Non-resolving liver abscess with Echinococcus cross-reactivity in a non-endemic region.

A 40-year-old woman presented with high fever with chills and rigors. Imaging studies revealed multiple liver abscesses with hepatosplenomegaly and gall-stones. Ultrasound-guided aspirate revealed pus that was negative on Gram and acid-fast staining and for amebic trophozoites. ELISA for echinococcus was strongly positive, but she did not respond to albendazole therapy. At surgery, Fasciola hepatica was detected and she responded well to bithinol postoperative.

N-hexane neuropathy in screen printers.

BACKGROUND: To study the clinical and electrophysiological profile of n-hexane neuropathy in a tertiary care center of India. METHODS: Twenty five screen printers from five different factories, with peripheral neuropathy were included in the study. A detailed general physical, systemic and neurological examination was conducted Visual acuity, color vision and field charting was done in all the subjects. All patients were subjected to Folstein mini mental scale examination. Electrophysiological evaluation included motor and sensory conduction studies of the conventionally studied nerves of upper and lower limbs, Needle EMG of various distal and proximal muscles and patterned visual evoked responses. The electrophysiological profile was repeated every three months till one year. Sural nerve biopsy was studied in six patients. The patients were followed for a maximum of 4 years. RESULTS: Twenty three [92%] patients had sensory- motor neuropathy, while pure sensory neuropathy was seen in two. The sensory conductions were affected almost equally in upper as well as the lower limbs, while the motor conductions were affected more in the lower limbs than the upper limbs. The sensory conductions were not recordable in both the upper and the lower limbs in 18 [72%] patients. Motor conduction studies revealed an asymmetric and patchy involvement. Proximal conduction block was seen in 3 patients [12%]. On needle EMG features of denervation were seen in all patients. P100 latency was normal in all. Sural nerve biopsy showed a selective decrease in large myelinated axons with demyelination. Axonal swelling with focal areas of demyelination was observed in two patients. CONCLUSIONS: The electrophysiological patterns as well as the histopathology reflect the pathophysiology of n-hexane neuropathy.

Thyrotoxic neuropathy- an under diagnosed condition.

Many neurological diseases like myopathy, periodic paralysis, ophthalmoplegia, and myasthenia gravis are known associations of thyrotoxicosis. However the association of neuropathy with thyrotoxicosis is not frequently recognized. First described by Charcot in 1889, thyrotoxic neuropathy or 'Basedow's Paraplegia' is a rarely reported entity. We describe here a case of a young woman with subacute distal neuropathy as the presenting manifestation of thyrotoxicosis. The neuropathy improved on antithyroid treatment. A careful literature search leads us to believe that peripheral neuropathy in thyrotoxicosis is under recognised. Thyroid function tests can be helpful in the diagnosis of this treatable neuropathy and should be included in the routine work up.

Effect of collagenase on nerve fibre teasing.

Teased fibre preparations are important in the investigation of peripheral nerve disorders, but can be a rather tedious procedure. A technique is described in which pretreatment of the nerve sample with collagenase before osmication substantially simplifies the actual teasing procedure. The technique also does not alter the morphology or interfere with any further investigations required on teased fibres--for example, fluorescent antibody studies.

IgA monoclonal gammopathy of undetermined significance with peripheral neuropathy.

Monoclonal gammopathy of undetermined significance (MGUS) and peripheral neuropathy may be causally linked. In most cases, the M-protein is of IgG or IgM type. Peripheral neuropathy associated with IgA MGUS is uncommon, and there are limited reports. Here, we report a case of a 55-year-old male who was diagnosed to have symmetrical sensorimotor peripheral neuropathy associated with IgA MGUS with deposits of IgA-monoclonal protein in the myelin sheath.

Hypophyseal tuberculoma: direct radiosurgery is contraindicated for a lesion with a thickened pituitary stalk: case report.

OBJECTIVE AND IMPORTANCE: Hypophyseal tuberculomas are extremely rare lesions. The recognition of hypophyseal tuberculomas in the differential diagnosis of pituitary tumors is important, even with no evidence of systemic tuberculosis. CLINICAL PRESENTATION: A 27-year-old female patient presented with continuous, dull, generalized headaches and amenorrhea, with no history of visual diminution, galactorrhea, or endocrinological abnormalities and no evidence of systemic tuberculosis. The patient exhibited a normal water balance, without polyuria or polydipsia. A gynecological examination, including an endometrial biopsy for amenorrhea, did not reveal any abnormalities. Perimetric and endocrinological examination results were normal. Contrast magnetic resonance imaging revealed a dense enhancing intrasellar mass, with thickening of the pituitary stalk. INTERVENTION: Sublabial rhinoseptal transsphenoidal decompression of the lesion was performed. The histopathological features were consistent with a diagnosis of tuberculoma, and acid-fast bacilli were demonstrated in the surgically removed tissue with Ziehl-Neelsen staining. As soon as the histopathological features were known, the patient underwent a lumbar puncture for cerebrospinal fluid analysis, which indicated normal findings. An intradermal tuberculin test yielded negative results. The patient was treated with medical therapy for 18 months, and complete resolution of the lesion was observed in follow-up examinations. CONCLUSION: Hypophyseal tuberculomas are often mistaken for pituitary adenomas. The finding of a thickened pituitary stalk in contrast magnetic resonance imaging scans may be useful for the differentiation of these lesions from pituitary adenomas. Direct radiosurgery is not an appropriate primary treatment method for pituitary adenomas and is principally restricted to elderly, medically unfit patients with microadenomas and patients with residual or recurrent tumors after microsurgery. It is contraindicated for patients who exhibit a thickened pituitary stalk in contrast magnetic resonance imaging scans.

