Classical open lumbar laminectomy and discectomy for disc herniations among manual labourers in India

Background: Lumbar disc herniations are most common at L4/5 and L5/S1 levels and this is most prevalent condition among manual laborers. The aim of the study to analyze the clinical presentation, age and sex distribution, immediate postoperative complications and long-term complications/recurrence of symptoms and to formulate recommendations to avoid complications and recurrence of symptoms.Methods: This is a retrospective study which includes 250 patients operated for lumbar disc herniations at L4/5 and L5/S1 levels. A detailed history of presenting complaints, clinical examination and corresponding findings on imaging are correlated. In all these patients, there was severe symptomatology with failed conservative management which necessitated classical open lumbar laminectomy and discectomy. These patients were followed for a period of 5 to 10 years.Results: Assessment of outcome was done using the modified Macnab criteria. The overall success rate was 96% in our series. Post operatively, 9.2% of them experienced localized low back pain which is mild to moderate and being treated with NSAIDS and exercises. 2.4% developed residual disc herniation or hypertrophic fibrotic scar at the operated site which needed surgical intervention. 2% developed spondylolysis and spondylolesthesis at the level of previous surgery, and 4.4% developed adjacent disc herniations.Conclusions: The overall success rate was 96% in our series. In addition to removal of herniated disc other compressing elements like hypertrophied Ligamentumflavum, facet arthropathy and narrowed spinal canal diameter are also addressed with open procedure. To prevent later complications, these patients are supposed to avoid strenuous work, lifting weights, torsion and jerky movements, faulty posture at work and rest, gait training, crouching, sitting on the floor and haunches

Fine Needle Aspiration Diagnosis of Histoplasma Lymphadenitis using Multidisciplinary Expert Opinion through Telepathology

Background: Histoplasmosis is an opportunistic fungal infection commonly seen in immunocompromised patients, especially in AIDS patients, children and elderly patients. Early detection of these organisms can help in curbing the mortality and complications. Fine needle aspiration is an ideal cost effective diagnostic procedure. Diagnosis may be missed if the pathologist is not familiar with cytological features. Case: We describe a case of histoplasma lymphadenitis in retroviral positive female where accurate diagnosis was made possible by using the availability of multidisciplinary expert opinion through referral and telepathology. Conclusion: Diagnosing a fungal infection can prove challenging because of uncommon presentations. Availability of multidisciplinary expert opinion through referral or telecytology can be of great value to a solitary pathologist practicing in a remote community hospital

MicroRNAs sequencing unveils distinct molecular subgroups of plasmablastic lymphoma

Plasmablastic lymphoma (PBL) is an aggressive lymphoma, often arising in the context of immunodeficiency and associated with Epstein-Barr virus (EBV) infection. The most frequently detected genetic alteration is the deregulation of MYC gene through the translocation - t(8;14)(q24;q32). The diagnosis of PBL is often challenging because it has an overlap in morphology, immunophenotype, cytogenetics and virus association with other lymphomas and plasma cell neoplasms; further, its molecular basis remains elusive. In the present study we aimed to better define the possible contribution of EBV infection as well as miRNA deregulation in PBL pathogenesis. We studied 23 cases of PBL, 19 Burkitt lymphomas (BL), and 17 extra-medullary plasmacytoma (EMPC). We used qPCR and immunohistochemistry to assess EBV latency patterns, while micro-RNA (miRNA) profiling was performed by next generation sequencing (Illumina) and validated by qPCR. Our analysis revealed a non-canonical EBV latency program with the partial expression of some proteins characterizing latency II and the activation of an abortive lytic cycle. Moreover, we identified miRNA signatures discriminating PBL from BL and EMPC. Interestingly, based on the miRNA profile, PBL appeared constituted by two discrete subgroups more similar to either BL or EMPC, respectively. This pattern was confirmed in an independent set of cases studied by qPCR and corresponded to different clinico-pathological features in the two groups, including HIV infection, MYC rearrangement and disease localization. In conclusion, we uncovered for the first time 1) an atypical EBV latency program in PBL; 2) a miRNA signature distinguishing PBL from the closest malignant counterparts; 3) the molecular basis of PBL heterogeneity

Congenital extraskeletal Ewing′s sarcoma of chest wall - A rare case report

Congenital extraskeletal Ewing′s sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing′s sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing′s sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing′s sarcoma in neonates are reported in the literature

Effective utilization of B20 blend with diethyl ether and ethanol as oxygenated additives

