Microbiological study for aerobic organisms, anaerobic organisms and fungi from 105 cases of diabetic foot ulcers was carried out to determine the aetiological agents and their antibiograms. Out of 265 microbial isolates obtained, 160 were aerobes, 50 anaerobes and 55 fungal strains. Polymicrobial infection was observed in 73 (69.5%) cases. The most frequently isolated aerobic microorganisms were Staphylococcus aureus and Pseudomonas aeruginosa. Among the anaerobes Bacteroides melaninogenicus and Bacteroides fragilis were most common. Candida species were preponderant among the fungal isolates. Antimicrobial sensitivity pattern of the isolates is discussed in detail.

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Polymerase chain reaction assay using ureC gene specific primers for the detection of Helicobacter pylori in gastric biopsy specimens from 116 dyspeptic patients was compared with other routine invasive diagnostic methods (culture, rapid urease test [RUT] and histology). In parallel, gastric biospy specimens from 54 patients and their corresponding Helicobacter pylori isolates were subjected to PCR with cagA targeting primers using standard protocols. Helicobacter pylori were detected in 53%, 43%, 48% and 50% of patients by PCR, RUT, culture and histological examination respectively. Based on histology and culture positive and at least three test positive result, 44 (37%), 46 (39%) and 26 (22%), and 56 (48%), 52 (44%) and 8 (6%) patients were classified as Helicobacter pylori positive, negative and indeterminate respectively. The sensitivity and specificity of PCR assay was the highest-95% and 100% when compared with both culture and histology positive, and at least any three positive results respectively. The result of cagA positivity in 54 gastric biopsy specimens and their corresponding Helicobacter pylori isolates were identical; 18 of 20 (90%) duodenal ulcer patients and 23 of 28 (82%) patients with chronic gastritis and 2 (40%) of 5 patients with portal hypertension and one gastric biopsy specimens from gastric cancer patients were found to be cagA positive. PCR-based method to detect Helicobacter pylori and the virulence gene cag A directly from gastric biopsy specimens appears to be promising and can curtail the lengthy process of culture-based approaches. The procedure proved to be rapid and reliable and could be utilized for diagnostic purposes.

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Inflammation is the hallmark of Clostridium difficile associated diarrhoea and lactoferrin is produced by inflammatory cells. The aim of this study was to find out whether faecal lactoferrin latex agglutination (FLLA) assay done simultaneously with Clostridium difficile toxin (CDT) assay would help in the diagnosis of C. difficile infection in paediatric patients. One hundred and fifty faecal samples were obtained from paediatric group of patients. Both FLLA and CDT assays were done in conjunction on these samples. The data were expressed by descriptive statistics. One hundred and nineteen patients received antibiotics while 31 did not receive it. Of the former group 89 (74.8%) had diarrhoea while 30 (25.2%) did not have it. No significant relationship (p=0.287) was seen between antibiotic usage and occurrence of diarrhoea. However, CDT positivity was seen to be influenced by prior antibiotic usage as 51 (42.9%) patients receiving antibiotics were CDT positive when compared to 4 (7.3%) of those who did not receive antibiotics (p=0.002). A highly statistically significant (p<0.001) relationship was seen between CDT and FLLA positivity. FLLA appears to be an useful adjunct for C. difficile associated intestinal diseases in children when both the tests are done simultaneously and when other enteropathogens causing inflammatory diarrhoeas are ruled out.

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Metaplastic changes are commonly found at widespread locations occurring in both reactive and neoplastic conditions. They can simulate tumors histologically. Squamous metaplasia is rarely seen in areas of fibrosis and inflammation secondary to hemorrhage in nodular goiters. If it is extensive with associated degenerative changes and present clinically in the form of a nodule, cytopathologist must take care to differentiate this from primary or metastatic squamous cell carcinoma or even anaplastic carcinoma.

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Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.

