GISTS are the largest category of non-epithelial neoplasms of stomach and small bowel. Numerous immunohistochemical, ultrastructural and flow cytometry studies have been carried out for evaluation of prognostic factors which could predict malignant behaviour of these neoplasms. Tumor size of 5 cm and mitosis of 2/10 hpf were suggested as two important parameters which could predict the chances of recurrence and clinically aggressive course. The aim of this study is to examine predictive value of these two important parameters in assigning the tumors as high, intermediate and low risk groups. Using these two parameters we categorized 30 cases of GIST over a period of 6 years (1990-95) into low, intermediate and high risk groups and examined other features of these cases. Based on these two parameters alone we found that 4 cases each in low and intermediate group could be assigned to a higher risk group clinically as there were presence of adjacent organ infiltration, lymphatic emboli, serosal nodules, lymph node metastasis and transmural infiltration. Hence, other features like hemorrhage, necrosis and anaplasia should also be included in risk assessment. Metaplastic tissues like bone, cartilage and adipose tissues were seen only in high-risk categories.

OBJECTIVES: To compare the accuracy of semi quantitative methods for estimation of protein and sugar in urine as shown by their agreement with the quantitative estimation. Hundred randomly collected samples of urine were analysed for levels of protein and sugar. Protein estimation was dine by dipstick and sulphosalicylic acid method (SSA) and sugar by dipstick and Benedict's semi-quantitative methods. Kappa analysis was done on Epi Info 6.03 software to assess the agreement of these semi quantitative methods with the quantitative estimation. Neither of the two tests for urine protein, dipstick or SSA, showed good agreement with the quantitative estimation (Kappa coefficient: 0.26 and 0.07 respectively). However, the dipstick was significantly better than SSA (p < 0.05). For urine sugar, both dipstick and Benedict's tests showed good agreement with the quantitative estimation (Kappa coefficient: 0.78 and 0.84 respectively). The difference between them was insignificant. Results demonstrate that for urine protein, dipstick or SSA show poor agreement with quantitative values. For urine sugar estimation, Benedict's semi-quantitative test shows good agreement with the quantitative values and is as good as the dipstick method.

Prevalence of anti-HCV among the people at risk and general population were reported across the globe. We investigated HCV activity among the members of "Lisu" community settled in a remote and isolated area of Changlang District, Arunachal Pradesh during 1999-2000. The families were scattered with 380 households. Blood samples were collected from 76 (35 males and 45 females) apparently healthy individuals from randomly selected 10% families. Sera were processed for detection for antibody to HCV by using 3rd generation ELISA kit. All the persons were within the age of 18-98 years and 75% of them were uneducated and 92% were cultivators. The prevalence of anti-HCV was found to be very high (7.89%). Since the HCV activity is high in an isolated community, transmission dynamics study will be interesting for this epidemiologically important viral disease.

A 5 year retrospective study from June, 1994 to May, 1999 was conducted at Zonal Blood Transfusion Centre, Umaid Hospital and Department of Pathology, Dr. SN Medical College and Associated Group of Hospitals, Jodhpur (Rajastha, Western India. Donors were evaluated for seroprevalence of HIV, HBV, HCV and Syphilis. A Total 46,957 donors were tested, out of which 42,291 (90.1%) were replacement donors and 4666 (9.0%) were voluntary donors. The incidence of HIV was 0.44% in total donors, more in replacement (0.461%) as compare to voluntary (0.279%). The seroprevalence of HBV in total donor was 3.44%. The replacement donors had high incidence (3.52%) as compared to voluntary donors (2.57%). The incidence of HCV seropositivity was 0.285% (5 month data), all were replacement donors (0.328%). The seroprevalence of VDRL in total donor was 0.22%, more in replacement donor (0.239%) as compare to voluntary donors (0.129%). Hence forth, it has been observed that voluntary blood donation is more safe and advocated as compare to replacement donation, as high incidence of HIV, HBV, HCV and Syphilis are observed in replacement donors.

