Donate organs not malignancies: postoperative small cell lung carcinoma in a marginal living kidney donor.

A widening gap between supply and demand for transplantable kidneys has led to increasing use of marginal living donors from an elderly population in kidney transplantation programs. Although the graft survivals of these marginal organs are comparable with those of standard donors, the attendant risk of transmission of malignancy from older donors is high, given that aging is a risk factor for malignancy. Herein we have highlighted a case of small cell carcinoma developing in a marginal elderly donor at 10 months after kidney donation. The recipient remains free of malignancy at 36 months after transplantation. The exhaustiveness of tests for screening of elderly living donors for malignancy as well as the surveillance of recipients at high risk of developing donor-derived malignancy remain uncertain.

Importance of RT-PCR for detection of hepatitis C virus among different patient groups.

A pilot study was undertaken to evaluate a sensitive single step reverse transcription polymerase chain reaction (RT-PCR) to detect hepatitis C virus (HCV) RNA in plasma samples as an adjunct to antibody detection. In this study, digoxiginin labelling of the amplicon was carried out during the PCR and the product was detected by an ELISA format (DIG-ELISA) as well as ethidium bromide stained gel detection. DIG-ELISA detection of PCR product compared favourably with gel detection. We tested 42 individuals with either parenteral risk factors or chronic liver disease and found the RT-PCR enhanced the detection rate by 19 per cent. Considering either plasma RNA or antibody positivity, HCV infection was detected in 64.3 per cent of patients.

Tc-99m albumin scintigraphy in the localization of protein loss in the gut.

Scintigraphic localization of gastrointestinal protein loss has been recently reported. A noninvasive method for the localization of protein loss in the gut using Tc-99m labeled albumin seems encouraging and is described here. In six patients studied for protein-losing enteropathy, scintigraphic results of four were positive.

Nephrotic syndrome associated with meningioma.

A 58-year-old man presented with recurrent frontal meningioma and nephrotic syndrome. Renal biopsy could not be done in view of the rapid neurological deterioration. The patient underwent surgical resection of the tumor. Within 4 weeks, the edema decreased, serum albumin improved, and proteinuria decreased spontaneously. At three months of followup, the patient had attained complete remission of nephrotic state.

Acute oxalate nephropathy due to 'Averrhoa bilimbi' fruit juice ingestion.

Irumban puli (Averrhoa bilimbi) is commonly used as a traditional remedy in the state of Kerala. Freshly made concentrated juice has a very high oxalic acid content and consumption carries a high risk of developing acute renal failure (ARF) by deposition of calcium oxalate crystals in renal tubules. Acute oxalate nephropathy (AON) due to secondary oxalosis after consumption of Irumban puli juice is uncommon. AON due to A. bilimbi has not been reported before. We present a series of ten patients from five hospitals in the State of Kerala who developed ARF after intake of I. puli fruit juice. Seven patients needed hemodialysis whereas the other three improved with conservative management.

Bilateral emphysematous pyelonephritis in autosomal dominant polycystic kidney disease.

Emphysematous pyelonephritis (EPN) is an uncommon infection of renal parenchyma with gas-forming organisms. EPN is usually seen in patients with diabetes mellitus (DM). The association of EPN with conditions other than DM is extremely rare. We report a case of autosomal dominant polycystic kidney disease with bilateral EPN who had to undergo bilateral nephrectomy.

Tracheal stenosis in hyper immunoglobulin E syndrome: a novel case report.

Hyper Immunoglobulin E Syndrome, or Job's Syndrome, is a rare multisystem disorder that classically presents in early childhood with a triad of clinical manifestations that include severe eczematous dermatitis, recurrent infections (skin and lung), and elevated serum immunoglobulin E. Hyper Immunoglobulin E Syndrome is a relatively uncommon condition and as such requires careful consideration of a constellation of patient symptoms to correctly diagnose the underlying disease. In this report we present a unique case of a child with previously undiagnosed Hyper Immunoglobulin E Syndrome presenting with biphasic stridor associated with multiple areas of tracheal stenosis.

Hennekam lymphangiectasia syndrome.

Hennekam lymphangiectasia syndrome is a rare disorder comprising of intestinal and renal lymphangiectasia, dysmorphic facial appearance and mental retardation. The facial features include hypertelorism with a wide, flat nasal bridge, epicanthic folds, small mouth and small ears. We describe a case of a multigravida with bad obstetric history and characteristic facial and dental anomalies and bilateral renal lymphangiectasia. To our knowledge this is the first case of Hennekam lymphangiectasia syndrome with anodontia to be reported from India.

Malaria in seasonal migrant population in Southern Gujarat, India.

Malaria in migrant workers is always a major problem to control due to their temporary stay in shelters, and other operational constraints. Hence, a study was undertaken in brick kilns in Bharuch district, Gujarat state, India to study the problem of malaria in the work force. Mass blood surveys were carried out in 15 brick kilns. Blood slides were collected from both febrile and afebrile cases. Positive cases were treated as per the national drug policy and were followed up. Mosquito collections were carried out by pyrethrum spray collection in early morning hours. Human blood index and sporozoite rates were determined as per standard procedures. All age groups were found affected with malaria at brick kilns. Prevalence of malaria was significantly higher in ≤ 14 years of age-group as compared to adults. Post treatment follow up examination of patients revealed high malaria infection due to non-compliance of chloroquine. The appearance of parasitaemia among Plasmodium falciparum treated cases indicate the possibility of chloroquine resistance. The proportion of P. falciparum was >50% in migrant population. In stable population in villages, overall decline in malaria cases was observed in 2008-2010. The sporozoite rate of 4.2% in Anopheles culicifacies indicates active malaria transmission at brick kilns. The investigation demonstrated that suitable microclimatic conditions for malaria transmission exist in these areas during hottest period. The district health department should consider these factors in planning malaria surveillance and control. As current magnitude and diversity of population movements in rural as well as in urban areas are unprecedented, this issue is worthy of attention.

Primary carcinoma of the trachea.

Five cases of primary carcinoma of the trachea are summarized together with a review of 97 cases recorded at the Birmingham Cancer Registry between 1957 and 1974. Squamous cell carcinoma is the most frequent type (46.4%) followed by anaplastic and oat cell carcinoma (18.5%). The annual incidence rate is 0.15 per 100 000 in males and 0.06 per 100 000 in females. The mean age at presentation is 60.08 years and 63.89 years for males and females respectively. Although there has been an increase in the number of cases reported over this period, the increase in larynx (43%) and trachea (50%) has not kept pace with that for bronchial carcinoma (85%). Some experimental studies in animals and the results of treatment in 97 cases from the Cancer Registry are reported. A brief summary of methods of treatment for carcinoma of the trachea is included. In suitable cases, primary surgery with direct anastomosis offers the best survival rates, although the overall survival rate is poor.