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Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken. Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

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PURPOSE: Prostatic lesions on routine staining sometimes cause a diagnostic dilemma, especially when malignant tissue is limited and is mixed with benign prostatic glands or because of the presence of benign mimickers of carcinoma. The application of immunohistochemistry contributes a valuable differential diagnosis. This study aimed to evaluate a complete spectrum of various prostatic lesions and to supplement the histopathological diagnosis with immunohistochemistry in suspicious or atypical cases. METHODS: A total of 364 consecutive prostatic specimens were evaluated. Routine hematoxylin and eosin staining and immunohistochemical staining against 34ßE12 cytokeratin and proliferative marker (alpha-methylacyl-CoA-racemase, AMACR) were performed by use of the peroxidase antiperoxidase method. RESULTS: Benign prostatic hyperplasia was the most frequent finding and involved 285 patients (78.3%). Prostatitis (majority nonspecific) formed the predominant subgroup in nonneoplastic lesions (n=119, 32.7%). The incidence of carcinoma was low (n=73, 20.1%). Of the 26 atypical or suspicious cases, 18 cases were positive for high molecular weight cytokeratin (high molecular weight cytokeratin, HMWCK) only, 4 cases were positive for AMACR only, and 4 cases showed positivity for both HMWCK and AMACR. CONCLUSIONS: Biopsy remains the gold standard. However, as an adjunct to biopsy, proliferative markers and basal cell markers have value for resolving suspicious or atypical cases.

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Chronic gastritis is a very common disorder which is commonly caused by Helicobacter pylori. Histopathological examination is the mainstay of the diagnosis. We evaluated 300 gastric antral biopsies using revised Sydney system and concluded that it helps to analyse gastric biopsies in a very comprehensive manner. It was seen that H. pylori, chronic inflammatory infiltrate, neutrophilic infiltration, presence of lymphoid follicles and aggregates and surface epithelial damage are strongly associated with each other. The presence of one of these histological feature is a strong indicator for presence of other features. On the other hand intestinal metaplasia and atrophy of gastric glands was not associated with the above mentioned histological features. In the presence of dense chronic inflammation and infiltration by neutrophils one should carefully search for H. pylori organism. We also correlated histological features with endoscopy and found that cases of duodenal ulcer had more severe antral gastritis on histology as compared to those with hyperemia or antral erosions.

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PURPOSE: Sarcoidosis is increasingly diagnosed in developing countries, although it was earlier thought to be uncommon. We describe the pattern of ocular manifestations in sarcoidosis in India. METHODS: A total of 48 consecutive patients with histologically confirmed sarcoidosis, referred to a teaching university hospital, underwent a detailed ophthalmological examination, irrespective of whether they had eye symptoms or not. RESULTS: Ocular involvement was seen in 14 (29%) patients. The mean age at presentation was 50 years, and neither two peaks of incidence nor a female preponderance could be demonstrated. The majority of patients had chronic disease. Posterior uveitis was distinctly more common (12/14) than anterior (5/14) uveitis. Conjunctival involvement was uncommon. These findings differ from those reported in the Western literature. CONCLUSIONS: Eye involvement is common in sarcoidosis in India and may occur without ocular symptoms. Posterior segment involvement is more common than has been reported. Ophthalmologists need to be aware of ocular involvement in this disease as untreated disease can have significant visual consequences.

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The study was undertaken to determine the accuracy of cytological diagnosis of CNS lesions by comparing it with the final histopathological diagnosis of CT guided stereotactic brain biopsy. Squash preparations were prepared from 25 cases of CNS lesions operated in two years. These included 18 astrocytomas, 1 metastatic deposits, 1 epidermoid cyst, 1 Toxoplasmosis, 1 granulomatous inflammation and 3 cases showing normal brain parenchyma. The cytological diagnosis was available to the neurosurgeon within 10 minutes. The cytohistological correlation with paraffin block sections worked out to be 92%. Thus, this proved to be a fairly reliable and rapid method for immediate intra-operative diagnosis.

