Biomedical subjects
Publications and source records attributed to S C Gupta.
Colonization of areas of intestinal metaplasia by Helicobacter pylori is rare and there is only one report in the literature of this organism colonizing areas of intestinal metaplasia in the antral mucosa. We report two more cases where H. pylori were seen in the gastric pits with intestinal metaplastic changes in the antral biopsy specimens.
Histopathologic features of duodenal and jejunal mucosal biopsy specimens obtained from 58 patients with portal hypertension and 30 healthy volunteers were studied. Dilated mucosal vessels with thickened walls were seen in duodenal and jejunal biopsy specimens from 39 (67%) and 41 (71%) of the patients, respectively, compared with corresponding biopsy specimens from 8 (27%) and 6 (2%) of the control subjects. The difference between the two groups was statistically significant. Other important histologic features in the patient group included edema of the lamina propria, fibromuscular proliferation, a decreased villous/crypt ratio, and thickened muscularis mucosae. The mean +/- SD thickness of capillary wall and diameter were significantly more in the patient group compared with those in the control subjects. We conclude that thick-walled dilated vessels along with edema of the lamina propria, fibromuscular proliferation, a decreased villous/crypt ratio, and thickened muscularis mucosae form a characteristic picture of portal hypertensive enteropathy. These changes seem to be a part of the changes seen in the gastrointestinal tract of patients with portal hypertension without any meaningful clinical implication except the increased chance of occult gastrointestinal blood loss.
Sections from 104 cases of benign, preneoplastic and neoplastic lesions of the prostate were studied for argyrophilic nucleolar organizer regions (AgNORs). The mean NOR counts in normal controls (2.87) and benign prostatic hyperplasia with or without chronic prostatitis (4.90 and 3.84 NORs/nucleus, respectively) were found to be significantly less (p < 0.001) than that in prostatic intraepithelial neoplasia (PIN) and adenocarcinoma of the prostate (5.65 and 5.78 NORs/nucleus, respectively). The mean AgNOR count of a section with atypical adenomatous hyperplasia was significantly lower than that in PIN. No statistically significant difference was observed between AgNOR counts of high-grade PIN and well-differentiated adenocarcinoma (WDAC; 5.67 vs. 5.78 NORs/nucleus, respectively), however the difference between low-grade PIN and WDAC was statistically significant (5.46 vs. 5.78 NORs/nucleus, p < 0.005). The increase in NOR counts occurred concomitantly with the decrease in the degree of differentiation of adenocarcinoma. Thus, NOR was found to be a good adjuvant to the existing diagnostic parameters to pick up more cases at the stage of PIN when prognosis is better.
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Endoscopic mucosal biopsies from 323 patients (201 from upper gastrointestinal tract and 122 from lower gastrointestinal tract) were studied to correlate the diagnostic efficacy of histology and imprint cytology in the diagnosis of malignant lesions of gastrointestinal tract. Of these 71 were from normal controls, 113 from benign lesions and 131 from malignant lesions. Histology showed no false positive reports but it was false negative in 6 cases (3 in oesophagus, 1 in stomach and 2 from colon). Imprint was false positive in 3 cases (2 oesophagus, 1 colon) and false negative in 2 cases (both oesophagus). The overall diagnostic accuracy of histology and imprint cytology in oesophagus, stomach and lower gastrointestinal tract was 95%, 98%, 98% and 95%, 100%, 98% respectively. When combined, the diagnostic accuracy increased to 98%, 100% and 100% in oesophagus, stomach and lower gastrointestinal tract respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy for histology and cytology irrespective of the site was 96%, 100%, 100%, 94%, 97% and 98.5%, 97%, 98%, 98%, 98% respectively. Thus imprint cytology can act as an adjunct to bioptic histology to increase the diagnostic efficacy and save the time but definitely it cannot replace it as chances of false positives are high.
Alkaline phosphatase have been demonstrated histochemically in the cytoplasm of neutrophils. Altered LAP activity has been observed in a number of conditions. Increased values are found in various inflammatory lesions where as in different malignancies LAP falls. Our study was aimed to see the alteration in LAP activity in case of squamous cell carcinoma. The study was carried out in peripheral blood smears of 185 cases (110 cases of squamous cell carcinoma and 75 of normal persons). After histochemical staining, LAP scoring was done. LAP score in Squamous cell carcinoma (mean +/- SD = 57.41 +/- 16.9). No significant difference in LAP score was found according to the site and grade of carcinoma, and in relation to metastasis. 43 cases were followed up after variable periods of treatment. LAP score was found to be significantly raised following treatment, (mean +/- SD = 21.14 +/- 5.94, p < 0.001). It is concluded that LAP scoring might be used as a cheap and simple technique to diagnose occult malignancies and to assess the response to therapy.