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Four cases of histiocytic necrotizing lymphadenitis without granulocytic infiltration (Kikuchi-Fujimoto Disease) are described. All the cases were seen in young women who presented with cervical lymphadenopathy with mild or no fever. Histology of the lymphnode revealed paracortical necrotizing lesions with abundant karyorrhexis. Neutrophils were conspicuous by their absence. Diagnosis of Kikuchi-Fujimoto disease was considered after ruling out connective tissue disorders. Three of the four cases that were followed up showed a self-limiting course. It is important to differentiate this rare cause of febrile disease with enlargement of lymphnodes, from other causes of febrile disease with enlargement of lymphnodes, from other causes of lymphadenopathy, especially lymphoma.

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One hundred strains of Enterococci obtained from various clinical specimens over a period of six months were speciated of which 56 were E. faecalis and 44 were E. faecium. Antimicrobial susceptibility pattern showed 90% of them were resistant to penicillin and 20% of them were resistant to vancomycin. Comparative evaluation of Beta-lactamase production by iodometric method and cloverleaf method showed that the latter was cost effective and easy to perform for routine use.

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Bone marrow aspiration and biopsy is a useful means of detecting systemic involvement in patients with non haematological malignancy. Metastases of malignant melanoma may be detected in the bone marrow in a small percentage of patients. Two cases of malignant melanoma, with metastasis to marrow at the time of presentation, are described. In one case, bone marrow was the first site where the malignancy was identified. Subsequent investigations revealed an anal melanoma. In the second case, the patient had widespread dissemination from a tonsillar melanoma to many organs of the body, including bone marrow.

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Fine needle aspiration cytology (FNAC) was done on 150 patients with swelling in the head and neck region, during the period of 18 months from July 1994 to December 1995. Of these, 55 patients underwent surgery permitting a correlation between the histopathological diagnosis based on permanent paraffin sections and the diagnosis made by FNAC in order to evaluate FNAC in terms of accuracy along with its complications and limitations. The overall accuracy in the 55 cases evaluated was 92.73% with sensitivity of 90.91% and specificity of 93.18%. It was confirmed that FNAC is a highly diagnostic procedure for assessing swellings in the head and neck region. The method is simple, safe and economical.

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The unusual occurrence of very large cysticerci presenting as tumour-like lesions prompted this search of the pathology records of a south Indian hospital, to find similar cases. The maximum diameter of 187 consecutively diagnosed extraneural cysticerci, was recorded and those cases exceeding the mean by two standard deviations reviewed. Six biopsies showing cysticerci with a maximum diameter ranging from 4 to 11 cm, were identified, and hospital records and all pathological material available, were reexamined. The clinical differential diagnosis included benign and malignant tumours, hydatid cyst and haematoma. All the cysts were confirmed to be cysticerci, but species diagnosis was not possible by examining archival material. In an appropriate geographical setting, large cysticerci should form part of the differential diagnosis of cystic tumour-like lesions. An attemp can then be made, while the specimen is still fresh, to identify the species.

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The study was conducted during a suspected epidemic of leptospirosis in Maharashtra. A total of 13 acute phase blood samples, collected at 5-6 days from the onset of symptoms, and 10 convalescent phase samples, colected at around 20 days from the onset of symptoms were obtained from 13 patients. Sera were separated and the samples were subjected to Microagglutination Test (MAT) and IgM-Indirect Immunofluorescence assay (IFA) to detect antibodies against leptospira. In the acute phase sera, only one sample was positive by MAT while seven were positive by IFA. In the convalescent samples, six were positive by MAT and seven were positive by IFA. IFA is a rapid test and can be used for early diagnosis of leptospirosis.

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Two cases of Papillary cystic tumor of pancreas--one metastasizing to lymph node and the other non-metastasizing are reported for their rare occurrence. Both occurred in young females and presented with heaviness and pain in the left hypochondrium with palpable mass. On radiological examination, mass was arising from tail of pancreas and had typical gross features. The histological findings seen in metastasizing tumor were capsular invasion, infiltration to surrounding pancreatic tissue and vascular invasion with metastasis to lymph node. Difference in nuclear grade or mitosis was not observed. Adjuvant chemotherapy was given for metastasizing tumor and patient is symptom free after 56 month. Non-metastasizing case is well after 15 months.

