Cytogenetic study is not essential in patients with aplastic anemia

Depending on contemporary treatment approach of aggressive immunosuppression, Aplastic Anemia (AA) is caused by immunological destruction of otherwise normal hematopoietic stem cells. The aim was to summarize the cytogenetic abnormalities in AA patients and the frequency of Fanconi Anemia (FA) in morphologically normal AA patients in eastern India. Ethical clearances were obtained from both institutions involved in this study. Out of 72800 patients attending the outpatient department, 520 pancytopenia patients were screened for AA after Bone marrow (BM) aspiration and biopsy. Samples were collected from 117 cases in 3 phases. 51 peripheral venous blood (PVB) samples in the first phase, 19 BM & PVB paired samples in the second phase and 47 BM samples in third phase were collected followed by leukocyte and/or BM stem cell culture. Next GTG banding and karyotyping were performed. PVB was collected from 63 (< 50 years) AA patients and stress cytogenetics was done to diagnose FA. In the first phase of the study, out of 51 PVB samples, 1 (1.96%) showed a unique chromosomal abnormality, i.e. 45,XY,rob(14:21)(p10:q10)[20]. In the second phase of study, among 19 BM & PVB paired samples, 1 (5.26%) showed abnormal karyotype i.e. 45,X,-Y[3]/46,XY[47]. In the third phase of the study, 47 BM samples showed normal karyotype. Only 6 (9.52%) cases were found positive for stress cytogenetics. A negligible percentage showing cytogenetic abnormality in such a considerable number of AA cases indicates that routine cytogenetic analysis of AA patient is not essential. A significant percentage was positive for stress cytogenetics; suggestive for FA, even the patients were morphologically normal.

Eccrine angiomatous hamartoma: late onset facial presentation

Eccrine angiomatous hamartoma (EAH) is a very rare benign neoplastic condition characterized by hamartomatous proliferation of eccrine glands and accompanying blood vessels and lymphatics. These lesions are more often present at birth or appear during early infancy and childhood and present as solitary nodule or plaque with occasional pain and sweating. They are generally present on the extremities, mostly the palms and soles. We report here a case of EAH in a 20-year-old female who presented with a solitary angiomatous plaque close to the lower eyelid of the right eye with occasional pain and sweating for its rarity.

Analysis of FNAC of cervical lymph nodes: experience over a three-year period

This study was taken up with the aim to investigate the pattern of cervical lymphadenopathy among patients presenting to IPGME&R, Kolkata, a tertiary care institution in Eastern India to evaluate the diagnostic efficacy of FNAC, and to dissect the diagnostic pitfalls. A total of 509 patients were subjected FNAC of cervical lymph nodes over a three-year period (August 2006-July, 2009). Since in 34 patients, as either the aspirate was inadequate or the opinion equivocal, the remaining 475 cases were analysed. Overall tuberculous lymphadenitis was the most common finding (222/475; 46.7%), while reactive hyperplasia was the commonest presentation (45%) in patients less than 20 years of age. Malignant pathology accounted for 13.7% (65/475) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (44/65; 67.7%). Histopathology reports were available for comparison in 220 cases. Twelve cases of tuberculosis were missed in FNAC and were reported as either reactive hyperplasia (n = 9) or acute non-specific lymphadenitis (n = 3). Among the 3 cases of metastatic squamous cell carcinoma that were missed in FNAC, one was reported as tuberculous lymphadenitis (due to granuloma formation) and the other 2 as reactive hyperplasia due to sampling error. FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

Eccrine angiomatous naevus revisited

Hamartomatous, circumscribed swellings of the extremities make an interesting study. Presentations are manifold and the naevi are not always present from birth. Excessive growth of hairs leads to remarkable appearance of such swellings. A young woman presented to the dermatology department, complaining of tenderness over 4^th finger of her left hand. The defect was present for the last couple of years and was typified by visible hyperhidrosis on gentle tapping. Counseling of the affected lady made her agree for a skin biopsy. The histopathology revealed it to be of the nature of eccrine angiomatous hamartoma. Blood vessels were scarce. Eccrine ducts were plentiful without other associated anomalies. The deformity was removed by simple excision with good result.

Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period

AIMS

This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls.

MATERIALS AND METHODS

A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases.

RESULTS

Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases.

CONCLUSION

FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India

OBJECTIVE

The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed.

METHODS

Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India. A training program was implemented in Midnapore Medical College in West Bengal, India, under the direction of the Health Minister to train care providers in the new protocol. After training, data were collected for 839 snakebite victims over a 12-month period and included epidemiological data, ASV volumes administered, and mortality. The results were collated and compared with results calculated from 780 snakebite victims treated during the 12-month period before implementation of the protocol. Treatment prior to protocol implementation was based on knowledge gained by the care providers from western and forensic medicine textbooks.

RESULTS

Protocol-guided treatment resulted in a 66% decline in the amount of ASV administered to victims. Fewer victims received ASV based on rational guidelines for assessing envenomation, dosage and repeat dosage, and clear endpoints to ASV therapy. In addition, there was a trend towards reduced mortality and an absolute reduction of 24%.

CONCLUSION

Use of the protocol reduced ASV utilization and the number of deaths. Locally developed protocols should be encouraged by such organizations as the World Health Organization and national and state governments and should be established with significant input from local experts.

A clinicopathological study of malignant melanoma with special reference to atypical presentation

Malignant melanoma is a tumor of melanocytic origin. Lymphatic and hematogenous metastases are common in this condition. Retrospective analysis was performed in 16 consecutive cases diagnosed histopathologically as malignant melanoma at the pathology department of a medial college in eastern India. 75% of the patients were male; majority of them was in their sixth decade. All (100%) the lesions were pigmented. The primary site was known in all cases, except two (12.5%). Out of the 14 cases with known primary site 11 (78.57%) were cutaneous melanomas, including one arising in labia minora, two (14.29%) were ocular and one (7.14%) was vaginal in origin. Among cutaneous melanomas, superficial spreading type was the commonest variety and mixed population of epithelioid and spindle cell was the commonest histopathological pattern. The commonest grade of invasion was grade III (Clark's). The clinical presentation of the case of vaginal melanoma and the two cases of secondary melanomas, including the one with obscure primary tumor, were bewildering and hence are discussed separately.

A study on body mass index (BMI) and some biochemical parameters of the medicos with family history of diabetes mellitus, hypertension and coronary heart disease

Increasing prevalence of diabetes mellitus (DM), hypertension (HT), coronary heart disease (CHD) is alarming; risk factors are fairly stable, passing fairly well from childhood to adulthood; genetic factors play a role. This is important to know the status of some biochemical parameters viz, fasting plasma glucose level, fasting serum insulin (FI), serum triglyceride (STG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) among the medicos with family history (FH) of DM, HT or CHD and the relationship of biochemical parameters with body mass index (BMI). Mean age of the sample (n=67) was 22 years with 76.12% males and 23.88% females; 44.78%, 29.85% and 19.40% had FH of DM, HT and CHD respectively; 8.96% had the FH of three diseases. High BMI was seen in 62.69% cases; it was significantly high among those with FH of DM (p<0.05) but not significant against HT (p>0.05) or CHD (p>0.05). All had normal fasting plasma glucose level. Positive association existed (a) between BMI with FI, LDL and HDL, FI with LDL and HDL, TG with TC, TC with LDL and HDL, LDL with HDL among those with FH of DM; (b) between BMI with FI, STG and HDL, FI with LDL and HDL, TC with LDL and HDL, LDL with HDL among those with FH of HT; (c) between BMI with FI, STG and HDL, FI with TC, LDL and HDL, TC with LDL and HDL, LDL with HDL among those with FH of CHD. Multiple correlation coefficients (R) also indicated moderate association.

