Malignant tumours of the male breast--a review of 50 cases

Carcinoma of breast is one of the less frequent malignancies in males. In this study 50 cases of malignant tumours of male breast diagnosed during a 10 years period (1980-1989) are analysed retrospectively. The malignant breast tumours in males were about 3% of all breast malignancies in both sexes and 0.34% of all types of malignant tumours diagnosed during the study period. One male breast was involved for every 33 female cases. The peak incidence was between 5th to 7th decade with mean age of 58.54 years. The mean duration of symptoms was 13.69 months and 46.15% cases reported to the hospital after one year of their symptoms. Clinically, a painless lump in the breast was most frequently seen, followed by ulceration of the skin. Histologically, the infiltrating duct carcinoma (grade III) was the predominant lesion and one case of Paget's disease of the breast was also seen.

Pattern of malignant bone tumour in northern areas of Pakistan

A review of 280 primary malignant bone tumours diagnosed during 1984-1988 is presented. These constituted 3.14% of all malignant tumours. Male to female ratio was 2.3:1. Majority of these patients presented with rapidly growing mass, pain and deformity. Histologically, osteosarcoma was the most frequent (36.4%) primary malignant tumour. Male to female ratio was 3.31:1. More than 49% of these cases were in their second decade of life. In females the greatest frequency was in 10-15 years and in males 16-20 years age groups. Femur was the most frequent site. Other common malignant bone tumours included chondrosarcoma (22.1%), plasma cell myeloma (15.0%) and Ewings's sarcoma (8.6%). Miscellaneous cases of fibrosarcoma, chrodoma, adamentinoma and ameloblastoma were also seen. This study outlines the frequency, symptomatology and histological pattern of various malignant bone tumours in northern areas of Pakistan.

Peculiar histopathological features of giardiasis in distal duodenal biopsies

Histological changes in 20 Giardia positive duodenal biopsies (Group A) were compared with 50, Giardia negative duodenal biopsies (Group B), taken during the same period. Stool examinations in Group B were negative for Giardia. Surface epithelium, villous and crypt architecture and cellular infiltrates were examined and compared between the groups. Atrophic changes in the villi were more common in Group A as compared to B(P < 0.0001). Intraepithelial neutrophil infiltration (P < 0.001), infiltration of the lamina propria with plasma cells (P < 0.5), and presence of eosinophils in the lamina propria (P < 0.001) were significant findings in group A. Some of the changes were related to the density of Giardia colonization e.g., the goblet cell depletion (P < 0.05) and the density of plasma cell infiltration in lamina propria (P < 0.01). Erosions and ulcerations were less commonly seen in group A. Thus we conclude that giardiasis manifests its peculiar features in the distal duodenal mucosa and a biopsy of this region is an important diagnostic tool for detection of this disease.

Ki-1 large cell anaplastic lymphoma--a clinicopathological study

Ki-1 large cell anaplastic lymphoma is a recently described variant of malignant lymphoma. A retrospective study of 10 cases of Ki-1 lymphoma was carried out at the Armed Forces Institute of Pathology (AFIP) Rawalpindi to document its clinical and morphological features. The morphological features were evaluated by a study of paraffin embedded sections stained with haematoxylin and eosin stains. Immunohistochemical stains for BER-H2 and leucocyte common antigen (LCA) were performed in all cases. The age of the patients ranged from 2 to 60 years and male to female ratio was 2.3:1. Cervical lymphadenopathy was the most common presentation. Histologically, there was a complete effacement of the lymph node architecture in 8 cases. The Reed-Sternberg like cells were seen in 2 and histiocyte like cells in 7 cases. Immunohistochemically all cases were positive for BER-H2. It is suggested that the possibility of Ki-1 lymphoma should be considered in all cases of lymphoma with pleomorphic morphology.

Management of chronic ventricular arrhythmias

Premature ventricular contractions occurring in asymptomatic patients without heart disease are benign and need not be treated. Beta blockers may be used for symptomatic patients. Antiarrhythmic therapy for patients after myocardial infarction is controversial; authors of recent studies have tended to discourage this therapy. Patients with malignant arrhythmias--who have been resuscitated from cardiac arrest caused by ventricular ectopy or who have ventricular tachycardia-associated syncope--should be referred for electrophysiologic testing and individualized therapy.

Non-Hodgkin's lymphomas with primary manifestation in gonads--a clinicopathological study

Analysis of 19 cases of Non-Hodgkin's lymphoma (NHL) with primary manifestation in gonads, diagnosed during 1984-1990 at AFIP Rawalpindi is presented. It constituted 10.4% of all extranodal lymphomas during the same period in this institute. Testis were more commonly involved. Mean age at diagnosis was 60.4 years and only 11.4% cases were below 50 years of age. Majority of the patients reported early (mean duration was 4.2 months). The mean tumour size was 3.2 cm. In a significant number of cases (43.5%). NHL was associated with hydrocoele. Diffuse large cell lymphoma was the predominant (73.70%) subtype in testicular lymphoma. One case of Burkitt's lymphoma presenting as ovarian mass was also noted. Most of these cases (56.4%) were in le stage according to Ann Arbor staging. More clinical work-up is required to delineate the course of this entity in Pakistan.

