A case of synchronous malignancy of stomach and kidney.

The synchronous occurrence of primary renal cell carcinoma with gastric cancer is very rare. We report a case of 41 year old male who presented on 05/07/2011 to M S Ramaiah hospital, Bangalore with history of fever, pain abdomen and malena. Ultrasound abdomen and pelvis showed large heterogenous mass arising from the upper pole of left kidney. Computed tomography of the abdomen showed left renal cell carcinoma. Renal biopsy showed features consistent with renal cell carcinoma - clear cell type. Oesophagogastroduodenoscopy revealed gastric polypoidal growth. Gastric biopsy from the growth revealed poorly differentiated adenocarcinoma of stomach. We report this case to highlight a rare occurrence of synchronous malignancy of stomach and kidney.

Oral cancer in Southern India: the influence of body size, diet, infections and sexual practices.

Between 1996 and 1999, we carried out a study in Southern India on risk factors for oral cancer. The study included 591 incident cases of cancer of the oral cavity (282 women) and 582 hospital controls (290 women). Height was unrelated to oral cancer risk. Body mass index (weight in kilograms/height in metres squared) was inversely associated with risk (P for trend<0.001). Paan chewers with low BMI were at particularly high risk. Risk was increased among subjects consuming meat (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.00-2.37), ham and salami (OR 4.40, 95% CI 2.88-6.71) two or more times per week. Frequent consumption of fish, eggs, raw green vegetables, cruciferous vegetables, carrots, pulses, apples or pears, citrus fruit, and overall consumption of vegetables and fruit decreased oral cancer risk (P for trend for each of these items less than or equal to 0.001). The risk associated with low consumption of vegetables was higher among smokers than among non-smokers. Men, but not women, who practised oral sex had an increased oral cancer risk (OR 3.14, 95% CI 1.15-8.63). Women with more than one sexual partner during life were at increased oral cancer risk (OR 9.93, 95% CI 1.57-62.9).

High incidence of oligozoospermia and teratozoospermia in human semen infected with the aerobic bacterium Streptococcus faecalis.

Bacterial culture of semen samples from 100 male partners in infertile couples revealed the presence of aerobic bacteria in 49 cases. Streptococcus faecalis (Enterococcus) was isolated from 53%, micrococci species from 20% and alpha-haemolytic streptococci from 16% of the infected samples. The incidence of oligozoospermia and teratozoospermia was significantly (P < 0.05) higher in men whose semen samples contained S. faecalis than those whose semen samples contained micrococci or alpha-haemolytic streptococci or those that did not contain bacteria. The mean sperm concentration, as well as the mean percentage of morphologically normal spermatozoa, was significantly (P < 0.03) lower in semen infected with S. faecalis compared with that containing micrococci or alpha-haemolytic streptococci and the uninfected samples. There is a high incidence of semen infection with S. faecalis, and it is associated with compromised semen quality in terms of sperm concentration and morphology. The presence of micrococci or alpha-haemolytic streptococci does not appear to have any detrimental effect on sperm quality.

Invasive aspergillosis in cancer.

Ten confirmed cases of invasive aspergillosis (IA) in cancer patients were analysed retrospectively. Eight were pulmonary, one was sinonasal and one was cutaneous. The majority of patients had haematological malignancies (7), the remaining three were cases of solid tumours. Fever was present in all 10 cases. Cough and lung signs were present in all eight cases of invasive pulmonary aspergillosis. Haemoptysis was encountered in three of nine cases of pulmonary and sinonasal aspergillosis. Mortality was low (2%). While corticosteroids, antibiotics and anticancer chemotherapy/radiotherapy were factors predisposing the patients to IA, neutropenia was perhaps responsible for their mortality. Seven of the patients had other associated pathogens isolated in culture in addition to Aspergillus spp. Aspergillus fumigatus was the predominant species, followed by A. flavus, A. glaucus, A. nidulans and A. niger. Direct microscopic examination (in six of seven cases) and culture (six of seven cases) correlated well with radiographic and clinical findings in cases with lung involvement. Serology for anti-Aspergillus antibodies performed by gel diffusion precipitin test was positive in one case of sinonasal aspergillosis, wherein only one precipitin band was observed. Correlation of clinical symptoms, consistent radiographic findings and microbiological work-up (the latter including a triad of direct microscopy, culture and serology) are required to arrive at a diagnosis of IA, especially where histology cannot form the mainstay of diagnosis.

