The present study was carried out in 75 patients of macrocytic anaemia categorised on bone marrow examination (into megaloblastic and non-megaloblastic anaemia) to evaluate the efficacy of total serum LDH levels and LDH isoenzyme pattern in the diagnosis of megaloblastic anaemia. 25 healthy adults were taken as controls. From this study it can be concluded that total serum LDH levels more than 3000 IU/L are diagnostic of megaloblastic anaemia. Reversed LDH isoenzyme pattern (LDH1 > LDH2) by chloroform inhibition test is an adjuvant in the diagnosis where total serum LDH levels are between 451-3000 IU/L and it will also differentiate megaloblastic anaemia from haemolytic anaemia.

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Systemic lupus erythematosus (SLE) is a multisystem, autoimmune disease with varied clinical manifestations and outcome. It may prove fatal due to disease activity or intercurrent infections. In recent years, earlier diagnosis and better treatment modalities have resulted in a change in the pattern of organ involvement and mode of death in the west. This aspect of the disease is unknown in India. Hence, in this autopsy series of SLE, the organ involvement and cause of death have been studied. Twenty five cases of clinically diagnosed SLE have been analysed retrospectively. Renal involvement was invariably present (96%) with class IV being the commonest lesion in 60% cases. Disease activity was noted in 60% cases. Pleuro pulmonary lesions were seen in 92% cases with infection being the commonest. Pulmonary infections included bacterial pneumonias (13), disseminated tuberculosis (3), pulmonary mucormycosis (1) and aspergillosis (1). Massive pulmonary haemorrhage in 5 cases and acute lupus pneumonitis in one, contributed to the demise of the patient. Vasculitis was evident in single organ in 9 cases, in two or more organs in 3 cases with systemic vasculitis significantly attributing to morbidity in 1 case. Active disease was the cause of death in 60% cases and infection in 40%.

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Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.

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Nephrotic syndrome is a hypercoagulable state with variable prevalence of clinical thrombosis. The role of platelet aggregation, fibrinogen and antithrombin III and protein S levels in the pathogenesis of hypercoagulable state in these patients is controversial. Since no study on Indians is available, the clinical and laboratory profile of 22 patients of nephrotic syndrome (age 18-35 years with an MF ratio of 4:3), have been studied. The coagulation profile revealed a prolonged APTT in 12 patients (54.5%), and a prolonged TT in four (18.1%). In the rest APTT and TT were normal. PT was raised in two patients. Fibrinogen, an acute phase reactant was raised in five patients (22.7%). Antithrombin III levels were reduced in 19 patients (86.4%), normal in one and raised in two patients. Free Protein S levels were high in 12(54.5%), normal in seven and decreased in three patients. Platelet aggregation with adrenaline and adenosine diphosphate was raised in 6 patients. Ultrasonographically detected deep vein thrombosis was seen in one patient only (4.5%) who had ATIII levels of 48%. This low incidence can be explained by elevated protein S levels which was found to be raised in 12(54.5%) cases, protein S being an anticoagulant factor. This low level of clinical thrombosis in Indian patients of nephrotic syndrome may be an ethnic variable factor. It is thus concluded that although patients with nephrotic syndrome have a hypercoagulable state, clinical thrombosis is rarely seen in Indian patients with nephrotic syndrome.

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Fifty cases of hepato-renal dysfunction of unknown etiology were studied over a two-year period. Urine samples were examined microscopically and cultured for Leptospira. Serum samples were examined for antibodies against Leptospira by the Macroscopic slide agglutination test (MSAT). Seventeen out of fifty patients (34%) showed evidence of Leptospiral infection by at least two diagnostic techniques used. 15/17 i.e. 88.2% were positive by dark ground microscopy, 7/17 were diagnosed by culture technique and 16/17 i.e. 94% were confirmed by serology. There was a good correlation between Microscopic agglutination test (MAT) and MSAT. Thus Leptospires seem to play a major role in the causation of hepato-renal dysfunction in and around Pune, Maharashtra.

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Chediak Higashi anomaly is a very rare disorder in which patients suffer frequent and severe pyogenic infections that are secondary to abnormal functions of polymorphonuclear leukocytes, associated with albinism and bleeding tendency. Blume RS and Wolff SM (1972) reported that only 59 cases were diagnosed after the first description of Chediak-Higashi Syndrome in 1943 by Cesar AB (cited by Wintrobe MM Clinical Haematology). As per recent literature available (Internet) last case was reported on 16th July, 1997.

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Induced sputum samples were collected from 32 AIDS patients with respiratory ailments. Pneumcystis carinii was demonstrated in 9 out of 32 AIDS cases by Indirect Immunofluorescence technique (HF). Four cases were positive by all the three techniques namely Giemsa staining, Toluidine blue staining and IIF, three were positive by both toluidine blue and IIF, and two were positive only by IIF. Among other microbial pathogens, acid fast bacilli was demonstrated in all the P carinii positive cases and Candida albicans in 53% AIDS cases from the induced sputum sample.

