Pulmonary mycoses diagnosed using exfoliative cytology: infection or colonization?

OBJECTIVES

Flexible bronchoscopy with exfoliative cytology is an important tool for the diagnosis of pulmonary fungal infections. The question of colonization versus true fungal infection is of critical importance.

STUDY DESIGN

A 5-year retrospective analysis of all cases of pulmonary fungal infection diagnosed using exfoliative cytology was performed. Clinical, radiological, bronchoscopy and histopathology findings were recorded.

RESULTS

A total of 69 cases of mycoses were retrieved. The most common fungal organism identified was Aspergillus followed by Candida and Pneumocystis. Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobronchial growth and were diagnosed as carcinomas in biopsy specimens, thus representing colonization. All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection. Histoplasma was identified in pleural fluid from a known case of lung carcinoma.

CONCLUSION

Aspergillus and Candida species are the most common fungal organisms. Most of these represent colonization of malignant growths. However, true fungal infections may also present as mass lesions and may masquerade malignancy clinically. Fluid cytological examination is an important diagnostic modality for pulmonary mycoses; however, it is important to correlate results with clinical, bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.

Diagnostic dilemma in histopathology report following robot assisted laparoscopic prostatectomy: tumour 'hide and seek'

INTRODUCTION

Widespread PSA (prostate specific antigen) screening has resulted in stage migration of prostate cancer. Smaller tumor volumes are being detected in radical prostatectomy specimens. This has coincided with increasing reports about the 'vanishing cancer phenomenon.'

AIMS

To analyse the cases of robot assisted laparoscopic prostatectomy (RALP) at our institute in which the pre operative prostate biopsy was positive for adenocarcinoma but no tumor could be identified in the final histopathology, and to review the literature for possible reasons for such a phenomenon.

MATERIALS AND METHODS

Nine patients were identified out of a total of 184 cases of RALP in which the final histopathology did not correlate with the initial biopsy report. The initial biopsy slides as well as the final histopathology slides were reviewed by a second pathologist. The specimens were processed in entirety and additional sections were taken until no tissue was left.

RESULTS

Two patients had cancer diagnosed on TURP (transurethral resection of prostate) chips, while the remaining patients had undergone TRUS biopsy for elevated PSA. The final histopathological diagnosis was benign prostatic hyperplasia in two patients, chronic prostatitis in four patients, and acute florid prostatitis in one patient, granulomatous prostatitis with glandulostromal hyperplasia in one patient and TCC (transitional cell carcinoma) of prostate in one patient.

CONCLUSION

Most cases of pT0 are due to inability of routine histopathological analysis to identify minute tumor focus. Urologists need to be aware of this in view of the potential medico legal implications.

Bowen's disease on finger: a diagnostic and therapeutic challenge

Bowen's disease commonly presents as a solitary asymptomatic plaque involving head and neck region or lower limbs. We present a case of a sixty seven-year-old man with an itchy, oozy, crusted solitary plaque on the right ring finger of eighteen months duration with histopathology consistent with Bowen's disease. The lesion was initially treated with topical 5% imiquimod but due to relapse and inadequate response to a second course, complete surgical excision followed by full thickness skin grafting was done. Recurrence after about 6 months in the form of a small papule adjacent to the initial site was also treated with excision. This report highlights the potential of Bowen's disease to mimic more common dermatoses and a high index of suspicion, supported by histopathology, is required to diagnose and treat it without delay, which in turn may require a multimodality approach. We also reviewed the current literature on the same.

Analysis of urine sediment for cytology and antigen expression in acute renal allograft rejection: an alternative to renal biopsy

Acute rejection in renal transplant recipients is diagnosed by renal biopsy at an advanced disease stage. There is no modality for sequential monitoring of graft status. We studied the role of urine cytology in predicting acute cellular rejection (ACR) and its ability to correctly diagnose ACR and differentiate it from drug toxicity (DT). Urine samples from 203 renal transplant recipients were studied to determine the cellular composition using cytology and immunocytochemistry for HLA-DR, intercellular adhesion molecule (ICAM)-1, and interleukin (IL)-2R. In a 3-month follow-up period, there were 36 episodes of graft dysfunction, of which 28 occurred due to ACR and 8 due to DT. The cytology results showed a significantly increased percentage of lymphocytes and polymorphonuclear cells in samples obtained before and during the clinical manifestations of ACR. A greater level of expression of antigens was observed before and during ACR. The use of IL2-R-, ICAM-1-, and HLA class II-specific monoclonal antibodies gave very high specificity, sensitivity, and positive predictive values in diagnosing rejection through urine cytology, suggesting that routine cytology along with immunocytochemistry of urine sediment has clinical potential for early diagnosis and management of ACR and DT.