A water-soluble fragment of Micrococcus lysodeikticus cell wall

A fragment of Micrococcus lysodeikticus cell wall was obtained by extraction of walls with water, dimethylformamide or dimethyl sulfoxide. The water-soluble polymer was obtained from the cell walls prepared either with or without trypsin treatment of the cell. This fragment was studied by the Smith periodate oxidation, methylation, mild acid treatment and enzymic procedures. The polymer consists of polysaccharide chains composed of (1-->4)-O-(2-acetamido-2-deoxy-beta-D-mannopyranosyluronic acid)-(1-->6)-O-alpha-D-glucopyranosyl residues. The polysaccharide chain is linked to C-6 of a 2-acetamido-3-O-(D-1-carboxyethyl)-2-deoxy-beta-D-gluco-pyranosyl residue of a peptidoglycan chain composed of repeating (1-->4)-O-(2-acetamido-2-deoxy-beta-D-glucopyranosyl)-(1-->4)-[2-acet ami do-3-O-(D-1-carboxyethyl)-2-deoxy-beta-D-glucopyranosyl] residues. The water-soluble cell-wall fragment was also observed in the-culture medium of Micrococcus lysodeikticus and was also extractable from the cells in minor quantity.

Melancholy: an elusive dimension of depression?

This paper presents a view of melancholy based on Kierkegaard's insight of the self, showing that this dimension of depression is anticipatory of threat to well-being. The view of self, contrasted with a view presuming a connection between two factors only--body and mind--has a third factor or ethico-spiritual element. Taken as an explanatory category, this factor allows for making a distinction between melancholy as crisis and melancholy as ailment, and has implication for detecting and treating the latter. That is, in the initial patient-physician dialogue, the physician might be expected to indicate whether she/he is open to consider the possibility of a third factor as an explanatory category in the formation of self-hood. Such indication would provide for patients with an inkling of their own condition, a basis for making a choice about whom they will accept as caregiver.

Burkitt's lymphoma--a study of 50 consecutive cases

A retrospective study of Burkitt's lymphoma done over a period of 7 years is presented. The relative frequency of Burkitt's lymphoma as compared to other non-Hodgkin's lymphomas was 6.35%. Although Pakistan is non-endemic for Burkitt's lymphoma, but the frequency of the disease is higher than other non-endemic countries. There was male predominance (M:F 2.3:1). Majority of the cases were in pediatric age group and 12% were older than 35 years. The main clinical presentation was abdominal (42%), either in the intestinal tract (22%) or retroperitoneal (18%) region (American mode of presentation). Jaw tumour (4%) (African mode) was rare. Sporadic cases at almost all sites were also encountered. Burkitt's lymphoma presenting as primary nodal disease was seen in 36% cases. Fifty-four percent showed bone marrow infiltration. The stage of the disease at diagnosis was advance in 54% cases. Follow-up of ten cases revealed poor survival inspite of treatment.

Efficacy, safety, and tolerability of isradipine in hypertension as used in general practice in a developing country (Pakistan)

This open-label trial of isradipine was carried out in 3422 outpatients by 893 general practitioners to assess the efficacy, safety, and tolerability of isradipine as monotherapy in mild-to-moderate hypertension. Patients received 2.5 mg isradipine twice daily as monotherapy for 6 weeks following a placebo wash-out period of 1 week. After 6 weeks of active treatment, diastolic blood pressure was significantly reduced from 106 +/- 7.7 to 89.4 +/- 8.0 mm Hg (P < .001). Systolic blood pressure also decreased significantly, from 166.8 +/- 19.6 to 141.8 +/- 15.7 mm Hg (P < .001). Blood pressure was normalized in 75.68% of the patients. A total of 629 patients (19%) reported adverse events, 79 (2.3%) of whom withdrew from the study for this reason. The most common side-effects were headache (8.7%), palpitations/tachycardia (3.8%), vertigo (2.89%) and flushing (1.00%). In conclusion, 2.5 mg isradipine twice daily is a safe, effective, and well tolerated form of monotherapy in the treatment of hypertension in general practice in a developing country (Pakistan).

Pilomatricoma: a retrospective study

A study of 53 Pakistani patients with pilomatricoma diagnosed at AFIP during 1985-1989 is presented. It constituted 37.2% of all benign adnexal tumors, during the same period. 56.2% of patients were more than 30 years of age. Differences in site, sex, and age distribution from Western reports were observed. Unusual clinical presentations were also noted. This study outlines the clinicopathologic features of pilomatricoma in Pakistan.

