Human Pancreatic Cancer-Associated Stellate Cells Remain Activated after in vivo Chemoradiation

Pancreatic ductal adenocarcinoma (PDAC) is characterized by an extensive fibrotic reaction or desmoplasia and complex involvement of the surrounding tumor microenvironment. Pancreatic stellate cells are a key mediator of the pancreatic matrix and they promote progression and invasion of pancreatic cancer by increasing cell proliferation and offering protection against therapeutic interventions. Our study utilizes human tumor-derived pancreatic stellate cells (HTPSCs) isolated from fine needle aspirates of pancreatic cancer tissue from patients with locally advanced, unresectable pancreatic adenocarcinoma before and after treatment with full-dose gemcitabine plus concurrent hypo-fractionated stereotactic radiosurgery. We show that HTPSCs survive in vivo chemotherapy and radiotherapy treatment and display a more activated phenotype post-therapy. These data support the idea that stellate cells play an essential role in supporting and promoting pancreatic cancer and further research is needed to develop novel treatments targeting the pancreatic tumor microenvironment.

Surgical Management of Spinal Dysraphism: Five -year Experience in a Central Hospital

Introduction: Spinal dysraphism is a heterogeneous group of congenital spinal anomalies resulting from defective closure of the neural tube early in fetal life and anomalous development of the caudal cell mass. Meningomyelocele is common among Neural tube defects. Patients with myelomeningocele present with a spectrum of impairments, including primary functional deficits like are lower limb paralysis, sensory loss, bladderbowel dysfunction and cognitive dysfunction. Medical, surgical management and rehabilitation have helped patients with neural tube defects to participate and be productive in mainstream society. The aims of this study were to review the clinical presentation, surgical management and their outcome in the patient with spinal dysraphism. Materials and Methods: This is a retrospective study of Forty-one cases of spinal dysraphism managed during a period of five years from January 2008 to December 2012 in Department of Neurosurgery, National Academy of Medical Sciences (NAMS), Bir Hospital. Demographic profiles, clinical presentation of patients with spinal dysraphism, associated hydocephalus, surgical management and outcome were studied. Results: Out of total 41 cases studied, male patients outnumbered female with 58.5% to 41.5%. Age ranged from 5 days to 29 years and mean age was 2.71 years whereas. Lump (97%) and paraparesis (88%) were frequent mode of presentation. Lumbar lesion (65%) was commonest followed by lumbosacral (29%). Hydrocephalus was present in 51% of cases and in 24% cases developed hydrocephalus later after repair. Total 75.6% of cases were treated with VP shunt. Conclusion: Spinal dysraphism is debilitating entity and management is challenging. Lump on back and weakness of limb are major factor for children and their parents seek medical service. Lesion in low back (lumbar and lumbosacral) were most common location. Besides repair, majority of them needed CSF diversion surgery for hydocephalus. Aim of surgical management was to prevent further deterioration, control of hydrocephalus or leak. DOI: http://dx.doi.org/10.3126/jnps.v34i1.9378 J Nepal Paediatr Soc 2014;34(1):34-38

Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures

BACKGROUND

We compared outcomes and postpancreatectomy quality of life (QOL) in paired cohorts of patients undergoing conventional open pancreaticoduodenectomy (OPD) or laparoscopic-assisted pancreaticoduodenectomy (LAPD).

METHODS

Comparative analysis of QOL was performed in a matched cohort of 53 patients after OPD or LAPD between 2010 and 2013. The Medical Outcomes Study Short Form-36 Health Survey and the Karnofsky score were used.

RESULTS

Physical component score, mental component score, and Karnofsky scores were calculated at multiple time points for OPD (n = 25) and LAPD (n = 28). Operative times, complications, and readmission rates were equivalent. Time to starting adjuvant therapy trended toward clinical importance in LAPD (61 vs 110 days, P = .0878). Duration of stay was less in LAPD (7.10 vs 9.44 days, P = .02). LAPD had a superior QOL centered on functional status compared with OPD (physical component score 49.09 vs 38.4, P = .04; Karnofsky 92.22 vs 66.92%, P = .003). These statistical differences were not observed beyond 6 months.