A 'rapid' one step immunochromatographic, visually read, antigen capture assay--the "HEPACARD" (J Mitra & Co. Ltd., New Delhi, India) used for rapid screening of HBsAg was evaluated. Thousand consecutive sera sent to our laboratory for the purpose of HBsAg screening were tested by this device and by a third generation enzyme immunoassay (EIA) (Auszyme Monoclonal, Abbott Laboratories, Chicago, Illinois) or an automated Axsym microparticle enzyme immunoassay (MEIA) (Axsym HBsAg V2, Abbott Laboratories, Abbott Park, Chicago, Illinois, ISA). Hepacard showed a sensitivity of 79% (CU: 57.3-92%) and specificity of 98.9% (CI: 97.9-99.4%) when compared to the findings by the third generation EIA assays. This study suggested that this particular rapid HBsAg test results have to be confirmed by either an EIA or MEIA where the facility exists. The test may be used only in a small hospital setting where the facilities for enzyme immuno assays do not exist.

Previously considered solely as the laboratory contaminants and normal flora of skin in man, coagulase negative Staphylococci are now a major cause of nosocomial and opportunistic infections. This study was conducted at IGIMS, Patna to find out the coagulase negative Staphylococcus isolates from urine and their antimicrobial resistance. In a period of ten months, the relative frequency of main coagulase negative Staphylococci were as follows--Staphylococcus epidermidis-45.90%, Staphylococcus saprophyticus 34% and Staphylococcus haemolyticus-8.50%. others were 11.60%. most of the Staphylococcus saprophyticus was isolated from young female patients suffering from uncomplicated acute cystitis and Staphylococcus epidermidis was mainly from patients with indwelling catheters and complicated cases. Staphylococcus saprophyticus showed the highest sensitivities to all the antimicrobials whereas Staphylococcus haemolyticus had the highest resistance rates. 66.6% of staphylococcus epidermidis and 60% of staphylococcus haemolyticus were resistant to oxacillin, whereas only 10% of staphylococcus saprophyticus resistant and 90% were sensitive to it. As is in the emerging state, vancomycin resistance was very less but in future it may cause a major problem to treat these cases. So this area needs further exploration.

Certain strains of mesophilic Aeromonads like A. hydrophila, A. veronii biotype sobria and A. caviae when grown in broth containing 0.5% glucose, undergo growth inhibition concomitant with acetate accumulation. As these strains become nonviable after 24 h, this phenomenon is termed suicide. We investigated suicidal strains of Aeromonas species as means of understanding animal virulence and enteropathogenicity. Non suicidal strains of A. Hydrophila showed and overall 88.8% lethality rate and non suicidal strains of A. veronii biotype sobria showed 83.3% lethality rate and was nil for its suicidal part. Of the two suicidal A. caviae strains tested, none were lethal. The present data suggest that the suicide phenomenon may explain strain specific [A. veronii biotype sobria, A. hydrophila] and species specific [A. caviae] virulence and enteropathogenicity.

Klebsiella pneumoniae species (108) isolated from tertiary care hospitalized patients were investigated for antibiotic resistance patter. 74% isolates were from urine, 13.5% from pus, 4.5% from blood and 8% from sputum. The resistance pattern of the organisms to various antibiotics were as follows: ampicillin 93.3%, cefotaxime 70%, ceftazidime 81%, gentamicin 68.5%, amikacin 63.75%, netilmicin 74%, norfloxacin 55%, ofloxacin 53%, chloramphenicol 82%, tetracycline 85%, sulphamethoxazole 96%, trimethoprim 94%. 2-4 drug resistance was found in 34.5%, 5-8 drug resistance was in 25.1% and 9-12 drug resistance was found in 40.4% of strains. Out of 65 strains, 25 strains could be successfully conjugated. Common drugs which were transferred to transconjugants were sulphamethoxazole, trimethoprim, gentamicin, netilmicin, amikacin, chloramphenicol, tetracycline, ampicillin, cefotaxime and ceftazidime. A large plasmid of 98.7% kb could be demonstrated in these strains by alkali denaturation method and agarose gel electrophoresis.

Feracrylum, a water-soluble polymer of polyacrylic acid is known for its hemostatic property. Present work is an effort to evaluate its minimum inhibitory concentration (MIC) and compare it with the MIC of povidone-iodine. Ten different species of pathogenic microorganisms were selected, strains of which were obtained from Haffkine Institute. The organisms were maintained under appropriate culture media. The MIC of Freracrylum was determined by using tube culture method where its activity was compared against a standard antimicrobial agent providone-iodine. The study parameters showed that Feracrylum exhibits antimicrobial activity against a wide variety of microorganisms and its efficacy is comparable to that of povidone-iodine.

