Ruchika Gupta

MR evaluation of brachial plexus injuries

SummaryTen cases of brachial plexus injury were subjected to magnetic resonance (MR) to demonstrate the roots, trunks, divisions or cord abnormalities. Both normal and abnormal brachial plexuses were imaged in sagittal, axial, coronal and axial oblique planes. Myelography, using water soluble contrast agents, was performed in seven cases. MR demonstrated one traumatic meningocele, one extradural cerebrospinal fluid (CSF) collection, trunk and/or root neuromas in four, focal root fibrosis in two and diffuse fibrosis in the remaining two cases. Results of MR were confirmed at surgery in four cases with neuromas, while myelography was normal in two and was not carried out in the remaining two. In two cases, where MR demonstrated diffuse fibrosis of the brachial plexus, myelography showed C7 and T1 traumatic meningocele in one and was normal in the other. Both these patients showed excellent clinical and electrophysiological correlation with MR findings and in one of them surgical confirmation was also obtained. In the other two cases with focal nerve root fibrosis, myelography was normal in one and showed a traumatic meningocele in another. Operative findings in these cases confirmed focal root fibrosis but no root avulsion was observed although seen on one myelogram. Focal fibrosis, however, was noted at operation in more roots than was observed with MR. Initial experience suggests that MR may be the diagnostic procedure of choice for complete evaluation of brachial plexus injuries.

Prevalence, risk factors and awareness of hypertension in India: a systematic review

Indians have high rates of cardiovascular disease. Hypertension (HTN) is an important modifiable risk factor. There are no comprehensive reviews or a nationally representative study of the burden, treatments and outcomes of HTN in India. A systematic review was conducted to study the trends in prevalence, risk factors and awareness of HTN in India. We searched MEDLINE from January 1969 to July 2011 using prespecified medical subject heading (MeSH) terms. Of 3372 studies, 206 were included for data extraction and 174 were observational studies. Prevalence was reported in 48 studies with sample size varying from 206 to 167u2009331. A significant positive trend (P<0.0001) was observed over time in prevalence of HTN by region and gender. Awareness and control of HTN (11 studies) ranged from 20 to 54% and 7.5 to 25%, respectively. Increasing age, body mass index, smoking, diabetes and extra salt intake were common risk factors. In conclusion, from this systematic review, we record an increasing trend in prevalence of HTN in India by region and gender. The awareness of HTN in India is low with suboptimal control rates. There are few long-term studies to assess outcomes. Good quality long-term studies will help to understand HTN better and implement effective prevention and management programs.

Angle Dispersive X-ray Diffraction Beamline on Indus-2 Synchrotron Radiation Source: Commissioning and First Results

Angle dispersive x-ray diffraction (ADXRD) is a basic non destructive tool for the determination of crystal structure. Energy tunability and high flux are added advantages in using synchrotron radiation (SR) source for ADXRD technique. We have installed an ADXRD beamline (BL-12) on Indus-2, the Indian synchrotron source. Indus-2 is a 2.5GeV, 300mA SR source. The beamline consists of a Si (311) crystal pair based double crystal monochromator with bendable focusing optics. The experimental station consists of a six circle diffractometer with scintillation detector and an image plate area detector. The beamline has been used for wide range of experiments like powder and single crystal diffraction; grazing incidence diffraction, x-ray absorption near edge structure, Anomalous XRD, high pressure XRD etc. The beamline is being utilized by users from Indian universities and research institutions.

Spindle cell carcinoma of head and neck: an immunohistochemical and molecular approach to its pathogenesis

Background: Spindle cell carcinoma (SpCC) is a rare microscopic type of cancer of the mouth and oropharynx. Although SpCC is thought to arise from squamous cell carcinoma (SCC), it carries a worse prognosis. Aim: To find out the difference in immunohistochemical expression of cytokeratin, vimentin and smooth-muscle actin, and mutational alterations in the K-ras oncogene between the two tumours, in an attempt to characterise SpCC. Methods: Immunohistochemical analysis was performed by standard avidin–biotin complex method in 35 cases each of SpCCs and SCCs. DNA extracted from paraffin wax-embedded tumours was used for PCR followed by single-strand conformation polymorphism for mutational analysis of K-ras exon 1 and exon 2. Results: In the SpCC group, cytokeratin positivity was significantly higher in epithelial areas (52.2%) than in spindle cell areas (16.1%), whereas vimentin was more positive in spindle cell areas (18.7%) than epithelial areas (2.7%). Cells intermediate between epithelial and spindle cell areas were consistently positive for both cytokeratin and vimentin. Cytokeratin was found to be significantly more positive in SCC (72.6%) than the squamous component and spindle cell component of SpCC. In this study, no mutation was detected in the K-ras gene of either the SpCC or SCC group. Conclusions: The spindle cell component of SpCC is intermixed with cells that are morphologically mesenchymal but express dual antigen-positivity characteristic of epithelial (cytokeratin) and mesenchymal (vimentin) cells. These, possibly, are cells in transition suggesting that SpCC may be a sarcomatous metaplasia of SCC.

Commissioning of Angle Dispersive X‐ray Diffraction Beamline on Indus‐2

An Angle dispersive x‐ray diffraction (ADXRD) beamline on bending magnet source of Indus‐2 synchrotron (2.5 GeV, 300 mA) has been commissioned, for the study of single and polycrystalline samples. The beamline optics is based on vertically focusing Pt‐coated pre and post mirrors and sagittal focusing Si (311) based double crystal monochromator. Experimental station consists of a six circle diffractometer equipped with scintillation detector and an image plate area detector for powder diffraction. XRD experiments have been performed to study single crystal and polycrystalline samples.

Sclerosing polycystic adenosis of parotid gland: a cytological diagnostic dilemma.

