A Study to Know the Effect of Antiepileptic Drugs on Liver Enzymes

Objective: To know the effect of antiepileptic drugs on liverenzymes.Study Design: Cross sectional study.Materials & Methods: The study was conducted on 108patients at SIMS Hapur and G.S Medical College Hapurbetween Jan 17 to Dec 17. Patients divided into 3 groups,consisting of 36 patients in each group of phenytoin,carbamazepine and valproate.Results: Total No. of Patients was 108, out of which 36patients were there is each group of Phenytoin,Carbamazepine and valproate. Most of the patients 36(33.33%) and 32 (29.62%) belongs to age group of >40 – 50years and >50 year respectively. Regarding raised SGPT, itwas seen in 5 (13.89), 3 (8.33) and 3 (8.33) in phenytoin,carbamazepine and sodium valproate group respectively.SGOT were raised in sodium valproate group respectively.Alkaline phosphatase were raised in 10 (27.78), 20 (55.56) and22 (61.11) in phenytoin group, carbamazepine group, andsodium valproate group respectively.Conclusion: From the present study we can conclude thatsodium valproate is more hepatotoxic than carbamazepinewhich is more toxic than phenytoin. It is recommended thatbase line Liver Function Test (LFT) is essential before startingof AEDs and regular monitoring of LFT is also done betweenthe course of treatment.

Neuropathy in cases of Hypothyroidism as Confirmed by Motor Nerve Conduction Studies: A Prospective Study in a Tertiary Care Hospital

Background: Thyroid hormone play important role in development of Central Nervous System and in myelination of neurons. Patients of hypothyroidism may suffer from peripheral nervous dysfunction. Aim of our study is to find out the neuropathy in hypothyroidism. Methods: This prospective study was conducted on 40 subjects, out of which n=20 were euthyroid control and n=20 were hypothyroid. The Study was performed in the Medicine department of Saraswathi Institute of Medical Sciences, Hapur in collaboration with the department of Physiology at G.S. Medical College, Hapur. MNCV and latency of Median, Ulnar, and Common Peroneal nerve of both upper and lower limb were done in patients of Hypothyroidism and in Control subjects. Results: Significant bilateral decrease is observed in the MNCV of the Median Nerve in Hypothyroid subjects as compared to the control subjects. Also, there  is Significant  bilateral  increase  in the  Motor Latency of the Median Nerve in Hypothyroid subjects as compared to the control subjects. Conclusion: Hypothyroidism cause significant decrease in MNCV of Median Nerve as well as increase in Motor latency in Median Nerve.

Synchronous Clear Cell Renal Cell Carcinoma And Tubulocystic Renal Cell Carcinoma

Tubulocystic renal cell carcinoma (TCRCC) is a recently described rare subtype of RCC. To best of our knowledge less than 70 cases have been reported till date. The concurrent papillary RCC (PRCC) and TCRCC has been documented in literature, but the co-occurrence of clear cell RCC (CCRCC) and TCRCC is very rare. We are describing a rare case of incidentally detected TCRCC occurring with CCRCC in a 45 years old male who presented with high grade fever with chills and rigors. Grossly, there were two distinct tumors in the total nephrectomy specimen. The larger tumor displayed the histopathological features of CCRCC and the smaller tumor revealed the features of TCRCC.treatment in the present case.

Renal cell carcinoma in India demonstrates early age of onset & a late stage of presentation.