Atlantoaxial rotatory fixation in a case of tubercular lymphadenitis

Atlantoaxial fixation is a relatively rare cause of torticollis which may be easily missed in practice. Early diagnosis is important as this indicates a compromised atlantoaxial complex with the potential to cause neural damage or even death. Here, we report a case of atlantoaxial rotatory fixation in a 13 yr old male with torticollis for two years and history of defaulting treatment for tubercular lymphadenitis. In this case, the odontoid peg view revealed asymmetric distance between the odontoid and lateral mass of atlas which was confirmed with Fluoroscopy and Computed Tomography (CT) scan. Magnetic Resonance Imaging (MRI) was also done which showed hyperintensity in alar ligaments with posterior inclination of the odontoid peg along with cervical lymphadenopathy.

A Global Electricai-Optical Model of Thin Film Solar Cells on Textured Substrates

In order to simulate the performance of the present day state-of-the-art multijunction solar cells in its entirety, an integrated electrical-optical model has been developed. The one-dimensional ab initio electrical model for the analysis of the transport properties of such devices can handle a very general semiconductor device structure where the material properties vary with position and the gap state properties with position and energy. The original semi-empirical optical model used takes into account both specular interference effects, and diffused reflectances and transmittances due to interface roughness. The latter are derived from angular-resolved photometric measurements and used as input parameters to the numerical programme. Comparison of the illuminated current density-voltage (J-V) characteristics, calculated on the basis of (a) a simple exponential absorption law and (b) the optical model, reveals an increase of ˜1 mA cm−2 in the short-circuit current and ˜8% in the cell conversion efficiency for case (b). Also the long wavelength quantum efficiency (QE) shows a marked improvement, while the blue QE decreases since proper account is taken of the absorption in the transparent conducting oxide and reflection from the device. The combined model is being applied to simulate the characteristics of wideband-gap-emitter-layer solar cells deposited in a three chamber conventional glow discharge reactor onto (i) highly textured SnO2 and (ii) weakly textured indium tin oxide substrates. The cells have been characterised experimentally by J-V and QE measurements. Preliminary results indicate that the integrated model matches the experimental J-V and QE data with a more realistic set of material parameters as compared to case (a).

Gastrointestinal stromal tumours: a clinico-radiologic review from a single centre in South India

Gastrointestinal stromal tumours (GISTs) are rare tumours but are the commonest mesenchymal neoplasms in the gastrointestinal tract. To our knowledge, there is no large case series in Asian countries in which a clinico-radiological descriptive analysis of these tumours has been carried out. In this retrospective study, we analysed our experience of 70 patients with histopathologically proven GISTs, who were presurgically investigated by using CT, and describe the demography, anatomical distribution, imaging features and clinical course of the GIST. We found an unusually large predominance of males in our study, stomach and small bowel appeared to have been involved similarly and small bowel tumours had a higher rate of metastases. We also highlight some unusual CT features of these tumours that we encountered during the study, such as the presence of metastatic lymphadenopathy and satellite nodules, relapse in appendices epiploicae of the bowel, metachronous liposarcoma, adrenal and lung metastases, multiplicity of lesions and aneurysmal dilatation of the bowel. Two of our patients also had multiple neurofibromas, whose association with GIST has been seen in earlier reports. To the best of our knowledge, this article presents one of the largest series of articles on GISTs, to date, in Asian countries. We conclude with a differential diagnosis of GIST, with salient features distinguishing each entity.

Drosophila simulans Lethal hybrid rescue mutation (Lhr) rescues inviable hybrids by restoring X chromosomal dosage compensation and causes fluctuating asymmetry of development

The Drosophila simulans Lhr rescues lethal hybrids from the cross of D. melanogaster and D. simulans. We describe here, the phenotypes of Lhr dependent rescue hybrids and demonstrate the effects of Lhr on functional morphology of the salivary chromosomes in the hybrids. Our results reveal that the phenotypes of the 'Lhr dependent rescued' hybrids were largely dependent on the genetic background and the dominance in species and hybrids, and not on Lhr. Cytological examination reveal that while the salivary chromosome of 'larval lethal' male carrying melanogaster X chromosome was unusually thin and contracted, in 'rescued' hybrid males (C(mel)X(mel)Y(sim); A(mel)A(sim)) the X chromosome showed typical pale staining, enlarged diameter and incorporated higher rate of (3)H-uridine in presence of one dose Lhr in the genome. In hybrid males carrying simulans X chromosome (C(mel)X(sim)Y(mel); A(mel)A(sim)), enlarged width of the polytene X chromosome was noted in most of the nuclei, in Lhr background, and transcribed at higher rate than that of the single X chromosome of male. In hybrid females (both viable, e.g., C(mel)X(mel)X(sim); A(mel)A(sim) and rescued, e.g., C(mel)X(mel)X(mel); A(mel)A(sim)), the functional morphology of the X chromosomes were comparable to that of diploid autosomes in presence of one dose of Lhr. In hybrid metafemales (C(mel)X(mel)X(mel)X(sim); A(mel)A(sim)), two dose of melanogaster X chromosomes and one dose of simulans X chromosome were transcribed almost at 'female' rate in hybrid genetic background in presence of one dose of Lhr. In rescued hybrid males, the melanogaster-derived X chromosome appeared to complete its replication faster than autosomes. These results together have been interpreted to have suggested that Lhr suppresses the lethality of hybrids by regulating functional activities of the X chromosome(s) for dosage compensation.

