Search PubMed⌕ Search

Biomedical subjects

K Verma

Publications and source records attributed to K Verma.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Inquiry-driven strategies for innovation in medical education: experiences in India.

Four medical institutes, viz, AIIMS, New Delhi; CMC, Vellore; JIPMER, Pondicherry and IMS-BHU, Varanasi formed a consortium to introduce reforms in undergraduate medical education. A detailed inquiry was conducted by administering questionnaires to the faculty, recent graduates and patients to identify the deficiencies in the present system. Morbidity patterns prevalent in the community at primary, secondary and tertiary care levels were determined. These were matched with the actual curricula being followed and the assessment patterns. The main findings were: inadequate emphasis on practical skills (including communication), insufficient coverage of common diseases; and neglect of behavioral, social and ethical aspects in the curriculum. Based on these findings certain corrective programmes are being introduced. The content areas in the curriculum have been classified in to 'must know', 'good to know' and 'need not know'. A list of essential skills have been identified. Steps are on to ensure that these skills are acquired by the graduates. A modular approach to the teaching was suggested and modules on some of these topics are under preparation.

Child↗
PubMedDate not supplied

Langerhans cell histiocytosis in lymph nodes. Cytomorphologic diagnosis and pitfalls.

OBJECTIVE: To delineate the cytomorphology of Langerhans cell histiocytosis (LCH) in lymph nodes. STUDY DESIGN: Nine histologically documented LCH cases with a prior lymph node aspirate and five more cases in which a cytologic diagnosis of LCH was rendered in a background of corroborative clinical and radiologic findings were included in a retrospective study over a 12-year period (January 1988-January 2000). Papanicolaou- and May-Grünwald-Geimsa-stained smears were reviewed by two independent observers. Staining for S-100 protein was available in four cases. RESULTS: Nine cases had multisystem involvement, while in five cases only lymph nodes were involved. The ages ranged from 5 months to 27 years, with 11 males and 3 females. An initial cytologic diagnosis of LCH had been rendered in six, suspected in four and missed in four. On review, all were reclassified as LCH except two cases, which were still thought to be reactive and necrotizing lymphadenitis. The pathognomic feature of LCH, the "LCH cell," was identified in 12 of 14 cases along with varying numbers of eosinophils, polymorphs and lymphocytes. Giant cells were seen in six cases, and plasma cells were rarely seen. CONCLUSION: Lymph node involvement by LCH can be identified by fine needle aspiration in 85% of cases. The presence of the LCH cell is a must. The differentials to be considered are dermatopathic lymphadenitis, sinus histiocytosis with massive lymph-adenopathy, Hodgkin's lymphoma and malignant histiocytosis.

Adolescent↗
PubMedDate not supplied

Tuberculosis of the breast. A cytomorphologic study.

OBJECTIVE: Extrapulmonary tuberculosis occurring in the breast is rare despite the fact that 1-2 billion people worldwide suffer from tuberculosis. The aim of this study was to examine the cytomorphology of breast tuberculosis (breast TB) and to review the literature. STUDY DESIGN: Old records from the Cytopathology Laboratory, All India Institute of Medical Sciences, were reviewed from January 1980 to December 1998. Cases of breast TB where a cytologic diagnosis was rendered or a histologic diagnosis with prior fine needle aspiration cytology (FNAC) was available were selected. These slides were reviewed for determining the cytologic findings. RESULTS: One hundred sixty cases of breast TB were included in the study. Six males and 154 females with a clinical suspicion of carcinoma had undergone FNA that was reported as TB. The majority of the patients (111) were in the reproductive age group, 21-40 years. Of the 160 cases, 118 (73.75%) had cytomorphology diagnostic of tuberculosis--epithelioid cell granulomas with caseous necrosis. Eleven of the remaining 42 cases were positive for acid-fast bacilli (AFB) on Ziehl-Neelsen (ZN) staining, while 31 cases were confirmed to be tubercular on histology. ZN staining was done in 44 cases, and AFB were demonstrated in only 38.6% of cases. CONCLUSION: Up to 73% of breast TB can be confidently diagnosed when both epithelioid cell granulomas and necrosis are present. Also, the possibility that a woman in the reproductive age group who presents with a palpable lump in the breast may have tuberculosis must be kept in mind, especially as the incidence of breast TB may increase in the future with the global spread of AIDS.

Adolescent↗
PubMedDate not supplied

Phyllodes tumor of the breast. A cytohistologic study of 80 cases.