Health profile of two social groups living in a squatter settlement in Calcutta

Health and well-being of individuals largely depend on socioeconomic and environmental conditions. The low socioeconomic groups face the highest health burdens. In the present study an attempt has been made to compare and contrast the health related traits prevalent in two social groups (Hindu and Muslim), living in a squatter settlement in Calcutta, India. The study has been conducted on women between 20 to 40 years of age. The results show that the Muslims are more frequently affected with respect to most of the traits than the Hindus, but the difference is significant with respect to only a few traits. Thus, micro-cultural traits associated with religion do not seem to have much effect on the health related traits considered in this study.

Correlation between human papillomavirus DNA detection in maternal cervical smears and buccal swabs of infants

Acquisition of human papillomavirus (HPV) infection in buccal mucosa by the infants at birth has been investigated. Presence of HPV DNA was evaluated in cervical smears of 30 pregnant women before delivery and in buccal swabs of the corresponding 31 infants (1 set of twins). HPV DNA was detected among the 40% of women, 16% of infants an the detection was concordant in 23 mother-infant pairs. HPV DNA was demonstrated in buccal mucosal cells of 41.6% of the infants born to HPV positive mothers. Maternal-infant transmission was highest for HPV 6/11. Assessment of the risk of developing HPV related oral lesions in children at later life owing to acquisition of HPV during perinatal period may help in determining a strategy to combat the disease.

Clinicopathological study of clinically undiagnosed cases of kala-azar with special reference to grading of parasites

Clinicopathological study of 34 clinically undiagnosed cases of kala-azar has been undertaken with a view to establish the diagnosis and correlate the quantitative grading of Leishmania donovani in bone marrow/splenic aspirates with clinical features and duration of disease. The ages of the patients were between 5 and 45 years. The duration of illnesses ranged from 2-24 months with 47% having 2 months' duration. Splenomegaly was less than 7 cm in 70.5% cases. Anaemia, leucopenia and mild thrombocytopenia were present in all the cases. Aldehyde test was positive in 47% cases. Bone marrow aspiration revealed the parasites in 82.3% cases. L donovani was also observed in 66.6% cases of splenic aspiration including 6 cases where bone marrow failed to reveal the parasite. Grading of the parasites in bone marrow and splenic aspirates revealed majority of the cases (73.5%) were in 3+ and 4+ grades. No correlation between splenic size and duration of illness or parasite grading was detected. Neither any positive correlation between parasite grading and duration of illness was observed.

Fine needle aspiration cytology of cervical lymphadenopathy with special reference to tuberculosis

One hundred eighty cases of cervical lymphadenopathy have been studied by fine needle aspiration cytological examination followed by histopathologic examination of the excised lymph nodes. The diagnostic accuracy was 84.4% for tuberculous lymphadenitis by fine needle aspiration cytological examination. Observation of caseous necrosis (84.2%) and epithelioid cells (73.6%) were the most characteristic diagnostic features in the aspirated smears. Acid-fast bacilli were observed in 45.6% cases. Metastatic carcinoma also yielded a high diagnostic accuracy ie, 89%. Fine needle aspiration cytology has been found to be safe, quick, inexpensive with high diagnostic accuracy in cervical lymphadenopathy.

Rare variant of acute promyelocytic leukaemia

Acute promyelocytic leukaemia (APL) is a peculiar sub-type of acute myeloblastic leukaemia characterised by presence of atypical promyelocytes in bone marrow and peripheral blood and common occurrence of haemorrhagic episodes associated with disseminated intravascular coagulation. Two morphological forms of APL are recognised--typical hypergranular and microgranular or M3 variant. This microgranular form of APL is rare but has got some peculiar features and often can be diagnosed by peripheral blood smear examination alone without bone marrow examination. Three cases of microgranular form of APL observed during a period of 6 months are reported here.