,000 were 3.3 (2.9%) and 2.1 (1.6%) in males and females, respectively, with mean ages of of 41.4 years (95% CI 35.77-46.97) and 40.2 years (95% CI 31.27-49.03). The age-specific curves showed a gradual increase in risk from the first until the eighth decade in both genders, with the highest peak at 75+ in females and 70-74 years in males. In males, 8 (12.7%) STS cases were diagnosed in the pediatric age group (0-14), 12 (19.1%) in adolescents and young adults (15-24 years), 19 (30.1%) in adults 25-49 years of age and 24 (38.1%) in the 50 years+ age group. In females the respective frequencies were 11%, 26%, 30% and 33%. The most common histological tumor was rhabdomyosarcoma, though the occurrence of the histological subtypes was age-dependent. Rhabdomyosarcomas and Ewing's sarcomas were more frequent in children and adolescents whereas fibrosarcomas, leiomyosarcomas, liposarcomas, malignant fibrous histiocytomas (MFHs) and schwannomas were encountered in the elderly. CONCLUSION: Karachi falls into a high risk region for STS, observed in a relatively younger population, with a male predominance, high frequency of rhabdomyosarcoma and advanced stage at diagnosis. Information on grading and staging remain incomplete for most cases, which negatively affect disease management and survival.

Time trends in the incidence of cancer cervix in Karachi South, 1995-2002.

INTRODUCTION: The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period. METHODOLOGY: Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002. RESULTS: Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5 and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate 10% increase. The mean age of the cancer cases was 53.3 years (SD 11.6; 95% CI 50.58, 55.96; range 32-85 years) and 50.7 years (SD 11.7; 95% CI 48.8, 52.5; range 51 years) in period 1 and 2 respectively. The morphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period, though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout. A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8% in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0% percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with a regional or distant spread of disease. CONCLUSION: Pakistan at present falls into a low risk cancer cervix region. The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanced disease at presentation; insignificant in-situ cancers and no preventive intervention or awareness practices in place.

Patho-epidemiology of cancer corpus uteri in Karachi South '1995-1997'.

AIM: To provide demographics and pathology of cancer of the uterine corpus in Karachi. METHODOLOGY: Data for 66 incident cases of cancer corpus uteri, ICD-10 category C54-5 registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997 were reviewed. RESULTS: Cancer uterine corpus (1995-97) was the sixth most common malignancy, following breast, oral cavity, ovary, esophagus and cervix. The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.4 (4.73 to 8.01) and 2.9 (2.18 to 3.57). The mean age was 53.7 years (SD 15.6; range 6-90 years). Fifty eight cases were endometrial carcinoma with ASR world and CIR per 100,000 of 5.77 (4.20 to 7.33) and 2.53 (1.88 to 3.18) respectively. Sarcomas comprised 6% of the cases. Approximately a third of the females (28.8%) were below 50 years of age. The age-specific curves showed a gradual increase from the fourth till the seventh decade, followed by an actual apparent decrease in risk after 70 years. Peak incidence was observed in the 65-69 year age group. Presenting symptoms were post-menopausal bleeding (86.4%) and purulent discharge (4%). Associated pathologies included adenomyosis, adenomatous hyperplasia (12% each) or leiomyoma (8%). Associated clinical conditions were diabetes mellitus and hypertension (4% each). The majority of the cases presented as well differentiated (39.4%), localized (59.1%) lesions. CONCLUSION: The incidence of cancer corpus uteri in Karachi South reflects a moderate risk population, predominantly middle aged with a higher socio-economic status. On the average the malignancy is observed a decade earlier then reported elsewhere. This calls for in-depth investigation of risk factors and identification of underlying etiology.

Patho-epidemiology of Cancer Cervix in Karachi South.

