51 cases of granulomatous hepatitis were seen among 1234 liver biopsies over a 10 year period. Tuberculosis was the commonest cause seen in 55 percent of cases. Other causes included leprosy, sarcoidosis, histoplasmosis, brucellosis, amoebic liver abscess, lymphoma and malignant granuloma. 12 percent of cases remained undiagnosed. Clinically these patients presented with pyrexia and hepatosplenomegaly. Jaundice was uncommon. Many showed elevated alkaline phosphatase levels, anaemia and raised ESR Granulomatous hepatitis of unknown aetiology with FUO was seen in 6 percent cases only.

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Intestinal parasites infections are common in the state of Bahrain, but the incidence is decreasing due to improvement in health and social standards. A community-based study sample of all population of Bahrain was done including all ages and nationalities. From 1st July 1984 to 28th February 1986, the first community-based study sample of all population of Bahrain was done including all ages and nationalities. A total number of 2123, about 0.006 of the population of 1981 census was chosen for the study. The study shown that 739 persons were infected with intestinal protozoa and helminths. The figure representing 34.8% of total sample size, whom 283 persons were symptomatic, about 38.3% of total infected sample size. Giardia lamblia and Trichuris trichuria were the most common parasites among the infected persons.

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"The use of stool culture in Boeck & Drbohlav's biphasic amoebic medium as a routine diagnostic aid in the detection of Entamoeba histolytica in the faeces, is evaluated in the present study. A total of 3803 faecal specimens were examined for the presence of E.histolytica by direct smear, formalin ether concentration and culture during a study period of 1982-1990. A total of 259 stool specimens were positive for the parasite by any or all of these methods 42 (16.21%) stool specimen not cultured in Boeck & drbohlav's medium were possible by direct smear and concentration methods. 99 (38.22%) stool specimens were positive by all of these methods (direct smear, concentration and culture). The culture detected E. histolytica in additional 62 (23.93%) stool specimens which were negative by both the direct smear and concentration methods. Results of this study recommends the use of stool culture as a routine diagnostic aid in the laboratory, for the detection E. histolytica in the faeces".

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Fine needle aspiration cytology (FNAC) is an extremely useful technique in the evaluation of hepatic masses. This study was undertaken with the aim of describing the morphological spectrum seen in fine needle aspirates from hepatocellular carcinoma (HCC) seen in our patients hailing from South India. Thirty two cases of HCC were studied. Trabacular pattern covered by endothelium was the most common. Pseudoglandular, spindle cell and dispersed patterns were also seen. Individual tumour cells were generally reminiscent of hepatocytes, and had a prominent nucleolus. The presence of intranuclear and intracytoplasmic inclusions were notable features. FNA cytology in HCC is sufficiently distinctive to form an invaluable tool in the diagnosis of this malignancy.

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A modified Rapid urease test developed by us was evaluated as a screening test for Helicobacter pylori (H. pylori) during and endoscopy survey on patients with Acid Peptic Diseases (APD) and Non Ulcer Dyspepsia (NUD). This was compared with commercially available CLO (Campylobacter Like Organism) test, culture and histopathological examination. The modified Rapid urease test gave a sensitivity of 89.83% and a specificity of 100%, when compared to 95% sensitivity and specificity for commercially available CLO test. Our modified Rapid urease test is simple, economical and a quick test in identifying H. pylori in routine screening of patients with APD and NUD.

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In vitro susceptibility testing of 43 isolates of dermatophytes was carried out against imidazoles-ketoconazole, miconazole and econazole and griseofulvin by agar dilution and disk diffusion methods. Econazole was the most effective drug inhibiting all the isolates at a concentration of 0.1 microgram ml-1. The MIC 50s and MIC 90s for ketoconazole and miconazole were 1 and 2.5 mg ml-1 whereas the values for griseofulvin were 1 and 5 micrograms ml-1. Good correlation was seen between the MIC and sizes of zones of inhibition around the disks. Regression analysis was used to measure the degree of correlation between the MIC values and matched averaged zones of inhibition and the correlation coefficients for econazole, ketoconazole, miconazole and griseofulvin were -0.5554, -0.5886, -0.8558 and -0.8268 (p < 0.001) respectively.

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One hundred and twenty seven patients belonging to Neurosurgery (49), Neuromedicine (48), Cardiac medicine (30) wards and Blood donors (30) as healthy controls were investigated for the prevalence of Toxoplasmosis by means of detecting specific IgM antibody against Toxoplasma gondii (T. gondii) employing Enzyme Immuno Assay (EIA). The detection rate of specific IgM antibody against T.gondii was found to be 32.7% (16/49) among Neurosurgery patients, 20.8% (10/48) among Neuromedical patients and 20% (6/30) among Cardiac medical patients. None of the voluntary blood donors tested was found to have T. gondii IgM antibody. Maximum prevalence rate was found among female patients undergoing Neurosurgery (42.3%) followed by Neuromedical patients (40%). There is an increasing rate of prevalence of Toxoplasmosis from the lower age group upto thirty years and a declining prevalence rate among the higher age groups. The present study revealed high prevalence rate of Toxoplasmosis in Neurosurgery patients (32.7%) and in particular among female (35.2%) than male (17.8%) patients.

