A clinico-histopathological report on low dose of amlodipine: A third-generation calcium channel blocker-induced gingival overgrowth

This clinical & histopathological report describes the clinical features, mechanism of action on drugs causing drug-induced gingival overgrowth (DIGO), diagnosis and management of patients with arterial hypertension with the regular usage of amlodipine drug. The report also highlights the importance of an involvement of cardiologist and his/her vital role in the management of amlodipine-induced gingival overgrowth.

A clinico-histopathological report on low dose of amlodipine: A third-generation calcium channel blocker-induced gingival overgrowth

This clinical & histopathological report describes the clinical features, mechanism of action on drugs causing drug-induced gingival overgrowth (DIGO), diagnosis and management of patients with arterial hypertension with the regular usage of amlodipine drug. The report also highlights the importance of an involvement of cardiologist and his/her vital role in the management of amlodipine-induced gingival overgrowth.

Study of 46 nephrectomies in rural India

Background: The first planned nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869 in Heidelbergs since then nephrectomy has been an essential part of urologic practice. Elective nephrectomy is done for both benign and malignant diseases of the kidney. The objective of this study was to know the various causes their pre-op factors like age, gender, laterality of disease, and intra operative factors like duration of surgery, blood loss and post-operative complications and histopathological report of the nephrectomy specimens of elective nephrectomy in a rural medical college of IndiaMethods: In our series, we have studied all the elective nephrectomies done in Pravara Rural Hospital, Loni during a span of three years from January 2018 to March 2021.Results: We have analyzed 46 cases of nephrectomies regarding their pre-op factors like age, gender, laterality of disease, and intra operative factors like duration of surgery, blood loss and post-operative complications and histopathological report of the nephrectomy specimens. Out of 46 cases, 21 were males and 26 females. Comparing the laterality right nephrectomy was done in 41% cases and left nephrectomy in 59% cases. In our series, 76% cases of nephrectomies were done for benign causes and 24% cases for malignant causes. Among the benign causes, pyelonephritis was the leading cause followed by neglected renal calculi and resultant non-functional kidney. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.Conclusions: In our series, majority cases of nephrectomies were done for benign causes.

Clinico-Histopathological Consistency in Dermatological Diseases

Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%. In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34

A clinical study of elective hysterectomies for benign lesions

Background: Hysterectomy is widely used for treating a variety of gynecologic conditions. Most hysterectomies are elective and are performed to treat benign indications. Hence the present study was undertaken to determine the benign indication of hysterectomy, choice of surgical approach, safety and clinical aspect of hysterectomy as a surgical procedure and to correlate the findings with histopathological reports of the specimen.Methods: The present series represents a clinical study of 120 cases of elective hysterectomies for benign lesions. Out of which 73 were done by abdominal and 47 by vaginal route. Finally, all operated specimen were subjected to histological examination.Results: The main indications for elective hysterectomy were leiomyoma 53 (44.2%), prolapse 47 (39.2%) and dysfunctional uterine bleeding 11 (9.2%). Type of operation performed were mainly total abdominal hysterectomy with bilateral salphingo-oophorectomy in 60% cases and vaginal hysterectomy with anterior and posterior repair in 38.3% cases. The mean duration of surgery and average blood loss was more in vaginal procedure (90 min and 100ml) compared to abdominal (70 min and 80ml) respectively. Vaginal hysterectomy was associated with less morbidity and a smoother convalescence than abdominal hysterectomy. In 81.2% cases of abdominal hysterectomies correspondence of indication with histopathological report (HPR) were found, in vaginal 74.5% cases corresponded their histopathological report with their symptoms and investigations. Associated adnexal pathology was found in 8.3% cases. There was no mortality during the whole study period.Conclusions: Hysterectomy for benign pelvic lesions is a safe procedure and an important component of health care for women.

