Biomedical subjects
Publications and source records attributed to K Joshi.
A case of mucinous adenocarcinoma of the renal pelvis occurring in association with staghorn calculus and severe pyelonephritis is reported. The incidence and aetiopathogenesis of this neoplasm is briefly discussed.
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A case of immunoblastic lymphadenopathy has been presented which had the characteristic clinical and histological features. The patient did not respond to chemotherapy and succumbed to the disease. Instead of the usual polyclonal gammopathy associated with this condition, he showed a fall in IgM levels, IgG and IgA being within normal limits. The significance of the latter finding is not known.
A case of retroperitoneal cystic lymphangioma is reported. Added to the 42 cases of retroperitoneal lymphangioma found from the English literature, this brings up the total of cases reported to date to 43. A critical review of the clinical picture and management of this condition is presented on the basis of these reported cases.
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Leiomyomas are the most common benign tumors of the esophagus. However, esophageal leiomyomatosis is a rare pathologic entity that has received little attention in the radiologic literature. We present a case of esophageal leiomyomatosis with imaging features on barium swallow and computed tomography (CT).
This paper presents the equity implementation model (EIM) in the context of a case that describes the implementation of a medical scheduling system. The model is based on equity theory, a well-established theory in the social sciences that has been tested in hundreds of experimental and field studies. The predictions of equity theory have been supported in organizational, societal, family, and other social settings. Thus, the EIM helps provide a theory-based understanding for collecting and reviewing users' reactions to, and acceptance or rejection of, a new technology or system. The case study (implementation of a patient scheduling and appointment setting system in a large health maintenance organization) illustrates how the EIM can be used to examine users' reactions to the implementation of a new system.
BACKGROUND: Epithelioid sarcoma is a rare type of soft tissue sarcoma affecting the extremities, particularly the hands and fingers. Though it is well described histopathologically, publications regarding its cytologic findings are limited. CASE: A 52-year-old woman presented with swelling of the left middle finger. Fine needle aspiration was performed. Smears showed oval to polygonal cells with epithelioid features. A diagnosis of soft tissue sarcoma with a possibility of epithelioid sarcoma was suggested. Histopathologic examination and immunohistochemistry confirmed the diagnosis. CONCLUSION: In the presence of classic cytologic findings, the diagnosis of epithelioid sarcoma can be suggested. Subsequent histologic examination and immunohistochemistry can confirm the diagnosis.
OBJECTIVE: To determine the usefulness of fine needle aspiration cytology in diagnosing breast ductal proliferations that fall short of invasive cancer (hyperplasia, atypia and in situ carcinoma). STUDY DESIGN: This study was a comparison of the cytomorphology and histomorphology of 30 palpable breast lesions in which an initial fine needle aspiration diagnosis of ductal hyperplasia or atypia was based on available criteria. RESULTS: Among six patients, a cytologic diagnosis of mild hyperplasia, based on monolayered cell sheets, was confirmed in five. Fourteen cytologic reports of moderate hyperplasia, based on three-dimensional cell clusters, cell overlap and sublumens, were confirmed in 12. A cytomorphologic diagnosis of atypical ductal hyperplasia was rejected in four of seven patients. Three cases of marked cytologic atypia were diagnosed histopathologically as ductal carcinoma in situ. CONCLUSION: In breast aspirates, three-dimensional ductal cell clusters, a swirling pattern of growth, sublumens, cell dyscohesion and conspicuous nuclear overlap indicate moderate ductal hyperplasia. Ductal atypia should be diagnosed only on such nuclear features as anisonucleosis, irregular nuclear membranes, clumped chromatin and eosinophilic macronucleoli. Cytologists should highlight those features which are important to diagnose breast proliferations as "significant" from the viewpoint of progressing to invasive cancer and not attempt too fine a classification of these lesions.