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Prognostic significance of non-caseating epithelioid granulomas in association with Hodgkin's disease has been studied. Such granulomas were found in 15 of the total of 104 cases of Hodgkin's disease encountered between Jan. 1981 and June 1990. These 15 patients were compared with 30 concurrent patients of Hodgkin's disease who did not have associated granulomas. All the patients were initially staged, treated and followed up for a period of two years. There was no significant difference in overall survival rate between the granuloma group and the control group. However, in relapse free survival rate in advanced stages of the disease (III & IV), although the difference between granuloma group and the control group was not statistically significant (p = 0.11), yet the relapse free survival curves revealed a tendency towards better survival with lesser number of relapses and longer remissions in granuloma group.

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Sections from eighty nine specimens of gall bladder including 40 cases of chronic cholecystitis, 9 dysplasia 15 well differentiated adenocarcinoma, 14 moderately differentiated adenocarcinoma and 11 poorly differentiated adenocarcinomas were studied for argyrophilic nucleolar organizer regions (AgNOR's). The difference between mean +/- SD NOR counts of chronic cholecystitis (1.97 +/- 0.28), dysplasia (5.6 +/- 0.88) well differentiated adenocarcinoma (7.2 +/- 0.30) and moderately differentiated adenocarcinoma (8.0 +/- 0.63) was statistically significant (p < 0.001). NOR counts of poorly differentiated adenocarcinoma (8.5 +/- 0.78) were higher than moderately differentiated carcinoma but the difference was not statistically significant. Despite the significant difference in the mean values, a considerable overlap in the NOR counts of individual cases of different groups was observed suggesting that though NOR counts can not act as a specific diagnostic parameter for diagnosis of early carcinoma and dysplasia in isolated cases, they may prove to be a good adjunct to already existing parameters like imaging techniques or cytology.

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A total of 108 whole skin organ cultures taken from vitiliginous skin were incubated in MEM containing ACTH. It was observed that 53.7% that is 58 showed a positive response with an increase in pigment production and enzyme activity, as observed on frozen sections stained for dopaoxidase activity. On immunohistochemical staining for locating ACTH binding, it is observed that 27.3% control skin and 72.7% ACTH treated skin show positivity. The ACTH is seen to bind with the melanocyte membrane as well as the cytoplasm. This indicates that ACTH can bind to the MSH-receptors expressed by the melanocyte. Thus, ACTH acts directly on the melanocyte to enhance melanogenesis and does not require to act via the adrenal-pituitary axis. This also indicates that the response is not associated with immune suppression by ACTH.

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Forty nine multiple drug resistant strains of E. coli isolated from UTI were serotyped. The pattern was found to be 057 (eight strains); 0109 (four strains); 020, 038, 068, 0106, 0148. Rough (three each). 012, 054, 0101, 0160 (two each) and 02, 032, 046, 053, 060, 065, 090, 091, 0117, 0118, untypable (one each). The resistance pattern of all E. coli were identified and matted with recepient strain in penassay broth and in human urine. In a penassay broth transfer of resistance was demonstrated in 38 strains (77.5%) while in human urine transfer was demonstrated only in 14 strains (28.57%).

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The in vitro activity of itraconazole was investigated against 25 clinical isolates of filamentous fungi by agar dilution method. The isolated included Aspergillus sp., hyalohypomycetes, dematiaceous fungi and zygomycetes. Intraconazole was more active, inhibiting 50% (MIC 50) and 90% (MIC 90) of the Aspergillus sp., at a concentration of 0.5 and 2.5 ug ml-1 (MIC range 0.1 and 5 micrograms ml-1) Ketoconazole (MIC range 0.5-10 ug ml-1) required 1 and 5 ug ml-1 for inhibiting 50% and 90% of the isolates. For the hyalophypomycetes and dematiaceous fungi, the MIC 50s for itraconazole were 1 and 0.5 ug ml-1 and Ketoconazole required 2.5 ug ml-1 for both the groups. For the zygomycetes, the MIC range and MIC 50s for Ketoconazole were 1-100 and 10 ug ml-1 whereas the values for itraconazole were 5- > 100 and > 100 micrograms ml-1.

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Autosomal Recessive Polycystic Kidney (ARPKD) is a very rare entity (1 in 15,000 live births) and mostly not compatible with life. Early diagnosis and genetic councelling may help prevent such births. Two interested cases are presented.