CONCLUSION

LAPD provided a more favorable QOL within the first 6 months and shorter length of stay compared with conventional OPD. LAPD may serve as an alternative operative therapy to potentially minimize delays in receipt of and enhance tolerability of adjuvant therapies.

Efficacy of Misoprostol as a Post Abortion Care

Aims: This study was done to find the efficacy of Misoprostol as a post-abortion care in our setting. Methods: Women with incomplete abortion of gestational age ≤ 12 weeks or uterine size ≤ 12 weeks with open cervical os, haemoglobin ≥ 9 gm% and stable physical condition; were given 600 microgram Misoprostol orally and were observed for 24 hours for complete expulsion. If the patient failed to expel within 24 hours of Misoprostol administration manual vacuum aspiration or suction evacuation was done. Results: One hundred and twenty-two women were enrolled in the study. Among them, 41% had complete expulsion within 24 hours of administration of misoprostol and 49% had incomplete expulsions. The success rate was high in the group of < 8 weeks of pregnancy. Among 50 (41%) successful cases, 38 (76%) belonged to 8 weeks of gestation by bimanual examination (p = 0.02). Conclusions: Single dose of oral Misoprostol was effective, safe and alternative method to the management of incomplete abortion compared to the manual vacuum aspiration or suction evacuation in case of early pregnancy abortion.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 71-74 DOI: http://dx.doi.org/10.3126/njog.v8i2.9778

Nutrient digestibility of lentil and regular- and low-oligosaccharide, micronized full-fat soybean fed to grower pigs

A study was conducted to determine the standardized ileal digestibility (SID) of AA and calculate the NE value for regular-oligosaccharide, micronized full-fat soybean (R-MFFSB), low-oligosaccharide, micronized full-fat soybean (LO-MFFSB), lentil, and enzymatically hydrolyzed casein (EHC) for growing pigs. Six ileal-cannulated barrows (31.4 kg BW) were fed 6 diets in a 6 × 6 Latin square. Five diets were cornstarch based, containing either soybean meal (SBM), R-MFFSB, LO-MFFSB, or EHC as sole protein source or N free. The sixth diet contained lentil as sole protein and energy source. The SID of AA for diets was calculated using the N-free diet. Digestibility of AA in feedstuffs was determined by the direct method. Energy digestibility in SBM, R-MFFSB, and LO-MFFSB was determined by difference from the N-free diet whereas energy digestibility in lentil was determined by the direct method. On DM basis, SBM, R-MFFSB, LO-MFFSB, and lentil contained 52, 43, 43, and 27% CP, 8, 12, 14, and 16% NDF, and 1.8, 19, 21, and 1.6% ether extract, respectively. The SID of Lys for SBM was greater (P < 0.05) than that for R-MFFSB or LO-MFFSB (76 vs. 79 and 79%). The SID of other indispensable AA (except Trp) for SBM was also greater (P < 0.05) than that for R-MFFSB or LO-MFFSB. The R-MFFSB and LO-MFFSB were similar in SID of AA. The SID of Lys for lentil (81%) was lower (P < 0.05) than that for SBM with a similar trend for SID of other indispensable AA except for Met and Thr whose SID was similar to SBM. The SID of AA for EHC ranged from 98 to 112%. The SBM had a lower (P < 0.05) NE value than R-MFFSB or LO-MFFSB (2.63 vs. 2.95 and 3.00 Mcal/kg DM). Lentil and SBM were similar in NE value (2.60 vs. 2.63 Mcal/kg DM). In conclusion, R-MFFSB and LO-MFFSB were similar in energy and AA value for pigs. Lentil had lower SID of AA than SBM. However, lentil and SBM were similar in NE value; therefore, lentil can serve as alternative pulse feedstuff for pigs. The AA in EHC were mostly completely digested indicating that EHC can be fed to estimate ileal endogenous AA losses.