Background & objectives: Clinical spectrum of most of the diseases in developing countries is different from the west. Similarly whether renal cell carcinomas (RCC) in a developing country like India is seen in the same spectrum in relation to the age at presentation as in the west is not described in the literature. This study was carried out to investigate the spectrum of RCC in India with regards to age of onset, stage at presentation and survival. Methods: Patients with renal tumour, treated between January 2000 to December 2012 in a tertiary care hospital in north India, were analyzed for age at presentation, clinical features and histopathological characteristics. Clinical diagnosis was made by contrast enhanced computerized tomography (CECT) scans and/or magnetic resonance imaging (MRI). Renal masses diagnosed as angiomyolipoma, infective masses and hydatid cysts were excluded from the analysis. Impact of various age groups on gender, tumour size, TNM stage, Fuhrman grade, histopathological subtypes, lymph node, inferior vena cava (IVC) involvement and survival was analyzed. Patients were grouped in five age groups i.e. ≤39, 40-49, 50-59, 60-69 and more than 70 yr of age. Results: Of the total 617 patients with 617 renal tumours (2 patients had bilateral tumours but only the larger tumour was considered) clinically suspected as RCC, 586 had epithelial cell tumour and the remaining 31 had non epithelial cell tumour. The mean tumour size was 8.08±3.5 cm (median 7, range 1-25 cm). Tumour of less than 4 cm size was present in only 10.4 per cent patients. The mean age at diagnosis was 55.15±13.34 (median 56, range 14-91 yr) years. A total of 30.03 per cent of renal tumours presented in patients younger than 50 yr of age. Though there was no difference in stage, Fuhrman’s grade, IVC involvement and lymph nodal spread among various age groups, younger patients had higher proportion of non clear cell RCC and only 48.59 per cent of them presented with conventional RCC. Mean survival was lower in patients younger than 39 yr with HR of 1.7 (0.8-3.2). Interpretation & conclusion: Our results showed that renal cell carcinoma was more frequent in younger people in India. One third of the patients were less than 50 yr of age and only 10.4 per cent patients had tumour of less than 4 cm (T1a). Younger patients of <39 yr of age had relatively lower survival rates.

Cytology Of Adrenal Lesions

Cystic and solid lesions in the adrenal glands commonly present as mass lesions and have varied etiology as infectious diseases, benign eysts, adrenal neoplastic lesions and metastasis. Smaller sized and nonfunctional small adrenal lesions, incidentaloma,are being picked up with the advancement in the radiological diagnostic modalities and widespread use of CT scans and USG. Main use of the FNA of adrenal lesions is to ascertain origin and character of cystic and solid adrenal masses, distinguishing benign adrenal nodules from metastatic tumors and diagnosis of infectious diseases commonly presenting as adrenal insufficiency (disseminated histoplasmosis). Radiological guided FNAC of adrenal gland provides an easy and quick method for the diagnosis of these lesions.

Aggressive osteoblastoma in mastoid process of temporal bone with facial palsy.

Osteoblastoma is an uncommon primary bone tumor with a predilection for posterior elements of spine. Its occurrence in temporal bone and middle ear is extremely rare. Clinical symptoms are non-specifi c and cranial nerve involvement is uncommon. The cytomorphological features of osteoblastoma are not very well defi ned and the experience is limited to only few reports. We report an interesting and rare case of aggressive osteoblastoma, with progressive hearing loss and facial palsy, involving the mastoid process of temporal bone and middle ear along with the description of cyto-morphological features.

Chronic diarrhea and malabsorption due to hypogammaglobulinemia: a report on twelve patients.

Hypogammaglobulinemic sprue (HGS), which may predispose to infection, is uncommon. Twelve patients (all men; median age 29 years, 15–50) with HGS (4%) of 296 with chronic small bowel diarrhea and malabsorption syndrome (MAS) during a 10-year period were analyzed. Treatment of HGS was delayed due to misdiagnosis as intestinal tuberculosis (n=7) and diarrhea-predominant irritable bowel syndrome (n=1). All had diarrhea and weight loss (median loss 12 Kg). Associated conditions were clubbing, bronchiectasis, and seizure (2 patients each), and hypothyroidism (n=1). Laboratory parameters were urinary D-xylose median 0.46 g/5 g/5 h (range 0.2–1.6; normal ≥1), fecal fat 11.9 g/day (3.8–16.7; normal ≤7 g), serum IgA, IgG, and IgM: 23.5 mg/dL (17–114; normal 90–450), 584 mg/dL (145–1051; normal 800–1800), and 23 (0–40.3; normal 60–280). IgA, IgG, and IgM were low in 10, 10, and 11, respectively. Duodenal biopsy was normal in 6 patients and showed partial villous atrophy in 6 and nodular lymphoid hyperplasia in two. Associated infections were giardiasis (n=1), disseminated strongyloidiasis (1), small intestinal bacterial overgrowth (3), septicemia (2), and septic arthritis (1). Two patients died of sepsis, five are well on immunoglobulin and specific antiinfective treatment, and five are lost to follow up. Approximately 4% patients with MAS have hypogammaglobulinemia, which is often associated with infection and is diagnosed late.

