Chronic cholecystitis with follicular lymphoid hyperplasia: nomenclature and diagnostic dilemmas

Background: To revisit the nomenclature, prevalence, histogenesis and the diagnostic dilemmas in cases of cholecystitis with lymphoid hyperplasia received in a private laboratory in one-year duration.Methods: A total of 51 cases of cholecystectomy were examined histopathologically to identify and review all the cases with emphasis on cholecystitis with marked lymphoid infiltration.Results: Out of 51 cholecystectomy specimens, some rare entities were observed such as 4 cases (8%) of xanthomatous change, 2 cases (4%) of cholecystitis with follicular lymphoid hyperplasia and a case of hyalinizing cholecystitis.Conclusions: The literature on cholecystitis with marked lymphoid infiltrate (with or without follicle formation) was overlapping and thus confusing. The same has been simplified with review of literature

Effect of timing of cord clamping (early vs delayed) on hemoglobin level among newborns: an Indian study

Background: Aim of the current study was to evaluate effect of delayed cord clamping on hemoglobin level among newborns and look for any adverse effects following delayed cord clamping. Methods: Total 60 newborns were enrolled in the study and were randomly allocated to either control (early cord clamping 15 secs) and cases (delayed cord clamping 3 mins). Samples were collected in labor room, during birth to check the hemoglobin, billirubin and hematocrit levels in two groups. Follow up data were collected in postnatal ward, 24 hours after birth to estimate hemoglobin, hematocrit and billirubin levels and infants were assessed for the presence of respiratory distress. Results: Hb levels among cases were significantly higher compared to controls at birth. The mean Hb at birth among controls was 14.90±1.28 g/dl and among cases was 16.06±2.37 g/dl (p value 0.023). Hb levels among cases were significantly higher compared to controls at 24 hours. The mean Hb at 24 hours among controls was 16.16±1.70 g/dl and among cases was 19.28±2.16 g/dl (p value <0.001). Conclusions: Hemoglobin and hematocrit levels were significantly increased at birth as well as at 24 hours of age in delayed compared to early clamping group with no significant adverse effects seen in the group with delayed clamping

Functional outcome and complications in closed and grade I open tibia shaft fracture operated with intramedullary interlocking nail

Background: Treatment of open tibia fracture is controversial. Complications such as infection, re-operation, non-union and poor consolidation are also relatively common after these fractures. While grade II and III fractures are mostly treated with detriment and external fixator, grade I fractures are a matter of controversy. The purpose of this study is to evaluate factors affecting deep infections and fracture healing of closed and grade I open fracture of the tibial shaft treated with immediate or delayed interlocking IMN, and to study the functional outcome of the same.Methods: 60 Patients admitted to our institute with diagnosis of closed or grade 1 open tibia shaft fracture aged more than 18 years old between May 2016 to December 2016 were included. After initial evaluation and investigation, they were posted for surgery. Closed reduction and fixation with intramedullary nailing were done under spinal anesthesia. After discharge patients were followed up at an interval of 3 weeks, 3 months and 6 months and were evaluated using Johner and Wruhs criteria.Results: In our study, 91.67% patients have got excellent, 3.33% good and 1.67% poor results according to Johner and Wruhs criteria. Conclusions: Closed and grade one open fractures of the tibia shaft, managed with interlocking intramedullary nailing involves minimal surgical trauma and negligible blood loss while provides the advantages of early ambulation, lower rate of infection, delayed union, non-union and mal-union.

An unusual case report of basal cell adenoma: a diagnostic enchanter

Oral lesions show a wide range of biologic behaviours. There are various lesions which may mimic others and present in such an unusual manner thus making them very difficult to diagnose clinico-pathologically. An accurate diagnosis is not only important for correct treatment planning but also for determination of prognosis. Thus, it is very important for a surgical pathologist to be aware of the various atypical presentations of the lesions. The present unusual case report of basal cell adenoma occurring on upper lip with frank areas of calcifications and abundant inspissated mucoid secretions is an example of one such case. BCA is an uncommon benign epithelial salivary gland neoplasm. It is one of the nine subcategories of salivary gland epithelial tumours according to WHO 2005 classification of salivary gland tumors. It is composed of basaloid cells organized with a prominent basal cell layer and distinct basement membrane-like structure and no myxochondroid stromal component as seen in pleomorphic adenomas. To our best knowledge, no case in English literature has been reported BCA with exuberant inspissated mucoid secretions and frank areas of calcifications to such a large extent and this is the first case to report the same

Effect of Pooled Human Intravenous Globulin (IVIG) on the Reversal of Cholinergic Inhibition of Smooth Muscle by Immunoglobulins (IgGs) from Patients with Scleroderma (SSc)