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Advances in understanding the mechanisms of human immunodeficiency virus (HIV)-1 entry have revealed that the cell surface CD4 expression alone is insufficient and needs an additional molecule on its surface for the viral entry. These are G-protein coupled seven transmembrane (7-TM) family molecules (chemokine receptor) and amongst them one is CXCR4. Feline homologue of CXCR4 acting as a co-receptor for feline immunodeficiency virus (FIV) entry is already reported for the Crandle feline kidney cells strain (CrFK) of FIV. An experiment was carried out to search the expression of CXCR4 retrospectively in FIV (CrFK) infected cat brain tissues using immunohistochemically in the formalin fixed paraffin sections against 12G5, a mouse monoclonal antibody to CXCR4. We observed the expression of this receptor in feline neurons, astrocytes and in some vascular endothelial cells. The study of expression of CXCR4 in the brain, which is one of the many chemokine receptors in the central nervous system, may provide further insight into the interactions between brain cells, pathogens, and the immune system, and help understand the pathogenesis of HIV dementia.

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Although extremely rare 10 years ago, antifungal drug resistance is becoming a major problem in certain populations, especially in those infected with HIV. This study was undertaken to study the resistance of Candida species isolated in our hospital to Fluconazole using Chrom agar Candida. The Candida strains which were routinely isolated from clinical specimens like blood, urine, sputum, pus, fluid and homograft isolates were included in the study. 142 Candida isolates were tested by using Chrom agar Candida incorporated with fluconazole. 16 strains were found to be resistant to Fluconazole and 126 strains sensitive to Fluconazole. Nine were C tropicalis, 3 C krusei, 2 C guillermondii, 1 Geotrichum candidum and one was an unidentified strain of Candida. The MIC of the 16 strains were done using RPMI 1640 medium by macro broth dilution method. MIC of 9 strains was 64 & > 64 micrograms/ml of 6 strains 32 micrograms/ml and 1 strain 16 micrograms/ml.

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Aims of the present paper was to study cell death by apoptosis and cell proliferation in normal cervical biopsies, cervical intraepithelial neoplasms (CIN) and squamous cell carcinomas of cervix (CaCx). There were each seven cases of normal cervical biopsy, CIN1 and CIN2 along with 10 cases of CIN3 and 14 cases of CaCx. Percentage of apoptotic cells and bodies (i.e. apoptotic index, AI) and mitoses (i.e. mitotic index, MI) and turnover index (TI - AI + MI) were counted in formalin fixed, paraffin embedded, haematoxylin and eosin stained slides. AgNOR stain was done and mean AgNOR dots per cell was also estimated. AI, MI and TI were correlated with histology grade of CIN and invasive carcinoma cervix. Mean AI, MI, TI and AgNOR count increased from lower to higher grades of CIN. AI, MI & TI raised significantly from CIN3 to carcinomas; AI, TI & AgNOR count raised significantly from CIN1 to combined CIM2 & 3; TI & AgNOR count were high in CIN1 to CIN2; AI & TI were significantly raised in normal to CIN1. In conclusion, TI is probably more important for cell kinetic analysis of CIN and carcinoma of cervix because it reflects the frequency of two important events i.e. mitosis and cell death. Sudden increase of AI, MI, TI count from CIN3 to CaCx may indicate the possibility of genetic alteration of cells of CIN3 which induces a frank malignant transformation from CIN3 to CaCx.

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Metastasis into the hepatic hemangioma is a rare occurrence. We report a unique case of metastasis of intestinal carcinoma into hepatic hemangioma in a case of 65 year old male who presented with anorexia, weakness and headache. The postmortem examination revealed adenocarcinoma in the ileocaecal region. The liver showed a subcapsular hemangioma of 1.5 cms. diameter which on microscopic examination revealed metastasis of adenocarcinoma. The is the first documentation of metastasis in hepatic hemangioma. Such cases may pose problems of diagnostic difficulties and thus may result in mismanagement.

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Congenital-infantile fibrosarcoma is an unusual childhood tumor that occurs mainly in children under 5 years of age. More than 300 cases have been reported in the literature so far, very few of them at birth. A distinction must be made between it and its adult counterpart because of differences in their clinical behaviour. We report here a case of congenital fibrosarcoma in a 4-day-old female infant.

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Six cases of Pleomorphic Xanthoastrocytoma of central nervous system are presented. One case presented with recurrent refractory seizures and others as intracranial space occupying lesions. They were located in temporal/parietal lobes, were partly cystic and partly solid on CT scan, enhancing with contrast. Histopathology was characterized by pleomorphic giant cells and cells with vacuolated cytoplasm. Glial fibrillary acidic protein was strongly positive in all the cases.

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Glanzmann's thrombasthenia is a well defined inherited disorder of platelet function characterized by qualitative and qualitative defect in cytoadhesive membrane protein, glycoprotein IIb-IIIa (the platelet fibrinogen receptor). From January 1990 to October, 1999, five patients who presented with mucocutaneous bleeding were detected to have Glanzmann's thrombasthenia. Clinical and laboratory spectrum of this rare disorder was studied which revealed heterogeneity of disease with respect to nature and severity of bleeding unpredictable by laboratory findings.