A total of 206 gram negative anaerobic bacilli were isolated from 2591 routine clinical specimens. Majority of them (78.2%) were part of a mixed flora. A high incidence of gram negative anaerobic bacilli was found in post-operative wound infections and diabetic foot infections (30.1%), followed by necrotizing fasciitis and crush injuries (18%), pus of empyema and lung abscesses (14.5%) and aspirates from other deep abscesses (10.7%). Bacteroides fragilis was the most frequently recognized species (42.2%), followed by Fusobacterium sp. (17.4%), Prevotella sp. (15.1%) and Porphyromonas sp. (11.2%). Neomycin blood agar plate yielded the maximum number (72.8%) of strains in pure culture. Gram negative anaerobic bacilli in infective processes are significantly on the rise and so suspected cultures should be processed for both aerobic and anaerobic organisms.

Malakoplakia is a rare disease expressed as a special type of inflammatory reaction to infection with various bacteria and fungi. We present a case of renal malakoplakia in a 30-year-old female patient. The symptoms were not characteristic enough for making the ture diagnosis preoperatively. A preoperative diagnosis of renal cell carcinoma was made in this case.

Persistent Mullerian Duct Syndrome (PMDS) is characteristically associated with unilateral or bilateral cryptoorchidism. Like other undescended testis, these gonads are at an increased risk of malignant transformation. We report a case of intra abdominal seminoma in cryptorchid testis of a patient with the Persistent Mullerian Duct Syndrome, hitherto uncommonly reported in India.

Lactating adenoma is an uncommon well-differentiated benign tumor of secretory mammary epithelium that occurs in pregnant and lactating women. Three percent of all breast cancers are diagnosed during pregnancy and need to be differentiated from other breast masses occurring in pregnancy and lactational states. Its origin, though controversial, is believed to be de novo or a variant of pre-existing tubular adenoma or fibroadenoma, that reflects the morphologic changes resulting from the physiologic state of pregnancy. Four pregnant/lactating women presenting with solitary breast masses were aspirated. Spontaneous regression of the mass was observed in two of the four cases, one underwent excision biopsy and one case was lost to follow up. All four cases were diagnosed as lactating adenoma on fine needle aspiration cytology. Cytomorphologic features included cellular aspirates comprising of epithelial cells, scattered and in small groups. The acinar cells had foamy to vacuolated cytoplasm. The nucleus had prominent nucleoli. Background showed abundant foamy material. Biopsy confirmed lactating adenoma in one of the cases. Lactating adenoma needs to be differentiated from other breast masses, including carcinoma, in pregnant or lactating women. Sonographic studies are not diagnostic and surgical biopsies are not recommended as a majority of the lesions are known to regress spontaneously.

Secretory carcinoma is the currently preferred designation for a unique neoplasm earlier thought to be exclusive to the adolescent/pre-menarchal breast. The neoplasm has a predilection for juveniles and young adults (< 30 years of age), becoming progressive less common with advancing age. This report is of one such instance in a 52 year old female, rare occurrence in the elderly (> 50 years of age), with only five earlier cases on record in the English literature.

A 25-year old man with hematuria had a polypoid tumor of the urinary bladder which was diagnosed as transitional cell carcinoma (TCC) on transurethral resection with partial cystectomy. One year following post-operative radiotherapy, he had to undergo surgery for intestinal perforation. On laparotomy the recurrent tumor had involved pelvic organs and sigmoid colon. It now showed predominantly osteogenic sarcoma on histopathologic examination. The case is reported in view of rarity of primary osteogenic sarcoma in the urinary bladder.

We describe a case of plexiform variant of vascular transformation of lymph nodes sinuses in association with myelodysplastic syndrome. The patient had repeated bacterial infections and terminal fungal infection and dies after a protracted illness of seven years.

Intestinal metaplasia of renal pelvis occurs uncommonly and is usually secondary to persistent chronic irritation or inflammation. It is considered to be precursor of adenocarcinoma. A case of horse-shoe kidney which showed extensive intestinal metaplasia and focal severe dysplasia in the renal pelvis is being presented. The metaplastic change in this case is being attributed to persistent inflammation due to more chances of stasis in horse-shoe kidney coupled with renal calculi.

Cysticercosis is unlikely to be the first diagnosis for a swelling over the tongue. In this report we document an unusual case of lingual cysticercosis presenting as an isolated lesion.

