2-Bromo-5-tert-butyl-N-methyl-N-[2-(methyl-amino)-phen-yl]-3-(1-methyl-1H-benzimidazol-2-yl)benzamide.

In the title compound, C27H29BrN4O, benzimidazole ring system and the amide moiety are planar [r.m.s. deviations = 0.016 (2) and 0.017 (1) Å, respectively]. The mol-ecule adopts a conformation in which the amide linkage is almost perpendicular to the central ring [dihedral angle = 85.79 (8)°], while the benzimidazole ring system makes a dihedral angle of 70.26 (11)° with the central ring. In the crystal, the mol-ecules form dimers through N-H⋯O hydrogen bonds and C-H⋯O interactions. These dimers are further linked into zigzag ribbons along [201] by weak C-H⋯Br inter-actions. As a result of the bulky nature of the mol-ecule, as evidenced by the large dihedral angles between rings, there is little evidence for any π-π inter-actions.

Clinico-hematological profile of visceral leishmaniasis among immunocompetent patients.

We studied cases of visceral leishmaniasis (VL) over a 2-year period among immunocompetent patients who presented to a rural medical college in West Bengal, India to determine a clinical and hematological profile among these patients. We studied a total of 36 cases of VL; the male to female ratio of the cases was 1.6:1 and the mean age was 20.1+/-11.1 years. A detailed history, physical examination, hemogram, bone marrow or splenic aspiration and chest x-ray were conducted on all cases. A CT-scan of the thorax and fiberoptic bronchoscopy were performed in selected cases. Fever and splenomegaly were present in all cases. Weakness, abdominal pain, bleeding, and hepatomegaly were seen in 63.9, 27.8, 8.3 and 58.3% of cases, respectively. Pancytopenia, bicytopenia, leukopenia and thrombocytopenia were seen in 58.3, 41.7, 61.1 and 83.3% of cases, respectively. Five patients (13.9%) had cough, 2 (5.6%) had hemoptysis, 6 (16.7%) had an abnormal chest x-ray and 3 (8.3%) had localized reticulo-nodular opacities on a CT-scan of the thorax. Bronchoalveolar lavage showed gram-positive cocci in 2 cases (5.6%). One patient died of acute respiratory distress syndrome. Cytopenia was common among the series of VL patients. Pulmonary complications, usually secondary infection, were less frequent (found in 13.9% cases) but was fatal in one patient.

Mucin histochemistry of stomach in metaplasia and adenocarcinoma: An observation.

BACKGROUND: There is a variable pattern of occurrence of gastric carcinomas world-wide, partially reflecting the frequency of various changes of gastric mucosa from, which such neoplasm occur. Many cases of gastric carcinoma originate in the background of chronic gastritis caused by Helicobacter pylori. Subsequent intestinal metaplasia (IM) can be morphologically classified by routine and special histopathological stains. MATERIALS AND METHODS: The present study was conducted over the 2 years at NRSMC & H, Kolkata. Aims of the present study were to search for evidences of H. pylori infection, classification of different metaplastic and/or malignant changes, identification of types of mucin by mucin histochemistry and their interrelationship in gastrectomy and gastric biopsy specimens (total 70). After obtaining clinical history, radiological and endoscopic findings were noted. After macroscopic study of the specimen, hematoxylene and eosin, southgate mucicarmine, periodic acid schiff-alcian blue (PAS-AB) and gomori aldehyde fuchsin (GAF)/AB staining were performed to classify gastric carcinoma and metaplastic changes and to correlate with staining patterns of mucin. RESULTS: The overall male to female ratio was 2.89:1. Age ranged from 22 years to 78 years and the commonest age group of gastric carcinomas being 41-50 years (26 cases, 37.1%). Gastric adenocarcinoma was found in 61 (87.1%) cases (22.9% were of intestinal type and 77.1% of diffuse type) and only IM was found in 9 (12.9%) cases. Overall the rapid urease test was positive in 18 (25.7%) cases majority of which showing either pure IM or IM associated with intestinal type of gastric carcinoma. All diffuse types of gastric carcinoma (47 cases, 77.1%) were showed PAS positive staining (indicating neutral mucin) whereas in 15 (65.2%) cases of IM columnar cells stained with AB (representing acidic mucin). GAF/AB stain revealed Type II IM in 10 (43.5%) cases and Type III IM in 4 (17.4%) cases. CONCLUSION: Routine and special histological staining is particularly useful for histological subtyping of gastric carcinomas and IMs.

Clinicohaematological profile of aplastic anaemia in a rural medical college of Northern West Bengal.

