Tetranectin positive expression in tumour tissue leads to longer survival in Danish women with ovarian cancer. Results from the ‘Malova’ ovarian cancer study

The primary objective of this study was to analyse Tetranectin (TN) expression in tumour tissues and TN serum concentration in 758 women with epithelial ovarian tumours. The second was to evaluate, whether TN tissue expression levels correlate with clinico‐pathological parameters and prognosis of the disease. Using tissue arrays we analysed the expression levels in tissues from 166 women with borderline ovarian tumours (BOTs) and 592 women with ovarian cancer (OC). A panel of three antibodies was used for immunohistochemistry: a polyclonal and two monoclonal antibodies. Serum TN was measured using the polyclonal antibody A‐371. Univariate survival analyses stratified for chemotherapy showed that positive tissue TN as demonstrated by the polyclonal antibody indicated a significantly longer overall survival (OS) (p = 0.0001) as well as cancer specific survival (CSS) (p < 0.0001). High serum TN was likewise found to imply longer OS (p < 0.0001) and CSS (p < 0.0001), whereas tissue staining with the two monoclonal antibodies failed to demonstrate any significant correlation with either survival type. Univariate Kaplan–Meier survival analysis performed on all OC cases showed a significantly longer OS (p = 0.0009) and CSS (p = 0.0006) for women with TN positive tumour tissue and in women with high serum TN levels (p < 0.0001 for both). However, in the multivariate Cox regression analysis, only serum TN was found to be an independent prognostic factor for OS (p = 0.01) and not for CSS (p = 0.08). In conclusion, our results predict that a positive TN expression of both tumour tissue and serum points to a more favourable outcome for OC patients.     

Cutaneous nocardiosis with discharging sinus clinically mimicking tuberculosis diagnosed by cytology

Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl–Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine‐needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine‐needle aspiration method of tissue diagnosis and scrape cytology.     

Echocardiography in the diagnosis of apical non-compaction associated with congenital heart diseases

Background

Isolated left ventricular non-compaction has been reported extensively. However, apical non-compaction of both ventricles and the interventricular septum (IVS) is not often reported in the literature. The objective of our study is to evolve the echocardiographic diagnostic criteria and to assess the types and impact of the associated lesions in “apical non-compaction”.

Methods and results

Seventy consecutive cases that fulfilled standard echocardiographic criteria for non-compaction of the left ventricle and, in addition, N/C ratio of >3 for the right ventricle and apical IVS formed the material. The age of patients ranged from 3 days to 35 years, with 37 males and 33 females. The associated lesions were present in all 70 cases: 62 had acyanotic (88.6 %) and 8 had cyanotic congenital heart diseases (11.4 %). Of the 70 cases, 18 had pump failure (25.7 %): 8 cases had left ventricular dysfunction, 7 had right ventricular dysfunction, and 3 had biventricular dysfunction; 33 (47.1 %) had pulmonary hypertension, 2 (2.9 %) had thrombus, and 1 (1.4 %) had tachyarrhythmia. Pump failure was worsened by volume overload in 33.9 % and by pressure overload in 8.1 % of cases. Some very rare lesions were detected. All 70 cases had Swiss cheese appearance of the apical half of the IVS, looking like the delta of a river.

Conclusion

All of the apical non-compaction syndrome cases had associated lesions, mostly acyanotic congenital heart disease with volume overload, rather than obstructive lesions. Transthoracic echocardiography plays an important role in the diagnosis of apical non-compaction syndrome and associated lesions that worsen the pump failure.     

Vitamin D Deficiency in a Tropical Country — Treatment and Prevention in Children

Vitamin D has an important role to play in skeletal and extraskeletal health. Inspite of being a sun rich country, India has widespread vitamin D deficiency. Vitamin D deficiency can lead to serious consequences like hypocalcemic seizures and increased risk of respiratory tract infections in neonates and infants. International expert groups advocate universal supplementation for non-formula fed infants, pregnant and lactating women and those at risk of deficiency. A body of literature on vitamin D status in India is being generated, which may guide clinical practice in our country. Treatment of deficiency must be undertaken with minimally effective doses to avoid the risk of toxicity. Sensible sunshine exposure should be encouraged to facilitate vitamin D production from natural sources.     

Primary Extracranial Meningioma: The Royal Pearl Experience

The extracranial occurrence of meningioma, which is a tumour of the central nervous system, is rare. Two cases of primary extracranial meningioma of the psammomatous variant are reported here. Both cases were managed successfully by endoscopic endonasal approach. Literature has been reviewed and their clinicopathological features are described.     

A New Lead for Transvenous Atrial Pacing and Sensing Clinical and Electrophysiological Experiences

The Medtronic 6961 lead has been used in 14 patients for transvenous atrial sensing and/or pacing. This lead is furnished with small tines of silicone rubber at the distal end. The conductor coil material is space wound for flexibility. Thus, the lead lacks intrinsic elasticity and can be fastened within the right atrial appendage without a preformed J-shape. The clinical experiences with the lead are encouraging. The lead is easier to introduce and position in the right atrial appendage than the previously used tined J-shaped leads (Medtronic 6991). The small size of the new lead makes the choice of vein less critical and a normally-sized external jugular or cephalic vein permits the use of the same vessel for a second ventricular lead. By means of a lead extension wire, consecutive determinations of the P-wave amplitude, stimulation threshold of the right atrium, electrode resistance, and P/QRS-ratio were made for four weeks following electrode insertion. The mean P-wave amplitude at insertion was 4.9 +/- 1.5 mV (mean +/- SD). There was a significant decrease to a lowest mean level of 309 +/- 1.1 mV after one week. From that time there were only small variations. In the supine position and with normal breathing there was a spontaneous variation of the P-wave amplitude of +/- 12%. The P-wave amplitude was influenced by body position and maximal breathing movements to a minor extent. The threshold of stimulation was 0.9 +/- 0.4 V after one week. Later there was a small decrease in the threshold which, however, still remained significantly higher than at the time of insertion. The total resistance of the electrode system was about 700 ohms and P/QRS-ratio about 4 +/- 3. During an observation time ranging from 4 to 11 months there were no electrode dislocations. The electrodes were connected to the intended pacemakers without complications. In conclusion, the transvenous endocardial atrial lead, Medtronic 6961, shows attractive and promising qualities. The electrophysiological data recorded are suitable for the pacemakers in use. The electrode definitely deserves further evaluation.