BACKGROUND/AIMS: Helicobacter pylori infection has been implicated in pathogenesis of gastric cancer. Since there is paucity of reports from developing countries on association of H. pylori with gastric cancer, we performed case control study to find out the relationship between H. pylori and gastric cancer and also compared characteristics of gastric cancer and H. pylori positivity in younger and older patients. PATIENTS AND METHODS: Gastrectomy (n = 37) or endoscopic biopsy (n = 43) samples from area adjoining the cancer were collected from 80 patients of gastric cancer. Tissue specimens were stained with hematoxylin-eosin and Giemsa stains and histological type of cancer was determined according to Lauren, as intestinal or diffuse type. The presence of H. pylori was assessed by Giemsa staining. Eighty age and sex matched patients with non-ulcer dyspepsia (NUD) served as controls. RESULTS: Of 80 patients, 48 had intestinal type, 28 diffuse type and 4 had mixed type of gastric cancer. Tumour was located in antrum in 37, in body in 31, and at other sites in 12 cases. H. pyolri infection was present in 29 of patients compared to 36 patients with non-ulcer dyspepsia (p > 0.05, odd ratio 0.69, confidence interval 0.37-1.32). The positivity for H. pylori was higher in intestinal type than in diffuse type (p < 0.05) of gastric cancer but similar in patients with growth in antrum and body (p = NS) of stomach. There was no significant difference in tumor type, tumor site, frequency of intestinal metaplasia and H. pylori positivity (39% vs 35%, P > 0.05, odd ratio 1.19, confidence interval 0.44-3.23) in younger (< 45 yrs) and older (> 45 yrs) patients. CONCLUSIONS: Approximately one-third of patients with gastric cancer show presence of H. pylori infection on histological examination. No difference in H. pylori positivity were observed in young and old patients of gastric cancer.
We describe here two patients with tracheobronchial involvement by amyloidosis. One of them had presented with discrete tracheobronchial mass lesions simulating bronchogenic carcinoma. The other had intermittent streaky hemoptysis and was found to have diffuse tracheobronchial involvement at bronchoscopy. Both patients are doing well without any definitive therapy.
BACKGROUND: Effect of renal dysfunction in fulminant hepatic failure is not studied extensively. METHODS: Fifty consecutive patients of fulminant hepatic failure were studied prospectively to determine the prevalence of renal failure and its effect on survival. RESULTS: The mean age of these patients was 36 +/- 7.2 years and there were 21 males and 29 females. Twenty two patients (44%) were hepatitis B surface antigen (HBsAg) positive. Renal dysfunction was observed in 19 patients (38%). Acute tubular necrosis was seen in 7 patients (38%) while prerenal azotemia and functional renal failure occurred in six patients each (37%). Renal failure occurred more commonly in patients with jaundice. In these patients it occurred in less than four days and prior to onset of encephalopathy, ascites, and gastrointestinal hemorrhage. Histopathological examination of kidney (done in 8 patients) revealed acute tubular necrosis in 4 patients while patients with functional renal failure and prerenal azotemia had normal histology. A good correlation was observed between biochemical parameters and histology of kidney in all the patients. The survival amongst the patients with FHF was 28% (14 of 50 patients). Poor prognostic indicators were a leukocyte count of more than 16.5 x 10(9)/liter, prothrombin index of less than 34%, a peak serum bilirubin of more than 376 mumol/liter and presence of renal failure. Only 3 of 19 patients with renal failure survived. CONCLUSIONS: Renal dysfunction is a major indicator of poor prognosis in patients with FHF.
BACKGROUND: Helicobacter pylori is a leading cause of gastritis. Some of the histological changes revert after eradication of H. pylori. There is paucity of reports from India. AIM: To study the effect of H. pylori eradication on the histopathological changes. METHODS: Endoscopically obtained antral biopsies from 164 consecutive H. pylori positive cases of dyspepsia were analysed before and 4 weeks after completion of treatment. RESULTS: Treatment for H. pylori resulted in eradication of the organism as confirmed histologically in 123 out of 164 (76.22%) cases. Analysis of histopathological changes in pre and post treatment biopsies from the same patient revealed a significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia (p < 0.001) There was no difference in these findings in cases where H. pylori eradication failed when compared with their pre-treatment biopsies (p > 0.05). Similarly the pre and post treatment biopsies revealed, no difference in frequency of intestinal metaplasia and gastric atrophy in cases where H. pylori was eradicated or persisted after treatment. CONCLUSION: There was significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia, following eradication of H. pylori.
We report a patient with fibrosing cholestatic hepatitis (FCH)-like syndrome in renal transplant recipient, who was negative for hepatitis-B and C-virus infection. The patient presented initially with extrahepatic biliary obstruction due to stricture at the lower end of the common bile duct. Cholestasis persisted inspite of effective biliary drainage. He was operated for empyema of the gallbladder and histological examination showed the presence of cytomegalovirus inclusions in the wall of the gallbladder. The patient died inspite of aggressive management; autopsy examination of the liver revealed evidence of FCH-like changes.