Strongyloides stercoralis eggs in the stools during anticancer therapy.

We report a 45-year-old man with granulocytic sarcoma who, following anticancer chemotherapy, developed florid strongyloidiasis, wherein eggs of Strongyloides stercoralis embedded in the exfoliated mucosa were seen in the stools. The eggs were interspersed with numerous rhabditiform larvae. He was treated with albendazole.

Fusarium solani fungemia in a patient with acute lymphoblastic leukemia.

A patient with ALL on anticancer chemotherapy developed fever which was later attributed to be due to Fusarium fungemia. The details of the case & a review of literature follows.

Association of tuberculosis with malignancy at KIMIO--an oncology centre.

The association of tuberculosis and malignancy was studied at an oncology centre in Bangalore. The study period was from January 1981 to December 1995. A total of 8779 clinical material obtained from patients were screened for Mycobacterium tuberculosis infection. Out of which 675 were positive for acidfast bacilli, 385 from non malignant conditions and 290 from malignant conditions. Highest incidence is seen in Head and Neck cancer (42%) followed by Gastrointestinal cancer (14.1%), Lung cancer (13.8%), Haematological cancer (10.7%), Reproductive cancer (10.3%) and miscellaneous group (9%), Antibiogram of Mycobacterial cultures was done in 282 subjects. Resistance patterns to antitubercular drugs showed highest with Isonicotinic acid hydrochloride (INH) (17.7%), followed by para amino salicylic acid (PAS) (8.5%), Streptomycin (SM) (6.7%), Rifampicin (RIF) (4.6%) and Ethambutol (EM) (0.35%).

Bacterial infection and endotoxin in female reproductive tract in rats: correlation with the developmental status of preimplantation embryos.

During mammalian preimplantation development, a substantial numbers of embryos are believed to be lost for reasons that are unclear. Using female rats, we investigated whether the developmental status of embryos is influenced by bacterial infection and endotoxin in the reproductive tract. From the vagina of cycling rats (n = 11), 21 bacterial isolates were identified; they were Streptococcus faecalis (S. faecalis; 38%), Escherichia coli (E. coli; 19%), Acinetobactor calcoaceticus (A. calcoaceticus; 14%), and coagulase negative staphylococcus (14%), Micrococcus sp. (5%), Bacillus subtilis (B. subtilis; 5%) and Proteus vulgaris (P. vulgaris; 5%). From the vagina of day 4 pregnant rats (n = 12), 26 isolates were identified; they were S. faecalis (23%), A. calcoaceticus (23%), E. coli (15%), Micrococcus sp. (15%), B. subtilis (8%), P. vulgaris (4%), Staphylococcus aureus (4%), beta-hemolytic streptococcus (4%) and Pseudomonas aeruginosa (4%). Gram negative bacteria found in the vagina of cycling and day 4 pregnant rats were 38% and 46%, respectively. In both, bacterial load was 10(3)-10(5) colony forming units and there was no association with the abnormality of the recovered embryos. However, in two day 4 pregnant animals, pathogenic bacteria (Staphylococcus aureus and beta-hemolytic streptococcus) were isolated and embryos recovered from them were degenerated and deformed. The vagina of day 9 pregnant animals (n = 7) were, however, sterile. Consistently, in all animals, the upper reproductive tract (uterus and oviduct) was devoid of any bacteria and no anaerobic bacteria were isolated from any part of the tract. The levels of endotoxin in the vagina of cycling and day 4 pregnant rats were 1.35 +/- 0.1 and 1.17 +/- 0.1 endotoxin units (EU), respectively. It was undetectable in the oviduct and uterus of all animals (n = 5) except one which showed high levels of endotoxin in uterus (4.5 EU) and oviduct (2.2 EU) and the animal also produced degenerated and deformed embryos. These results indicate that common bacterial flora of vagina may not affect embryo development and the presence of pathogenic bacteria in the vagina and/or endotoxin in reproductive tract could be detrimental to viability of gametes and preimplantation embryos in rats.

Intestinal parasitic infections in patients with malignancy.

