Kimura's disease: Rare cause of head & neck swelling.

Kimura 's disease presents as subcutaneous painless swelling in head and neck region often mimicking inflammatory or neoplaitic disease. This case report draws attention of otolaryngologist-head & neck surgeons to recognise this rare clinical entity.

Value of core needle biopsy in the diagnosis of soft tissue tumours.

We performed a prospective study to determine the accuracy of core needle biopsy in the diagnosis and grading of soft tissue tumours and to study the morbidity of core needle biopsy. Forty one cases of soft tissue tumours, 24 of them malignant and 17 benign, were biopsied with an 18G core needle. Core needle biopsy reports were compared with the final histopathological report after definitive procedure or incisional biopsy. 85.3% of core biopsies yielded adequate sample. Core needle biopsy had a sensitivity of 90%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 88.23%. Overall accuracy for diagnosis of malignancy was 94.28%, 77.7% of tumours were correctly subtyped and none of them were histologically graded. There was no immediate complication of haemorrhage in any of the cases. Thus, we conclude that core needle biopsy is equivalent to incisional biopsy in diagnostic accuracy and being simple, less expensive and unlikely to compromise further management, can be used in place of open biopsy of soft tissue tumours.

Redistribution of gastric Helicobacter pylori after surgery for duodenal ulcer.

OBJECTIVES: To study the distribution of H. pylori in the stomach before and after truncal vagotomy and drainage (TV + D) for chronic duodenal ulcer. METHODS: Twenty two consecutive patients studied prospectively. H. pylori positivity detected by urease test and histology (Giemsa stain). One or both tests positive indicated positive H. pylori status. Biopsies taken from antrum, body, fundus and stoma (postoperatively) to document H. pylori status before and 6 months after TV + D. RESULTS: Antral prevalence of H. pylori significantly decreased after surgery while fundal colonization significantly increased. No change was seen in body of stomach. CONCLUSION: There is significant redistribution of H. pylori after TV + D. This has important diagnostic implications in evaluation of postoperative symptoms.

Anti - H. pylori IgG seroprevalence rates in asymptomatic children and adults from South India.

This study was undertaken to determine the seroprevalence of H.pylori in asymptomatic children and compare it with that seen in the asymptomatic adult population from south India. One hundred and five children and one hundred adults admitted to the wards for conditions other than gastrointestinal disorders were included for this study. H.pylori status was determined by ELISA for IgG. The prevalence of H.pylori in children of various ages varied from 44% to 46% with an overall prevalence of H.pylori in children of 45%. 67% of adults were infected with H.pylori which was significantly higher than children (P = 0.002). The prevalence of H.pylori increased markedly with age with the maximum colonization (74%) occurring in young adults (16-30 years). The antibody levels too followed a similar pattern. In conclusion, it was seen that almost half the children in south India acquire H.pylori infection early in life which increases slowly and steadily with a peak prevalence in the young adults. Gender does not affect the prevalence in children and adults. As age advances further there is a slight decline in the prevalence of H.pylori infection. The immune response reflected by the levels of the antibody levels also follows the same pattern.

Clinical and sonographic findings in carcinoma of the penis.

PURPOSE: This study was performed to assess the accuracy of high-resolution sonography in measuring penile carcinoma. METHODS: Sonography was performed using a 7.5-MHz linear-array transducer in 59 patients with penile carcinoma. The sonographic measurement of tumor extent was compared with clinical and pathologic measurements. The tumor extent measured by gross pathologic evaluation on cut sections of the fresh penectomy specimen was used as the definitive standard. The echogenicity of the tumor was compared with that of the surrounding normal penile tissue to classify the tumor as hyperechoic, hypoechoic, or of mixed echogenicity (containing both hyperechoic and hypoechoic elements). We evaluated the relationship between the echogenicity of the tumor and both tumor morphology (exophytic or infiltrative) and tumor grade as determined on pathologic examination. RESULTS: The overall mean difference +/- standard deviation in the tumor extent between clinical and gross pathologic evaluation was 3.9 +/- 5.3 mm (range, 1-9 mm), whereas the overall mean difference between sonographic and gross pathologic evaluation was 1.2 +/- 1.7 mm (range, 1-7 mm). As determined with reference to the gross pathologic extent, the error in measuring the extent on clinical examination was significantly greater than the error on sonography (p < 0.001). Lesions involving the glans alone were more often underestimated by clinical examination than were lesions involving the shaft (with or without glanular involvement). The error in measuring the extent of tumor by sonography was not related to the site of the tumor. The tumor was hyperechoic in 21 cases (36%), hypoechoic in 28 cases (47%), and of mixed echogenicity in 10 cases (17%). There was no significant association between echogenicity and tumor morphology or grade. CONCLUSIONS: Sonography gives a more accurate estimate of penile tumor extent than does physical examination. Routine use of sonography for such measurements should enable preservation of more of the penis.

The histological extent of the local spread of carcinoma of the penis and its therapeutic implications.

OBJECTIVE: To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. PATIENTS AND METHODS: Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test. RESULTS: Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. CONCLUSIONS: Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.

Progeria (Hutchinson-Gilford): a case report.

A new case with the typical features of progeria (Hutchinson-Gilford) occurred in India. Histopathology of the skin showed atrophic epidermis and diffuse fibrosis of dermis with loss of appendages. Roentgenographic findings were characteristic of progeria. The child also had a gangrenous ulcer over the left foot, a finding not highlighted in the literature.

Pebbling of the skin: a marker of Hunter's syndrome.

