Acute appendicitis is the most common surgical emergency worldwide, with appendix being the most frequently encountered specimen by a reporting histopathologist. They may sometimes show rare and uncommon histomorphologic pictures that may create diagnostic dilemmas, few of such cases being discussed here. There are two cases of appendicular neuroendocrine tumors (NETs) that initially presented as acute appendicitis clinically, with microscopic tumor foci measuring <1 cm each. Immunohistochemistry for synaptophysin substantiated the histopathological diagnosis in one case. Neurogenic appendicopathy is another non-neoplastic entity discussed that may be overdiagnosed as appendicular neoplasms such as NET, neuromas, or neurofibromas. Granulomatous appendicitis may be another cause of recurrent appendicitis due to a variety of cases, tuberculosis being one of them and antitubercular therapy being the mainstay of treatment for these cases. Xanthogranulomatous appendicitis may simulate colonic malignancy, Crohn’s disease, malakoplakia, etc. Histopathological features are the main diagnostic modalities for these instances. Pinworm is a common helminthic infection of the gastrointestinal tract. Currently, its incidence is on the declining side due to better sanitation practices. However, it must be reported in appendectomy sections, if present, to initiate a course of antihelminthic drugs. Pseudomyxoma peritonei is an uncommon entity classically characterized by mucinous ascites resulting from ruptured appendiceal mucinous tumors, one such rare case being reported here. Low-grade appendiceal mucinous neoplasm is a distinctive entity rarely seen in appendectomy cases, belonging to groups of appendiceal mucinous neoplasms. One such instance has been depicted here.
Background: Hemoglobinopathies especially thalassaemia and its interaction with HbE and HbS are significant cause of morbidity and mortality in our country. With no feasible treatment, prevention of cases by carrier detection is the only option for successful reduction of the disease burden. VARIANT hemoglobin testing system BIORAD using principle of cation exchange chromatography has been in use and considered as gold standard for carrier detection. The purpose of this study is to compare the efficacy of a different, cheaper instrument; D10 by the same manufacturer BIORAD for carrier detection in beta thalassaemia.Methods: Patients diagnosed as beta thalassaemia carrier by VARIANT hemoglobin testing system (HbA2 value between 4.0-9.0) were retested using D10 instrument and checked for agreement.Results: There was good correlation between VARIANT and D-10 methods with Intraclass correlation coefficient 0.832 (95% Confidence Interval 0.756-0.884). Bland-Altman analysis showed mean bias of +0.3526 (95% CI -0.3958 to +1.101).Conclusions: Although further study is needed with larger sample size for assessment of sensitivity and specificity of D10 instrument, it is evident from this study that this instrument can be an effective and cheaper alternative of VARIANT hemoglobin testing system.
Background: Contrast induced nephropathy (CIN) following angiography is one of the leading causes of in-hospital acute kidney injury (AKI). The aim of this study was to investigate the renoprotective effect of remote ischemic preconditioning (RIPC) to prevent CIN in patients with peripheral arterial disease (PAD) undergoing lower limb angioplasty with standard preventative measures. Methods: 40 adult patients (eGFR >45 ml/min) undergoing peripheral arterial angioplasty received either: (1) Control: standard preventative measures comprising intravenous (IV) hydration with 0.9% normal saline (1ml/kg/hour) or (2) RIPC: four-5 min inflations and deflations of a pneumatic cuff placed on the upper arm in addition to IV hydration prior to the angiographic procedure. Serial measurements of serum creatinine, serum cystatin and urinary NGAL were taken at baseline and 2, 24, 48- and 72-hours post-procedure. The primary outcome was CIN as defined by a rise of creatinine by 25% above baseline. Other outcome measures included the rise in urine NGAL and serum cystatin from base line at 2 hours, as an early marker of acute kidney injury (AKI). Results: Both groups had similar baseline characteristics. All recruited patients had eGFR >45 ml/min, and RIPC had no renoprotective effect. AKI occurred in five (13%) patients. Changes in serum creatinine at 2 hours post-procedure did not correlate with changes in urine NGAL or serum Cystatin C. Conclusion: In stable PAD patients (eGFR >45ml) undergoing lower limb angioplasty with standard preventative measures, RIPC did not offer any protection against development of CIN. This study is registered on ClinicalTrials.gov (Clinical Trials No. NCT02516072)
The absence of prior medical records presents a diagnostic challenge for physicians managing patients with renal failure in primary care. Elevated parathyroid hormone levels or echogenic contracted kidneys on ultrasound are known to point to a diagnosis of chronic kidney disease (CKD). The literature on the use of these tools to differentiate AKI from CKD is however, limited. The objective of this study is to assess the role of intact parathyroid hormone (iPTH) blood level and bedside ultrasound in differentiating acute kidney injury (AKI) from CKD. Methods: A systematic review which included 3 databases, PubMed, Embase and Cinahl (R), as well as secondary sources, was done up to 1 January 2018. Literature search was limited to human studies in English language. Inclusion criteria included articles using iPTH or ultrasound to differentiate AKI from CKD. A uniform filter strategy was applied to all the major database engines. The relevant articles were reviewed and an assessment of their methodological quality was made based on the CASP: Critical Appraisals Skill Programme. Results: Of the 2256 articles identified, only 5 were identified as relevant (Table 1). Ozmen et. al. concluded that renal length in patients with CKD was significantly shorter 90AE15 mm, than those with AKI, 112AE14 mm (p<0.001) 1. The Receiver Operating Characteristic (ROC) analysis curve for renal length cut off to differentiate AKI from CKD was 0.865. Bennidor et al found 121 of the 137 patients with AKI (88.3%) had a normal renal ultrasound 2. Ozmen, in a separate study, reported ROC analysis curve for iPTH in CKD patients was 0.92 3. A cutoff, set at 170 pg/mL for iPTH to discriminate patients with CKD, yielded a sensitivity of 88% and a specificity of 89%. Cavayero 4 and Parmar 5 reported similar findings supporting the use of iPTH to aid in diagnosis of CKD. Conclusions: Elevated parathyroid hormone level or finding of echogenic contracted kidneys on bedside ultrasound in the primary care can help differentiate AKI from CKD. This helps decide the need for hospital admission as well as for further management. Although iPTH level may also rise in AKI, the value of 2.5 times upper limit of normal was suggested to discriminate AKI from CKD.
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