Thyroid hormone profile in patients with chronic kidney disease: a single centre study.

BACKGROUND: Chronic kidney disease (CKD) is a global burden and now recognized as a major public health problem worldwide. Patients with CKD have alteration in thyroid hormone metabolism. This study aims to evaluate the status of thyroid hormone profile in different stages of CKD. METHODS: The cross-sectional study included 103 CKD patients attending Nephrology and Dialysis unit of KIST Medical College Teaching Hospital, Lalitpur, Nepal. Serum creatinine, free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) were measured. Risk factors, duration of illness and physical examination of patients were recorded along with their written informed consent. Patients with history of any thyroid function abnormalities, on medication for hypothyroidism and pregnancy were excluded. RESULTS: Out of 103 CKD patients, 59 (57.28%) were males and 44 (42.71%) were females. Thirty five (33.98%) CKD patients had low fT3 and 19 (18.44%) had low fT4 with normal TSH. Six (5.82%) CKD patients had increased TSH concentrations with normal fT3 and fT4. The median value of creatinine, fT3 and fT4 were significantly altered at different stages of CKD. Among the risk factors for CKD, diabetic nephropathy (44.66%) was found to be the lead primary cause followed by chronic glomerulonephritis (26.21%) and hypertension (23.30%). CONCLUSIONS: In our study thyroid hormone profile was altered in CKD patients, mainly in the stage 5 CKD. Most common thyroid dysfunction was low fT3 and low fT4 with normal TSH levels.

Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens.

Cholecystectomized specimens are one of the frequently encountered specimens in daily routine histopathological work in the pathology department. With the expectation that most of the gallbladder specimens harbor benign disease, it is at times surprising to find occult malignancy. This study aims to find out the frequency of primary gallbladder carcinoma and incidental primary carcinoma, detected during routine histological examination of gallbladder specimen that were submitted in pathology department of Nepal Medical College Teaching Hospital (NMCTH) as well as to assess the need of histopathological examination of cholecystectomy specimens. Retrospective study was done in total 668 cases of cholecystectomies specimens submitted in NMCTH histopathology department during 5 yrs of duration from Jan 2003 to Dec 2007. There were total 22 cases of primary gallbladder carcinoma and 2 cases of metastatic cholangiocarcinoma in gallbladder. The incidence rate of primary malignancy was 3.3% and was commonly found in female at 7th decade of their life. Adenocarcinomas were the most common histological type with poor differentiation and diagnosed frequently at stage IIA. The rate of incidental primary carcinoma of gallbladder was 1.4%, detected commonly at stage I. Combined preoperative and intraoperatively, only 55.0% of histologically proven gallbladder malignancies were correctly identified. Intraoperative findings of incidental carcinomas included thickened GB (3 cases), distended GB (2 cases), GB polyp (1 case) and no obvious abnormality were mentioned in 3 cases. Therefore, every cholecystectomy specimen should be examined histopathologically to detect possible incidental carcinomas.

Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic.

Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. Most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology have been reported and are useful in cytological detection of bancroftian filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The objective of the study was to investigate importance of cytology in diagnosis of filariasis in lesions clinically anticipated to be of neoplastic and to review the cytomorphology of bancroftian filaria and its association with neoplasm. This is a retrospective study carried out in cytology department of Tribhuvan University Teaching Hospital. 14 cases of cytological specimen out of 4291 (0.3%) showed microfilaria; 12 cases were from FNAC from different sites and 2 cases were from pleural fluid. 2 cases showed ova in addition to microfilaria and one of them in addition showed fragment of adult worm. Microfilaria in 4 cases of FNAC and one case ofpleural fluid were associated with malignant cells.

Diagnosis of subcutaneous cysticercosis in fine needle aspirates: a study of 10 cases.

The objective of this study is to document the value of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of subcutaneous cysticercosis. Aspirates smears of 10 cases of subcutaneous swellings were studied over a period of 1 year between January 2004 and January 2005. The subcutaneous swellings were presented at different sites like cheek, neck, forearm, arm, chest wall and abdominal wall. In none of these cases was cysticercosis considered as diagnostic possibility. The characteristic cytomorphological features of parasitic tegument, parenchymatous portion, presence of epithelioid cells, giant cells and inflammatory cells in cytological smears help diagnose the cases of subcutaneous cysticercosis. Biopsy confirmation was possible in 5 cases, of which, two cases showed parenchymatous portion of the parasite. FNAC provides safe and rapid tool for diagnosis of subcutaneous cysticercosis. In endemic areas, cysticercosis should be considered one of the differential diagnosis of the subcutaneous swellings.

Histopathologic diagnosis of lymph node biopsies.

This is a retrospective study of biopsies of lymph nodes received in the department of pathology, Nepal Medical College (NMC), from January 2004 to December 2005. Total number of lymph node biopsies during the two year period was 55, out of which 56.0% cases were females and 44.0% were males with M:F 1:1.29. Most common cause of lymphadenopathy was tuberculosis and most common group of lymph node was cervical lymph nodes. Metastatic deposits were seen in only six cases. So, like other developing countries, in our country also, tuberculosis is the leading cause for lymphadenopathy.