In the recent times' fatty acid methyl ester popularly called as biodiesel has become more prominent alternate fuel for compression ignition engines based on a single fuel concept. Since, use of neat biodiesel on a large scale is raising certain difficulties and is being adopted in a blended form with petro-diesel fuel and B20 blend has become standardized. However, the HC and NOx emissions of B20 are still on the higher side. Present work aims at experimental evaluation of a single cylinder water-cooled diesel engine by adopting various proportions of ethanol and diethyl ether blends in order to improve performance and emission characteristics of B20 blend. Besides employing different amounts of ethanol and diethyl ether, simultaneous influence of injector nozzle hole size and fuel injection pressure are also investigated to arrive at an optimum configuration. Brake specific fuel consumption and hydrocarbon emissions values are lower with B20 and DEE 5 whereas B20 with DEE15 yielded lower NOx emissions. It is observed that addition of oxygenates have improved the combustion process and lower emissions are obtained. The present investigation revealed that blends with oxygenated additives having higher Cetane rating are superior to neat blend

Fine Needle Aspiration Diagnosis of Histoplasma Lymphadenitis using Multidisciplinary Expert Opinion through Telepathology

Background: Histoplasmosis is an opportunistic fungal infection commonly seen in immunocompromised patients, especially in AIDS patients, children and elderly patients. Early detection of these organisms can help in curbing the mortality and complications. Fine needle aspiration is an ideal cost effective diagnostic procedure. Diagnosis may be missed if the pathologist is not familiar with cytological features. Case: We describe a case of histoplasma lymphadenitis in retroviral positive female where accurate diagnosis was made possible by using the availability of multidisciplinary expert opinion through referral and telepathology. Conclusion: Diagnosing a fungal infection can prove challenging because of uncommon presentations. Availability of multidisciplinary expert opinion through referral or telecytology can be of great value to a solitary pathologist practicing in a remote community hospital

mTOR, VEGF, PDGFR, and c-kit signaling pathway activation in Kaposi sarcoma

Kaposi sarcoma (KS) is a locally progressive, intermediate-grade vascular neoplasm with no known cure, high recurrence rates, and potential for wide dissemination. Low efficacy and high toxicity limit current therapeutic options for advanced disease. Activation of mammalian target of rapamycin (mTOR), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and c-kit signaling pathways has been implicated in KS pathogenesis and may suggest a role for targeted inhibitors. KS cases were retrospectively retrieved (N=274), most (90%) associated with human immunodeficiency virus. Tissue microarray slides were stained with human herpes virus-8, Friend leukemia integration 1 transcription factor, CD117 (c-kit), phospho-S6 (pS6), PDGF receptor-β, VEGF, and phospho-mTOR. Both intensity and extent of staining were scored. Multiplying these scores for each core yielded total staining H-scores. Human herpes virus-8 was positive in 87% and Friend leukemia integration 1 transcription factor in 95.7% of cases. Most were also VEGF+ (97.6%), pS6+ (95.7%), CD117+ (92.5%), and PDGFRB+ (87.4%). Approximately half (55.6%) were phospho-mTOR+. There was no significant difference in staining among patients with low (<500 cells/mm3) or preserved CD4 T-cell counts. Immunohistochemistry confirms upregulation of the mTOR, PDGF, VEGF, and c-kit pathways in a large cohort of KS samples. Of proteins tested, pS6, downstream of mTOR, demonstrated the highest proportion of strong positivity (67.1%). These results support the possibility of using targeted inhibitors in KS. Overexpression was independent of CD4 count, suggesting that even patients with low counts may be targeted therapy candidates. •Kaposi sarcoma is tested for upregulation of mTOR, PDGF, VEGF, and c-kit pathways.•Most express VEGF, c-kit, pS6, and PDGFB by immunohistochemistry.•pS6, downstream of mTOR, is expressed strongly in most (67.3%) Kaposi sarcomas.•Overexpression is independent of CD4 T-cell count in HIV-associated cases.•Results support the use of targeted inhibitors for management of Kaposi sarcoma

Kaposi Sarcoma in Association With Molluscum Contagiosum: An Uncommon Diagnosis in a Single Biopsy and Potential Diagnostic Pitfall

Molluscum contagiosum is a cutaneous poxviral infection that is rarely associated with other skin diseases, such as cutaneous neoplasms. Such associations are likely to be coincidental, except in immunocompromised Patients. Kaposi sarcoma, an angioproliferative neoplasm derived from lymphatic endothelium, is mediated by human herpes virus-8 infection and occurs with increased frequency in immunocompromised individuals. We report an unusual case of molluscum contagiosum with underlying cutaneous Kaposi sarcoma diagnosed in a single skin biopsy of a human immunodeficiency virus-positive Patient. Our case highlights the importance of adequate sampling to avoid missing secondary diagnoses in histopathologic sections and alerts pathologists and dermatologists to the possibility of coinfection in high-risk Patients by 2 virally-mediated skin conditions