DNA Ploidy Analysis and Cell Block Immunohistochemistry in the Diagnosis of Malignant Effusions.

BACKGROUND: Effusion cytology is a major diagnostic tool in medicine and has both therapeutic and prognostic implications. One of the dilemmas encountered is the differentiation between atypical cells and reactive mesothelial cells. The use of ancillary tools can reduce this grey zone and help to achieve a definitive diagnosis. OBJECTIVES: The main objective of this study was to evaluate the role of flow cytometry (FCM) and cell block with immunohistochemistry (IHC), along with the clinicoradiological investigations, to achieve a final diagnosis in effusion cytology to the maximum extent possible. METHOD: A prospective study was conducted. Effusion fluids, showing adequate amount and cellularity, were processed for conventional cytology, ploidy analysis by FCM, and cell block analysis, followed by IHC wherever required. Conventional cytological analysis was done by 2 independent pathologists, to look for interobserver variation, if any. The final result was achieved on the basis of integration of the results of the aforementioned studies, cytological details, clinicoradiological information, tissue biopsy findings, and follow-up. RESULT: A total of 90 samples were analyzed. On cytological examination, observer I categorized 60% samples as benign and 18.8% (n = 17) as malignant versus 58% categorized as benign and 23.3% (n = 21) as malignant by observer II. Observer I reported 19 (21.1%) equivocal cases and observer II reported 16 (17.7%). When both pathologists were considered together, the number of equivocal cases increased to 20. Sensitivity and specificity of FCM were 96.67 and 100%, respectively, and 100% for the cell block. On combining all techniques, the equivocal cases were resolved and a total of 33 cases were reported as malignant. However, 3 cases could still not be categorized and were labeled inconclusive. CONCLUSION: Conventional cytology combined with cell block IHC and FCM has the potential to minimize the requirement of tissue biopsy for confirmation. If the first sample is used judiciously for all the techniques, this may reduce the requirement for a second sample and possibly also the time required for a definite diagnosis and the initiation of therapy.

Autoimmune pancreatitis masquerading as carcinoma head of pancreas: A case report and review of literature.

INTRODUCTION: Autoimmune pancreatitis (AIP) is a rare form of chronic inflammatory pancreatic disease secondary to an underlying autoimmune mechanism. It is now considered as pancreatic manifestation of IgG4 related disease, which is a multisystem disease. CASE REPORT: We are reporting a patient who presented with obstructive jaundice and mass head of pancreas on Computed Tomography (CT) scan. Considering a strong clinical suspicion of pancreatic cancer, Whipple procedure was done. Histopathological report revealed intense lymphoplasmacytic infiltrate and fibrosis with collagenisation, so possibility of AIP was suggested. Serum IgG4 levels were advised and found to be increased. Diagnosis of AIP was made and patient responded to steroids. DISCUSSION: Pre-operative core biopsy of the pancreas and Serum IgG4 levels are sufficient to make the diagnosis and resection is usually not recommended in AIP. CONCLUSION: Awareness of the entity and use of ancillary techniques in making the pre-operative diagnosis could have saved the patient from an extensive surgical procedure.

A Comprehensive Study on Fast Dispersible and Slow-Releasing Characteristic of Orange Peel Pectin in Relation to Established Synthetic Polymer.