INTRODUCTION: The present study was conducted with the objective of examining descriptive epidemiological and pathological characteristics of cancer cervix in Karachi South, an all urban district population of Karachi, Pakistan. METHODOLOGY: A total of 74 cases of cancer cervix, ICD-10 (International Classification of Diseases 10th Revision) category C53 were registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997. RESULTS: The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 (5.2, 8.43) and 3.22 (2.49 to 3.96). Cancer cervix accounted for approximately 3.6% of all cancers in females and was the sixth malignancy in hierarchy. The mean age of the cancer cases was 53.27 years [standard deviation (SD) 11.6; 95% confidence interval (CI) 50.58, 55.96; range (R) 32-85 years)]. The distribution by religion was Muslims (90.5%), Christians (8.1%) and Hindus (1.4%). There were no cases reported in Parsees. The frequency distribution by ethnicity was Urdu speaking Mohajirs (20.3%), Punjabis (17.6%), Gujrati speaking Mohajirs (4.1%), memon Mohajirs (8.1%), Sindhis (10.8%), Baluchs (8.1%), Pathans (5.4%) and Afghan migrants (2.7%). The ethnicity was not known in approximately a fourth (23.0%) of the cases.The socio-economic distribution was 27.0% financially deprived class, 24.4% lower middle class and 48.7% upper middle and affluent classes. The majority of the women were married (86.5%); a smaller number were unmarried (2.7%) or widows (10.8%). The age-specific curves showed a gradual increase in risk from the fourth up till the seventh decade, followed by an actual apparent decrease in risk after 64 years of age. The peak incidence was observed in the 60-64 year age group. The morphological categorization was squamous cell carcinoma (86.5%), adenocarcinoma (10.9%) and adenosquamous carcinoma (2.6%). The majority of cases presented with moderately differentiated or grade 2 lesions (45.9%). There were no in-situ cases. Approximately half the cancers (58.1%) had spread regionally and 8.1% to a distant site at the time of diagnosis. Odds ratios (OR) were calculated for socioeconomic residential categories, religion, ethnicity, age groups and education. The OR for socioeconomic residential categories ranged between 0.69 and 2.9 with a marginally higher risk in the lower [OR 2.09 (95% CI .97; 4.49)] and lower middle class [OR 2.08 (95%CI 0.95; 4.58)]. Hindus [OR 1.2 (95% CI 0.18; 2.2)] had a slightly higher risk then the Muslims [OR 0.14 (95% CI 0.17; 1.2)]. A higher risk was also observed for Christians [OR 7.76 (95% CI 1.74; 34.5)]. CONCLUSION: The incidence of cervical cancer in Karachi South (1995-97) reflects a low risk population with a late presentation and a high stage disease at presentation. It is suggested that cervical screening if implemented should focus on once a life time methodology involving 36-45 year old women. This should be combined with HPV vaccination for the young and public health education for all. A regular cervical screening program would require mobilization of considerable financial, structural and human resources along with training for personnel. This may burden the already stretched health resources of a developing country.

Patho-epidemiology of breast cancer in Karachi '1995-1997'.

OBJECTIVE: Provide an overview of the demographics and pathology of breast cancer in the female population of Karachi South during a 3 year period, 1995-1997. METHODS: Epidemiological data for 709 incident breast cancer cases, ICD-10 category C50 registered at Karachi Cancer Registry during 1st January 1995 to 31st December 1997 were reviewed. RESULTS: Breast cancer accounted for approximately one-third of the cancers in females. The age standardized incidence rate (ASR) world per 100,000 was 53.8, the crude incidence rate was 30.9. In KS 60% of the newly diagnosed breast cancers were observed in women below 50 years. The age-specific curves showed a gradual increase in risk from the third up till the seventh decade, followed by an actual/apparent decrease in risk. The socio-economic distribution was 24.9% in category I the financially deprived class, 38.9% in category II the middle class and 35.9% in category III, the affluent class. Microscopic confirmation of malignancies was 99%. Invasive breast cancers predominated with 99.4%, with in-situ cancers contributing to 0.6% of the malignancies. The morphology of cancers was tilted towards duct cell carcinoma (DCC), pure DCC (92%), combinations of DCC /Paget's disease (0.6%) and lobular carcinoma (0.4%). Approximately 45% of duct cell carcinoma were seen in the premenopausal age group (<45 years). All bilateral breast cancers were duct cell carcinoma with a family history of first degree relative with breast cancer. The majority of the cases presented as moderately differentiated or grade 2 lesions (59.0%). Approximately 56% cancers had spread to the regional lymph nodes and 8.3% to a distant site at the time of diagnosis. A family history of first degree relative with breast cancer was present in 3% and second degree relatives in 7% of the cases. Odds ratio (OR) for 680 breast cancer cases with complete demographic information was calculated with 675 gender matched controls. A slightly higher risk was observed in non-Muslims and migrant ethnicities: two to three fold elevation in the Indian migrants (Gujrati speaking Mohajirs OR 3.86 (95% CI 2.51; 5.92) Urdu speaking Mohajirs OR 2.85 (95% CI 2.05; 3.96), Memon Mohajirs OR 2.21 (95% CI 1.48; 3.29) and Afghan migrants [OR 2.99 (95% CI 11.20; 7.44)]. The risk was also high in the females of Punjabi ethnicity settled in KS [OR 2.73 (95% CI 1.87; 3.99)]. The risk seems much less for the ethnicities belonging to North Western Pakistan i.e. Pathans [OR 1.684 (95% CI 0.89; 3.17)] and Baluchs [OR 0.90 (95% CI 0.58; 1.39)]. A marginally higher risk was observed in the higher socio-economic categories.The risk of developing breast cancer increased gradually for each age category from illiterate [OR 1.2 (95% CI 0.94; 1.55)] to college graduates [OR 13.12 (95% CI 7.31; 23.73)]. CONCLUSIONS: The incidence of breast cancer in Karachi South (KS) for the period 1995-1997 was the third highest in Asia. The hallmarks were a high reproductive age malignancy involving a higher socio-economic class, an invasive duct cell carcinoma diagnosed at an advanced stage, in younger more educated females and a low in-situ malignancy. More studies are required to obtain a deeper insight into this breast cancer epidemic in Karachi. Implementation of breast cancer screening with stress on public health education is today a major responsibility of the government.