Nutritional characteristics and in vitro digestibility by near-infrared spectroscopy of local and hybrid napiergrass varieties grown in rain-fed and irrigated conditions

Napiergrass can produce large amounts of biomass and its nutritive value has a significant effect on its effectiveness for animal production. However, temperature and drought stress limit its productivity. Drought-tolerant pearl millet × napiergrass hybrid (PMN) varieties were developed and produce high biomass yields. The nutritional content and digestibility of PMN is not well known, which limits its use in animal feeding. It was hypothesised that PMN hybrids are more drought tolerant and have higher nutritive value than napiergrass varieties. Four napiergrass varieties (Bana grass, Mott, MB4, and N51) and four PMN (PMN2, PMN3, 5344, 4604) were tested with or without irrigation treatment in a strip-plot design, with the objective of evaluating the nutritional value and in vitro digestibility of PMN hybrids and napiergrass. The forages were harvested on Day 110 of planting. Samples were hand chopped, oven-dried, ground to pass through a 1-mm screen and analysed for their nutrient content and in vitro digestibility using near-infrared spectroscopy. Dry matter (DM) content of PMN2 (24.3%) and PMN3 (22.9%) was significantly higher (P < 0.05) than 5344, Bana grass and N51 napiergrass varieties. No differences (P > 0.05) in acid detergent fibre, neutral detergent fibre, crude protein and metabolisable energy were found among napiergrass varieties. With no effect (P > 0.05) of irrigation, lignin content was highest (P < 0.08) in 4604 (8.2%) and lowest in 5344 (5.2%). Starch was highest (P < 0.05) in irrigated MB4 than both irrigated and non-irrigated 4604. Non-fibre carbohydrate content was highest (P < 0.05) in PMN2 (12.8%) than MB4 (8.7%). The in vitro true digestibility was significantly higher (P < 0.05) in 5344 and Bana grass (70.0% and 68.0% of DM, respectively), than PMN3 (54.5%). Rate of digestion was significantly higher (P < 0.05) in 5344 (4.9%/h) than PMN2 (2.7%/h), others were in between. Neutral detergent fibre digestibility (NDFD) of 5344 and Bana grass (56.7% and 53.2% of neutral detergent fibre, respectively) was significantly higher (P < 0.05) than PMN2 (38.0%). Although no effect of irrigation was observed, there was an interaction (P < 0.05) between variety and irrigation on neutral detergent fibre digestibility of napiergrass varieties. In conclusion, among four PMN varieties tested, PMN3 and 5344 has higher nutritional value and in vitro digestibility than PMN2 and 4604 even when grown in non-irrigated condition. Thus, PMN3 and 5344 is the preferred napiergrass variety for animal feeding, even in rain-fed farming conditions.

Effect of implant-supported prosthesis on the bite force and masticatory efficiency in subjects with shortened dental arches

The aim of the study was to assess changes in bite force and masticatory efficiency in shortened dental arch (SDA) subjects rehabilitated with implant-supported restoration for 1st molar. Ten SDA subjects with bilaterally missing mandibular molars (experimental group) were recruited. In each subject, one tapered threaded implant was placed bilaterally in 1st mandibular molar region and restored. Masticatory efficiency was evaluated objectively by measuring the released dye from chewed raw carrots, with a 'spectrophotometer' at 530 nm preoperatively and at 3 months after restoration. Bite force was evaluated using 'bite force measuring appliance' preoperatively, at 6 weeks and at 3 months after restoration. Ten completely dentate-matched subjects (in terms of age, sex, height and weight) acted as control. The results revealed that as compared with the control group, the experimental group showed significantly less (P < 0.05) mean maximum bite force at pre-restoration and at 6 weeks after restoration. Although at 3 months the mean maximum bite force value was less than the control group but the mean difference was statistically insignificant. The mean difference of masticatory efficiency between control and experimental group was statistically significant (P < 0.05) before restoration, but was statistically insignificant at 3 months after restoration. Thus it was concluded that after the restoration of mandibular arch with implant-supported prosthesis, both bite force and masticatory efficiency of all SDA subjects increased and were comparable to that of matched completely dentate subjects after 3 months.