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True cysts of the central nervous system (CNS) are rare lesions. A retrospective study of patients with symptomatic non-neoplastic cystic lesions of CNS operated in the Department of Neurosurgery, G.B. Pant Hospital, New Delhi between Jan 1994 and Feb 2001 was conducted. Parasitic cysts, cystic transformation of hemmorhages, vascular malformations and cystic tumours were excluded from the study. A total of 109 cases were reviewed. There were 34, 27, 17, 16, 8, 3 and 2 cases of epidermoid, arachnoid, dermoid, colloid, neurenteric, Rathke's and ependymal cysts and 1 case each of choroid plexus and glial cysts. The clinical presentations, locations, incidence and pathogenesis of these cysts is discussed.

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The aim of this analysis was to observe the pathologic changes in the kidney in 23 children dying of cirrhosis, including five children with renal failure. Besides these pathologic changes, glomerular cellularity and arteriolar wall thickness of these patients were compared with 18 age matched autopsy controls dying of nonhepatic and nonrenal causes. Histologic examination of the kidneys in these cirrhotic children showed significant tubular changes in five patients, diffuse glomerulosclerosis in five, only one child had membranous glomerulopathy or glomerulonephritis and one cirrhotic with serum hepatitis B surface antigen positivity had polyarteritis nodosa. No statistically significant changes were observed in the glomerular cellularity and the arteriolar wall thickness in these cirrhotic children as compared to the controls. However, medial proliferation and hyaline arteriolosclerosis were observed in four cirrhotic children. Tubular bile casts and nephrocalcinosis were the sole lesions causing renal failure in two cases. A combination of glomerulosclerosis, cast formation and arteriolosclerosis was seen in the remaining three patients. Thus the kidney showed a spectrum of pathology in pediatric cirrhosis. The tubular lesions causing renal failure represent acute treatable lesions whereas glomerulosclerosis and arteriosclerosis stand for a more chronic and less reversible renal damage.

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FNAC of soft tissue tumours was done in 67 patients. The findings were compared with histopathologic findings. Overall diagnostic accuracy was 93.33% for all lesions 93.93% for malignant mesenchymal tumours 93.33% for benign mesenchymal tumours and 100% for metastatic lesions. FNAC of soft tissue tumours provided acceptable diagnostic accuracy when supported by appropriate clinical and other diagnostic data.

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Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).

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In the present study, the adhesibility of Acanthamoeba castellani trophozoites and cysts to hydrogel contact lenses and to human cornea was investigated. Segments of unworn contact lenses were prepared (120 segments in total). In addition, 8 corneal buttons were obtained from 8 enucleated eyes. And each cornea cut into 8 radial segments. To these lens and corneal segments, 1.2 x 106/ml and 1.3 x 106/ml of cysts and trophozoites respectively were added under varying conditions. The adhesion was checked at 0, 3 and 24 hours after the exposure. Adhesion analysis showed that the trophozoites adhered equally well to lens or cornea. There is an increase in the number of trophozoites adhering to contact lenses as well as cornea. This difference is more significant for contact lenses. Washing of contact lenses significantly decreased the adherence of the trophozoites after 3 hours of incubation. When the comparison of adhesion was done between the unwashed worn and unwashed unworn contact lenses, it was observed that there was a significant difference in adherence to new lenses where the adherence was much lower. The study shows that washing of contact lenses does decrease the chances of colonization by Acantamoeba catellani and also that older lenses have higher chances of getting colonized probably due to the occurrence of scratches et. on the surface which may help in colonization.

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A 14 year old girl presented with a 6 months' history of headache with vomiting, ataxia and cerebellar signs. CT and MRI revealed obstructive hydrocephalus secondary to a large fourth ventricular mass which enhanced markedly on contrast administration. Histopathology of the resected mass revealed papillary structures lined by cuboidal cells confirming choroid plexus papilloma.