INTRODUCTION: In the present work, the method to extract, isolate, and characterize orange peel pectin using soxhlation, and thereafter, the use of this polymer-polymer in the formulation of fast dispersable and slow-releasing tablet has been studied. Thereafter, the evaluation and comparison of fast dispersible/slow-releasing tablets using orange peel pectin versus prepared using sodium starch glycolate (SSG) were carried out. MATERIALS AND METHODS: In the present investigation, extraction methodology was employed for isolation of pectin from orange peels. Four different batches with each polymer were prepared with varying concentration of superdisintegrant and bulking agent using diclofenac sodium as model drug. Diclofenac sodium stands as easily available, cheap, and good candidate to demonstrate disintegrant property. The formulation involved wet granulation method for the preparation of tablets of each batch. The tablets were evaluated for hardness, friability, thickness, wetting time, deaggregation time, and in vitro release characteristic data. RESULTS: It was observed that parameters for batch O2* were comparable with that of synthetic superdisintegrant. This batch gave around 92.12% drug release in period of 90 min. The study showed that orange peel pectin could be a potential candidate for formulation of orodispersible dosage forms in competence to SSG, which is established superdisintegrant. CONCLUSION: The results led to the conclusion that the use of natural polymers in formulation of pharmaceutical dosage form can be put into practice on industrial scale meeting the similar requirements as done by synthetic polymers. SUMMARY: The present work aims to demonstrate and establish the use of naturally derived polymer, i.e., orange peel pectin as a superdisintegrant. The extraction methodology has been discussed followed by comparative analysis with a synthetic polymer. Abbreviations used: O1-O2: Batches Containing Orange peel pectin, S1-S2: Batches containing SSG, SSG: Sodium starch glycolate, NDDS: Novel drug delivery system.

Tumefactive Fibroinflammatory Lesion: A Diagnostic Dilemma.

Tumefactive fibroinflammatory lesions (TFLs) are rare idiopathic benign fibrosclerosing lesions that clinically simulate a malignancy. TFLs are seen more frequently in males between 10 and 74 years of age. The usual site of involvement is the head and neck region, but rarely the extremities may be involved. Coexisting fibrosclerotic processes have been reported including retroperitoneal fibrosis, sclerosing cholangitis, sclerosing mediastinal fibrosis, and orbital pseudotumors. The etiology of this poorly understood entity remains unknown. Possible suggestions include exaggerated responses or autoimmune reactions to any chronic infection. The clinical and radiological appearance of TFLs is that of malignancy, but histopathology reveals them to be a benign process broadly classified under non-neoplastic, fibroinflammatory proliferations. The treatment strategies for these lesions are not well defined and variable and include steroids, surgery, and radiotherapy either alone or in combination. TFLs, albeit not fatal, have a high recurrence rate; patients should, therefore, be kept on long-term follow-up. We describe a young female patient presenting with a rapidly developing cheek swelling, which was diagnosed histopathologically as a TFLs.

Rasayana properties of Ayurvedic herbs: Are polysaccharides a major contributor.

Rasayana constitutes a very important class of Ayurvedic herbs, which acts as rejuvenators and tonic. Despite intensive research on evaluating the medicinal basis for the purported medical benefits of Rasayana herbs, still a specific chemical guiding principle for the characterization of these herbs in one single category is unclear. Here we explore the possibility that polysaccharides play a key role in Rasayana properties exhibited by medicinal plants. Further on this could be a possible field for exploration for a common factor present in some of the Ayurvedic herbs. The present review covers a literature spanning from 1956 to 2011. Some translations of traditional Ayurvedic texts dating back to the first century AD have been referred to as well. In our assessment of the present literature and studies carried out it is presupposed that the presence of benevolent plant polysaccharides must be one of the important features symbolizing a common effectiveness in most of the Ayurvedic Rasayana herbs. Of the many plant metabolites polysaccharides have not so far been considered and studied effectively compared to other secondary metabolites like saponins, alkaloids, etc. Although all the results reported until now suggest a major contribution of polysaccharide towards the maintenance of physiological homeostasis, which is the guiding principle of Rasayana therapy. The present review is an attempt to find a connective link between the concept of Rasayana and well-being; and the role of plant polysaccharides. Lack of clinical information on number of polysaccharides showing promise is a limiting factor for a complete understanding. It is also important to carry out a molecular interaction study to understand the behavior of polysaccharides discussed in the present review.

A comparative study on aphrodisiac activity of some ayurvedic herbs in male albino rats.

