Histological evaluation of placenta in hypertensive pregnancies

Background: Maternal and fetal status are reflected in placenta. Toxemia of pregnancy exerts great impact on placenta and thereby fetal and maternal outcomes. Placenta reflects changes of toxemia and these changes are seen morphology as well as histology. Hence study of placenta gives information on the in-utero fetal condition.Methods: A total of 1000 placenta, 500 each from hypertensive and normotensive groups were included in this study conducted in Anatomy Department of SBKS Medical College and Research Centre, Vadodara. Histological evaluation of the samples taken was done under microscope.Results: Microscopic examination of the placenta revealed the presence of calcification, infarction, fibrinoid necrosis, villous hyalinization, syncytial knots and cytotrophoblastic cellular proliferation in both control and hypertension groups. In the present study, calcification was seen in 35.8% in the control group, while the same was seen in 53.8% patients in test group. Fibrinoid necrosis was seen in 48.8% patients in control group as against 69% patients in test group. Villous Hyalinization was seen in 7.40% and 21.4% patients in control and test groups respectively. On the other hand, syncytial knots were seen in 38% and 69% patients in control and test groups respectively. In test group, cytotrophoblastic cellular proliferation was seen in 69% patients while in control group, it was seen in 33.2% patients. Infarction was also seen in test (42.4%) and control (12.6%) groups.Conclusions: Hypertensive disorders of pregnancy have significant effect on the histology of placenta and also influences the fetal outcomes

Modern cemented Furlong hemiarthroplasty: Are dislocations rates better?

BACKGROUND: Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. METHODS: Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. RESULTS: Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups (p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties (p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. CONCLUSION: There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates

Study of metastasis in lymph node by fine needle aspiration cytology: our institutional experience

Background:Fine needle aspiration cytology (FNAC) is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor, prognosis as well in the management of patient for staging purposes. The aim of the study was to detect and diagnose metastasis in lymph nodes. Methods:A study was done of all metastatic lymph node lesions reported in Department of Pathology, Govt. Medical College, Surat from May 2011 to April 2012.Results:A total of 2355 cases of fine needle aspiration cytology were carried out of which 580 cases were of lymph node. Cytology results were positive for metastasis in 157 specimens (27.06%). The most common site was cervical lymph nodes. Maximum numbers of cases of metastatic tumors were in 41-50 yrs age group. There were 115 males and 42 females with a male predominance (Male:Female= 2.8:1). The most common malignancy was squamous cells carcinoma, seen in 118 cases (75.15%), followed by metastatic mammary carcinoma (13 cases, 8.29%). In 26 cases out of 580 cases, histopathological confirmation was done and diagnostic accuracy of FNAC was 100%. Conclusions:Fine needle aspiration cytology of lymphadenopathy is a useful tool in diagnosing metastatic lesions with good certainty

Left ventricular volume: an optimal parameter to detect systolic dysfunction on prospectively triggered 64-multidetector row computed tomography: another step towards reducing radiation exposure

In this study, we define the correlation between LV volumes (both LV end-diastolic volume [LVEDV] and LV end-systolic volume [LVESV]) and ejection fraction (EF) on 64 slice multi-detector computed tomography (MDCT). We also determine the accuracy of all the LV volume (LVV) parameters to detect LV systolic dysfunction (LVSD) and investigate the feasibility of using LVV as a surrogate of LVSD on prospectively gated imaging to prevent the radiation exposure of retrospective imaging. 568 patients undergoing 64-detector MDCT were divided into 2 groups: Group 1—subjects without any heart disease and LVEF ≥ 50%; and Group 2—patients with coronary artery disease and LVEF < 50% (defined as LVSD). The LVV (LV cavity only) and Total LV volume (cavity + LV mass) at end-systole and end-diastole (LVESV, Total LVESV, LVEDV and Total LVEDV) were measured. The upper limit values (mean + 2 SD) of all LVV parameters in Group 1 were used as the reference criterion to diagnose LVSD in Group 2. An exponential correlation was found between LVEF and all the LVV parameters. The specificity to detect LVSD in Group 2 was >90% and the sensitivity was 88.9, 83.3, 61.3 and 74.9% by using LVESV, Total LVESV, LVEDV and Total LVEDV, respectively. Systolic and diastolic LV volumes had a high correlation with LVEF and a high accuracy to detect LVSD. Thus, on prospectively triggered imaging, ventricular volumes can predict patients with reduced LVEF, and appropriate referrals can be made

Reversing Melanoma Cross-Resistance to BRAF and MEK Inhibitors by Co-Targeting the AKT/mTOR Pathway

The sustained clinical activity of the BRAF inhibitor vemurafenib (PLX4032/RG7204) in patients with BRAF(V600) mutant melanoma is limited primarily by the development of acquired resistance leading to tumor progression. Clinical trials are in progress using MEK inhibitors following disease progression in patients receiving BRAF inhibitors. However, the PI3K/AKT pathway can also induce resistance to the inhibitors of MAPK pathway.The sensitivity to vemurafenib or the MEK inhibitor AZD6244 was tested in sensitive and resistant human melanoma cell lines exploring differences in activation-associated phosphorylation levels of major signaling molecules, leading to the testing of co-inhibition of the AKT/mTOR pathway genetically and pharmacologically. There was a high degree of cross-resistance to vemurafenib and AZD6244, except in two vemurafenib-resistant cell lines that acquired a secondary mutation in NRAS. In other cell lines, acquired resistance to both drugs was associated with persistence or increase in activity of AKT pathway. siRNA-mediated gene silencing and combination therapy with an AKT inhibitor or rapamycin partially or completely reversed the resistance.Primary and acquired resistance to vemurafenib in these in vitro models results in frequent cross resistance to MEK inhibitors, except when the resistance is the result of a secondary NRAS mutation. Resistance to BRAF or MEK inhibitors is associated with the induction or persistence of activity within the AKT pathway in the presence of these drugs. This resistance can be potentially reversed by the combination of a RAF or MEK inhibitor with an AKT or mTOR inhibitor. These combinations should be available for clinical testing in patients progressing on BRAF inhibitors