Amyloidoma of the thoracic spine. Case report.

The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple. A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red-stained section under polarized light. Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.

Rudimentary dysplastic valvar tissue guarding the tricuspid orifice with dilatation of the right ventricle and a patent outflow tract.

Tricuspid regurgitation due to rudimentary and dysplastic tricuspid valvar tissue associated with a patent right ventricular outflow tract is described in a 10-year-old child presenting with cyanosis since birth. The diagnosis was confirmed by cross-sectional echocardiography, angiocardiography and subsequently by histopathological data. We discuss the differentiation of these findings from Uhl's anomaly and from the congenitally unguarded tricuspid orifice.

Dysembryoplastic neuroepithelial tumors: report of 10 cases from a center where epilepsy surgery is not done.

Dysembryoplastic neuroepithelial tumor (DNT) is a recently recognized tumor entity with distinctive clinicopathological features and an excellent long-term prognosis. We report 10 cases of DNT out of neurosurgical specimens sent for histopathological examination since 1994. Epilepsy surgery is not done at our center, and all the cases were sent with a clinical diagnosis of glioma. On histopathological examination, all the 10 cases contained the specific glioneuronal element. In 6 cases, glial nodules were noted in addition. This study therefore reports 4 cases of simple DNT and 6 cases of complex DNT. There was no nuclear atypia or mitosis in any of the cases. Proliferative index by PCNA varied from negative to <1%. It is very important to recognize this entity, as surgery cures the patient, and radiotherapy or chemotherapy is not required.

Brain histomorphology in protein deprived rhesus monkeys with fatal malarial infection.

Healthy and protein deprived rhesus monkeys were inoculated with a virulent strain of Plasmodium knowlesi, to determine the morphological changes in the brain and to establish whether this model could be utilised as an experimental model for cerebral malaria. The histomorphological changes produced in the brain did not correspond with the changes conforming to those of cerebral malaria. The changes observed in healthy controls were cerebral oedema, high percentage of parasitised RBCs in the cerebral capillaries, with prominent and, at places, disrupted endothelium. In the protein deprived animals, cerebral oedema was the only conspicuous feature. It appears that the P. knowlesi-rhesus monkey combination is not suitable as an experimental model for cerebral malaria.

Thalamic epidermoid cyst. A case report.

A case of thalamic epidermoid cyst is reported. Its clinical presentation, radiological, operative findings and histological findings are discussed. Intraparenchymal epidermoids are uncommon and to our knowledge only one case of thalamic epidermoid has been reported earlier. The literature is reviewed in regard to incidence, location and etiology of Intracerebral epidermoid tumor cysts.

Glioblastoma of the cerebellum. A report of 3 cases.

Glioblastoma (GBM) is one of the commonest intra cranial tumors. Infratentorial GBM is, however, a rare entity. We report 3 cases of histologically proven posterior fossa GBM. The clinical presentation was of a rapidly growing posterior fossa mass. The diagnosis was made only on histological examination. The radiological features are non-specific and the clinical course same as GBM elsewhere. We describe their clinical presentation, radiological and pathological features and a review of describe the literature.

Molluscum contagiosum. A case report with fine needle aspiration cytologic diagnosis and ultrastructural features.

BACKGROUND: Cytomorphologic and ultrastructural features of molluscum contagiosum, a rare skin lesion of viral etiology, are presented. CASE: A 4-month-old female was referred for fine needle aspiration cytology of papules over the back and chest wall. A Giemsa-stained preparation of whitish material aspirated from the chest wall nodule showed numerous large, intracytoplasmic, basophilic bodies that pushed the host cell nucleus to the periphery, giving a signet-ring appearance to a few cells. A cytologic diagnosis of molluscum contagiosum was suggested. On electron microscopy numerous intracytoplasmic viral particles were demonstrated, thus confirming the cytologic diagnosis. CONCLUSION: In clinically unsuspected cases, the cytologic diagnosis of molluscum contagiosum can be suggested by demonstrating pathognomonic molluscum bodies in aspirated material.

Fine needle aspiration cytologic appearance of inflammatory pseudotumor of the liver. A case report.

