Pooja K Suresh

Volume Conductivity and Scatter Parameters as an Indicator of Acute Bacterial Infections by the Automated Haematology Analyser.

INTRODUCTION Complete blood picture is the first and foremost investigation ordered for evaluation of acute infectious processes which require early and prompt intervention. With the advent of automated Coulter (®) Haematology analysers, the Volume, Conductivity & Scatter parameters of the leucocytes could be analysed for the early detection of the infections. AIM To evaluate the clinical usefulness of Volume, Conductivity & Scatter parameters of neutrophils & monocytes in predicting the onset of acute bacterial infections. MATERIALS AND METHODS Peripheral blood samples from 94 patients with infections (systemic infections n=36 & localised infections n=58) and 46 control subjects were studied using the Volume, Conductivity & Scatter parameters by the Coulter Haematology analyser. RESULTS We observed a significant increase in the mean channel of neutrophil volume & mean channel of monocyte volume from patients with infections (both systemic & localised) as compared with control subjects (Mean Neutrophil Volume: 158.3 ± 13.7 vs 137.2 ± 4.3; p<0.001) & (Mean Monocyte Volume: 177.8± 16 vs 161.7 ± 6.04; p <0.001). However, there was no significant difference in the Mean Neutrophil Volume of patients with systemic infection & localised infections (160.5±17.5 vs 156.8±10.5, p>0.05). CONCLUSION The Volume, Conductivity & Scatter parameters like Mean Neutrophil Volume & Mean Monocyte Volume are more sensitive parameters and could prove to be a quick diagnostic indicator of acute bacterial infections.

Minimally Invasive Plate Osteosynthesis with Locking Plates for Distal Tibia Fractures

INTRODUCTION Distal tibia fractures are challenging injuries with multiple fixation options. Minimal invasive plating for distal tibia fracture is becoming more popular with documented good outcomes. AIM To evaluate the functional and radiological results of fixation of distal tibia fractures with locking plates with Minimally Invasive Plate Osteosynthesis (MIPO) technique. MATERIALS AND METHODS Fifty fractures of distal tibia without Intra-articular extension were operated with locking compression plating with MIPO technique. They were followed up at regular intervals. Functional and radiological results were evaluated at the end on one year. RESULTS The fractures united in 48 (96%) patients with 2 (4%) cases of delayed union which took 30 weeks of time. Postoperatively, 2 patients developed superficial skin infection, 2 patients developed deep infection and 3 patients developed ankle stiffness due to loss of postoperative protocol and 4 patients had implant failure in form of screw breakage. Good amount of range of mobility of ankle joint was present in almost all patients. CONCLUSION MIPO with locking plates for distal tibia fractures is associated with good functional outcomes and is an effective treatment for distal tibia fractures. Although, a larger sample of patients and longer follow up are required to fully evaluate this method of treatment, we strongly encourage its consideration in the treatment of such complex fractures.

Functional and radiological outcomes of operative management of displaced talar neck fractures.

AIM To evaluate functional and radiological results of internal fixation of displaced talar neck fractures. MATERIALS AND METHODS Twenty patients with displaced talar neck fractures who underwent surgery and fixation by cancellous screws were evaluated. Patients were evaluated by American Orthopedic Foot and Ankle Society score which is based on pain (40 points), function (50 points) and alignment (10 points) with excellent (90-100 points), good (75-89 points), fair (60-74 points) and poor scores (<60 points) and radiographically for assessment of union, osteonecrosis and osteoarthritic changes in the subtalar and ankle joint. RESULTS Among the 20 cases, 13 cases had closed injuries and 7 had open fractures. The most common etiology of injury was road traffic accidents. The average follow up time was 28 months. Osteonecrosis was evident on follow up X-rays in 7 cases of which 2 progressed to talar dome collapse. Post traumatic arthritis was observed in 11 cases. Based on American Orthopedic Foot and Ankle Society scores, excellent result was obtained in 4 cases, good 7 cases, fair 5 cases and poor 4 cases. CONCLUSION Talar neck fractures are associated with high rates of morbidity and complications. Post traumatic arthritis is more common complication than osteonecrosis following surgery.

