Rapid and reliable assaying of Tc-99 in sediment samples with novel MTPN polymeric resin

The paper describes a new method for the rapid determination of Technetium (Tc) in sediment samples using solid-phase extraction chromatography (SPEC) with a novel methyl triphenyl phosphoniumnitrate (MTPN) resin. The effectiveness of the resin in selectively recovering Tc was evaluated in both batch and column mode and exploited for rapid analysis of 'Tc'. The procedure involves the acid digestion of samples, pre-concentration of fission products in supernatant and co-precipitation of actinides with Fe(OH)3, followed by selective recovery of Tc by SPEC using a column filled with MTPN resin. The recovered Tc was then radiometrically assayed using beta counting. The method was validated using IAEA certified reference materials and was found to provide reliable and reproducible results for the activity concentration of Tc-99 in sediment samples within 24 h.

Correlation between Sonoelastographic, Doppler and Histopathological Findings in Chronic Kidney Disease Patients in Tertiary Care Centre

Background Ultrasound (USG) with Doppler examination of intrarenal vessels is the imaging modality of choice employed in patients with renal failure and is commonly performed early in the clinical course. The pulsatility index (PI) and the resistive index (RI) of downstream renal artery have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. Pathological process in any tissues alters their elastic properties which can be assessed non-invasively through newer technique like elastography. Objective To correlate the findings obtained by sonoelastographic, doppler and histopathological studies in chronic kidney disease patients. Method Study was done in 146 patients referred to Department of Radiodiagnosis and Imaging, TUTH for native renal biopsy. Renal sonographic morphology (length, echogenicity, cortical thickness), Sonoelastography (Young's modulus) and Doppler parameters (peak systolic velocity, resistive index) were assessed. The grading of estimated GFR (eGFR) was calculated based on chronic kidney disease (CKD) criteria. Result Among 146 patients, 63 (43.2%) were females and 83 (56.8%) were males. Maximum patients were in age group of 41-50 years (25.3%) followed by age group 51-60 years (24%). Mean age of patient was 42.06±14.70 for males and 39.57±12.54 females. Maximum mean Young's modulus was seen in eGFR stage G1 with 46.57±19.51 kPa followed by in stage G3a with 36.46±10.01 kPa and observed to be statistically non-significant (p=0.172). However, statistical significance difference was noted between the resistive index and elastographic measurement of Young's modulus (r=0.462, p=0.0001). Minimum mean cortical thickness was seen in eGFR stage G5 with 4.42±1.48 mm followed by stage G4 with 5.57±1.24 mm (p= 0.0001). Cortical thickness is decreasing as eGFR stage was increasing in our study (p=0.0001). Resistive index is increasing with decrease in renal size (r=-0.202, p=0.015). Conclusion Ultrasonography along with doppler study and elastography have limited role in diagnosing the pathology of chronic kidney disease, however, it has significant role in the disease progression.

Evaluation of BenzoDODA grafted polymeric resin for rapid and reliable assaying of plutonium in sediment samples

The paper reports a new rapid radioanalytical procedure for the determination of plutonium (Pu) in sediments by solid phase extraction chromatography (SPEC) using Bis-(2-ethylhexyl) carbamoyl methoxy phenoxy-bis-(2-ethylhexyl) grafted resin, abbreviated as Benzodioxodiamide (BenzoDODA) grafted resin. The resin was synthesized and evaluated for its sorption behaviour towards Pu in batch and column mode to determine its efficacy for selective recovery of Pu from sediment samples. The analytical procedure was based on the radiochemical separation of samples by acid digestion, followed by preconcentration of actinides by co-precipitation with Fe(OH)₃ and finally selective recovery of Pu by SPEC using a column filled with BenzoDODA grafted resin. Pu was then radiometrically assayed by preparing alpha disc sources with electro-deposition followed by alpha spectrometry. The method was further validated with IAEA reference materials. This method gives reliable and reproducible results for the activity concentration of Pu in sediment samples within 24 h.