Lymphoid associated antigen expression in new cases of Acute Myeloid Leukemia

Background: Occurrence of aberrant phenotype has been reported in acute leukemias with varying frequency though its prognostic importance remains controversial. In acute myeloid leukemias, aberrant phenotype, as high as 88 %, has been reported. To evaluate the occurrence of aberrant lymphoid phenotypes and to correlate their presence with various French American British classification, 100 cases of fresh acute myeloid leukemias were analyzed for lymphoid markers CD 4,7,8,10 and 19. Materials and Methods: Whole blood or bone marrow aspirate collected in EDTA were processed by standard method and subjected to immunophenotyping for B Cells marker CD 19 and 10 and T cell marker CD 4, 7 and 8. Results: Aberrant lymphoid markers were seen in 35(35%) cases. All FAB subtypes except M7 showed aberrancy for the markers studied. However it was the most common in M0 (100%), followed by M2 (51.9%). T cell aberrancy was the most common, comprising 62.8% (22/35) of total aberrancy. CD 7 was the most common aberrantly expressed marker, seen in 20% AML, followed by CD 4(14%) and CD 19 (8%). Conclusion: Occurrence of lymphoid phenotypes is frequent in pediatric as well adult AML. Though T cell markers are more common, only B cell as well as both B and T cell markers may be co expressed. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8999   Journal of Pathology of Nepal (2013) Vol. 3, 487-490

Degradation and fermentation characteristics of wheat coproducts from flour milling in the pig intestine studied in vitro

Use of wheat (Triticum aestivum) flour milling coproducts (WFM) in pig diets may ameliorate high feed cost. However, digestibility of WFM is lower than feed grains, and limited information exists about their fermentation characteristics. In vitro degradation and fermentation characteristics of 6 WFM samples (2 Shorts, 2 Millrun, middlings, and bran) with varying fiber and protein contents were studied. After a pepsin-pancreatin hydrolysis, WFM were incubated in a buffer solution with minerals and fresh pig feces as inoculum. Accumulated gas production was measured for 72 h and modeled. The VFA concentration was measured in the fermented solutions. The DM degradability during fermentation ranged from 31 to 52% and correlated negatively with ADF (r = -0.65; P < 0.01) and positively with CP (r = 0.50; P < 0.01) content of WFM. Total gas production ranged from 101 to 148 mL/g DM incubated and was negatively correlated with ADF and crude fiber (r = -0.70 and -0.59, respectively; P < 0.01). The VFA production ranged from 2.0 to 3.0 mmol/g and the fractional rate of degradation ranged from 0.08 to 0.11/h. In conclusion, fiber components were associated with degradability and fermentability of WFM. Therefore, treatments targeted to reduce the impact of fiber and protein may increase the digestibility and fermentability of wheat coproducts from flour milling.

Intracranial hypertension: An unusual presentation of mucormycosis in a kidney transplant recipient

Idiopathic intracranial hypertension (IIH), once called pseudotumor cerebri, presents with nonspecific signs and symptoms of increased intracranial pressure and papilledema, and is associated with high risk of loss of vision. Zygomycosis is a rare but serious fungal infection seen occasionally among renal transplant recipients in the late transplant period with high mortality risk. Early diagnosis coupled with multidisciplinary care can salvage the patient from the risk of death. We present an unusual case of adult renal transplant recipient with IIH followed by rhinocerebral zygomycosis secondary to amplified immunosuppression that was managed successfully.

Emphysematous pyelonephritis: A single center study

We present our experience of 22 cases of emphysematous pyelonephritis (EPN) treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT) scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females) of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22). Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV) with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.

