Pulmonary Hydatid without Liver Involvement: A Case Series

Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India.

BACKGROUND: This retrospective study was performed in a tertiary care center from India analyzing the histopathological reports and the clinical data of the adult patients admitted in this institute with a diagnosis of renal tumors and had undergone nephrectomy for the disease. OBJECTIVE: The objective of this study is to determine the relative frequencies of different renal tumors in adults (above the age of 16 years) and to analyze the histopathological characters of the tumors. MATERIALS AND METHODS: In this retrospective study, we have analyzed the histopathology reports along with the demographic and clinical data of the adult patients who had undergone nephrectomy for renal tumors in our institute from January 2005 to December 2011. RESULTS: A total 113 adult patients underwent tumor nephrectomy during the last 7 years in our institute. Mean age of the patients was 54.5 years (range 16‑69 years). Male:Female ratio was 1.9:1. Out of 131 cases of adult renal tumors, 91.6% cases were malignant and 8.45 cases were benign tumors. Among the malignant tumors, renal cell carcinoma was the most common type. There were 2 cases of renal primitive neuroectodermal tumors and one case of renal myofibroblastoma in our series. CONCLUSION: The spectrum of adult renal tumors in this series is consistent with the other series of cases reported by different authors. Only few cases of the renal tumors were diagnosed incidentally among our patients which is just opposite to the rate of renal tumors diagnosed incidentally in the developed countries. Myofibroblastoma, a benign kidney tumor diagnosed in our series is probably the first reported case in the world.

New Hope for Resistant Hypertention.

Hypertension is a major public health problem. Despite the increasing awareness of hypertension and its implications among patients and treating physicians, the prevalence of resistant hypertension remains high. Resistant hypertension define as blood pressure that remains elevated above treatment goals despite administration of an optimal three drug regimen that include a diuretic1 The prevalence of resistant hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. It is estimated that at least 10% of all patients with hypertension are resistant to existing drugs. Management of resistant hypertension must begin with a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with “pseudo-resistance,” such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Despite the use of the appropriate dose and type of diuretic to overcome the management of resistant hypertension, we can’t achieve our goal. But there is at least two devices namely Baroreflex Activation Therapy and Catheter-based renal sympathetic denervation make the new hope for the patient with resistant hypertension.

Efficacy of noninvasive nasal mechanical ventilation in acute respiratory failure: monitored by breathing patterns.

OBJECTIVES: Till a decade back, the mainstay delivery of mechanical ventilation to patients with acute respiratory failure was through the endotracheal tube. To obviate the various complications of endotracheal intubation, noninvasive mechanical ventilation (NIMV) techniques were devised which could be used outside the confines of an ICU setting, and have been employed by several workers to achieve a high success rate. METHODS: Twenty patients of acute respiratory failure (ARF) were treated with NIMV. The latter was delivered by assist control mode of ventilator and nasal CPAP mask. Improvement of the illness was monitored by serial ABG analysis and breathing pattern parameters over one week. RESULTS: The application of NIMV was successful in reversing the illness in 17 patients (85%) and the other three patients had to be intubated. The pH rose from 7.267 +/- 0.087 at presentation to 7.411 +/- 0.032 (p < 0.00005), the PaCO2 dropped from 85.17 +/- 13.48 mmHg to 46.27 +/- 3.79 mmHg (p < 0.00005). The PaO2 improved from 52.36 +/- 11.14 mmHg to 63.60 +/- 7.55 mmHg (p < 0.005) on the seventh day. The respiratory rate (RR) decreased from 30.07 +/- 6.10 breaths/min to 22.05 +/- 4.05 breaths/min (p < 0.00005), the %RC (percent rib cage) also showed a significant reduction in rib cage contraction from 61.7 +/- 10.17 to 42.76 +/- 10.66 (p < 0.00005). A marked improvement during the initial four hours of application of NIMV was observed in all the 17 patients. CONCLUSIONS: It was concluded that NIMV resulted in marked improvement in both the breathing pattern and blood gas parameters in patients of ARF; and PaCO2, pH, RR, %RC served as the best indicators of improvement. NIMV was observed to be most useful in those patients who had CO2 retention.

Correlation of the growth fraction, nucleolar organizer region counts and epidermal growth factor receptor with histomorphological prognostic criteria in breast cancer.

A total of 60 cases of breast cancer were studied to find the correlation between newer parameters of prognosis viz growth fraction (GF), nucleolar organizer region (AgNOR) counts and epidermal growth factor receptor (EGFR) positivity with the various histomorphological factors such as tumour size, nuclear grade, histological grade and mitoses. Growth fraction measured by Ki67 monoclonal antibody varied from 3.6 to 73.7 percent. AgNOR counts ranged from 1.2 to 16.9 dots per tumour cell nucleus with a mean of 6.26 dots. EGFR positivity was seen in 66.7% of cases. Ki67 score correlated with all prognostic variables studied except the presence of axillary metastases. AgNOR counts correlated with size of tumour, axillary lymph-node metastases and Ki67 score but no correlation was seen with histologic or nuclear grade. EGFR positivity correlated strongly with size of the tumour and weakly with Ki67 score, AgNOR counts and mitoses.

Morphologic and arteriographic changes in the pulmonary vasculature in children with congenital heart disease.