To Determine the Accuracy of Frozen Section in the Management of Ovarian Tumours

BACKGROUND Frozen section done during surgery provides a valuable tool in the diagnosis and classification of tumours into benign, borderline and malignant. In this study, we evaluated the intraoperative findings and the accuracy of the frozen section and compared it with the final histopathology report. METHODS A retrospective study was done in the Department of Obstetrics and Gynecology in Sri Ramachandra University and Research Centre from January 2017 to January 2020, for a period of 3 years and data was taken from the patients who underwent surgery-staging laparotomy for ovarian masses along with frozen section in the diagnosis of their tumor. The final histopathology report is the gold standard for detection of ovarian tumours. The accuracy of the frozen section was compared with the final histopathological report on paraffin section. RESULTS There was a total of 109 cases during the study period of 3 years. Out of the total, frozen section showed 55 malignancy cases, 7 cases were borderline, and 47 cases were benign tumors; whereas the final histopathology report showed 51 malignant cases, 9 borderline cases, and 49 cases were benign tumors. This shows that frozen section has almost 97 % accuracy. CONCLUSIONS Frozen section is a very good tool in the diagnosis of tumour whether benign, borderline or malignant and when compared with the final histopathological report gives good accuracy. The diagnosis given during surgery is helpful in the further management of patients according to the stage of the tumour. KEY WORDS Frozen Section, Benign, Borderline, Malignant tumours, Final Histopathological Report

EVALUATION OF ACUTE APPENDICITIS USING ULTRASOUND

The diagnosis of acute appendicitis is mainly clinical and to confirm the clinical diagnosis ultrasonography (USG) of the abdomen is being used to help in diagnosis of the disease. To find out the role of USG in the diagnosis of acute appendicitis in clinically equivocal cases and to correlate USG findings with histopathological reports (HPR) of removed appendix.Total numbers of 100 patients were included in the study from 12March 2019 to 5 December 2019. Findings on ultrasound were finally compared with histopathological report of appendices removed on surgery. Those cases with alternate diagnosis were followed up and proved with other means of investigation. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of ultrasound in diagnosis of acute appendicitis in our study were found to be 79 %, 84.20 %, 95.50%, 48.40% and 80% respectively.

ISOLATED TUBERCULOSIS OF THE EPIDIDYMIS

Tuberculous epididymitis is one of the causes of chronic epididymal lesions. It is difficult to diagnose in the absence of renal involvement.All 3 patients underwent biopsy or excision of epididymal lesion. Histopathological report confirmed the diagnosis.Isolated tuberculous epididymitis commonly develops in sexually active young men. In the early phases, tuberculous epididymitis is not discernible from bacterial epididymo-orchitis. The treatment of tuberculous epididymitis consists of epididymectomy in patients with chronic forms and constitutes a diagnostic confirmation procedure.

Part II: Accuracy of Teledermatology in Skin Neoplasms

Teledermatology has been proving to be of great help for delivering healthcare, especially now, during the SARS-CoV-2 pandemic. It is crucial to assess how accurate this method can be for evaluating different dermatoses. Such knowledge can contribute to the dermatologists' decision of whether to adhere to teledermatology or not. Our objective was to determine the accuracy of teledermatology in the 10 most frequent skin neoplasms in our population, comparing telediagnosis to histopathological report and in-person dermatologists' diagnosis. A retrospective cohort study was conducted in São Paulo, Brazil, where a store-and-forward teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen teledermatologists who participated in the project had three options to refer the patients: send them directly to biopsy, to the in-person dermatologist, or back to the general physician with the most probable diagnosis and management. In the groups referred to the in-person dermatologist and biopsy, we looked for the 10 most frequent International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) of skin neoplasms, which resulted in 289 histopathologic reports and 803 in-person dermatologists' diagnosis. We were able to compare the ICD-10 codes filled by teledermatologists, in-person dermatologists, and from histopathological reports. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's, histopathologic report, and the teledermatologist's diagnosis was assessed. We also calculated Cohen's kappa, for complete and complete plus partial agreement. The mean complete agreement rate comparing telediagnosis to histopathological report was 54% (157/289; kappa = 0.087), being the highest for malign lesions; to in-person dermatologists was 61% (487/803; kappa = 0.213), highest for benign lesions. When accuracy of telediagnosis for either malign or benign lesions was evaluated, the agreement rate with histopathology was 70% (kappa = 0.529) and with in-person dermatologist, 81% (kappa = 0.582). This study supports that teledermatology for skin neoplasms has moderate accuracy. This result reassures that it can be a proper option for patient care, especially when the goal is to differentiate benign from malign lesions.