The roots of Asparagus racemosus, Chlorophytum borivilianum, and rhizomes of Curculigo orchioides are popular for their aphrodisiac and immunostimulatory properties. The herbs have been traditionally used as Vajikaran Rasayana herbs because of their putative positive influence on sexual performance in humans. Lyophilized aqueous extracts obtained from the roots of A. racemosus, C. borivilianum, and rhizomes of C. orchioides were studied for sexual behavior effects in male albino rats and compared with untreated control group animals (total N = 60). The rats were evaluated for effect of treatments on anabolic effect. Seven measures of sexual behavior were evaluated. Administration of 200 mg/kg body weight of the aqueous extracts had pronounced anabolic effect in treated animals as evidenced by weight gains in the body and reproductive organs. There was a significant variation in the sexual behavior of animals as reflected by reduction of mount latency, ejaculation latency, post ejaculatory latency, intromission latency, and an increase of mount frequency. Penile erection (indicated by Penile Erection Index) was also considerably enhanced. Reduced hesitation time (an indicator of attraction towards female in treated rats) also indicated an improvement in sexual behavior of extract treated animals. The observed effects appear to be attributable to the testosterone-like effects of the extracts. Nitric oxide based intervention may also be involved as observable from the improved penile erection. The present results, therefore, support the folklore claim for the usefulness of these herbs and provide a scientific basis for their purported traditional usage.

Effect of Chlorophytum Borivilianum Santapau and Fernandes on sexual dysfunction in hyperglycemic male rats.

OBJECTIVE: To investigate the effects of Chlorophytum borivilianum (CB) on sexual dysfunction, loss of body weight, and lack of libido in hyperglycemic rats induced with streptozotocin or alloxan. METHODS: Wistar strain male albino rats were divided into five groups of six animals each: the control group (2% polyvinylpyrollidone solution), the streptozotocin control group (50 mg/kg), the alloxan control group (100 mg/kg), the streptozotocin + CB treated group (200 mg/kg), and the alloxan + CB treated group (200 mg/kg). Only after confirming the induction of diabetes, the animals of test groups were treated with CB. The sexual behavior of male rats of in presence of female rat in a special cage was recorded. The effects of induced diabetes in control groups and on simultaneous extract treatment in CB treated groups were tested for sexual parameters. The parameters evaluated included mount, ejaculation, and intromission latencies/frequencies, hesitation time, and penile erection index. Parallel to this, using a separate set of similarly treated animals, the influence of diabetes and CB treatment on anabolism and weight of secondary sexual organs were determined on day 0 and day 28 of the treatment. RESULTS: CB extract treatment ameliorated the diabetes-induced dysfunction at 200 mg/kg dose. There was very low weight loss (P<0.05) in CB-treated animals as compared to the diabetic control. There was a very high latency time (P<0.05) in the diabetic animals, whereas the latency time was very low in CB-treated animals. Mount, intromission, and ejaculation frequencies were very high (P<0.01) in CB-treated animals, while streptozotocin and alloxan groups animals had a very significantly lower sexual behavior (P<0.05) compared to the normo-glycemic control group animals. CONCLUSION: CB can significantly ameliorate diabetes-induced sexual dysfunction. Polysaccharide and saponin-rich aqueous extract appears to have the most suitable effects on diabetes and its associated effects on sexual functionality.

Immunomodulatory Activity of Chlorophytum borivilianum Sant. F.

Chlorophytum borivilianum Santapau & Fernandes (Liliaceae) is a very popular herb in traditional Indian medicine and constitute a group of herbs used as 'Rasayan' or adaptogen. Ethanolic extract of the roots and its sapogenin were evaluated for their immunomodulatory activity. Effect of azathioprine-induced myelosuppresion and administration of extracts on hematological and serological parameters was determined. Administration of extracts greatly improved survival against Candida albicans infection. An increase in delayed-type hypersensitivity response (DTH), % neutrophil adhesion and in vivo phagocytosis by carbon clearance method was observed after treatment with extracts. Immunostimulant activity of ethanolic extract was more pronounced as compared to sapogenins. The results, thus justifies the traditional use of C. borivilianum as a rasayana drug.