Management of a case of thromboembolism post spine surgery: a case report

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran

Ewing’s sarcoma or peripheral primitive neuroectodermal tumor at the base of tongue: a rare location case report

Peripheral primitive neuroectodermal tumor now termed as Ewings sarcoma/PNET, representing a family of tumors with varying degrees of neuronal differentiation and genetic rearrangements. Most common sites are extraosseous involving trunk and lower limb. Base of tongue is a very rare site for Ewing’s/PNET, hence in view of rarity of the location as an uncommon presentation, the case has been reported for the better understanding and supporting the literature with the similar finding. A 68 years old female patient presented with the complaint of difficulty in swallowing since 3 months. On examination growth was identified at the left side base of tongue. Biopsy was processed and stained with H&E and other relevant markers. Differentials on the basis microscopic examination were lymphoma, neuroendocrine tumor and primitive neuroectodermal tumor. Various immunohistochemical markers to rule out the given differential were used. The tumor was positive for CD 99 and vimentin. The case was repored as PNET. Peripheral PNET is a challenging topic. Wide range of extraosseous locations have been observed but head and neck being less reported needs to be studied for understanding the behavior of this highly malignant disease in this rare location so that patient can be benefitted by advanced multimodality treatments including surgery, chemotherapy and radiotherapy

Immunophenotyping of non-Hodgkin’s lymphoma by flowcytometry on fine needle aspiration

Background: Lymphoma represents one of the major health problems all over the world. Flow cytometry (FCM) can be used on fine-needle aspiration cytology (FNAC) from lymph node as an ancillary technique. Aim of the study was to assess the utility of flowcytometry (FCM) in diagnosis and differentiation of reactive hyperplasia and non-Hodgkin’s lymphoma (NHL) on FNAC.Methods: The study was carried out on 50 cases, 25 each of reactive hyperplasia and suspicious or confirmed NHL on FNAC. FCI was performed with a complete panel of antibodies on FACS Canto II FCM.Results: All 25 cases of reactive hyperplasia on FNAC were polyclonal on FCM. FCM could be performed in 22 cases (88%) out of 25 suspicious NHL and in three cases the material was inadequate on aspirate. Out of 22 cases of NHL on FNAC 17 cases (77.30%) were diagnosed as B-NHL on FCM. Light chain restriction was demonstrated in 15/17 cases. With the help of FCI, 6 cases were diagnosed as small cell lymphocytic lymphoma, one case as mantle cell lymphoma, one case as follicular lymphoma, and 9 cases as B-NHL-NOS. Histopathology diagnosis was available in nine cases and were in concordance to FCM. Sensitivity of combined FNAC and FCM in sub-classification was 77.30% (17/22). Four cases showed discordance between FNAC and FCM.Conclusion: We concluded that FCM enhances the diagnostic ability of FNAC, playing a crucial role in a rapid and accurate differential diagnosis between reactive hyperplasia, B-NHL and T-NHL

Prevalence of early T-cell precursor acute lymphoblastic leukemia among immunophenotypically categorised acute T-cell lymphoblastic leukaemia cases

Acute lymphoblastic leukaemia is the most common hematopoietic malignancy in childhood, comprising of B-cell lineage (85%) and T-cell lineage (15%). Recent studies have identified a subtype of T-cell acute lymphoblastic leukaemia (T-ALL) termed “early T-cell precursors (ETP)” recognised as a new provisional entity in 2016 update to the World Health Organization (WHO) classification of acute leukaemia, early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is characterized by a unique immunophenotype and genetic profile and its origin has been found to be from migration of cells from thymus to bone marrow. Hence, our study aims at reporting the prevalence of ETP-ALL among immunophenotypically categorised acute T-cell lymphoblastic leukaemia cases. Present work is a retrospective observation of acute T-cell lymphoblastic leukemias and reporting ETP-ALL cases seen during the period of over two years (from August 2018 to August 2020) received for flowcytometry in the department of Pathology, PGIMS, Rohtak, Haryana. Peripheral blood showed features of acute leukemia and immunophenotyping was performed. Fourteen cases were received for flowcytometry showing features of acute leukemia and immunophenotyping was performed revealing two ETP-ALL cases with positivity for cytCD3, CD7 (T-cell markers), HLA-DR, CD13 (myeloid marker-aberrant expression), sCD34, CD117 (stem cell markers), CD19 (B-cell marker) and dim expression of CD45. This study is a supportive data for immunophenotypic identification of ETP-ALL cases in centres where genetic study and other ancillary techniques are not available. It needs to be differentiated from non ETP-ALLs as this entity has been reported to show treatment failure with the treatment modalities for non ETP-ALLs