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A 15-year-old girl with Duke's B mucinous carcinoma of the rectosigmoid was treated with surgical resection and adjuvant chemotherapy. The patient is alive and has been disease-free for 15 months. Colorectal carcinoma is extremely rare in children and adolescents. Adenocarcinoma of colon is a virulent disease in children and has a poor prognosis. This is because of the poor histological characteristics and difficulty in diagnosis.

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Five viruses are usually associated with hepatitis in humans: A-E. In addition to these viruses as aetiological agents of hepatitis, there remain a number of patients with hepatitis in whom no virus could be identified. It was therefore postulated that there may be other agents which may be causing hepatitis. Recently, two viruses have been associated with hepatitis: hepatitis G virus (HGV), and transfusion transmissible virus (TTV). Hepatitis G virus (HGV) is a single stranded RNA virus which represents a newly discovered virus belonging to the flavivirus family. HGV is distinct from hepatitis C virus (HCV) and the newly discovered GBV-A and GBV-B agents, while GBV-C represents an isolate of HGV. The structure of the HGV genome resembles that of HCV. HGV replicates in peripheral blood cells, while replication in liver cells has not been observed till date. Diagnosis of HGV infection is mainly by use of polymerase chain reaction (PCR), as serological techniques are still being developed. Epidemiological data indicate that the virus is prevalent throughout the world, including India and is transmitted via blood/blood products, sexually and vertically from infected mothers to children. The relationship between infection with the virus and presence of liver pathology is controversial and has not been proven beyond doubt, as majority of patients with HGV have no detectable evidence of disease.

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Literal meaning of artefact given by 'Oxford Advanced Learner Dictionary' is 'a thing made by people'. In medical science 'the fact' is not true; but we observe routinely is called artefact. We face various types of artefacts in daily reporting of pathology specimen. Many times artefacts hinder the actual diagnosis. The artefacts i. e. fixation artefact, processing artefact, staining artefact, mounting artefact, air bubbles etc. can cause difficulty in diagnosis and a pathologist should be trained to identify those artefacts.

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Undergraduate medical education is currently undergoing extensive re-evaluation with new core educational objectives being defined. Consequently, new exam systems have also been designed to test the objectives. Objective structured practical examination (OSPE) is one of them. We conducted OSPE in a regular batch of 64 students. The batch was divided into 4 groups, one group taking the conventional practical exam and the other groups OSPE with minor variations. Different aspects were compared and analyzed and we found that OSPE was more objective, measured practical skills better, had a wide discrimination index and eliminated examiner bias. The questionnaire given to the students revealed a high acceptance rate among them.

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31 patients of peptic ulcer (PU) treated in the past by vagotomy with Gastrojejunostomy (GJ)/pyloroplasty, later presented with dyspesia. These postvagotomy dyspeptic patients were investigated. Antral and corpus endoscopic biopsies were taken to evaluate for Helicobacter pylori (Hp) infection by inhouse rapid urease test (RUT), histopathological examination and scanning electron microscopy (SEM). Dyspepsia score was done in both pre and post treatment phase. Hp positive patients were randomised to receive anti H. pylori therapy. Hp eradication was recorded by repeat RUT and endoscopic biopsy followed by SEM. Coccoid form of Hp were detected in 76.92% cases of vagotomy with gastrojejunostomy (GJ) and coccobacillary forms of Hp were seen in 75% cases of pyloroplasty. After treatment with anti Hp therapy coccoid forms persisted in 69.23% of GJ cases, whereas 22% of pyloroplasty cases showed coccoid transformation. Anti Hp therapy did not reveal any statistically significant improvement in 'Dyspepsia Score' in GJ group, whereas it improved significantly in pyloroplasty group (p=0.002).

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Two (2) primary breast sarcomas out of 110 primary breast malignancies from N.R.S. Medical College, Kolkata are being reported. Primary Breast Sarcomas are classified into five (5) broad groups with their representative features. Our two cases are classified as fibrosarcoma and malignant haemangioendothelioma and their features are documented. Because of its rarity, we are presenting this case with brief review of literature.

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