Polyomavirus nephropathy and Cytomegalovirus nephritis in renal allograft recipients.

Background: Polyomavirus nephropathy (PVN) and Cytomegalovirus (CMV) disease are the most common viral pathogens causing allograft dysfunction in renal allograft recipients. They have been observed in transplant recipients with increasing frequency in the recent years with various reports describing wide differences in the incidence of these infections in renal allografts. We present our experience with Polyomavirus (PV) infection and CMV infection in allograft of renal transplant recipients from a transplant centre in North India performing more than 100 transplants per year. Materials and Methods: 390 renal allograft specimens from 327 patients over a 4 year period, presenting with renal dysfunction were re-evaluated for presence of PVN and CMV disease utilizing histo-morphological features and immunohistochemistry. Results: Thirteen patients with PVN and four with CMV disease were identified. All patients were on triple drug immunosuppression receiving cyclosporine, prednisolone and tacrolimus or MMF. The mean period of diagnosis of viral infection after transplant was 12.4 months (seven days to 3.5 yrs) for PVN and 4.8 months (two to seven months) for CMV nephritis. Biopsies showed varying degrees of tubulointerstitial inflammation, viral inclusions and evidence of tubular damage. Associated features of acute rejection were present in 69.2% of patients with PVN. Conclusion: Histological features of PVN involving the kidneys have considerable morphological overlap with acute rejection while CMV disease presents primarily as tubulointerstitial inflammation. We observed a prevalence of 4% for PVN and 1.2% for CMV nephritis in renal allografts.

Morphological features and prognostic significance of tip variant of focal segmental glomerulosclerosis: Study of an Indian cohort.

Context: Several attempts have been made to formulate a morphologic classification of focal segmental glomerulosclerosis (FSGS) variants with therapeutic and prognostic implications. Differences in study populations such as racial profile or therapy offered have hampered attempts to define prognostic variables in FSGS. Literature reveals conflicting results regarding the prognostic significance of tip variant of FSGS in different populations. Aims: To study the clinical and pathologic parameters in tip and not otherwise specified (NOS) variants of FSGS, in subjects from the Indian subcontinent with prognostic significance. Materials and Methods: First we performed a retrospective analysis of patients with biopsy proven primary FSGS, diagnosed between January 2004 and December 2008. Twenty cases of tip variant were encountered in adult population and similar numbers of adult cases of NOS variant were randomly selected. Renal biopsies were studied using light and immunofluorescence microscopy. Medical records for clinical data at presentation, biopsy and three monthly follow-up intervals were reviewed and compared between two groups. Results: At presentation, clinical profiles for the two groups were similar; however, significant differences in histological parameters and clinical outcome in tip and NOS variant cases were noted. Interstitial fibrosis and tubular atrophy were significantly higher in NOS variant. Greater response rate to steroid therapy was observed in tip variant cases while higher proportion of NOS variant cases showed renal failure. Conclusion: Analysis of histological parameters is important in assessing the outcome of tip and NOS variants. Tip variant signifies a better prognostic subset for a population of Indian origin affected by FSGS.

Weiss criteria in large adrenocortical tumors: A validation study.

Background: Several systems including pathologic criteria alone or in combination with clinical features have been proposed to differentiate between benign and malignant adrenocortical tumors and assess their prognosis. The Weiss system appears to be the most commonly used method for assessing malignancy but there are only a few studies which have evaluated its diagnostic power. Since we see large adrenocortical carcinoma (ACC), we attempt to evaluate the diagnostic power of Weiss system in large ACC. Materials and Methods: In this study clinicopathological characteristics of 42 adrenocortical neoplasms are studied and classified into adrenocortical adenoma (ACA) and ACC based on Weiss score of less than or equal to three or greater than three. Results: The histological criteria of Weiss appeared to predict tumor prognosis accurately. Five year survival of patients with Weiss scores of less than or equal to three was 100% compared to 0% of those with Weiss scores greater than three. The average weights of ACA and ACC were 13.0 plus/minus 8.4 grams and 621.1 plus/minus 335.2 grams respectively; average sizes of ACA and ACC were 2.8 plus/minus 1.0 cmsand 13.6 plus/minus 3.7 cms respectively. Conclusion: Weiss score was found to be a good prognostic factor for tumors of the adrenal cortex.