Cystic fibrosis presenting as small bowel obstruction in pediatric patient: a case report

Intestinal obstruction complete or incomplete has been found commonly in patients with cystic fibrosis in all age groups with variable presentation. Prevalence of intestinal obstruction in children with cystic fibrosis is 7-8%. Neonates present with meconium ileus due to inspissated meconium and complete obstruction. This case demonstrates similar presentation in a pediatric patient. A six day old male patient presented in the pediatric surgery department with abdominal distention, vomiting and fever. Patient was operated and intraoperative meconium plug was seen along with dilated proximal bowel, filled with sticky meconium. Resected gut segment was received in the Department of Pathology. Grossly dilated gut segment on cut section was seen filled with thick putty like greenish fecal matter. Histopathological examination showed features consistent with cystic fibrosis. There are multiple causes for intestinal obstruction in neonates, cystic fibrosis can be one of them which needs to be considered by the clinicians. Such cases need to be reported for better understanding of their clinico-pathological presentation and prevalence

A comparative analysis of conventional smear and sure path liquid-based cytology with cell block preparation

Background: Cervical cancer is ranked as the most frequent cancer in women in India. Conventional papanicolaou smear has been the mainstay of cervical cancer screening since the 1960s. As an alternative liquid-based cytology (LBC) was introduced in the mid-1990s, which are found to increase cytologic detection of squamous intraepithelial lesions and a reduction in the number of unsatisfactory pap tests.Present study aims at comparison of liquid-based cytology with conventional cytology in detecting uterine cervical intraepithelial lesions.Methods: The present study was conducted in the department of pathology in collaboration with the department of obstetrics and gynecology, Pt. B.D. Sharma PGIMS Rohtak including 100 non-pregnant female patients coming in the outpatient department of obstetrics and gynecology. Both liquid based and conventional pap smears were examined under the microscope and reported according to the 2001 Bethesda system. Cell blocks were prepared sin all the cases from the residual material of LBC.Results: Median age was 42 years. More inadequate smears were reported on CS (17%) as compared to LBC (11%). In both, maximum number of cases reported were inflammatory. Equal number of cases were reported as SCC (n=4) in both.Conclusions: Liquid based cytology has been developed to address the sampling problems of conventional Pap smear. But because of the increased cost of LBC in terms of capital investment, operation and disposables, developing countries should carefully consider the potential benefits and drawbacks of LBC before adopting this new technology

Male breast carcinoma: study from a tertiary care centre in North India

Male breast cancer is a rare malignancy. In recent years a rise in the number of male breast cancer cases has been seen. Due to rarity of the disease the reporting of such cases is important to support the present status of this aggressive malignancy. Fine needle aspiration method for breast FNA is an invasive procedure but can provide a diagnosis without causing much morbidity to the patient. Hence, objective of the present work was to report and study the clinico-pathological behaviour of male breast cancer at a tertiary care centre in North India using fine needle aspiration-based diagnosis. Present study includes cytologically diagnosed male breast carcinoma cases over a period of 4 years. Eleven cases of male breast cancer were identified. Median age of presentation was 57years. All the eleven patients presented with main complaint of swelling in breast (100%), nine (81.8%) patients presenting in left breast and two (18.2%) in right breast. Four cases presented with nipple retraction. Also, axillary lymphadenopathy was evident in four (34.4%) patients. Male breast cancer an aggressive disease having distinct clinical presentation, can be cytologically diagnosed easily as other benign conditions are rare in male breast.