BACKGROUND: Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of the liver that can be clinically confused with a malignant process. CASE REPORT: A 28-year-old male presented with fever and a palpable, firm liver. Ultrasonography and computed tomography revealed a mass in the right lobe of the liver. Fine needle aspiration biopsy (FNAB) under ultrasonographic guidance showed inflammatory cells, fibroblasts and a few hepatocytes. A diagnosis of inflammatory pseudotumour was suggested and confirmed on a true-cut biopsy. CONCLUSION: The cytologic appearance of IPT is characteristic. FNAB under ultrasonographic is a quick and easy technique for its diagnosis and differentiation from malignant space-occupying lesions.

Immunological alterations following open heart surgery.

Immunological changes in thirty patients undergoing various cardiac surgical procedures (twenty patients undergoing open heart surgery with either the bubble or the membrane oxygenator and ten patients undergoing closed surgical procedures) were studied. There was an activation of suppressor T cells and secretion of lymphokines in patients undergoing open heart surgery with activation of the classical complement pathway. The immunological alterations were similar in all patients irrespective of the type of oxygenator used.

Endomyocardial biopsy--its evaluation in cardiac disorders.

Endomyocardial biopsies (EMBs) of 47 patients with various cardiac disorders were analysed. Clinically 26 patients were diagnosed as having dilated cardiomyopathy (DCM), 9 myocarditis, six restrictive heart disease and six as Duchenne muscular dystrophy. EMB showed normal histological picture in six cases of DCM and findings consistent with DCM in rest of the twenty cases. None of these biopsies showed evidence of myocarditis. Diagnosis of myocarditis could be confirmed on EMB only in three out of nine clinically diagnosed cases. Cases with restrictive heart disease showed normal biopsy in two, infarction in one, findings consistent with endomyocardial fibrosis in one and amyloidosis in two cases. EMB on six cases of Duchenne muscular dystrophy showed nonspecific histological changes. To conclude, in this series, cases of DCM did not show evidence of underlying myocarditis in endomyocardial biopsies.

Surgical management of cardiac myxomas.

Cardiac myxomas are rare cardiac lesions, though they are the commonest tumours of the heart. Seventeen cases of cardiac myxomas have been operated during the last one decade. Exertional dyspnoea, palpitation and chest pain were the main presenting symptoms. Echocardiographic assessment was the only definitive diagnostic investigation required prior to surgery. Early surgical excision was planned in all the cases. Irrespective of the exposure techniques, removal of the tumour with wide excision of its base was practised. There was one early death due to low cardiac output in a patient brought in a shock like state. Follow up study has revealed 14 patients in NYHA class I and two patients are having class II symptoms. Periodic echocardiographic follow up study has not revealed any recurrence till date. It is concluded that an early diagnosis and surgery gives excellent long term results in these cases.

Histological and immunological analysis of gastric and intestinal lymphomas.

Immunophenotyping of 28 gastrointestinal non-Hodgkin's lymphomas was done using specific antibodies. Twenty six of these were successfully classified using this technique.

Thymic histology in myasthenia gravis.

Histological features of resected thymuses of 18 patients with myasthenia gravis were evaluated. Thymoma were seen in 16.6% of the patients. In the non-thymomatous group, thymic hyperplasia with follicle formation was seen in 33.3%, involuted thymus with occasional lymphoid follicle formation in 11.1%, thymitis with B cell infiltration in 16.6%, involuted thymus in 11.1% and normal thymus in 11.1% of patients. Immuno-histological staining for B and T lymphocytes delineated the group labelled as thymitis with B cell infiltration. Mast cell and eosinophils were frequently seen in thymuses with thymic hyperplasia with follicle formation and thymitis with B cell infiltration. Thymic hyperplasia with follicle formation was more frequent in young patients and these patients had better prognosis.

Nucleolar organiser regions in different colonic epithelia.

The argyrophilic technique (AgNOR) was applied to paraffin sections of 10 acute self-limited colitis, 15 ulcerative colitis (UC), 5 ulcerative colitis with indefinite dysplastic change, 10 adenomatous polyps, 20 colorectal adenocarcinomas and 10 normal colorectal mucosa. The mean number of nucleolar organiser regions (NORs) per nucleus ranged between 1.62-2.00 (95% CI 1.77-1.93) for normal colon, 2.47-3.80 (95% CI 2.71-3.21) for acute colitis, 1.66-2.75 (95% CI 2.13-2.44) for UC, 3.60-4.00 (95% CI 3.67-3.94) for UC with indefinite dysplasia, 3.00-4.04 (95% CI 3.41-3.81) for adenomatous polyps and 3.59-6.70 (95% CI 4.04-4.72) for colorectal adenocarcinoma. The differences observed were statistically significant. There was a significant difference of AgNOR counts between adenomatous polyp and UC with indefinite dysplasia in comparison to those observed in regenerative epithelium of acute colitis and UC without dysplasia. Hence the technique may be used as an adjunct to routine histology for delineating dysplastic changes in colonic epithelium.