Value of bone marrow examination in Hodgkin lymphoma: Report of three cases with review of literature

Bone marrow involvement by Hodgkin lymphoma is rare with an average incidence of 10%. However, the incidence of bone marrow involvement has been shown to be less than 1% in patients with clinical stage IA or IIA disease. The involvement of the marrow in a patient with Hodgkin lymphoma represents stage IV disease. We report our experience wherein three cases of marrow involvement were picked up on bone marrow aspirates/ -imprints and confirmed on trephine biopsy. In this paper we wish to highlight the significance of bone marrow examination in the initial diagnosis and staging of even clinically early stage Hodgkin lymphoma. Staging investigations performed at the time of diagnosis for patients with Hodgkin lymphoma are vital for determining the appropriate treatment and prognosis.

Hydroxychloroquine-induced erythroderma.

Erythroderma is characterized by diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. Drug-induced erythroderma has rarely been reported with hydroxychloroquine. We report a case of a 50-year-old female patient, with systemic lupus erythematosus, who developed itchy lesions all over the body 1 month after starting treatment with hydroxychloroquine. Drug-induced erythroderma was suspected. Hydroxychloroquine was withdrawn and the patient was treated with emollients, mid-potency corticosteroids, and oral antihistamines. A biopsy was done which confirmed the diagnosis of erythroderma. She recovered with treatment and was discharged. A careful history and clinical examination to search for potential causative factors will help prevent disabling sequelae in erythroderma.

The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

Introduction: Glandular lesions of the female genital tract (FGT) are quite uncommon compared to squamous lesions. Their cytological diagnosis is difficult because of their architectural and cytological complexity, as well as the lack of experience of many cytopathologists in this field. The aim of this study was to determine the significance of Papanicolaou (Pap) smears in the diagnosis of glandular FGT lesions. Methodology: All Pap smears reported during the period of January 2012 to December 2013 were retrieved. Cytohistopathological correlation was done. Results: Among 7,609 Pap smears, squamous epithelial abnormalities were seen in 110 cases (1.5%) and glandular cell abnormalities in 32 cases (0.42%). Among the glandular abnormalities, we encountered 18 cases of atypical glandular cells (AGC) not otherwise specified, 4 cases of endocervical-type AGC and 4 cases favoring neoplastic-type AGC, 2 cases of adenocarcinoma of the endocervical type, 3 cases of adenocarcinoma of the endometrial type, and 1 case of extrauterine adenocarcinoma. Histopathological correlation was available in 12 cases (37.5%). Eighty-three percent showed premalignant or malignant lesions on histopathology. Conclusion: As glandular epithelial lesions are associated with premalignant and malignant FGT lesions, in patients with cytological diagnosis of glandular epithelial abnormalities, it is mandatory to undergo colposcopic examination with endocervical and endometrial curettage.

Patterns of granulomatous responses in TB lymphadenitis and their correlation with treatment outcomes

INTRODUCTION Four patterns are noted in aspirates of TB lymphadenitis with or without concomitant HIV. They are granulomatous, necrotizing granulomatous, predominantly necrotizing and necrotizing suppurative designated pattern 1, 2, 3 and 4, respectively. The present study attempted to correlate granulomatous patterns, Acid Fast Bacilli (AFB) density with treatment outcomes. MATERIALS AND METHODS The MGG and Papanicolaou stained slides of 56 lymphadenitis patients, 38 TB and 18 TB with seropositive HIV were studied for two years. The AFB were stratified into: 0 - nil (1 - ≤1 AFB, 2 - >1 but <10 AFB, 3 - ≥10 AFB)/10 fields. RESULTS There were 35 males and 21 females. Eleven aspirates demonstrated AFB. TB+HIV lymphadenitis displayed a higher AFB score. TB+HIV lymphadenitis aspirates significantly showed higher grade granulomas and AFB. TB+HIV lymphadenitis required ≥8-month treatment. Granulomas (pattern 3 or 4) but not high AFB scores required longer treatment (>6 months). Treatment of AFB (≥1) often extended to >6 months. CONCLUSION TB with seropositive HIV, possibly due to defective immune regulation exhibited granulomas (pattern 3 or 4) necessitating treatment for ≥8 months. Pattern 3 or 4 granulomas irrespective of HIV status demanded >6-month treatment.