This study was undertaken to determine the morphologic changes occurring in the pulmonary vasculature in congenital heart disease. Autopsy was performed in twenty cases of congenital heart disease ranging in age from newborn (full term) to 14 years. Postmortem arteriography was performed in most of them followed by histomorphometry. It was found that medial hypertrophy of the muscular pulmonary arteries was the most consistent change and the smallest muscular arteries were the most severely affected. The lesions were focal and randomly distributed. Hence, morphologic observations on open lung biopsies may not be accurate.

Primary IgA nephropathy: a preliminary report.

A total of 106 renal biopsies were examined. Each biopsy was processed for routine paraffin sectioning and frozen sectioning. Direct immunofluorescence was done by the conventional method. The immunofluorescence patterns were correlated with histopathological changes and clinical presentation. Fourteen biopsies revealed weak to strong IgA staining and out of these, 11 seemed to fulfil the criteria of primary IgA nephropathy. These cases were diagnosed in a brief period of eleven months and there had not been any earlier published series from India.

Non-surgery related aspergillus native valvular endocarditis: report of two cases.

Two unusual cases of aspergillus valvular endocarditis without any history of cardiovascular surgery found at autopsy are reported. As there is a chance of dissemination, early diagnosis is important. Clinical awareness can lead to early recognition and effective treatment of this potentially lethal condition.

Pattern of hypertrophy of left ventricle--a histometric analysis of eighteen cases.

The pattern of myocardial hypertrophy in different sites of the left ventricular wall was morphometrically analysed in aortic stenosis (6 cases), hypertensive hypertrophy (5 cases), mitral incompetence (4 cases), and dilated cardiomyopathy (3 cases). The diameter of individual circumferentially oriented mid wall (or middle) fibre was significantly greater than those of subepicardial and subendocardial zones. Thus, hypertrophy does not affect the entire left ventricular myocardium uniformly. It seems to vary according to the spatial configuration of the fibrosis in relation to the cavity.

Class specific antinuclear antibodies in systemic lupus erythematosus.

The incidence and significance of class specific antinuclear antibodies (ANA), specially with relevance to clinical manifestations of arthritis, renal disease and serositis was studied in 40 patients of systemic lupus erythematosus by the indirect immunofluorescent method. Clinical activity was scored by Morimoto's scoring system. A significant correlation was obtained between IgD ANA and clinical activity of the disease and IgG ANA exhibiting lupus pattern of immunofluorescence and serositis.

Intracardiac autonomic ganglion cells in leprosy and dilated cardiomyopathy.

Disturbances in cardiac autonomic functions are known to occur in patients of lepromatous leprosy and dilated cardiomyopathy. We have analyzed the number of cardiac autonomic ganglion cells in patients of lepromatous leprosy (2 cases), dilated cardiomyopathy (2 cases) and compared with those of control subjects (2 cases). The average number of ganglion cells in cases of dilated cardiomyopathy (1164) and leprosy (1138) did not show any significant deviation from the average neuronal number of control subjects (1352).

Transmural bowel infarction: a rare complication of aortic dissection.

A 50 year old hypertensive man presented with acute epigastric pain associated with massive gastrointestinal bleed and died within 48 hours of admission. Autopsy revealed transmural infarction of the gut due to a long aortic dissection.

Extrathoracic Castleman's disease.

Castleman's disease is an uncommon clinical entity. We report two cases of this disease with a brief review of literature. Both of them had extrathoracic disease which is relatively infrequent. One of them presented with localized hyaline vascular type of the disease and the other with the multicentric plasmacytic variety. The patient with the latter form of Castleman's disease had sclerodactyly, which has not been reported earlier in association with this disease.

Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies.

Histological analysis of 33 rectal biopsies from 26 patients of solitary ulcer syndrome (SUS) of rectum was undertaken. Fibrous obliteration and smooth muscle extension into the lamina propria were the characteristic and most constant findings. The limitation of the biopsy procedure in procuring deeper tissue made the detection of colitis cystica profunda rare in our study. A combination of fibrosis of the lamina propria, superficial mucosal ulceration, muscularis mucosae hypertrophy and submucosal fibrosis, along with the clinical suspicion should clinch the diagnosis of SUS.

Catecholamine-induced experimental cardiomyopathy--a histopathological, histochemical and ultrastructural study.

An experimental model of myocardiopathy was induced in rhesus monkeys following noradrenaline (NA) infusion (20 ug/kg body wt/minute), for a period of 2 hours daily for three consecutive days. The animals were sacrificed after two hours (acute phase), forty-eight hours (sub-acute phase) and twenty-one days (chronic phase). Focal depletion of succinic dehydrogenase, increase in adenosine triphosphatase, acid phosphatase and appearance of large fat droplets in myocardial muscle was noted in the acute phase. Histopathological examination revealed focal edema, opacity and fuchsinorrhagia of the muscle fibres distributed in both the ventricles. Myofibrillar degeneration, myocytolysis and vacuolization with aggregation of lymphomononuclear cells were the significant features in the acute phase. During sub-acute and chronic phases, these features became less prominent and reparative changes with proliferation of fibroblasts became more marked. By the twenty-first day, irregular, focal scars replaced the necrosed myocardium. Ultrastructurally, heart muscle showed myofibrillar disorganisation, distortion of Z and A bands, dilatation of sarcoplasmic reticulum and swelling and rupture of mitochondria. Altered membrane permeability was evidenced by the presence of reaction products of horseradish peroxidase within the cardiac cells. In the reparative phase, however, myocytolytic changes regressed and collagen deposition was the prominent feature. This experimental study has several histological features simulating human cases of myocardial infarction without coronary occlusion.