Effects of increasing co-product inclusion and reducing dietary protein on growth performance, carcass characteristics, and jowl fatty acid profile of growing-finishing pigs

Dietary inclusion of co-products (Co-P) provides opportunities for diversifying the feedstuff matrix by using local feedstuffs, reducing feed costs, and producing value-added pork. In 2 studies, we determined effects of Co-P (canola meal, distillers dried grains with solubles, and co-extruded oil seed and field pea) inclusion level and reduced dietary CP concentration on growth performance, carcass characteristics, and jowl fatty acid profiles of growing-finishing pigs. Pigs were fed isoenergetic and isolysinic diets over 4 growth phases with 8 pen observations per dietary regimen. At slaughter, carcasses were characterized for all pigs and jowl fat was collected from 2 pigs per pen. In Exp. 1, 1,056 pigs (initial BW, 35.3 ± 0.4 kg) were fed 3 levels of dietary Co-P (low, mid, and high) and 2 CP concentrations (low and normal). Overall (d 0 to 86), increasing Co-P inclusion from low to mid or high decreased (P < 0.001) ADFI and ADG of pigs. Low CP concentration increased (P < 0.05) ADFI and ADG compared with normal CP concentration. An interaction (P = 0.026) occurred between dietary Co-P inclusion and CP concentration for G:F; low CP reduced (P < 0.05) G:F compared with normal CP for pig fed low Co-P, but G:F did not differ between CP concentrations for pigs fed mid and high Co-P. Increasing dietary Co-P inclusion from low to high increased (P < 0.001) α-linolenic acid (ALA) in jowl fat but decreased (P < 0.001) carcass weight and loin depth. In Exp. 2, 1,008 pigs (initial BW, 30.3 ± 0.4 kg) were assigned to 5 dietary regimens with Co-P increasing from 2.0 to 50.0% or a sixth regimen with 10% extra supplemental AA for the 37.5% Co-P diet. Overall (d 0 to 97), increasing Co-P inclusion did not affect ADFI, ADG, and G:F. Increasing dietary Co-P inclusion linearly decreased (P < 0.01) carcass weight, dressing percentage, backfat thickness, and loin depth but linearly increased (P < 0.001) jowl ALA. Supplementing 10% extra AA to the 37.5% Co-P diet did not affect growth performance or dressing percentage but increased (P = 0.014) carcass leanness and decreased (P = 0.023) backfat thickness compared with the 37.5% Co-P diet, indicating that dietary AA supply did not limit BW gain. In conclusion, Co-P can be included by up to 50% in diets for growing-finishing pigs without affecting G:F. However, increasing dietary Co-P may reduce ADG, ADFI, and carcass weight even if diets are balanced for dietary NE and standardized ileal digestible AA content.

Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety

Background

Concurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC.

Methods

Patients received gemcitabine, 1000 mg/m² for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires.

Results

Between September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment.

Conclusions

SBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.

Study of AgNOR count and SAPA score in fine needle aspirates of breast lumps

Background: Argyrophilic Nucleolar Organizer Region technique has a potential value in the diagnosis of malignancy and can be used in cases with equivocal and inconclusive cytological picture. The purpose of this study was to evaluate mean Argyrophilic Nucleolar Organizer Region count and Subjective Argyrophilic Nucleolar Organizer Region Pattern Assessment score in fi ne needle aspirates of breast lumps. Materials and Methods: A prospective, cross sectional study consisting of 110 patients (38 malignant and 72 benign) with clinically palpable breast lumps who underwent fi ne needle aspiration followed by subsequent histopathologic examination were included. Fine Needle Aspiration smears were studied by conventional methods and silver staining for Argyrophilic Nucleolar Organizer Regions. Histopathologic diagnosis was taken as the gold standard. Results: Argyrophilic Nucleolar Organizer Region count and Subjective Argyrophilic Nucleolar Organizer Region Pattern Assessment score were helpful in differentiating benign from malignant lesions. Mean Argyrophilic Nucleolar Organizer Region count and Subjective Argyrophilic Nucleolar Organizer Region Pattern Assessment score were 2.63 ± 1.36 and 6.26 ± 1.19 respectively in benign lesions while they were 8.42 ± 2.53 and 10.05 ± 2.22 respectively in malignant lesions. With few exceptions, cases with high counts had high scores. Conclusion: Mean Argyrophilic Nucleolar Organizer Region AgNOR count and Subjective Argyrophilic Nucleolar Organizer Region Pattern Assessment score provide useful information regarding cellular proliferation. Both count and score have comparable diagnostic potential but the latter is a more convenient and rapid method for Argyrophilic Nucleolar Organizer Region evaluation. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7248 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.3-9