Primary spinal extradural hydatid cyst causing paraplegia.

Spinal hydatid disease is an uncommon cause of spinal cord compression and it constitutes 1% of all cases of hydatid disease. The authors present a case of a 21-year-old female presenting with rapid onset paraplegia caused by pathologically confirmed by extradural spinal hydatid cyst. Patient had marked improvement following surgical intervention. The case is discussed and the relevant literature is briefly reviewed.

Renal mucinous tubular and spindle cell carcinoma.

Mucinous tubular and spindle cell carcinoma is a rare variant of renal cell carcinoma, which has recently been described. It has a low malignant potential and is usually confined to the kidney. These are thought to be of the loop of Henle or distal nephron origin. We report a 65-year-old male who presented with flank pain, hematuria and a well-defined renal mass that was diagnosed as mucinous tubular and spindle cell tumor.

Carcinosarcoma of the gallbladder.

Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder, treated by simple cholecystectomy for a tumor which was confined to the gallbladder.

Congenital irreducible atlantoaxial dislocation associated with cervical intramedullary astrocytoma causing progressive spastic quadriparesis.

Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD) and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte's phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline myelotomy and duroplasty. An occipitocervical lateral mass fixation was performed. Histopathology revealed a low-grade astrocytoma. At three-month follow-up, her spasticity had decreased and quadriparesis and sphincteric disturbances were persisting. Postoperative lateral radiographs and intrathecal contrast CT scan showed a stable occipitocervical construct. Thus, the suboccipital craniectomy and laminectomy with midline myelotomy and duroplasty facilitated space for progressively expanding intramedullary astrocytoma with irreducible AAD; the lateral mass fixation provided stability at the craniovertebral junction.

Localized amyloidosis of urinary bladder: a diagnostic dilemma.

Amyloidosis is a heterogeneous group of disorders affecting a single-or multiple-organ system and presents as generalized or localized disease. Both generalized amyloidosis and localized amyloidosis can be primary or secondary. Localized amyloidosis affects organs like urinary bladder, lung, larynx, skin, tongue and the region around the eye, producing detectable nodular masses which are clinically suspected as malignancy. We present six cases of localized urinary bladder amyloidosis that were clinically and cystoscopically suspected as bladder tumor or cystitis, which occurred over a period of last 10 years. Histology in all cases revealed diagnosis of primary amyloidosis. None of them had any stigmata of secondary disease. The cases were treated by simple transurethral resection of bladder. Two out of the six cases recurred after 3 to 5 years of initial presentation and were asymptomatic thereafter. Amyloidosis of the bladder is a rare condition which often mimics bladder neoplasm clinically and cystoscopically and histological examination is a must for definite diagnosis and proper management.

Usefulness of testicular fine needle aspiration cytology in cases of infertility.

Testicular fine needle aspiration cytology (FNAC) is an important investigation in management of male infertility, especially to differentiate between obstructive and non obstructive causes of azoospermia. It is less invasive and associated with no or minimal complications. Nowadays when assisted fertilization techniques are being practiced, fibrosis after biopsy may further hamper in sperm extraction for intra cytoplasmic sperm injection (ICSI). Present study describes a detailed analysis of aspiration cytology in 546 cases and also compared 48 cases of testicular biopsies with cytology. The cytological diagnoses correlated well with histological diagnoses and helped in management of infertility. FNAC can help in management of surgical and medical causes of infertility and can save unnecessary expensive investigations in cases of sertoli cell only syndrome and atrophic patterns. FNAC in combination with semen analysis and serum follicle stimulating hormone levels are of great help in management of male infertility.