Correlation of visual inspection with cytological and histopathological findings in cervical neoplasia

Background: Cervical cancer is one of the commonest malignancies and a leading cause of morbidity and mortality among women. The aim of this study was to evaluate the diagnostic value of Papanicolaou (PAP) smear and visual inspection with acetic acid as methods of cervical cancer screening.Materials and Methods: This was a observational cross-sectional study conducted from the period of 2068.11.01 to 2069.11.01. The study population consisted of women with histologically confirmed cervical intraepithelial neoplasia or invasive carcinoma who had undergone prior PAP smear.Results: During the study period 160 patients underwent both PAP smear and cervical biopsy. Of these patients, 49 had a histological diagnosis of cervical intraepithelial neoplasia or invasive carcinoma. The histopathological and cytological diagnoses were compared. Visual inspection with acetic acid status was available for 31 of the 49 cases. The sensitivity of PAP smear was 61%, specificity 97%, positive predictive value 91%, negative predictive value 85% and diagnostic accuracy 86% for detection of cervical neoplasia. Visual inspection with acetic acid had a sensitivity of 74%, specificity 48%, Positive predictive value 64%, Negative predictive value 60% and diagnostic accuracy of 63%. Combining the two procedures increased sensitivity by 26%, Negative predictive value by 11%  and diagnostic accuracy by 2 per cent.Conclusion: PAP smear has a higher specificity, Positive predictive value, Negative predictive value and diagnostic accuracy but lower sensitivity than visual inspection with acetic acid. Visual inspection with acetic acid by itself is not an effective screening method. A combination of PAP smear and visual inspection with acetic acidcan ensure adequate screening of cervical neoplasia.

T-cell lymphoblastic lymphoma with generalized lymphadenopathy and bone marrow involvement

A 16-year-old girl presented to the out patient department in Grande International Hospital with complaints of fever since 3 weeks, tonsillitis and multiple lymphadenopathy.  Fine needle aspiration cytology from one of the cervical lymph nodes showed atypical lymphoid cells with prominent nucleoli in some cells; hence, a diagnosis of Non Hodgkin lymphoma was made.  Bone marrow aspiration and biopsy also showed presence of similar atypical lymphoid cells.  One of the lymph nodes was also excised for purpose of immunohistochemistry, and the biopsy showed effacement of lymph node architecture with diffuse proliferation of intermediate sized atypical lymphoid cells.  These tumor cells showed positivity for CD3, TdT, and Ki-67.  A diagnosis of T-cell lymphoblastic lymphoma was made.Lymphoblastic lymphomas are rare, accounting for 2% of all lymphomas, of which majority are of T-cell type.  TCLL usually occurs in young males.  In addition to lymphadenopathy, other common sites of involvement include mediastinum, CNS and bone marrow.  It runs an aggressive course and overall survival of patients is poor.

Correlation of FNAC and histopathology in diagnosis of salivary gland lesions

Background: Value of fine needle aspiration cytology in preoperative diagnosis of salivary gland lumps has been established in various studies. This study aims to calculate sensitivity, specificity accuracy of FNAC, correlate FNAC findings with histopathology and find out reasons for common diagnostic pitfalls in FNAC.Materials and methods: This study was performed in 67 patients that presented with salivary gland lumps at Department of pathology, Tribhuvan University Teaching Hospital, Institute of medicine, Kathmandu, Nepal from January 2009 to June 2010. FNAC was performed and was correlated with histopathological diagnosis to judge the sensitivity, specificity and accuracy of FNAC.Results: Out of 36 cases there was cyto-histological correlation in 28 cases. Pleomorphic adenoma was the most frequent lesion in this study. Parotid gland was the most common site affected by salivary gland lesions. The sensitivity, specificity and accuracy for non-neoplastic lesions was 100%, 89.28%, 91.67%, for benign neoplasms was 100%, 86.95%, 91.67% and for malignant neoplasms was 57.14%, 100%, 83.33% respectively.Conclusion: FNAC is a useful tool in preoperative diagnosis of salivary gland lesions and can be crucial for the management of the patient. Aspiration and reporting of salivary gland lesions demands a competent pathologist who considers all the possible diagnostic pitfalls in mind.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11593 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 654-657

Lupus nephritis: Update on aetiopathogenesis and controversies in classification

Systemic Lupus Erythematosus; a chronic autoimmune disease; is characterized by loss of tolerance against its own antigens and leads to production of autoantibodies and causes formation and deposition of immune complexes in different organs. Recent articles have been trying to unravel the mysteries of SLE. Different theories that have been proposed for the aetiopathogenesis of SLE are a)The circulating immune complex theory, b) The direct binding to endogenous renal antigens theory, and c) binding of antibody to antigens that were previously ‘planted’ into the kidney.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11596 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 672-676

The role of electron microscopy in kidney lesions: A review of its diagnostic importance

Electron microscopy is a technology which was at one time widely used for renal as well as non-renal benign and malignant diseases, but its use has been rapidly declining as hospitals all over the world cut down on expenses. This leaves the renal pathologist with only light microscopy and immunofl uorescence at his disposal to diagnose diseases. Few studies have stated the importance of electron microscopy in routine renal biopsy reporting. We look at different cases where electron microscopy has been helpful in diagnosis and review the literature to assess the role this investigative modality still has to play in modern renal pathology. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 411-415 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7871

Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic

Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. Most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology have been reported and are useful in cytological detection of bancroftian filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The objective of the study was to investigate importance of cytology in diagnosis of filariasis in lesions clinically anticipated to be of neoplastic and to review the cytomorphology of bancroftian filaria and its association with neoplasm. This is a retrospective study carried out in cytology department of Tribhuvan University Teaching Hospital. 14 cases of cytological specimen out of 4291 (0.3%) showed microfilaria; 12 cases were from FNAC from different sites and 2 cases were from pleural fluid. 2 cases showed ova in addition to microfilaria and one of them in addition showed fragment of adult worm. Microfilaria in 4 cases of FNAC and one case ofpleural fluid were associated with malignant cells.

Diagnosis of subcutaneous cysticercosis in fine needle aspirates: a study of 10 cases

The objective of this study is to document the value of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of subcutaneous cysticercosis. Aspirates smears of 10 cases of subcutaneous swellings were studied over a period of 1 year between January 2004 and January 2005. The subcutaneous swellings were presented at different sites like cheek, neck, forearm, arm, chest wall and abdominal wall. In none of these cases was cysticercosis considered as diagnostic possibility. The characteristic cytomorphological features of parasitic tegument, parenchymatous portion, presence of epithelioid cells, giant cells and inflammatory cells in cytological smears help diagnose the cases of subcutaneous cysticercosis. Biopsy confirmation was possible in 5 cases, of which, two cases showed parenchymatous portion of the parasite. FNAC provides safe and rapid tool for diagnosis of subcutaneous cysticercosis. In endemic areas, cysticercosis should be considered one of the differential diagnosis of the subcutaneous swellings.

Histopathological analysis of hysterectomy specimens

This was a retrospective study carried out on all hysterectomy specimens sent to Department of Pathology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 1st September 2005 to 28th February 2006, to study the histopathological findings of these specimens. All informations used in the study were obtained from the records of Department of Pathology of the hospital. Out of 221 hysterectomy specimens received during the study period, 139 (62.9%) were total abdominal and 82 (37.1%) were vaginal hysterectomy specimens. Mean age of the patient was 53.4 years for vaginal hysterectomy group where as it was 37.6 years for total abdominal hysterectomy with unilateral salpingo-oophorectomy and 46.3 years for total abdominal hysterectomy with bilateral salpingo-oophorectomy group. Uterine prolapse was commonest indication of hysterectomy overall (37.1%) and accounted for 98.8% of vaginal hysterectomies. Other common indications of hysterectomy were uterine fibroid (24.9%), ovarian tumor (14.9%) and dysfunctional uterine bleeding (7.7%). Leimyoma was the most common pathology found in uterine corpus (27.1%). Chronic cervicitis in cervix, functional cysts in ovaries and paratubal cysts in fallopian tubes were most common histological findings. Ovarian neoplasms accounted for 18.3% of ovarian pathology. 38% specimens were unremarkable histopathologically. In Tribhuvan University Teaching Hospital, abdominal hysterectomies are more common than vaginal hysterectomies. Most vaginal hysterectomies are done for uterine prolapse and patients are older than those undergoing abdominal hysterectomies. Most abdominal hysterectomies are performed for uterine leiomyomas. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapse.

Light chain deposition disease in kidney: A review of the literature

Light chain deposition disease is a rather uncommon monoclonal gammopathy with predominantly renal manifestations with presence of monoclonal light chains in serum and urine. It usually occurs in elderly male patients but can have a wide age range. Patients usually present with proteinuria and some renal dysfunction, but other organs like the liver and heart may also be involved and lead to the death of the patient. The survival of the patients is only about 18 months and benefit of renal transplantation in these patients is debatable, because of high chances of recurrence. Typical light microscopic diagnostic features are important to recognize this disease, which include mesangial nodules and thickening of tubular and glomerular basement membranes. Immunofluorescence shows a monoclonal pattern for kappa light chain, or much less commonly lambda light chain. Electron microscopy is further invaluable in identifying the granular deposits in the mesangial nodules and basement membranes. Keywords: Light chain deposition disease; Renal failure; Plasma cell dyscrasia; Immunofluroescence; Electron microscopy DOI: 10.3126/jpn.v1i1.4454 Journal of Pathology of Nepal (2011) Vol.1, 56-59

Cadaver kidney transplantation in Nepal: is it time to start?

DOI: http://dx.doi.org/10.3126/jpn.v1i2.5415JPN 2011; 1(2): 164