Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Lesions with Histopathological Examination (HPE) Correlation in a Tertiary Care Centre in Southern India.

This study aimed to determine the diagnostic yield of fine-needle aspiration cytology (FNAC) in salivary gland lesions compared to histopathological diagnosis. The present study was done on patients above 18 years of age, with a palpable swelling, who are clinically diagnosed as salivary gland lesions were evaluated. A total of 31 patients were evaluated in this study. The mean age of the patients was 41 years ± 16.08. The male to female ratio of patients evaluated in our study was 1: 1.066, with a marginal preponderance in the female population. There was a higher incidence of carcinoma in females than males. Parotid gland lesions comprised 83.9% of all the salivary gland lesions analyzed, while submandibular gland lesions comprised 16.1%. In our study, the distribution between non-neoplastic, neoplastic benign, and neoplastic malignant lesions was 9.6%, 83.8%, and 6.4%. The overall diagnostic accuracy for non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity of 89% and a specificity of 100%. The segregation of the results into the positive and negative class of diagnostic outcomes shows 80.6% for true positive, 9.7% for true negative, 0% for false-positive, and 9.7% for false-negative reports. Diagnostic accuracy in differentiating non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity and specificity of 89.0% and 100%, respectively. The diagnostic accuracy of FNAC in differentiating benign from malignant lesions in our study is 93.5% (29 out of 31), the sensitivity of FNAC in our study for diagnosing malignancy is poor, and the specificity is 100%. It can be concluded that FNAC is more accurate in diagnosing benign lesions and more specific than sensitive in diagnosing malignant lesions.

Factors Affecting the Outcome of Stapes Surgery.

To study the outcome of stapes surgery based on the Clinical, Audiometry, and Surgical pre- and postoperative factors. This study is a prospective study of factors affecting the outcome of stapes surgery in otosclerosis patients. From February 2010 to June 2011, 57 patients of confirmed clinical otosclerosis were analysed. Out of them, 31 patients were included in our study as were available for follow-up. Clinical, audiometry and surgery-related parameters were included to assess the surgery outcome. Results were reported as suggested by AAO-HNS (American Association of Otolaryngology and Head and Neck Surgery) guidelines for stapes surgery, 1995. The paired t-test and analysis of variables test (ANOVA) were used to evaluate the results. A p value of <0.05 was considered significant. There was statistically significant improvement in ABG (air bone gap) closure at 3 months of surgery (p value <0.001). Among all cases, PTA BC (pure tone average bone conduction) at 3 months of surgery was found in the range of 7.5 dB to 43.75 dB. ABG closure was achieved in the range of 0 dB to 27.5 dB among all cases. Variables like gender, degree of hearing loss, type of footplate, sealing material, and piston diameter were definitely predicting the outcome of stapes surgery. Pure tone audiometry plays an important role to diagnose the otosclerosis, to evaluate degree and type of hearing loss and to assess hearing outcome after surgery. Our results may improve knowledge of predictive factors, providing the surgeon with useful information to plan surgery with a better case selection as well as to counsel the patient on the likelihood of success of the procedure.

A case of intestinal MALToma with co-existent tuberculosis and Peutz-Jeghers polyp.

A 22-year-old male patient underwent a segmental resection of the ileum due to clinical symptoms of bowel obstruction and radiological evidence of ileal wall thickening and enlarged mesenteric nodes. Histopathological examination of the resected specimen revealed an extranodal marginal zone B-cell lymphoma(MALToma) of the intestine and tuberculous lesions along with a solitary Peutz-Jeghers polyp. The case is presented for its rarity and to stress upon the clinical and radiological challenges that arise when lymphomas and tuberculous lesions co-exist at the same site.

Effect of dietary ß carotene on cerebral aneurysm and subarachnoid haemorrhage in the brain apo E-/- mice.

Atherosclerosis will lead to stenosis/occlusion in the lumen of various arteries of living body. This can lead various conditions including myocardial infarction, cerebral infarction/aneurysm and peripheral artery disease. Ang II is believed to be an important regulatory peptide involved in maintaining cardiovascular homeostasis and pathogenesis of various cardiovascular diseases. Matrix metalloproteinase's (MMPs), adhesion molecules and plasminogen systems are involved in the inflammatory reaction of various blood vessels as well as pathogenesis of cerebro vasuclar disease in apo E(-/-) mice during angiotensin II injection. The present study analyses the role of ang II in development of cerebral aneurysm and also evaluated the mRNA levels of MMPs, adhesion molecules, plasminogen systems and peroxisome proliferators-associated receptors in the brain of apo E(-/-) mouse during the progression of cerebral aneurysm and ischemic conditions. Also, this study evaluates the role of dietary ß carotene on cerebrovascular disease. Serum total cholesterol (TC), Low density lipoprotein (LDL) and triglyceride (TG) levels were significantly increased in angiotensin II treated animals and further ß carotene supplementation reduces TC but does not affect the triglyceride and LDL levels. Circulating levels of macrophages were significantly increased in angiotensin treated animals and further beta carotene supplementation significantly reduced the circulating macrophages. Cerebro meningeous aneurysm, subarachnoid haemorrhage, multiple foci of infarction, necrosis and infiltration of inflammatory cells were observed in the cerebral hemispheres of ang II treated animals, however, infarction size were reduced and no aneurysm, inflammatory foci was observed in ß carotene treated animals. Real time analysis showed down regulation of mRNA levels of MMP 2, uPA, PAI, PPAR-A, MCSF1 and up regulation of tPA and MCP-1 in the brain during the progression of cerebral aneurysm and ß carotene supplementation to bring to normal expression levels of all the candidate genes for cerebrovascular diseases. Based on above results, Ang II may induced cerebral aneurysm, ischemia/infarction on brain through RAS system by down regulating the mRNA levels of MMP 2, uPA, PAI, PPAR-A, MCSF1 and up regulating tPA and MCP-1 and ß carotene attenuates the disease condition and bring down to normal expression levels of above genes.

Use of colistin in treating multi-resistant Gram-negative organisms in a specialised burns unit.

Patients with burns are at an increased risk of infection which can affect their outcome-duration of hospital stay, intensive care requirements, organ support, inotrope requirements, renal replacement therapy, ventilatory requirements and overall mortality. Our study aimed to evaluate the use of colistin in our burns intensive care unit (ICU) in treating multi-resistant Gram-negative infections. This was a retrospective study carried out in a regional referral centre for burns and plastics, Chelmsford, UK. We looked at data from patients admitted to our intensive care over a two-year period from November 2003 to November 2005. All patients who received colistin were included in the study. Admission data included demographic data and burn data, other relevant medical history, and blood results. We also recorded: length of ICU stay, ultimate outcome, total dose of colistin, repeated doses, and mode of drug delivery, organ support, organisms grown and their resistance. Response to colistin was judged by improvement in clinical status, decrease in white blood cell count (WCC) and inflammatory markers and no growth on cultures. The data were subjected to non-parametric Wilcoxon Signed Rank Test using SPSS version 14. Twenty-nine patients were included in the study all of whom received colistin in one form or the other. The average total dose of colistin was 69 million units (range 1-268). Of these, 17 patients survived (58.6%) and 12 died (41.4%). Twenty patients improved (69%) and 9 did not improve (31%) after administration of colistin. We also compared creatinine levels on admission and post colistin. We used non-parametric Wilcoxon Signed Rank test which showed no difference in the two groups (p=0.38). We found colistin to be safe and effective in treating multi-resistant Gram-negative infections in burns patients and we did not see any statistically significant impairment of renal function.