Non-Hodgkin's lymphoma--clinicopathological pattern

A study of histopathological and clinical features of non-Hodgkin's lymphoma in 495 consecutive cases, diagnosed at AFIP during 1984-1989 is presented. Children below the age of 15 years were not included in this study. The relative frequency of non-Hodgkin's lymphoma was 4.29% in our material. Non-Hodgkin's lymphoma was more frequent than Hodgkin's disease, ratio being 2.44:1. Lymphadenopathy (78.78%), fever (33.08%), weight loss (31.62%) and anemia (30.14%) were the main presenting features. New working formulation was used for morphological characterisation. Follicular lymphoma constituted 8.08% of all cases. Follicular lymphoma was seen only in older age whereas diffuse lymphoma occurred in all age groups. Intermediate and high grade lymphoma represented 73.54% of all NHL. Small lymphocytic lymphoma was common in low grade tumours (13.13%). Extra nodal lymphoma was encountered in a significant proportion (21.22%), gastrointestinal tract being the most frequent site. This study outlines certain interesting features of NHL in Pakistan.

Hodgkin's disease in children

This study provides information about histological types of Hodgkin's disease (HD) among children of Pakistan. Hodgkins disease constitutes 12 per cent of all pediatric malignant tumours. The peak incidence is between 6 and 10 years. The male to female ratio is 5.25:1. The majority (78 per cent) present with cervical lymphadenopathy. Mixed cellularity (MC) is the commonest histological type. In the developed countries nodular sclerosis (NS) and lymphocyte predominant (LP) subtypes are more common, and which have better prognosis. The developing countries have a higher incidence of poor prognostic subtypes. Our study indicates a situation intermediate between the two.

Anorectal melanoma in northern Pakistan

Melanoma of the anorectum is a rare malignancy. At Armed Forces Institute of Pathology (AFIP), 11 cases were diagnosed over a 10 year period (1981-1990) constituting 14.2% of all primary malignant melanomas. The anorectum was the commonest site for noncutaneous melanomas (45.8%). The age group commonly affected was the fifth to seventh decade (72.7%). Most of the tumours were extensive involving both anal canal and rectum. The proportion of anorectal melanoma is much higher in our study as compared to western reports (0.4-1.6%). The distribution of noncutaneous melanomas in our population also differs, with a relatively lower proportion of ocular melanomas (33.3%) which are the commonest (80%) in western studies (JPMA 42: 155, 1992).

The postcardiac injury syndromes

Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.

Gastric carcinoma--a study of 100 cases in northern Pakistan

We describe 100 consecutive patients with histologically proven gastric carcinoma who were admitted to various hospitals in Northern Pakistan. Twenty-six per cent of patients were under 40 years of age. In a majority of patients the tumour was of a morphological type associated with poor prognosis. In most cases the disease was already at an advanced stage at the time of diagnosis, and most patients died within one year.

Toxoplasmic lymphadenitis--a clinicopathological study

Forty-three cases of toxoplasmic lymphadenitis were studied. They constituted 0.5% of all lymph node biopsies and 4.2% of reactive lymphadenitis. The histological findings supporting a diagnosis of toxoplasmosis were correlated with serological studies. The condition primarily affects young men, causing cervical lymph node enlargement and varying degrees of fatigue, malaise, cough and fever. It is usually self-limited. This study emphasizes the need for clinicians to consider toxoplasmosis in the differential diagnosis of lymphadenopathies.

The pattern of malignant tumours in northern Pakistan

A retrospective study of 14,018 malignant tumours from northern Pakistan is presented. The data reflects the pattern of cancer distribution in this region. Among males most common sites are lymphnode, leukemia, skin, prostate, colorectal, bone and stomach and in females breast, skin, ovary, leukemia, gall-bladder, thyroid and bone. The distribution of malignant tumours in various districts of northern Pakistan and different ethnic groups like Pathans, Punjabis and Urdu speaking have also been outlined. Age standardized cancer ratio (ASCAR) was calculated to compare the data from the neighbouring countries of the region. Prostatic cancer in males and gall-bladder carcinoma in females is more frequent in our material as compared to other countries of the region. Comparison of the pattern of malignant tumours in North and South has also been highlighted.

Yet another cause of chronic viral hepatitis?

The clinical features, course and histology of liver in 20 patients; mostly middle aged to elderly females, closely resembling chronic Non A Non B hepatitis is presented. They presented quite late in their disease and therefore, complications such as variceal bleeds, ascites and encephalopathy were frequent. Our patients were negative for hepatitis B and C virus serology. Metabolic and immune causes of chronic liver disease were also ruled out. To the best of our knowledge, this is the first study of its kind elaborating the clinical features, course and histology of liver in chronic Non B Non C hepatitis and raises a number of questions as to the nature of the infecting virus and the epidemiology of disease.