Exogenous Treatments to Enhance Splice-Grafted Watermelon Survival

This study evaluated the use of splice grafting as a propagation strategy for watermelon. In experiment 1, the treatments consisted of sucrose, antitranspirant A, antitranspirant B, auxin (indole-3-butyric acid (IBA)) at two concentrations (10 and 20 mg·L−1), plus a water control. The survival (%) of splice-grafted watermelon plants differed due to the number of days after grafting and treatment (p < 0.0001, for both). At 21 days after grafting, plants treated with sucrose and antitranspirant A, and sucrose and antitranspirant A with 10 mg·L−1 auxin had 90% and 88% survival, respectively, whereas the graft survival was 18% for plants treated with water. Experiment 2 included the three top performing treatments from experiment 1 and a water control treatment, applied to both root-intact and root-excised rootstocks. There was a significant difference in survival (%) of splice-grafted watermelon due to root treatments, exogenous treatments, and the number of days after grafting (p < 0.0001, for all). At 21 days after grafting, survival for root-excised grafted plants was 11% lower compared to root-intact plants. Plants treated with sucrose and antitranspirant A, and sucrose and antitranspirant A with 10 mg·L−1 auxin had 87% and 86% survival, respectively, whereas plants treated with water had 14% survival. The external application of auxin applied to rootstock seedlings does not appear to be cost-effective; however, other products should be evaluated

OPTIMIZING WATERMELON GRAFTING TO ENHANCE GRAFTING EFFICIENCY AND ITS IMPACT ON FRUIT MATURITY AND QUALITY

Due to its efficacy grafting watermelon (Citrullus lanatus) onto resistant rootstock has emerged as a promising biological management strategy against biotic and abiotic stressors in many regions of the world. However, grafted transplants are expensive due in part to the grafting methods that are commonly used for this crop, the one-cotyledon and hole insertion methods. In order to reduce cost and expand utilization on a large scale in the U.S., the grafting process needs to become more efficient. To accomplish these goals, the studies were designed to advance the splice-grafting method where both cotyledons are removed from the rootstock as it exhibits great potential to reduce time and labor for watermelon grafting. The first study evaluated the efficacy of sucrose with antitranspirant applied to rootstock seedlings before grafting and found that survival of splice-grafted plants was 91% for plants that received sucrose solution + antitranspirant compared to 25% for plants that received only water. In addition, a follow-up field study found that fruit yield and quality attributes were similar for watermelon grafted with splice and one-cotyledon methods and for nongrafted watermelon plants. Another greenhouse study was conducted to determine if external applications of auxin in combination with sucrose and antitranspirant solutions to rootstock seedlings before grafting can increase the survival of splice-grafted watermelon transplants, but did not show any difference in the survival with and without auxin. Additionally, this study tested if cutting the roots from rootstock seedlings prior to grafting and rerooting the grafted plants could increase the survival of splice-grafted watermelon seedlings. However, survival decreased by 11% compared to root-intact plants. The third study was a 2-year field study to evaluate the combination of four different rootstocks and two types of plastic mulch (black and clear) on date of watermelon first flowering, fruit ripening, yield and fruit quality when plants were exposed to Verticillium dahliae. Rootstocks reduced verticillium wilt severity and increased fruit yield whereas mulch had no effects, and 5 V. dahliae cfu.g-1 of soil may be the minimum level for impact on watermelon fruit yield

Impact of Grafting on Watermelon Fruit Maturity and Quality

Watermelon (Citrullus lanatus) grafting has emerged as a promising biological management approach aimed at increasing tolerance to abiotic stressors, such as unfavorable environmental conditions. These conditions include environments that are too cold, wet, or dry, have soil nutrient deficiency or toxicity and soil or irrigation water salinity. Studies to date indicate that fruit yield and quality may be positively or negatively affected depending on rootstock-scion combination and growing environment. Growers need information regarding the general effect of rootstocks, as well as specific scion-rootstock interactions on fruit maturity and quality so they can select combinations best suited for their environment. This review summarizes the literature on watermelon grafting with a focus on abiotic stress tolerance and fruit maturity and quality with specific reference to hollow heart and hard seed formation, flesh firmness, total soluble solids, and lycopene content