Poster presented at: Digestive Disease Week (DDW) International meeting in San Diego, California. Backgrounds and Aims: The gastrointestinal (GI) tract is the most common internal organ system affected in SSc. We and others have shown before that the SSc immunoglobulins (IgGs) cause selective blockade of muscarinic type-3 cholinergic (M3-R) in the GI tract. Presently, there is no effective treatment for SSc although numerous cytotoxic and immunomodulatory agents have been employed with limited success and are marred with serious side effects. Present studies investigated the reversibility of SScIgGs-caused M3-R blockade by the pooled Intravenous immunoglobulins (IVIG)

Squamous Metaplasia in Pleomorphic Adenoma: A Diagnostic and Prognostic Enigma

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Histologically, squamous metaplasia has been reported in PA, but has rarely been documented as being extensive enough to cause significant misdiagnosis. Here, we present an unusual case of PA in a 50-year-old female patient presenting with swelling on the postero-lateral aspect of the palate for a week. Histopathologically, the tumor exhibited the features of conventional PA with extensive squamous metaplasia and giant keratotic lamellae in cyst-like areas. Such exuberant squamous metaplasia and keratin can be a diagnostic and prognostic pitfall and lead to overtreatment of the patient

Effects of scleroderma antibodies and pooled human immunoglobulin on anal sphincter and colonic smooth muscle function.

BACKGROUND & AIMS: Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic the type-3 receptor (M(3)-R). We investigated whether it is possible to neutralize these antibodies with pooled human IgGs (pooledhIgG). METHODS: We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M(3)-R activation by bethanechol (BeCh), M(3)-R occupancy, and receptor binding using immunofluorescence, immunoblot, and enzyme-linked immunosorbent analyses of human internal anal sphincter (IAS) smooth muscle cells, before and after administration of pooledhIgG. Functional displacement of M(3)-R occupancy by the SScIgGs was compared with that of other IgGs during the sustained phase of BeCh-induced contraction of intact smooth muscles from rats. RESULTS: SScIgG significantly attenuated neurally mediated contraction and acetylcholine release in rat colon as well as BeCh-induced sustained contraction of the IAS smooth muscle. In immunofluorescence analysis, SScIgG co-localized with M(3)-R. In immunoblot and enzyme-linked immunosorbent analyses, M(3)-R loop-2 peptide and human IAS SMC membrane lysates bound significant amounts of SScIgG, compared with IgGs from healthy individuals and pooledhIgG. Binding was attenuated significantly by application of pooledhIgG, which by itself had no significant effect. Incubation of samples with pooledhIgG, or mixing pooledhIgG with SScIgG before administration to tissues, significantly reduced binding of SScIgG, indicating that pooledhIgG prevents SScIgG blockade of M(3)-R. CONCLUSIONS: In studies of rat and human tissues, pooled human IgG prevent and reverses the cholinergic dysfunction associated with the progressive gastrointestinal manifestations of SSc by neutralizing functional M(3)-R antibodies present in the circulation of patients with SSc

Boerhaave\u27s syndrome as an initial presentation of eosinophilic esophagitis: A case series

Background Prior studies report esophageal rupture following endoscopy or bolus impaction in eosinophilic esophagitis (EoE). The purpose of this study is to add new information to available evidence defining the clinical spectrum of spontaneous rupture (Boerhaave\u27s syndrome) associated with vomiting in EoE. Methods A retrospective search of inpatient and outpatient records was conducted from January 2001 to January 2011. A faculty member in pathology blindly reviewed all esophageal biopsy specimens. EoE was defined as 15 or more eosinophils in at least 2 high-power fields (hpfs) or 25 or more eosinophils in any single HPF. Results In ten years, 447 patients were identified with a diagnosis of EoE. Of these, four patients presented with Boerhaave\u27s syndrome in the setting of EoE. None of the patients had an established diagnosis of EoE prior to presentation. All cases presented with a triad of vomiting, chest pain and pneumomediastinum. In two patients, water-soluble contrast extravasation prompted surgical intervention (50%). Full thickness surgical specimen provides a unique opportunity to show eosinophils in the muscularis propria. Intraepithelial eosinophil infiltration was seen on all mucosal biopsies (\u3e25/hpf) with significant improvement after steroid (topical or systemic) treatment. Conclusions Spontaneous esophageal rupture is a rare (4/447, less than 1%) but critical presentation of EoE manifesting with vomiting, chest pain and pneumomediastinum. Surgery is required if extravasation is seen with water-soluble contrast. We suggest that EoE may be a transmural disease in some patients, thus making the esophageal wall susceptible to spontaneous rupture with vomiting (Boerhaave\u27s syndrome). © 2013 Hellenic Society of Gastroenterology