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Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.

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BACKGROUND: The aim of the study was to analyse the morphology, clinical presentation and predisposing factors for chronic hepatitis C infection. METHODS: Clinical presentation of 220 patients who presented with hepatitis C virus infection over five years period (January 1996 to December 2000) were recorded. Liver biopsy specimens from 80 adult patients with chronic hepatitis C virus were evaluated using a semiquantitative scoring system. The possible predisposing risk factors for infection in these patients were recorded. RESULTS: Grading of chronic hepatitis C was minimal/mild in 51 (64%) cases. Seven (8.7%) had high-grade necroinflammatory activity. Fibrosis was absent in 22(27.5%), mild in 29(36.25%), moderate in 11 (13.75%) and 18(22.5%) had evidence of cirrhosis. No significant correlation was found between the level of transaminases and degree of fibrosis or grade of inflammation. More number of patients with history of alcohol consumption had moderate/severe grade of necroinflammatory activity and cirrhosis as compared to those not taking alcohol at all. Potential predisposing factors were use of unsterile syringes, previous surgery and tattooing in multivariate analysis. CONCLUSION: Nearly two-thirds of patients of chronic hepatitis C where liver biopsy was possible have minimal/mild disease at time of diagnosis; 22% have cirrhosis. Though disease severity can only be assessed by liver histology, liver biopsy may not be possible in a sizeable proportion of patients as they present with advanced liver disease. Most of the patients do not have specific symptoms. Reusable needles/syringes is the commonest potential risk factor.

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OBJECTIVE: To study the presentation of adult celiac disease in a northern Indian hospital. METHODS: Case records of all patients diagnosed as having adult celiac disease in the Gastroenterology unit of this hospital during January 1996 till December 2001 were reviewed. Celiac disease was diagnosed according to the revised ESPGAN criteria. Adult celiac disease was diagnosed if disease manifestations started after 15 years of age. All patients had a minimum of one-year follow up. RESULTS: The mean duration of illness in the 96 patients (mean [SD] age 32.9 [11.4] years; 50 men) diagnosed over the 6-year study period was 7.3 (2.4) years. Diarrhea was present is 67.7% of cases; 18.7% presented with refractory iron-deficiency anemia, and 9.4% with abdominal symptoms like flatulence and distension. Three patients presented with dysphagia and anemia and were diagnosed as having Plummer-Vinson syndrome. Ulcerative colitis, non-alcoholic steatohepatitis, and aphthous ulcers were associated conditions. All patients had significant improvement in symptoms and hematological and biochemical parameters after dietary gluten restriction. CONCLUSION: Adult celiac disease is not rare and usually presents as diarrhea, abdominal distension and flatulence, and refractory anemia.

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BACKGROUND: The search is on to find more effective drug regimens for patients with severe ulcerative colitis, as conventional drugs such as sulfasalazine and its congeners fail to prevent relapse in a significant number of patients. Azathioprine has also been reported to be useful as a steroid-sparing drug in patients who suffer from frequent relapses. As these drugs when used individually fail to sustain remission in a significant number of patients, we evaluated the combination of these two drugs. METHODS: Thirty-five newly diagnosed patients with severe ulcerative colitis were randomized into two groups; group A (combination therapy) received sulfasalazine and azathioprine, while group B (sulfasalazine monotherapy) received sulfasalazine and placebo. In addition, all the patients received steroids initially to achieve clinical remission. The patients were followed-up for a period of 1 year. The therapeutic outcome was measured by the number of patients who suffered relapse in each group. RESULTS: All the patients completed the 1-year study period. While 4 patients (23.5%) in group A suffered relapse of disease, 10 (55.6%) in group B suffered relapse, the difference being statistically significant. The relapse-free period was also significantly longer in group A. CONCLUSIONS: Combination therapy (sulfasalazine and azathioprine) is more effective than sulfasalazine and placebo in the maintenance of remission in patients with severe ulcerative colitis.

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