Validity of 20 meter multi stage shuttle run test for prediction of maximum oxygen uptake in Indian female university students

BACKGROUND

The 20-meter multi stage shuttle run test (20-m MST) has not yet been used by Indian scientists and validity of the test has not been studied for use with any of the Indian population.

AIMS

The purpose of this study was to validate the applicability of the 20-m MST in Indian adult female.

MATERIALS AND METHODS

For application of direct method cross over design was followed. For validity of the results repeatability was used.

METHODS AND MATERIAL

32 female university students (age range 20.4 approximately 24.8 years) from three different universities of West Bengal, India were recruited for the study. Direct estimation of VO2 max comprised treadmill exercise followed by expired gas analysis by scholander micro-gas analyzer whereas VO2 max was indirectly predicted by the 20-m MST.

STATISTICAL ANALYSIS

Paired t-test, Pearson's product moment correlation, linear regression statistics and Bland and Altman approach for limit of agreement were adopted for statistical analysis of the data.

RESULTS

The difference between the mean (SD) VO2 max values of direct measurement (VO2 max = 32.84 +/- 2.92 ml/kg/min) and the 20-m MST (SPVO2 max = 32.60 +/- 3.40 ml/kg/min) was statistically insignificant (p>0.10). Limits of agreement analysis also suggest that the 20-m MST can be applied for use with the studied population.

CONCLUSIONS

The results suggest that the application of the present form of the 20-m MST be justified in the studied population. For better prediction of VO2 max a new equation has been computed based on present data for use with Indian female university students.

Double coins at the oesophageal inlet

Multiple foreign bodies lodged in the oesophagus are extremely rare. Here an unusual case of two coins accidentally lodged at the oesophageal inlet of a six-year-old girl is reported. The coins were successfully removed by oesophagoscopy. It is to be noted that apart from the straight x-ray (PA view) of the neck and chest, a lateral view is essential for proper characterisation and identification of the type and number of foreign bodies prior to surgical removal.

Study of plasma lipid and lipoprotein profile in elite women boxers during a six weeks' training progamme

The present study was undertaken with an objective to frame out the lipid profile of Indian Women Boxers. Women boxing is a newly recognized game and no work has been reported on elite female boxers in India till date. The study was based on a sample of 45 women boxers (age 17 ~ 24 years) attending Senior National Women Boxing Camp at Sports Authority of India. Each subject was evaluated for Lipid Profile variables at the beginning and end of the six weeks training camp. Fasting blood samples were taken from the antecubital vein by venipuncture. Before the samples drawn the subjects were asked to take rest for ten minutes. The blood sample was analyzed by HITACHI UV-2000 spectrophotometer (Japan). Standard techniques and procedures were followed for all the estimation. Volume and intensity of different components of training was measured by observational and physiological methods. Data were subjected to statistical treatment like mean and standard deviation. Test of significance't' - test (for paired sample) was applied to asses the difference in pre & post-test. Results reveal that mean (+/-SD) Cholesterol, Triglyceride, LDL, HDL - Cholesterol and Cholesterol / HDL Cholesterol ratio was 144.7 +/- 3.6 mg%, 59.7 +/- 17.5 mg% 81.4 +/- 21.1 mg% 51.3 +/- 8.2 mg% and 2.8 +/- 0.5 respectively as found in the pre-test. Significant difference (P < 0.01) was observed in Cholesterol, LDL-Cholesterol, HDL Cholesterol level in the post-test. The study concludes that women who practice sport of boxing on regular basis have a favorable lipid profile. A significant change in lipid profile of the boxers was observed after 6 weeks' training program.

Energy expenditure in women boxing

OBJECTIVES

Women boxing have got recognition recently and so far no work has been reported on energy expenditure of national women boxers in India. This study was aimed to estimate the energy expenditure in Indian female boxers during sparring.

METHODS

A total of 20 female boxers were subjected. Energy expenditure was estimated using the same individual's HR-VO2 regression equation. Heart rate was recorded through radiotelemetry.

RESULTS

Results reveal that average and maximum energy expenditure considering the total duration of boxing are 12.7 +/- 1.3 and 14.4 +/- 1.6 kcal/min.

CONCLUSIONS

It is concluded that depending on the severity of energy expenditure female boxing comes under heavy category and as it is a pioneer attempt in India, further studies in this aspect are really required which will guide the coaches regarding the energy expenditure pattern in women boxing.