The frequency of intestinal parasitic infections was studied retrospectively in 1,029 cancer patients presenting with symptoms of diarrhoea. Intestinal parasites were diagnosed by stool examination, using both the direct and concentration techniques and also the modified acid fast stain. Parasitic infection was found in 16.5% of the cases. The majority of the patients with intestinal parasitosis had cancer of the haemopoietic system and were on anticancer chemotherapy. The most prevalent parasites were Entamoeba histolytica/Entamoeba dispar (8.5%) and Giardia lamblia (3.1%). Much more rare were Strongyloides stercoralis (0.6%), Cryptosporidium parvum (0.3%) and Isospora belli (0.1%). All the patients with intestinal parasites were negative for HIV antibodies.

Fusarium solani infection in a patient with acute myelogenous leukemia--a case report.

Multiple necrotizing skin lesions due to Fusarium solani in an elderly man with acute myelogenous leukemia is described.

Cryptosporidiosis among cancer patients: an observation.

The incidence of cryptosporidiosis was studied in 560 cancer patients presenting with symptoms of diarrhoea. Cryptosporidium oocysts were detected in the stool specimens by modified acid fast staining. Blood was examined for HIV antibodies from patients whose stool specimens were positive for Cryptosporidium oocysts. Oocysts were detected in 7 of the 560 (1.3%) patients who were receiving chemotherapy and had diarrhoea; in five of them the symptoms were acute, while tow patients had chronic diarrhoea. Of these seven patients, five had cancer of haemopoetic system, one had cancer of cervix and one had uterine sarcoma. None of the patients positive for oocysts were positive for HIV antibodies, ruling out the possibility of an opportunistic infection due to HIV infection.

Prevalence of HIV infection in voluntary blood donors and cancer patients.

The HIV infection pattern amongst cancer patients and voluntary blood donors was studied at an oncology centre in South India. The study period was from May 1991 to March 1994. A total of 18,260 subjects were screened for HIV infection. Of which 14,266 were voluntary blood donors and 3994 were cancer patients. The HIV infection rate amongst voluntary blood donors and cancer patients was 0.042% (6/14266) and 0.4% (16/3994) giving a seropositivity rate of 0.42 and 4.0 per 1000 respectively.

A pilot programme of MRSA surveillance in India. (MRSA Surveillance Study Group).

This surveillance study was conducted simultaneously at three centres across India. A total of 13,610 test samples from various sites were obtained. Microbiological methods employed were similar at the three centres. Identification of S aureus was based on the recognition of the production of coagulase with positive isolates being recorded as S aureus. Both tube coagulase tests and slide coagulase test were performed. Antimicrobial susceptibility testing of the isolated strains of staphylococcus aureus and staphylococcus epidermidis to various antimicrobial discs were carried out according to standardized disk diffusion method recommended by NCCLS. Of the total 739 cultures of S aureus, 235 (32%) were found to be multiply resistant with the individual figures for resistance being 27% (Bombay), 42.5% (Delhi) and 47% (Bangalore). MRSA is emerging to be a significant problem pathogen in the surgical setting with vancomycin probably the only reliable choice for these infections.

Pneumocystis carinii pneumonia in two patients with Hodgkin's disease.

The incidence of Pneumocystis carinii pneumonia (PCP) in immunocomprOMised patients is on the increase. We describe two patients with Hodgkin's disease who were proved to have P. carinii pneumonia by toluidene blue "O" (TBO) staining of their induced sputa. To the best of our knowledge, there are no reports from our country regarding P. carinii infection in patients with malignancy.

Assessment of suitability & ease of performance of seven commercial assay systems for the detection of antibodies to HIV-1.

In this study, we have evaluated the suitability and ease of performance of seven HIV assays namely: Vironostika anti-HIV Uni-Form; Vironostika HIV MIXT; Elavia MIXT; Genelavia MIXT; Serodia-HIV; Immunocomb Bi-spot; and Test pack HIV-1 and 2 Abbott, for use in Indian laboratories. A panel of 41 blind coded Western blot confirmed sera were used for this purpose. Rapid assays like Immunocomb Bi-Spot, Serodia HIV and Test pack HIV-1/HIV-2 Abbott were found to be more suitable and easy to perform as compared to the ELISAs. Sensitivity of all the assays was excellent (100%). Specificity of Serodia HIV, Immunocomb Bi-spot, Test pack HIV-1 and 2 Abbott and Elavia MIXT were excellent (100%), while that of Vironostika MIXT and Vironostika anti-HIV Uni-Form was poor. Positive predictive value of the assays ranged from 64.5 to 100 per cent. Negative predictive value of six of the assays was 100 per cent and that of Vironostika anti-HIV Uni-Form was very poor.