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Clinicopathological features of 14 patients with histologically confirmed primary intestinal Non-Hodgkin lymphoma were analysed. Patients were mostly young males with median age of 27.2 years. Main presenting features was intestinal obstruction. Diffuse large cell lymphoma was the commonest histological type. All cases were found to be B cell type in immunohistochemistry.

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Eighty patients presenting with painless hematuria and 24 patients of transitional cell carcinoma bladder coming for follow up were included in this study to assess the role of exfoliative (voided urine) and lavage (saline lavage) cytology in initial diagnosis and follow up of the patient with carcinoma bladder. Freshly voided urine samples and saline lavage bladder washing samples were collected. A thorough cystoscopic examination was done and biopsy was taken from any apparent growth. Cytological smears were stained with hematoxylene and eosin and PAP's stain, histology sections were stained with hematoxylene and eosin. A statistically significant correlation (p < 0.001) was observed between the increasing grade of malignancy and cytopositivity. A good association was observed between histology and two methods of cytology (p < 0.01). The sensitivity, specificity and overall diagnostic accuracy of lavage cytology was more as compared to exfoliative cytology (71.05%, 56.0%, 78.85% Vs 47.37%, 41.18% and 61.54%). Cystopositivity was more with single large sessile tumour as compared to multiple small pedunculated tumours. Cytohistological discrepancy was observed in patients of transitional cell carcinoma with recurrence. It is concluded that cytology may act as a good adjuvant to histology in picking up early flat lesions and/or follow up of patients with transitional cell carcinoma.

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This new blood test (leukergy) for infection is based on the fact that white cells agglomerate in peripheral blood of patients with inflammatory diseases. We evaluated leukergy in 25 children with proven septic arthritis of hip. It was found to be the efficient and earliest indicator of septic arthritis than the erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), polymorphs and C-reactive protein (CRP). It also correlated well with the clinical severity of infection and the prognosis of disease. Thus leukergy is a simple, rapid and inexpensive slide test which was found as the best indicator profile for the presence of septic arthritis.

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An unusual presentation of filariasis as a breast lump simulating breast carcinoma, in a 50 year old woman residing in Pokhara, Nepal. The case was reported on Fine Needle Aspiration Cytology and also evaluated by histopathology. Morphology of the nematode is that of Brugia species which is unusual in Nepal.

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A specific subtype of teratoid tumour occurring in nasopharynx and oropharynx has been mentioned as 'hairy polyp'. This is a rare lesion and is to be differentiated from true teratomas. A case of hairy polyp of nasopharynx in a 12 year old girl is reported.

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Forty cases of squamous cell carcinoma and twenty cases of adenocarcinoma of the cervix were subjected to DNA ploidy analysis to find out the frequency of aneuploid DNA pattern in different types of invasive carcinoma of the uterine cervix and their possible correlation with the clinical stage and age of the patients. From the DNA analysis an increasing trend of DNA aneuploidy was observed from well differentiated (63.6%) to moderately differentiated (70.8%) to poorly differentiated squamous cell carcinoma (83.3%). However, 85% adenocarcinomas of endocervix showed aneuploid DNA pattern. It indicates that aneuploidy increases with tumour dedifferentiation and further confirms the importance of DNA ploidy as a high risk indicator.

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Rare occurrence of isolated right ventricular infarction is reported in four patients, three of whom were elderly. The causes of infarction were due to pulmonary thromboembolism and dissection of non-dominant right coronary artery. None of the hearts had right ventricular hypertrophy and significant coronary atherosclerosis.

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Antibiotic susceptibility was performed on sixty clinical isolates of nonsporing anaerobes against ten antimicrobial agents. The test was performed on Muller Hinton Agar and Wilkins Chalgren blood agar by preparing suspension of freshly isolated colonies in BHI broth. Apart from Metronidazole and Chloramphenicol newer antibiotics like Minocycline, Secnidazole, Tinidazole, Clarithromycin, Roxithromycin were also tried. Antimicrobial agents like Metronidazole, Secnidazole, Tinidazole and Minocycline were 100% sensitive, followed by Chloramphenicol, Clarithromycin and Roxithromycin. These newer agents can be good alternatives for the treatment of non sporing anaerobes.

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Two rare cases of intra-pericardial teratoma in infants are reported. The presenting symptoms were either due to pericardial effusion and cardiac tamponade or due to compression of the tracheo-bronchial tree. The tumors were well encapsulated and were attached to the ascending aorta. Histologically, they were composed of derivatives of the three germ cell layers.

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Giant cell tumor is seen in late adolescence or in the third or fourth decade of life. It arises from epiphysis of long bones, the commonest site being the distal end of the femur and the proximal end of tibia. This paper presents a case report of giant cell tumor of soft tissue.

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