A 9-year-old boy, the third child of nonconsanguinous parents, presented with asymptomatic, solid, raised skin lesions over the upper back. They first appeared at the age of 4 years. Gradually similar lesions appeared over the chest, neck, arms, and thighs. On examination, he had firm, hypopigmented to skin-colored papules and nodules which coalesced to form ridges in a reticular pattern (pebbling of the skin) and were arranged bilaterally and symmetrically over the scapulae, pectoral region of the chest, and lateral aspects of the arms and thighs. They resembled sulci and gyri of the brain. He had normal intelligence, short stature, coarse facial features, thick lips, a large tongue, clear corneas, a protuberant abdomen with hepatosplenomegaly, and broad hands with clawlike contractures of the distal interphalangeal joints. Investigations revealed cardiomegaly and proximal tapering of metacarpal bones. Although peripheral blood smear and urine spot test for mucopolysaccharides were negative, histopathology of a representative skin lesion was compatible with the diagnosis of Hunter's syndrome. The case is reported for its rarity and the typical skin lesions, the recognition of which may be helpful in diagnosis and genetic counseling.

Disseminated cutaneous rhinosporidiosis.

Two cases of longstanding rhinosporidiosis developed widespread asymptomatic nodular skin lesions. Cutaneous examination showed multiple, discrete, sessile and pedunculated, smooth and warty, friable nodular lesions of variable sizes and shapes. Histopathology of representative skin lesions showed hyperplastic epidermis with sporangia containing spores in the upper dermis diagnostic of rhinosporidiosis. Epidemiological data about rhinosporidiosis at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, is presented. Possible modes of dissemination to the skin and differential diagnosis are discussed in relation to this rare manifestation of rhinosporidiosis.

Helicobacter pylori infection in duodenal ulcer with gastric outlet obstruction.

One hundred and three patients were included in the study. Thirty seven had duodenal ulcer (DU) (Group I), 35 DU with gastric outlet obstruction (GOO) with presence of an active ulcer in the duodenum (Group II). Thirty one had DU with GOO but no active ulcer (Group III). Presence of H. pylori infection was determined by urease test, serology and/or histology. The prevalence of H. pylori in these groups was compared. Levels of Anti-H. pylori IgG antibody titres were also compared. The patients with duodenal ulcer (DU) were significantly younger (38 +/- 2 years) compared to those with established gastric outlet obstruction without ulcer (45 +/- 2 years) (P = 0.02). The prevalence of H. pylori infection in DU (95%), DU with GOO with ulcer (91%) and DU with GOO but no ulcer (90%) was not significantly different (p > 0.05). Anti-H. pylori IgG antibody titre levels were 72 +/- 6 EU/ml in Group III. The titre levels between Group I and Group III were significantly different (P < 0.05). The prevalence of H. pylori infection is high is patients with DU and is unaltered by gastric outlet obstruction. The presence or absence of an active ulcer with gastric outlet obstruction does not affect its association with H. pylori infection.

Wuchereria bancrofti microfilariae in the dentigerous cystic fluid: an unusual presentation.

An unexpected and unusual presence of Wuchereria bancrofti microfilariae in the cystic fluid of a maxillary dentigerous cyst in an 8-year-old boy is being reported for the first time. This was an incidental finding during routine fine-needle aspiration cytological examination.

Prevalence of Helicobacter pylori infection in disorders of the upper gastrointestinal tract in south India.

BACKGROUND: Helicobacter pylori (H. pylori) is the most common human infection. Though most individuals are asymptomatic, H. pylori plays a key role in the aetiology of many upper gastrointestinal disorders. The prevalence of duodenal ulcer in south India is high but there are very few reports regarding the prevalence of H. pylori infection in various upper gastrointestinal disorders in south Indians. Therefore, we studied the prevalence of H. pylori infection in upper gastrointestinal disorders in south Indians. METHODS: Three hundred and thirty-five patients with various upper gastrointestinal disorders were included in the study. Seventy-five patients with no gastrointestinal disease based on symptoms and endoscopy were taken as controls. The H. pylori status was determined by the urease test, serology and histology and the prevalence compared between various upper gastrointestinal disorders, with controls and with one another. RESULTS: The prevalence of H. pylori was high in the patients and controls. Duodenal ulcer patients had a significantly higher prevalence compared to controls (p < 0.001) and those with other upper alimentary disorders. There was no significant difference between patients with other disorders and controls nor between each other (p > 0.05). CONCLUSION: The prevalence of H. pylori infection is high in south India. It is closely associated with duodenal ulcer. More population-based studies are required to evaluate the relationship of H. pylori with other disorders of the upper gastrointestinal tract.

Helicobacter pylori infection and erosive gastritis.

One hundred and eleven patients were included in the study. Thirty seven had erosive gastritis, thirty four chronic gastritis and forty were controls without any gastrointestinal diseases confirmed by symptoms and upper gastrointestinal endoscopy. Patients with erosive gastritis were divided into non-steroidal anti-inflammatory drug (NSAID) users and non-users. H pylori status was determined by urease test, serology and/or histology. The prevalence of H pylori was compared between the various groups. The prevalence of H pylori infection in erosive gastritis, chronic gastritis and controls was 68%, 76% and 65%, respectively, the difference was not significant (P > 0.05), 8 out of 11 patients with erosive gastritis and NSAID use (73%) were positive for H pylori. Likewise 17/26 patients with erosive gastritis without NSAID use (65%) were positive for H pylori (P > 0.05). Body of the stomach (65%) was the commonest site for erosions compared to antrum (43%) or fundus (27%) (P < 0.02). H pylori infection does not predispose to erosive gastritis. NSAID use does not affect H pylori prevalence. Routine H pylori eradication is, therefore, not indicated in patients with erosive gastritis infection. Body of the stomach is the most predominant site for erosions.