There is a scarcity of clinical data in the field of aplastic anaemia from rural India. Present study was conducted in North Bengal Medical College to find out the clinicohaematological profile and the possible aetiological factors in patients with aplastic anaemia. The study population (n = 83) included 21 children with male to female ratio 4.93:1. Weakness was present in all cases and pallor was present in 74.70% cases. Fever, bleeding episodes and localised infection were found in 55.42%, 48.19% and 27.71% cases respectively. There was no difference in clinical manifestations between children and adult except occurrence of fever (p = 0.0365). We identified possible aetiological factors in 32.53% cases as relevant drug intake in 10.84%, exposure to chemicals in 13.25% and hepatitis in 8.43% cases. We found low mean haemoglobin (3.81 +/- 1.71 g/dl), leucocyte and platelet (3.05 +/- 1.3 and 37.30 +/- 35 x 10(3)/cmm), neutrophil (30.28 +/- 21.76%) and high lymphocyte (67.27 +/- 22.50%) in peripheral blood. At the time of presentation, aplastic anaemia was moderate in 59.04% cases, severe in 48.19% cases and mild in 4.82% cases. We estimated the prevalence of aplastic anaemia in 4 districts of West Bengal including tea garden areas was 2.98/million populations per year. It was concluded that aplastic anaemia is a major non-malignant haematological disease in this part of India, and an increasing use of chemicals in agricultural and tea garden areas might be the responsible factor. Larger population based study is suggested.

Clinicopathologic profile of non-Hodgkin's lymphoma in a rural medical college.

A prospective study was done at North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal over a period of two years. All patients diagnosed as non-Hodgkin's lymphoma were analysed for clinical presentation, classified according to the Working Formulation and staged according to Ann Arbor staging system. A lower median age (39.94 years) of onset and higher male to female ratio (3.22:1) as compared to western countries were observed. We found neck swelling was the commonest presenting symptom (65.79%) and peripheral lymphadenopathy was the commonest sign (94.74%). "B symptoms" were noted in 63.16% cases. Cervical lymph nodes were commonly involved (78.95%), followed by axillary (55.26%). Thoracic lymph nodes were enlarged in 31.58% cases and abdominal lymph nodes in 18.42% cases. We found diffuse mixed variant was the commonest (31.58%) followed by diffuse large cell (18.42%). At presentation most of the cases were of intermediate grade (55.26%) and in stage III (44.74%). We conclude that there is a distinct geographical pattern of non-Hodgkin's lymphoma in respect of age, sex, grade and stage of the disease which is distinctly different from those of western countries.

Hodgkin's and Non-Hodgkin's lymphomas in an indian rural medical institution: comparative clinicopathologic analysis.

In this prospective, hospital-based two year study, we comparatively evaluated clinicopathologic features of Hodgkin's lymphoma (HL, n = 48) and Non-Hodgkin's lymphoma (NHL, n = 76) in an Indian rural medical institution. A lower median age of onset (28.1 versus 39.9 years) and and higher male to female ratio (3.8:1 versus 3.2:1) were noted for HL compared to NHL. The commonest symptom was neck swelling (58.3% versus 65.8%) while peripheral lymphadenopathy was the commonest sign (83.3% versus 94.7%). The commonest lymph-node group involved was cervical (79.2% versus 79.0%). Bone marrow involvement was lower in HL (8.33% versus 18.4%). The commonest histological subtype was mixed cellularity (45.8%) in HL and diffuse mixed variant (31.6%) in NHL. Most cases presented at advanced stage (54.2% in HL, 71.1 % in NHL). Hence a distinct clinicopathologic profile was noted in HL and NHL that are comparable to other Indian studies but different from Western studies. Recognition of such characteristic features should assist in providing appropriate diagnosis and suitable management in rural communities having limited access to sophisticated medical services.

Clinicohaematological analysis of aplastic anaemia among children of northern districts of West Bengal.

Though aplastic anaemia in children is an important haematological disorder, not many studies have been undertaken in India and especially in the northern districts of West Bengal. The present study was carried out at North Bengal Medical College and Hospital to find the occurrence, clinical and hematological profile of children with aplastic anaemia. All the children (less than 15 years) having relevant history and clinical features underwent a complete blood count and bone marrow aspiration study (smear and histological sections) and trephine biopsy. Total number of children diagnosed were 21 (M = 17, F = 4), having an age range of 6-14.5 years (mean 11.36). Relevant aetiological factors were noted in 10 cases (47.61%), including history of exposure to insecticides, fungicides and fertilisers in 5 cases (23.81%). The common symptoms were due to anaemia (weakness, pallor in all cases), leucopoenia [fever in 16 cases (76.19%)] and thrombocytopenia [bleeding in 10 cases (47.61%)]. Severe and moderate aplastic anaemia were noted in 7 (33.33%) and 12 (57.14%) cases respectively. The calculated occurrence of aplastic anaemia is 1.96/million population of children/year in the four northern districts of West Bengal. The bone marrow aspiration was satisfactory in all cases. Histological sections of aspirated marrow particle produced better architectural relationship among different components. Aplastic anaemia is a major hematological problem among the children of northern districts of West Bengal. Simultaneous examination of smear and histological sections of marrow particles is a satisfactory method for detection of aplastic anaemia.