Acute Erythroleukemia is a rare disorder of hematopoietic system, accounts for 1-3% of all acute leukemia and 15% of myeloid leukemia. Recently, the World Health Organisation & Society of Haematopathology proposed a change in the categorization, with M6a and M6b subgroups of the original FAB classification. Hereby we report a case of acute erythroleukemia--M6b subtype, presented with pain abdomen and vomiting. The patient died within two days. The case is being reported for its rarity and uncommon presentation.

A case of Solid and Cystic Papillary Epithelial Tumor of Pancreas displaying low grade malignancy occurring in a 38 years old female is presented. It is a rare condition and could be diagnosed histopathologically after complete excision.

Six cases of mycotic infectation of the brain are presented. All the patients were in the age group ranging from 18 years to 38 years. the duration of clinical symptoms varied from 6 days to 7 months. Computerized tomographic visualization of brain revealed a mass lesion in all. Operative findings were suggestive of tumour in 3 cases. All the patients were non-immunocompromised. There was history of previous ear infection and sinusitis in one case. Histopathological examination of biopsy tissue showed dichotomously branching septate fungal hyphae highlighted by special stains like methanamin silver and PAS in all cases.

Chronic neutrophilic leukemia is a rare hematological disorder with hepatosplenomegaly and sustained mature neutrophilic leucocytosis. Increased serum vitamin B12, increased serum urine acid levels and increased leukocyte alkaline phosphatase activity are the associated features in the absence of fever or any other underlying disorder to cause leukemoid reaction. We report one such rare case.

We hereby report a case of a child who presented with abdominal distension and urinary retention. Radiological investigations and exploratory laparotomy revealed a cystic mass in the sacral region pushing the urinary bladder anteriorly and upwards. Histopathological examination revealed neuroglial elements. Neuroglial cysts are uncommon outside the central nervous system and this is the first report of its occurrence in abdomen and pelvis.

Giant cell tumor of bone is usually seen in adults affecting a single bone. Multiple giant cell tumour of bone occurring in skeletally immature patients is extremely rare. Multifocal giant cell tumor of bone in a ten year old boy involving upper end of humerus and tibia is being reported for its extreme paucity in literature.

Congenital thymic cysts are uncommon and often misdiagnosed as either branchial cleft or cystic hygromas. This paper presents the case of a male child, who presented with a soft, fluctuating mass in the left side of his neck. Surgical excision revealed an ectopic thymic cyst. The histopathologic features of thymic cysts are diagnostic. Ectopic thymic tissue may be an infrequent finding, but it should be included in the differential diagnosis of neck masses, especially in children.

We report a 60 year old male presenting with contralateral testicular metastasis 7 years following radical nephrectomy for renal cell carcinoma. Testicular metastases from renal cell carcinoma reported in literature are predominantly ipsilateral and invariably on the left side. Usually these are present simultaneously with the renal primary or precede the diagnosis of renal tumors. Delayed contralateral testicular metastatic has not been reported to the best of our knowledge. The case highlights the unique behaviour of renal cell carcinoma with an unusual site of recurrence. The clinical presentation, pathogenesis and management of this rare presentation along with review of recent literature are discussed.

We report a rare case of dual infection in a psoas abscess. Pus from the abscess grew Salmonella typhi and the abscess wall showed epitheloid granulomas giant cells, which we confirmed as tuberculosis by PCR. Such dual infection cases may be missed unless looked for since both these infections are common in our country.

Hydatid disease is caused by parasitic tapeworm Echinococcus. The larval stage of this parasite can thrive in many parts of the body, most frequently in the liver. Primary ovarian location is very rare. In our case the patient had bilateral ovarian cysts which on histopathological study was found to be hydatid cysts. Moreover one of the cysts was multilocular which is also unusual.

Fragile X syndrome is the most common of the inherited disorders causing mental retardation. This disorder results from an abnormal expansion in (CGG)n in repeat found in the coding sequence of the FMRI gene, located at Xq 27.3. Previously it was detected by Karyotyping. With the advent of Molecular Biology PCR, has become the best method in the diagnosis of this disorder. This is a case report of a family with this disorder detected by PCR.

Primary choriocarcinoma of the ovary (PCO) is rare. This can be gestational (GCO) or non-gestational (NGCO) in origin. It is difficult to differentiate between CGO and NGCO. Non-gestational choriocarcinoma carries a bad prognosis than GCO. We present a case of NGCO who had pulmonary metastasis.