Improved tissue sections for medical liver biopsies: a comparison of 16 vs 18 g biopsy needles using digital pathology.

BACKGROUND: Most medical liver biopsies in the UK are now taken in radiology departments using 18 g biopsy needles. Subjectively, the resulting biopsies are narrow and fragile. AIM: To compare the quality of liver biopsy tissue sections obtained from 16 and 18 g biopsy needles. METHOD: Fifty consecutive routine medical liver biopsies obtained with 16 and 18 g needles, processed identically in the same laboratory, were measured using digital pathology software. We recorded their fragmentation, length, width, area and number of portal tracts. RESULTS: Biopsies obtained with 16 g needles more often resulted in an intact core in tissue sections than those with 18 g needles (71% vs 24%, p<0.001) and were significantly wider (average width of tissue 0.88 vs 0.53 mm, p<0.001). The average total area of tissue per pass was 11.38 mm(2) compared with 8.34 mm(2) (p<0.001). The number of complete portal tracts per length of biopsy was very variable, but double for 16 vs 18 g biopsies. Routinely taking two passes with the 18 g needle compensated for the reduced area, but the resulting liver in tissue sections was fragmented and distorted. CONCLUSIONS: Our results support the routine use of 16 g rather than 18 g biopsy needles for routine ultrasound-guided medical liver biopsies. A second pass should be considered if the first biopsy core is short, especially for investigation of disease stage.

Clinical research regulation in India-history, development, initiatives, challenges and controversies: Still long way to go.

The Central Drugs Standard Control Organisation and its chairman Drug Controller general of India are bequeathed to protect the citizens from the marketing of unsafe medication. The startling findings, of the 59(th)report of the Parliamentary Standing Committee on Health and Family Welfare, have uncovered the lax standards followed by the regulatory authorities in India. The growing clinical research after the product patents rights for the pharmaceutical industries as per the trade related aspects of intellectual property rights agreement and adverse drug reaction monitoring of the marketed drugs have raised many ethical and regulatory issues regarding the promotion of new drugs in Indian markets. Many controversial group of medicines; unauthorised and irrational FDCs not relevant to India's medical needs, are available which are not sold in any of the countries with matured regulatory bodies. It becomes vital to understand the history, growth and evolution of the regulatory aspects of drugs which are handled by multiple Ministries and Departments of the Government of India. Although amendment to Schedule Y, registration of Contract Research Organisations, registration of Clinical Trials, Speeding up review process, Pharmacovigilance (PhV) programme for India and Inspection of clinical trial sites have been started by the various regulatory agencies. However due to casual approach in marketing approval for sale of the drugs, the unethical steps taken by some pharmaceutical companies and medical practitioners has reiterated the need to get appropriate understanding of present regulation of drugs and clinical research especially regarding the practical rules and regulations.

Recent advances in management of ureteral calculi.

The management of patients with urinary tract stone disease has changed dramatically over recent years, with current treatment modalities focused on their minimal invasiveness. In this article we will discuss the recent advances in the field of urolithiasis management, with a focus on medical expulsive therapy, extra-corporeal shockwave lithotripsy and ureteroscopy.

Case report of an intra-abdominal desmoid tumour presenting with bowel perforation.

Desmoid tumours are benign tumours originating from the musculoaponeurotic structures of the body. They are mainly composed of collagen. These tumours commonly occur in post-partum women in whom they originate from the rectus abominus and in old surgical incisions. Here we present a case report of a young gentleman who presented with an acute surgical abdomen and subsequently underwent a laparotomy and was found to have an inflammatory mass. Histological analysis of this mass revealed mesenteric fibromatosis (desmoid tumour). I wish to present this interesting case because the patient was neither female nor someone who had previously undergone any surgery. It is rare for mesenteric fibromatosis to present with intestinal perforation and only one case been reported in the literature thus far (1). An important learning point from this case is that rare pathology can manifest itself with common signs and symptoms.