Several lesions of the major salivary glands are morphologically similar to breast lesions. For example, salivary duct carcinoma bears resemblance to mammary ductal carcinoma; salivary epithelialmyoepithelial carcinoma is identical to mammary adenomyoepithelioma; adenoid cystic carcinoma, pleomorphic adenoma and collagenous spherulosis are described in both organs. A recent addition to this tumour similarity is sclerosing polycystic adenosis (SPCA), which is a pseudo-neoplastic lesion of the major salivary glands with histological similarity to fibrocystic disease of the breast. SPCA is a rare entity, with only 40 cases described in the literature. The cytological features and differential diagnoses of this rare lesion have not been well described in the literature. Only one report of aspiration cytology of SPCA was found in the literature. We report a case of SPCA in a male patient with aspiration cytology findings. This rare entity and its various cytological differentials are briefly discussed.

Clinico-pathological profile of 12 cases of chorangiosis

Chorangiosis is one of the vascular lesions that involvs terminal chorionic villi. It is commonly associated with various feto-maternal conditions like pre-eclampsia, diabetes etc. However, the clinical significance of this pathological finding has not been studied extensively. The aim of this study was to identify the various conditions associated with chorangiosis and to determine its clinical significance. A retrospective study to identify the cases of placentas diagnosed with chorangiosis was carried out and the clinical and morphological details of these cases were reviewed. Immunostaining for CD34 and muscle-specific actin was also performed to confirm chorangiosis and to exclude chorangiomatosis.A total of 12 cases of chorangiosis were retrieved, most of them were of term gestation. Five of these 12 cases were associated with various maternal conditions including syphilis (2 cases) and single cases of pre-eclampsia, diabetes and jaundice. One case in each had abruptio placenta and non-immune hydrops. Of these 12 cases, seven were stillborn. Microscopically, all 12 cases showed extensive chorangiosis involving terminal villi. In addition, two cases showed focal infarction and one had extensive calcification. Immunostaining for CD34 confirmed increased number of capillaries while muscle-specific actin was negative, excluding chorangiomatosis.The clinico-pathological profile presented in this study suggests that chorangiosis has characteristic pathological features for its recognition and needs to be differentiated from similar conditions like chorangioma and chorangiomatosis. Also, chorangiosis has potential clinical significance and should be mentioned in the pathology report and the patient should be investigated for associated conditions like syphilis, pre-eclampsia, diabetes etc.

Cytologic diagnosis of fibrous hamartoma of infancy: a case report of a rare soft tissue lesion.

BACKGROUNDnFibrous hamartoma of infancy (FHI) is a rare, benign lesion seen in the first 2 years of life. Despite adequate histopathologic descriptions, reports of it in the cytology literature are rare.nnnCASEnA 6-month-old male infant presented with an asymptomatic nodule in left anterior axillary fold. The nodule was noticed 6 weeks before presentation. On local examination, it was mobile and rubbery. Considering the endemicity, a presumptive clinical diagnosis of tuberculous lymphadenitis was made. Fine needle aspiration yielded moderately cellular smears composed of short spindle cells in a greasy background admixed with a few adipocytes. No mitosis or abnormal chromatin pattern was seen. In view of the young age of the patient, a cytologic impression of benign lesion or hamartoma was made. Excision of the nodule and histopathologic examination revealed it as FHI.nnnCONCLUSIONnThe cytologist should be aware of the cytologic features of FHI, so that in the proper clinical setting this diagnosis can be made with certainty. The mixture of adipose tissue and bland spindle cells is helpful to differentiate this lesion from other infantile soft tissue lesions.

Pilomatrixoma: a potential diagnostic pitfall in aspiration cytology

Dear Editor, In 1880, Malherbe & Chenantais described a benign skin tumour, Calcifying epithelioma of sebaceous gland . It is now clear that it shows differentiation towards hair matrix cells and hence is known as pilomatrixoma . Although the usual cytological features of pilomatrixoma are known, situations leading to mistaken diagnosis on aspiration cytology arise very often and these have therapeutic implications for the patient. We present the case of a 1-year-old child with a swelling in the neck, diagnosed as non-lymphomatous small round cell tumour, possibly rhabdomyosarcoma on cytology, which turned out to be a pilomatrixoma on excision biopsy. The cytological features along with recommendations for cytological diagnosis of pilomatrixoma are discussed.

Calcium in midpregnancy.

ObjectiveTo establish reference value for serum calcium concentration and urinary calcium excretion during mid pregnancy and to find out variation of calcium intake in pregnant women.Materials and methodsThis was a cross sectional study conducted in antenatal clinic of department of Obstetrics and Gyaenecology. A total of 543 pregnant women with pregnancy period of second trimester were enrolled for the study. Eligible healthy, vegetarian primigravid women provided serum and 24xa0h urinary samples for determination of serum calcium and urinary calcium excretion. Dietary intake calculated by 3-day recall method. Variation of calcium intake according to various demographic characteristics was noted.ResultsStatistical analysis done with SPSS software. The mean total serum calcium and 24xa0h urinary calcium and dietary intake of calcium were 8.1xa0±xa01.5xa0mg/dl (5.1–11.9), 129.56xa0±xa067.08xa0mg (40.5–400) and 324.37xa0±xa0199.47xa0mg/day (85.71–910.71) respectively. The 95th percentiles for serum calcium were 10.56xa0mg/dl and urinary calcium excretion was 280.70xa0mg/24xa0h. Educational level, monthly income and height were positive correlated with calcium intake.ConclusionThis preliminary study defines the first standard value for calcium status in pregnant second trimester females of northern India. Calcium intake in pregnant females is affected by various demographic characteristics. There is need to change dietary pattern by improving education and socio-economic level.