Mucin histochemistry of colo-rectal mucosa was studied in 124 biopsies which included 28 specimens from normal mucosa, 35 inflammatory lesions, 20 polyps, 26 malignant lesions and 15 specimens from transitional mucosa. The stains used were Haematoxylin and Eosin, Periodic acid schiffs, Alcian blue--Periodic acid schiffs (pH 2.5), Orcein--Alcian blue and Periodic acid sodium borohydride saponification. Normal mucosa, mucosa from inflammatory lesions, juvenile and hyperplastic polyps had neutral mucin in traces along with O-acylated sialomucins and sulphomucins. Predominant changes in adenomatous polyps and malignancy were a significant loss of sulphomucins and O-acylation at position C7, C8 or C9 in sialomucins. The changes in transitional mucosa were more on the pattern of malignant lesions. The alterations in the amount and/or pattern of mucin in colorectal mucosa has been found to predate frank morphological changes of malignancy. A routine use of mucin histochemistry in suspicious colorectal biopsies might be helpful in diagnosing premalignant and early malignant lesions in otherwise apparently normal colorectal mucosa or mucosa with chronic inflammatory changes and thereby reduce mortality.
Biopsies of cervix uteri from 166 patients with benign and malignant lesions (12 normal, 48 inflammatory lesion, 6 adenocarcinoma, 2 adenosquamous carcinoma and 98 from squamous cell carcinomas) were studied histochemically. The stains used were PAS with/without diastase, AB/PAS (pH 2.5) and OR/AB. In inflammatory lesions neutral mucin was predominent which was replaced by sialomucin and sulphomucin in endocervical polyps. In malignant lesions sulphomucin was predominent. Seventeen percent cases of squamous cell carcinomas needed reclassification after mucin staining. Of the fourteen large cell non-keratinizing squamous cell carcinomas, 12 were reclassified as squamous cell carcinoma with mucin secretion and 2 as adenosquamous carcinoma. One case of small cell non-keratinizing squamous cell carcinoma was reclassified as moderately differentiated adenocarcinoma. None of the keratinizing carcinomas had evidence of mucin secretion. Mucin histochemistry should be done routinely on non-keratinizing squamous cell carcinomas to pick up more cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stains. Such carcinomas are known to pursue a more aggressive clinical course and have a poorer prognosis than non-mucin secreting type of squamous cell carcinoma.
A study was conducted on the pharmacokinetics and therapeutic efficacy of triclabendazole at three low dose rates of 0.5, 1.0 and 1.5 mg/kg body weight in buffaloes experimentally infected with Fasciola gigantica. The pharmacokinetics were compared with the effects of a single intraruminal dose at 24.0 mg/kg body weight in uninfected buffaloes. At all three dose rates, an equilibrium between the absorption of triclabendazole and the disposition of its metabolites was observed by days 3 and 4 and remained almost unchanged thereafter. Continuous daily dosing at 1.5 mg/kg body weight proved to be efficacious against liver fluke infection in buffaloes.
A study was conducted to understand pharmacokinetics and flukicidal activity of intraruminal administration of triclabendazole (TCBZ) at 12.0, 24.0 and 36.0 mg kg-1 body weight in experimentally Fasciola gigantica-infected buffaloes on Week 2 and 10 post-infection. No fluke eggs in faeces and no flukes could be recovered from the liver of buffaloes following intraruminal administration of triclabendazole at 24.0 and 36.0 mg kg-1 body weight both on Weeks 2 and 10 post-infection, while the recommended therapeutic dose at 12.0 mg kg-1 body weight was 19-23% effective. Pharmacokinetic analysis of the data revealed a significantly higher (P < 0.05) concentration maximum of both the metabolites and area under concentration-time curve of TCBZ-SO2 in animals treated at 12.0 mg kg-1 body weight on Week 10 post-infection, whereas a significantly higher area under the concentration-curve and elimination half-life of both the metabolites and significantly higher concentration maximum and area under the concentration-time curve of both the metabolites were observed in animals treated on Week 10 post-infection at the dose rates of 24.0 and 36.0 mg kg-1 body weight, respectively. Bioavailability of triclabendazole was more in buffaloes with mature flukes than with immature flukes.
Spindle-cell carcinoma of the nasal septum is an extremely rare malignancy. Such a case along with the salient features of this variant of squamous cell carcinoma and a review of literature on carcinoma of the nasal septum is depicted.
A rare case of an overlooked fractured metallic Fuller's tracheostomy tube in the posterior basal segment of the left lung is reported along with a review of the literature. Incidence, delay in diagnosis, complications and management of overlooked foreign bodies are discussed. Various factors contributing to the fracture of tracheostomy tubes are reviewed.
Sarcocystis is an uncommon parasitic infection. We report four cases that presented with lumps, pain in the limbs or a discharging sinus of unknown etiology. Microscopic examination of the excised tissue in all cases showed characteristic cysts of the sarcocystis parasite. A discussion of the identification and recognition of this uncommon infection from muscle biopsies is given.
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