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Numerous representative samples taken from forty placentas immediately after delivery from mothers associated with prematurity (i.e. less than 38 weeks), were semiquantitatively studied by phase contrast microscopy. Twenty placentas delivered from mothers without any antenatal complication served as control. Hypoplasia of the syncytium, stromal edema, ischaemia were prominent findings on phase contrast microscopy in the study group. Increased basement membrane thickening and high villous edema scores observed on light microscopy were statistically significant in prematurity as compared to controls. Observations by phase contrast and light microscopy were found complementary to each other. Phase contrast microscopy provided quicker results without disadvantage of fixation artefact and was found distinctly superior over the conventional histological methods.

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A comprehensive prospective and retrospective study of 130 cases was carried out to evaluate the safety, adequacy and diagnostic accuracy of Transthoracic Needle Aspiration (TTNA) in various pulmonary lesions. Using both guided and unguided TTNA diagnostic material was procured in 86.15% cases. Rotex II, Chiba, lumber puncture and ordinary needles were used depending upon the type of lesion. Overall diagnostic accuracy of the procedure was 79.46 percent. Complication after the procedure were transient and self limiting. Haemoptysis was noted in 3.84 percent cases and pneumothorax in a single case. Thus TTNA can be safely included in the investigative protocol of lung lesions.

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The researches are conducted in adults and children infected with the species P. falciparum and P. vivax. The results indicated that complement C4 level showed a marked fall during the course of acute malaria in both the children and adults infected with both species. A highly significant hypocomplementaemia was recorded (p < 0.01). Children infected with P. falciparum developed acute cerebral malaria, which was associated with marked hypocomplementaemia. A marked rise in C4 level was noticed on 10th day and it was found normal with reference to control, on 20th and 30th day. A considerable reduction in C4 complement was recorded in P. falciparum when compared to P. vivax.

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Renal transplant dysfunction poses a diagnostic dilemma. Clinical evaluation frequently is inaccurate and needle biopsy carries a significant risk of bleeding. Fine needle aspiration biopsy (FNAB) being an easy to perform, a less traumatic, and rapid technique, was employed in 22 cases of clinically suspected renal allograft rejection. The results were described as nil rejection, mild and severe acute rejection, chronic rejection and cyclosporin nephrotoxicity. Seven of these cases were also needle biopsied. Histology confirmed the cytology findings in all. However, an additional finding of acute vascular episode was observed in a case of chronic rejection. Fine needle aspiration biopsy diagnosis helped in altering the immunosuppressive therapy in 16 graft rejections (excluding 2 cases of irreversible rejection) and 2 cases of cyclosporin toxicity. No rejection was found in 2 cases. Thus, 20 renal grafts could be brought back to normal function. Negligible incidence of complication viz. microscopic haematuria of short duration was noted in only 1 case.

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The present study was carried out to reveal the magnitude of individual variation in the diagnosis of Pap smears between two cytoscreeners and their compatability with cytopathologists and subsequent final diagnostic comparison with biopsy in 1,17411 cervical smears collected from different hospitals of Delhi during ten-year period. Smears diagnosed as dysplasia at initial level by any one of the cytoscreeners were screened by cytopathologists for confirmation of diagnosis. An overall agreement of 94.9 percent was observed between two screens. 79.5 percent was agreement between screeners and cytopathologists. An agreement between cytology and histology in the diagnosis of dysplasia and malignancy were found to be 61.9 percent and dysplasia and malignancy were found to be 61.9 percent and 40.1 percent respectively. From the above study, it was observed that consistency among the two screeners was fairly acceptable. Keeping this observation in view, we can possibly practice two tier screening in place of three.

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A total of 105 strains of Salmonella typhimurium resistant to Ampicillin, Co-trimoxazole and Nalidixic acid were included in the present study. Among the new line of Fluroquinolones resistance to Ciprofloxacin (3.8%), Norflox (16.19%) and Ofloxacin (24.76%) was very low as compared to older antibiotics. All the 3 fluoroquinolones had MIC values less than 1 mcg/ml.

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This experimental work was undertaken to study the difference in cell growth due to different attachment surface. Three types of attachment surface were studied (i) collagenized surface (ii) glass surface and (iii) plastic surface. Rat tail collagen suspension was prepared and coated on culture flasks. Human breast epithelial cells and breast carcinoma cells were cultured for three weeks. Cell counts were made before and after one, two and three weeks of culture. Out of five cases only two survived for more than a week. The best survival was observed on plastic surface. Collagenized and glass surfaces had similar results. Thus plastic surface is probably the best compared to glass and collagenized surface, possibly because the plastic surface provides better adhesion to malignant cells. It was also seen that in plastic surface the cells get lined up around a basement membrane like structure growing a resemblance to ductal structure. This is contradictory to the prevalent view that collagenized surface is best for in vitro growth and differentiation.

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