A simple chemical method for the oxidation of beta-hydroxybutyrate; application of the method for the estimation of ketone bodies.

A simple one-step method employing potassium persulphate as an oxidising agent in presence of catalyst, Ag2+, for the oxidation of beta-hydroxybutyrate (beta-OHB) to acetoacetate (AcAc) has been developed and standardized. Under the condition of assay, beta-OHB (0.079-0.395 microM) was quantitatively transformed to AcAc. The reaction linearity was observed from 0.079 to 0.634 microM. Optimum conditions were: pH, 6.2; temp., 40 degrees C; persulphate saturation, 40% and catalyst, 1.82 mM. Under the experimental condition, no reversal of inhibition caused by chloride (22.96 mM) was observed at Ag+ concentrations (9.09 and 18.18 mM), while higher conc. of Ag+ (27.27 mM) caused significant reversal of inhibition (about 60%). The maximum reversal of inhibition was achieved at Ag+ (36.36 mM). The level of ketone bodies, when estimated by the present method, was greatly enhanced during starvation period and about 2- and 12-fold higher level of ketone bodies was observed (compared to control) in rats fasted for 24 and 48 hr respectively.

Spectral evidence for the oxidation of beta-hydroxybutyrate to acetoacetate: diminution of spectra by glucose and chloride.

Chemical oxidation of beta-hydroxybutyrate (beta-OHB) to acetoacetate (AcAc) has been carried out by a simple and new method employing potassium persulphate as an oxidising agent. Under the conditions of assay, beta-OHB (0.079-0.395 microM) was instantaneously oxidised to AcAc and the authenticity of the oxidised product was proved by absorption spectroscopy. A common absorption maxima at about 446 nm was observed in all the spectra recorded for the product (AcAc-complex) obtained after the oxidation of beta-OHB (0.079-0.395 microM) to AcAc followed by coupling with diazotized p-nitroaniline. This absorption maxima was almost equal to that obtained for AcAc-complex using AcAc as reference standard. It implies that AcAc formed by the chemical oxidation of beta-OHB is identically similar to the AcAc used as reference standard for the study. This fact was further strengthened when absorption spectra, recorded either individually or in combination (mixed-type), exhibited a single peak with a common absorption maxima at about 446 nm. Absorption spectra was found to be partially diminished by glucose (1.77 microM) and chloride (17.1 microM), while almost complete diminution of absorption spectra was observed at higher concentration of glucose (8.88 microM) and chloride (51.3 microM).

A rapid method for preparation of sarcolemma from frog skeletal muscle.

A rapid method for the preparation of sarcolema from frog skeletal muscle has been described. The purified cell segments were transparent and devoid of contractile material. The Na+, Κ+ -ATPase and 5'-nucleotidase activities in sarcolemma purified by this method were comparable to those reported for sarcolemmal preparations purified by density gradient centrifugation. The preparation also possessed acid phosphatase, alkaline phosphatase and Κ+-activated, ouabain-sensitive p-nitrophenyl phosphatase activities. The cholesterol to phospholipid ratio of the sarcolemma was 0.33, indicating its high purity; further, the preparation was free from mitochondria and contractile proteins.

Effect of phospholipase-D on rat kidney mitochondria.

Incubation of purified rat kidney mitochondrial fraction with phospholipase- D resulted in the accumulation of phosphatidic acid in the membrane due to the degradation of membrane-bound phosphatidylcholine, -serine and -ethanolamine Simultaneously with the hydrolysis of the phospholipids, cholesterol and protein were released from the mitochondrial membrane into the medium, and binding of Ca2+ by mitochondrial membranes increased. Phospholipase Dtreated mitochondrial fraction exhibited increased swelling in vitro in the early stages of incubation (15 min) after which the mitochondria were ruptured. Membrane- bound adenosine triphosphatase was partially inactivated and the enzyme activity was not significantly restored by incubation with sonicated dispersions of phosphatidylcholine, -serine and cholesterol. These results indicate that removal of choline, serine and ethanolamine from membrane-bound phospholipids disrupt phospholipid-cholesterol and phospholipid-protein association and affect functions of the membrane.