Rajni Kaushik

Neonatal mortality rate: relationship to birth weight and gestational age.

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p<0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p<0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.

Neonatal morbidity in a Hospital at Shimla

During the study period there were 2063 live birth. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p<0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p<0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p<0.001)]. Hyperbillrubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p<0.001)] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.

Cutaneous leishmaniasis presenting as a submandibular nodule - a case report

A 42 year old male from Kinnaur district of Himachal Pradesh presented with a subcutaneous nodule in the submandibular region. It was 2x3 cm in size, firm, mobile and non-tender. Lymphadenitis and sialadenitis were kept as differential diagnosis. Fine-needle aspiration revealed Leishman Donovan (L-D) bodies along with non-caseating epithelioid cell granulomas. We are presenting this report for its rarity.

Primary Endometrioid Carcinoma of the Broad Ligament: A Rare Case Report

Although secondary involvement of the broad ligament by malignant tumours arising elsewhere in the abdomen is common, primary tumours in this location are rare. Most neoplasms in this region whether benign or malignant usually present clinically with vague symptoms and are often discovered either during a routine gynaecological examination or on abdominal exploration because of the presence of a pelvic mass and vague lower abdominal discomfort or pain [1]. The present case which was diagnosed clinically as left ovarian tumour and histopathologically as endometrioid carcinoma of the broad ligament is reported for its rarity and for the unique histological finding of transitional cell differentiation associated with the primary tumour.

Non-Hodgkin's lymphoma presenting as an ovarian mass

Involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Lymphoma presenting with ovarian mass as an initial manifestation is a rare entity and may cause confusion for the clinician since its presentation might resemble other, much more frequent primary ovarian tumors. We present a case of non-Hodgkins lymphoma where the initial presentation was an ovarian tumor. The patient underwent surgery and was receiving chemotherapy when she developed generalized lymphadenopathy. She did not respond well to the therapy, had a progressive disease and expired after 5 months.

Angiolipoma of the mammary region: A report of two cases

Angiolipoma is a benign variant of lipoma that is rare in the breast and may be confused clinically, radiologically and pathologically with other benign tumours. It accounts for 5 - 17% of all benign fatty tumours. Clinicians, radiologists and pathologists in particular should not forget the existence of an angiolipoma of the breast to avoid unnecessary re-aspiration of the lesion considering the smears with only adipose tissue fragments as inadequate. We report two cases of angiolipoma who presented with solitary lumps in the breast, and a clinical diagnosis of fibroadenoma was suggested in both the cases. Both were diagnosed as lipoma on cytology and, on subsequent histopathology, a diagnosis of angiolipoma was given.

Cytological diagnosis of lepromatous leprosy: A report of two cases with review of literature

The “gold standard” for the diagnosis and classification of leprosy to date, is histological examination of skin biopsy in correlation with the bacteriological indices. These are, however, time-consuming. An attempt was made to diagnose leprosy using fine needle aspiration cytology (FNAC) which is a simple, safe, cost-effective and time-saving procedure with minimal trauma and complications. This case report highlights the role of FNAC in rapid diagnosis and early management, in patients of leprosy.

Inguinal endometriosis: A case report

Inguinal (noncutaneous) endometriosis is an uncommon presentation of endometriosis. It usually presents as a painful, typically right-sided, hernia-like inguinal mass with catamenial exacerbation. Here we report a case of inguinal endometriosis in which fine needle aspiration cytology was instrumental in reaching the diagnosis which was subsequently confirmed on histopathology.

Cytological diagnosis of xanthogranulomatous appendicitis

Xanthogranulomatous reaction can occur in any organ but the most common sites are kidney and gallbladder. Xanthogranulomatous appendicitis (XA) is a rare clinical entity. There are a few case reports of XA diagnosed on histopathology but none on cytology. Here we report a case of a 47-year-old lady who presented with acute abdomen and was found to have a mass lesion in the right iliac fossa. She was diagnosed with XA intraoperatively on imprint cytology that was subsequently confirmed on histopathological examination. Due to the rarity of XA itself and the use of imprint cytology for intraoperative diagnosis the case is being presented.

Evaluation of AgNORs in gallbladder lesions

Background: Quantification of argyrophillic nucleolar organizer regions (AgNORs) is a good indicator of cellular proliferation activity and is useful diagnostic tool to estimate the malignant potential of lesions in gallbladder. The aim of the present study was to study the AgNORs and assess their correlation with various lesions of the gallbladder. Methods: This study was conducted in the department of pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. One hundred specimens of gall bladder lesions (50 cases chronic cholecystitis,30 cases epithelial hyperplasia and 20 cases of carcinoma) were study subjects. AgNOR staining was done on three micron thin sections of paraffin embedded tissue, as per the method of Crocker and Smith with safranin counterstain. The number of AgNORs, stained as black dots was counted in one hundred adjacent cells in different lesions. Results: Mean AgNOR count in chronic cholecystitis, epithelial hyperplasia and carcinoma was 2.44±0.31, 3.88±0.39 and 7.90±0.76 respectively. AgNOR counts in various lesions gradually increased from chronic cholecystitis to carcinoma and the increase was statistically significant (p<0.05). Conclusions: Despite inter-laboratory variations and lack of standardization of counts for a particular lesion, AgNOR technique is easy to perform, economical and reliable indicator of malignant potential of the gall bladder lesions, hence can be used in resource poor set up as an adjunct to histopathology.