Reversible dialysis-dependent renal failure due to undiagnosed renovascular disease

Renovascular disease (RVD) can present with resistant hypertension, acute or rapidly progressive renal failure and occasionally nephrotic proteinuria. Revascularization plays an important role in controlling blood pressure and preserving renal function. It is widely believed that delay in revascularization would result in irreversible loss of renal function. However, we report a favorable outcome despite delayed revascularization in two patients of RVD- one presenting with recurrent flash pulmonary edema and other with progressive renal failure. The former's serum creatinine returned to normal despite 3 months of anuria and the latter became dialysis-independent despite 2 months of progressive decline in renal function. Both remain dialysis-free 3 years after surgery.

Non-nephronal hematuria misdiagnosed as C1q nephropathy: Look before you leap

A 19-year-old male presented with persistent macroscopic hematuria for last 3 months. On initial evaluation, he was found to have minimal proteinuria, normal renal function, and normal complement with negative lupus serology. Light microscopy, immunofluorescence and electron microscopy of renal tissue confirmed the presence of C1q nephropathy. Because of poor response to immunosuppressive agent (prednisolone and mycophenolate mofetil), passage of urinary clot once and vexing persistent macroscopic hematuria, alternative diagnosis was considered. Cystourethroscopy showed urethritis of prostatic urethra. Immunosuppressives were stopped and doxycycline started to which hematuria responded dramatically. This case report illustrates that hematuria in this patient was because of undiagnosed urethritis rather than incidental C1q nephropathy.

Study of malignant germ cell tumors with special reference to malignant ovarian germ cell tumors: 5 years experience

Background: Germ cell tumors are rare and complex group of heterogenous neoplasms that comprise both benign and malignant histology. The testes and ovaries are the most common sites. This descriptive study focused on distribution of malignant germ cell tumors with more detail study of ovarian malignant germ cell tumors.Materials and Methods: All cases of malignant germ cell tumor reported from department of pathology of Tribhuvan University Teaching Hospital over five years from April 2007 to April 2012 were included in the study.Results: Thirty five cases (24 female and 11 male) were diagnosed as having malignant germ cell tumors. Most patients were below 30 years of age. Ovary was the most common site followed by testes. Malignant ovarian germ cell tumor comprised 54.3% of all malignant germ cell tumors. Age of these patients ranged from 6 years to 32 years. Most common histologic type was yolk sac tumor.Conclusion: Malignant germ cell tumors can be seen in any age group from new born to old age. However malignant ovarian germ cell tumors occur mainly in first three decades of life, are mostly unilateral and are of large size at the time of diagnosis due to rapid growth. However these tumors are often of low stage and managed with conservative surgery.Journal of Pathology of Nepal (2012) Vol. 2, 289-292DOI: http://dx.doi.org/10.3126/jpn.v2i4.6880

Comment on "status of pathology professionals"

In 2012 Jan issue, Journal of Nepal Health Research Council published an article "Status of Pathology Professionals" by Mishra SK affiliated to Concern for Public Health and Development (C-PHD), Kathmandu, Tiwari BR affiliated to Department of Clinical Microbiology, People's Dental College, Tribhuwan University and Yadav BK from Department of Clinical Biochemistry, Institute of Medicine, Kathmandu, TribhuwanUniversity, Nepal.As a result, comments were sent to JNHRC, and are published below.