OBJECTIVE: To study the cytologic features of phyllodes tumor (PT) of the breast and determine the accuracy of their subclassification in fine needle aspirates. STUDY DESIGN: Eighty cases of histologically diagnosed PT between 1982 and 1997 with a previous fine needle aspiration (FNA) were evaluated. The FNA smears of each case were reviewed without knowledge of the initial cytologic diagnosis and subclassified into benign, borderline or malignant PT. RESULTS: Benign PTs were characterized by a dimorphic mixture of stromal and epithelial cells. The stromal fragments showed mild to moderate cellularity with absent to minimal pleomorphism and no mitosis. There were occasional, if any, single stromal cells. Borderline PTs had stromal fragments with moderately cellular stroma exhibiting moderate pleomorphism. Two additional features were the presence of single stromal cells and an occasional mitosis in the stromal fragments/single cells. Aspirates from malignant PT were very cellular, with a high stromal/epithelial ratio and marked stromal cellularity. The stromal cells were highly pleomorphic, with frequent mitosis and atypical single stromal cells in the background. Fifty-seven of the 80 histologically documented cases (71.3%) were diagnosed as PT on FNA (40 benign, 10 borderline and 7 malignant). In 81% (46 of 57 PTs), good cytohistologic correlation (32 benign, 8 borderline and 6 malignant) was observed. In another eight cases, one grade differentiation between cytologic and histologic grade was observed. Six of the nine malignant PTs on histology were correctly subclassified on cytology. There were one false positive and two false negative cases. CONCLUSION: Cytologic diagnosis and grading of PT on FNA is possible. Special care should be undertaken in interpreting phyllodes fragments, cellularity of stroma, pleomorphism and mitosis. Single stromal cells are also important morphologic criteria for subclassification. Multiple-site aspiration is advisable to avoid diagnostic errors.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology in the management of male breast masses. Nineteen years of experience.

OBJECTIVE: To determine the utility and accuracy of fine needle aspiration cytology (FNAC) as well as its sensitivity, specificity and predictive value in the diagnosis of male breast masses. STUDY DESIGN: Data on male breast FNAC done between 1978 and 1997 were retrieved from the records of the cytopathology laboratory. FNAC diagnoses were categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, diagnostic accuracy and predictive values of FNAC were calculated using standard statistical methods. RESULTS: Five hundred seven of 13,175 patients undergoing breast FNAC were males. Of them, 393/507 had satisfactory aspirates. Of these, 70 were positive (13.8%), 295 were negative (58%), and 29 were inconclusive (5.7%). A total of 114 FNACs (22.5%) were unsatisfactory. Histopathology was available in 97/507 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. CONCLUSION: This large study shows that FNAC is a very accurate tool for diagnosis of male breast lesions. It is highly sensitive and specific, with good cytohistologic correlation. FNAC should therefore be an integral part of the primary assessment of breast lumps in males.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration cytology of dermatopathic lymphadenitis.

OBJECTIVE: To delineate and describe the cytomorphologic features of dermatopathic lymphadenitis on fine needle aspirated material. STUDY DESIGN: Thirteen cases of previously diagnosed dermatopathic lymphadenitis (DLN) and 10 cases of reactive lymphadenitis (RLN) (5 each of sinus histiocytosis and follicular hyperplasia) were reexamined by two independent observers. The cytologic features were semiquantitated (0-3+). Histology was available in two cases. RESULTS: A variable amount of melanin pigment was seen in all 13 cases of DLN and in only 3 cases of RLN. DLN had large histiocytic collections with blood vessels at the center (12/13). The histiocytic cells had an elongated nucleus (13/13) with nuclear grooves (13/13) and pseudonucleoli (11/13). Many of these nuclei had a convoluted and crumpled appearance (11/13). On immunocytochemistry these cells were S-100 positive (six cases) and CD68 negative (one case). In contrast, in RLN with sinus histiocytosis, the histiocytes were polygonal and had rounded nuclei. Spindle-shaped histiocytes were rare, while pseudonucleoli and nuclear grooves were absent. Sinus histiocytes were CD68 positive and S-100 negative on histologic sections. Tingible body macrophages were rare (2/13) in DLN and prominent (8/10) in RLN. Mitoses were seen in DLN (6/13) and RLN (9/10). CONCLUSION: The morphologic features found to be helpful in the diagnosis of DLN on fine needle aspiration cytology are melanin-laden macrophages with variable pigment; large, histiocytic clusters with blood vessels at the center; characteristic histiocytes, with elongated vesicular nuclei, nuclear grooves, crumpled and convoluted nuclei and pseudonucleoli; and absence of or very few tingible body macrophages. Positivity on immunostaining for S-100 and negativity for CD68 aid in the diagnosis.

Biopsy, Needle↗
PubMedDate not supplied

Follicular neoplasms of the thyroid. Decision tree approach using morphologic and morphometric parameters.

OBJECTIVE: Fine needle aspiration of the thyroid is limited in differentiating hyperplastic nodular goiters from true follicular neoplasms and in separating follicular adenomas from follicular carcinomas. The present study was done to evaluate if a panel of morphologic and morphometric parameters of the thyroid and ploidy status, either alone or in combination, would help differentiate hyperplastic nodular goiters from follicular adenomas and carcinomas. STUDY DESIGN: Fine needle aspiration smears of 75 cases classified as follicular neoplasms of the thyroid were studied for morphologic (cellularity, colloid and cellular patterns) and morphometric parameters (nuclear diameters and nucleoli). RESULTS: Of the large number of parameters utilized in this study, only two of the cellular patterns (honeycomb and single dispersed) and the average maximum nuclear diameter showed trends in differentiating these lesions. CONCLUSION: Based on these patterns and nuclear diameter (9 microns), we developed a decision tree classification that separated the benign from malignant lesions (follicular carcinomas) with a sensitivity and specificity of 92.8% and 57.4%, respectively.

Adenocarcinoma, Follicular↗