Thrombolysis Using Tissue Plasminogen Activator: Experience from a Critical Care Setting.

To describe the experience of thrombolysis using tissue plasminogen activator (tPA) in critically ill children admitted to the pediatric intensive care unit (PICU), retrospective review of medical records of all children (1 month-16 years), who were admitted in PICU since January 2014 to December 2017 and received systemic tPA for thrombolysis was done. Data was collected on a structured proforma and included thrombus location, tPA dose and duration, outcome (resolution, survival) and complications (bleeding). Total 9 patients (7 males, 2 females) received systemic tPA therapy for thrombolysis with mean age of 74.64 ± 69.58 months. Two patients had thrombus in femoral artery, 3 in IVC and 4 had intra-cardiac thrombosis. Median number of doses was 2 with a range of 1-5 doses. Complete resolution of the clot was noted in all except one patient. A standard starting dose of 0.01 mg/kg/h was used in all patients. Only one patient developed melena after TPA therapy which self-resolved. Systemic tPA therapy was very safe in pediatric critically ill patients and was effective for thrombolysis and did not show any adverse effects in children with varying underlying diagnosis.

Frequency and Outcome of Acute Neurologic Complications after Congenital Heart Disease Surgery.

OBJECTIVES: To determine the frequency and immediate outcome of acute neurologic complications (ANCs) in children undergoing congenital heart surgery (CHS). MATERIALS AND METHODS: In this retrospective study, all patients undergoing CHS at our hospital from January 2007 to June 2016 were included. Patients were followed up for the development of seizures, altered level of consciousness (ALOC), abnormal movements, and stroke. Results are presented as mean with standard deviation and frequency with percentages. RESULTS: Of 2000 patients who underwent CHS at our center during the study, 35 patients (1.75%) developed ANC. Seizures occurred in 28 (80%), ALOC in 5 (14%), clinical stroke in 2, brain death in 6 patients. Antiepileptic drugs (AEDs) were started in 32 patients, of which 13 patients required more than one AED. Mean length of stay was 10 ± 7.36 days. Of 35 patients who developed ANC, 7 expired during the study. CONCLUSION: Neurological complications are scarce but significant morbidity after CHS at our center.

Frequencies of different nuclear morphological features in prostate adenocarcinoma.

Diagnosis of prostate adenocarcinoma is primarily based on morphological analysis. Nucleomegaly, prominent nucleoli, and hyperchromasia constitute current nuclear diagnostic parameters but are seen in benign conditions, vary with Gleason grade, and pose diagnostic challenge in well-differentiated tumors with accompanying inflammation or equivocal architectural features. In such cases, other pleomorphic nuclear features such as variation in size and shape, irregular contours, nuclear membrane infoldings, and nonuniform chromatin, which are not incorporated in formal evaluation, may prove helpful. Our aim was to study different nuclear morphological features of prostate adenocarcinoma (including currently practiced ones) and highlight their variation with Gleason grades. We examined 84 cases of prostate adenocarcinoma using oil immersion microscopy where necessary. Commonest Gleason pattern observed was grade 4a accounting for 42.8% of cases. Nuclear enlargement (moderate to marked in 93.8%), nucleolar enlargement (62.1%), and nonuniform chromatin distribution (100%) could serve as useful diagnostic features but did not vary with tumor differentiation. Pleomorphism (moderate in 58.6%), nuclear overlapping (62.8%), nuclear membrane infoldings (66.2%), and irregular contours (frequent in 94.5%) were significant diagnostic features that increased in frequency and extent with increasing grade and could be used to differentiate low-grade from high-grade tumors. Worsening of nuclear morphology with advancing tumor grades indicated that nuclear anaplasia accompanies poor architectural differentiation. Coexistence of pale and dark nuclei signified variable chromatin density of no diagnostic significance.

Metaplastic squamous cell carcinoma in association with invasive lobular breast carcinoma with metastasis to axillary lymph nodes.

Squamous cell carcinoma (SCC) of the breast is very rare entity and when encountered it is found in association with invasive ductal carcinoma of the breast. We report a very unusual association of an invasive lobular carcinoma with metaplastic squamous cell carcinoma of the breast which was found not only in a mastectomy specimen but also in the axillary lymph nodes. The patient reported first with a lump breast which was diagnosed a case of invasive lobular carcinoma in a lumpectomy specimen, followed by adjunct radiation and chemotherapy. We encountered such association in only one case report in the literature.

Adult polycystic kidney disease: a disorder of connective tissue?

Adult polycystic kidney disease (APCKD) is one of the most common serious inherited disorders. Many affected patients succumb to the renal and non-renal manifestations of this autosomal dominant disease. The disease is characterized by cyst formation in several organs, most obvious of which is in the renal parenchyma. Other features associated with the disease include hepatic fibrosis, hepatic, pancreatic and splenic cyst formation, Berry aneurysms, colonic diverticulae, hernias and cardiac valvular disorders. Rupture of Berry aneurysm is a sudden and often fatal manifestation in some unsuspected cases of APCKD. We recently examined one surgically removed kidney from a 15-year-old male patient with APCKD. In addition to the classical cystic change, extensive changes in renal parenchymal matrix and vasculature are also present. The excessive and weak matrix may contribute to dilatations of both renal tubules giving rise to cysts and the blood vessels. Our findings suggest that APCKD may be a connective tissue disorder in which alteration of extracellular matrix may be a common denominator for the manifestations and organ pleotropism of APCKD.