Histopathological prognostic factor comparison of endometrial cancer patients in a tertiary hospital in India

Background: The objective of this study was to describe the histopathological features of patients with endometrial cancer in a tertiary hospital in South India.Methods: This retrospective study included cases diagnosed and operated in a tertiary hospital in the period of 3 years. Histopathological data was retrieved from records and analyzed. The study included both endometrial biopsy and post hysterectomy specimens of which prognostic factor comparison was performed on the latter following TNM and FIGO staging systems.Results: The sample consisted of 43 patients which includes 28 resected and 15 biopsy specimens. Age ranged from a minimum of 27 years to a maximum of 75 years (Mean around 52 years). Endometrioid adenocarcinoma was the predominant histological subtype (80 – 85%), while other types included papillary serous adenocarcinoma, stromal sarcoma and malignant mixed mullerian tumour (MMMST). Grade I tumours were 19 in number constituting 79.16% and stage IB tumours were the commonest. Pelvic nodal involvement, lymphatic invasion and recurrence were individually noted in one patient each.Conclusions: This study highlights the prognostic characteristics of endometrial cancer patients with most of them presenting in early stages thereby having a good prognostic outcome

Clinical study of acute subdural haematoma – a level I trauma care centre experience

Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyse the clinical spectrum, and to evaluate the postoperative outcome.Methods: This is a prospective observational Study which included 150 patients  admitted  in King George hospital, Andhra Medical College, Visakhapatnam, India over the past two years (01st August 2013 to 30th August 2015) with head injury, diagnosed to have Traumatic subdural Hemorrhage. A detailed clinical history, physical examination, CT scan was performed in all patients. Patients who were subjected to surgery, post-operative out-come were compared.Results: The maximum patients suffering from SDH are in the age group of 20-40 years (63%) with male predominance (73%). The most common mode of injury is RTA (73.33%). 40% of cases presented to hospital with gcs 10mm and midline shift of >5mm, Basal cisterns obliteration, post traumatic seizure and delay in interval between the surgery had greatly affected on outcome of patients. Out of 150 cases, surgical approach was considered in 120 patients while remaining 30 patients were managed conservatively.Conclusions: Interval between injury to surgery with interval <4 hours having favourable outcome. Basal cistern obliteration, which is an indicator of increased intra cranial pressure is the single most important factor for unfavourable outcome. Hypotension and post traumatic seizures influence high mortality

High Prevalence of Associated Birth Defects in Congenital Hypothyroidism

Aim. To identify dysmorphic features and cardiac, skeletal, and urogenital anomalies in patients with congenital hypothyroidism. Patients and Methods. Seventeen children with congenital primary hypothyroidism were recruited. Cause for congenital hypothyroidism was established using ultrasound of thyroid and 99mTc radionuclide thyroid scintigraphy. Malformations were identified by clinical examination, echocardiography, X-ray of lumbar spine, and ultrasonography of abdomen. Results. Ten (59%) patients (6 males and 4 females) had congenital malformations. Two had more than one congenital malformation (both spina bifida and ostium secundum atrial septal defect). Five (29%) had cardiac malformations, of whom three had only osteum secundum atrial septal defect (ASD), one had only patent ductus arteriosus (PDA), and one patient had both ASD and PDA. Seven patients (41%) had neural tube defects in the form of spina bifida occulta. Conclusion. Our study indicates the need for routine echocardiography in all patients with congenital hypothyroidism

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Comparison of pre operative fine needle aspiration cytology diagnosis and histopathological diagnosis of salivary gland tumours

Objective: FNAC is a useful method for evaluating suspicious salivary gland lesions due to its low cost, minimum morbidity, rapid turnaround time, high specificity, and sensitivity. The present study was undertaken to diagnose salivary gland tumors based on the cytomorphology and to correlate with histopathology wherever available and to review the histologic and cytomorphological features in discordant cases and evaluate the possible reasons of misinterpretation. Methods: The study was both prospective and retrospective. All the cases of salivary gland tumors that had fine needle aspiration cytology reports were taken from records of Nizam’s Institute of Medical Sciences. This study was done between January 2000 to May 2008. Results: A total of 135 cases of salivary gland neoplasms were identified during 8 1/2 period of our study. 1. Histologic correlation was available for 36 cases 2. There is a concordance between cytology and histopathology in 31/36 cases (86.1%). In three cases (8.3%) diagnostic possibilities were given. 94.1% of pleomorphic adenoma cases had concordance (16/17). 3. The number of discordant cases were 5/36 (13.9%) and the discordance was due to scant cellularity and rarity of the lesions. Majority of the cases 4(80%) it was underdiagnosis and in one case (20%) it was over diagnosis. Conclusion: FNAC is a highly reliable technique for pre-operative diagnosis of salivary gland tumors in the hands of experienced pathologists. However, there still remain few cases that may be inaccurately diagnosed on cytology due to overlapping features and in these cases histopathology is the only modality for final diagnosis

Squamous cell carcinoma of the breast – A rare entity

Primary squamous cell carcinoma (SCC) of the breast is a rare tumour classified as one of the metaplastic carcinomas of the breast. It is a tumour of elderly age group with an incidence of less than 0.1% of all ductal carcinomas. Clinical and biological characteristics of this tumour still remain obscure. The prognosis of this type of breast cancer remains a subject of controversy. We report one such case of primary squamous cell carcinoma of breast with review of literature