Fine needle aspiration cytology of salivary gland lesions: Our experience

Introduction: Fine needle aspiration cytology (FNAC) of salivary glands is one of the most commonly done first line investigations in the head and neck region. Objectives: To study the cytological features of various salivary gland lesions and to correlate with histopathological diagnosis wherever possible. Materials and Methods: All the FNAC slides of salivary gland lesions received at cytology lab of a tertiary hospital for a period of 3 years that is, from January 2011 to December 2013 were reviewed retrospectively. Histopathological correlation was done for cases wherever available. Results: During the study period salivary gland FNAC was done for 100 cases. Among them, 51 (51%) were reported as nonneoplastic and 49 as neoplastic (49%). Histopathological correlation was available in 18 cases (18%). The accuracy of salivary gland cytology is 77.7% (14/18 cases). The mean age of presentation of all the salivary gland lesions ranged from 12 years to 92 years with the mean age being 47.7 years. The male:female ratio was 1.5:1. Parotid gland was involved in 74 cases and submandibular gland in 26 cases. Bilateral involvement was noted in 1 case (1%). Conclusion: Being a minimally invasive procedure, FNA of salivary glands continues to be an important diagnostic tool in the preoperative diagnosis of salivary gland lesions in spite of few pitfalls in diagnosing due to cytomorphological overlapping.

Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma

This report highlights the utility of the reticulin stain in a completely infarcted chorangioma that facilitated the diagnosis. The patient had normal spontaneous delivery with good neonatal outcome in spite of the large size of the chorangioma and the presence of hydramnios in the antenatal period which may perhaps be due to the complete infarction of the tumor.

Diagnostic Pitfalls in Papillary Lesions of the Breast: Experience from a Single Tertiary Care Center.

INTRODUCTION Papillary neoplasms are a group of lesions that are characterized by presence of papillae supported by fibrovascular cores lined by epithelial cells with or without myoepithelial cell layer. These neoplasms may be benign, atypical or malignant. AIMS This study was conducted to analyse the clinicopathological characteristics of papillary lesions of the breast. MATERIALS AND METHODS A retrospective and prospective analysis of 34 cases of papillary lesions received over a period of 7 years from 2009 to 2015 was done. The patients clinical details were collected from medical archives and the histopathological findings were reviewed. The lesions were classified into benign, atypical and malignant categories. RESULTS During the study period, there were 34 cases of papillary lesions of breast. The mean age was 58 years. The central quadrant was the most common location (66.6%). The most common presenting complaint was lump (76.5% cases). Papillary lesions presented more commonly as solitary lump (82.4%) rather than multifocal disease. Benign papillary lesions were more common than the atypical and malignant lesions. The most common papillary lesion accounting for 43% of the cases was intraductal papilloma. Malignant lesions accounted for 41.2% cases with intraductal papillary carcinoma and invasive papillary carcinoma constituting 14.7% cases each. CONCLUSION Diagnosis of papillary carcinoma is challenging and its classification includes different entities that have specific diagnostic criteria. Due to their heterozygosity in morphology with benign, atypical and malignant subtypes, morphological features such as type of fibrovascular core and continuity of myoepithelial layer along with immunohistochemical stains for myoepithelial cells should be considered for proper and accurate diagnosis.