Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations.

OBJECTIVE: Until recently, surgeons have been posed with a dilemma---whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs. METHODS: Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs. RESULTS: Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases. CONCLUSION: This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.

Anterior intratumoural chemotherapy: a newer modality of treatment in advanced solid tumours in children.

OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS: Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS: Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION: Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.

Malignant eccrine spiradenoma: an unusual presentation.

An unusual case of a 60-year-woman with a progressively increasing painless, ulcerated plaque-like lesion in her right groin is described. The lesion was associated with multiple satellite nodules involving the right thigh with massive lymphoedema oft he involved limb. Histology established the diagnosis of an eccrine spiradenoma with malignant transformation in a satellite nodule. Wide surgical excision was not possible and the patient was subjected to palliative radiotherapy.

Endoscopic and histopathological evaluation of preschool children with chronic diarrhoea.

Fifty-seven children with chronic diarrhoea, aged 1-5 years, were studied. Protein-energy malnutrition was present in 49 (85.9 per cent) children. Anaemia (89.5 per cent), presence of mucus and blood in stool (66.6 per cent), abdominal distension (52.6 per cent), and abdominal pain (28.1 per cent) were the common clinical findings at admission. The enteropathogens isolated from the stool of 68.4 per cent of patients were Escherichia coli (19.3 per cent), Candida albicans (12.3 per cent), E. histolytica (8.8 per cent), and Giardia lamblia (7 per cent). Secondary lactose intolerance was present in 21 per cent of children, endoscopic appearance was abnormal in 23.3 per cent of children and the commonest finding was chronic duodenitis (16.7 per cent). Abnormal histopathology was observed in 73.3 per cent of cases and villous atrophy with mononuclear cell infiltration (56.7 per cent) was the most common abnormality detected. The mean duration of diarrhoea had no impact on endoscopic appearance but it significantly affected the histopathological changes. However, no correlation was found in endoscopic and histopathological lesions in relation to malnutrition and aetiological agents.

Histoplasmosis: an unusual presentation.

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Spectrum of breast disease in young females: a retrospective study of 1315 patients.

A total of 1315 breast lesions seen in women up to 40 years of age were registered in the files of Pathology Department. Out of these 807 were benign and 508 malignant lesions. Breast carcinoma was very rare up to second decade of life but its incidence progressively increased with age. Among benign tumours fibroadenomas were the commonest tumours. This study shows a higher incidence of inflammatory diseases and malignant tumours in young females as compared to the reports from the West.

'Studies on testicular regenertive potential of naga bhasma'.

Naga Bhasma is used in various ailments and also as tonic in Ayurvedic practice. Mention has been made in Ayurvedic literature that this drug has regenerative action on testicular tissue. Therefore plan was made to study the regenerative capability on tests. It was observed that the test drug when given simultaneously with Cd cl(2) showed marked prevention of toxic effects of Cd cl(2) and when given alone after 36 hours of Cd cl(2) administration, showed a notable regenerative potential on partially degenerated testes. It has showed specific regenerative effect on germinal epithelium of testes.

Germ cell tumors in Indian children.

The present paper is a retrospective study of one hundred and thirty five germ cell tumors seen in children at the University Hospital, Varanasi during a period of 21 years. These tumors constituted 7.5% of all solid tumors in the pediatric age group. Histologically 89 tumors (65.9%) were benign and 46 (34.1%) were malignant. Eighty percent of ovarian and all the testicular germ cell tumors were malignant. Thirty per cent of the tumors were located in the sacrococcyx. The ovaries were the next common site. There were 80 girls, 53 boys, and 2 cases in which the sex was not recorded. The predominance amongst girls was mainly due to the more frequent involvement of ovaries as compared to the testes. Twenty nine of the children were in the first year of life. The factors probably responsible for the higher incidence of malignancy, the differences in anatomic location, and the sex distribution in comparison to other reports have been examined and discussed.