Retiform hemangioendothelioma with lymph node metastasis: a rare entity.

Retiform hemangioendothelioma (RH) is a rare, recently described, unique kind of low grade angiosarcoma. The tumor is characterized by distinctive arborizing blood vessels that mimic the appearance of rete testis. The tumor chiefly originates from the skin and subcutaneous tissue and has a tendency to recur locally. Only one case with lymph node metastasis has been reported previously. Another such rare case of RH is being reported in an adult female who presented with a subcutaneous nodule, underwent multiple recurrences and uniquely metastasized to regional lymph node.

Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features.

Leukemias are the commonest childhood malignancy in West Bengal. This study was undertaken on 75 children at NRS Medical College, West Bengal to determine the distribution of signs and symptoms of leukemia and to identify unusual clinical features. After obtaining clinical history, physical examination, hematological and radiological investigations were performed. Acute lymphoblastic leukaemia (ALL, 72%) was the commonest followed by acute myeloid leukaemia (AML, 18.7%). Common symptoms and signs were fever (85.3%), pallor (64%), hepatomegaly (72%), splenomegaly (60%) and lymphadenopathy (50.7%). The uncommon signs and symptoms were abdominal pain (9.3%), joint pain (9.3%), hematemesis and malena (8%), diarrhea (5.3%), proptosis (2 cases), dysphagia, mediastinal mass and parotid swelling (1 case each). Uncommon clinical presentations lead to delay in diagnosis in some cases. Awareness of uncommon signs and symptoms of childhood leukemia together with laboratory tests may help in earlier diagnosis and proper management of the patients.

Immature teratoma with choriocarcinoma-like lesion of testis: case report of an unusual presentation.

An eighteen year old male presented with hemoptysis and superior vena caval syndrome. History and clinical examination revealed a testicular mass which was previously diagnosed as hematocele. Chest x-ray showed a four cm diameter shadow and several smaller shadows. Histological examination of the testicular mass established it as immature teratoma with choriocarcinoma-like lesion (CCLL)--a rare association in testicular tumours. Focal positivity for betaHCG was noted in the testicular tumour. Guided aspiration of the lung showed features of a metastatic non seminomatous germ cell tumour.

Clear cell carcinoid tumour of lung--a case report.

An unusual case of pulmonary clear cell carcinoid tumour in a fifteen year old boy is being described. The differential diagnoses considered in this case are described. This is one of the uncommon varieties of carcinoid of lung reported in the world literature.

Retroperitoneal tumours--a ten years retrospective study.

In a ten-year retrospective study (1985-95), 42 cases of retroperitoneal tumours were analysed. All cases were treated surgically. Among the relevant investigations CT scan and fine needle aspiration cytology were found to be most helpful to have a pre-operative idea regarding the best course of therapy. The highest incidence of retroperitoneal tumours were found in the 4th decade of life with roughly equal sex incidence. Malignant tumours were double in comparison to benign tumours and lymphoma was found to be the most common malignant tumour. Though complete resection should be the aim to treat them it may lead to sacrifice of other vital organs like kidney, spleen and part of large gut in advanced cases. Complication may be always for a heroic surgery leading to inadvertent injury to other structures, causing high mortality up to 19.1%.

Mason diabetes--report of a family.

A 48-year-old Hindu housewife was presented with increased appetite, thirst, frequency of micturition, weakness, cramps in the legs, tingling in the fingers, decline in bladder-bowel control and dimness of vision. She was a patient of diabetes. On investigations and history, she was diagnosed as a case of type 2 diabetes transmitted in three generations as an autosomal dominant trait.

Virilising adrenocortical carcinoma.

A 16-year-old, Hindu, female presented with rapidly growing abdominal lump for 6 months, primary amenorrhoea and non-development of secondary sex characters. Her BP was 180/120 mmHg. There was an excessive hirsutism involving face, neck, shoulders, abdomen and thighs. A lump was felt at left lumbar region extending on to left hypochondrium and part of umbilical region. Her serum testosterone level was 224 ng/dl and cortisol level was 15 microg/dl. Ultrasonography revealed a solid mass arising from the upper pole of left kidney. Exploratory laparotomy revealed a huge left adrenal tumour which was removed completely. Histopathology of the resected mass showed sheets of large round to polyhedral cells with hyperchromatic nuclei and eosinophilic granular cytoplasm with numerous giant cells. The case was diagnosed as virilising adrenocortical carcinoma.