Non-Tropical Idiopathic Splenomegaly (Dacie's Syndrome)

We describe 5 patients, aged 22–69 years, with massive splenomegaly of unknown origin and features of hypersplenism. Splenectomy corrected the cytopenia(s) and abolished the symptoms in each case; the histological features of the spleen were non-specific and included congestive changes and lymphoid hyperplasia. 2 of these patients developed non-Hodgkin's lymphoma (NHL) 2 and 6 years after spenectomy. A total of 46 cases of splenomegaly of unknown origin have been reported from UK, USA, and Australia so far, and in 9, NHL developed 8 to 80 months after splenectomy. The questions relating to the pathogenesis of splenomegaly and the subsequent development of NHL remain to be answered. We propose that this ‘entity’ be known as Dacie's syndrome, after Sir John Dacie who characterised it in 1969.     

Metastatic adenoid cystic carcinoma to the kidney in a young woman

The incidence of an adenoid cystic carcinoma on major salivary glands is low, constituting only about 10% to 15% of all parotid malignancies. Cases of delayed metastasis have been reported, but reports of specific renal involvement have not been extensively found. We present the case of a 21-year-old woman with a left renal metastasis from an adenoid cystic carcinoma of the parotid gland that had been surgically treated 7 years previously. The patient underwent successful left radical nephrectomy. During follow-up, the patient developed pulmonary nodules that were metastatic adenoid cystic carcinoma and were surgically excised. At last follow-up, the patient was doing well with no evidence of disease.     

Intrathoracic manifestations in non-Hodgkin''s lymphoma.

A total of 16 of 86 patients (19%) with non-Hodgkin's lymphoma were found to have intrathoracic disease in this retrospective study. Paratracheal, mediastinal, and hilar lymphadenopathy was the commonest manifestation followed by pulmonary lesions and pleural effusion. The lymphoma was at an advanced clinical stage in all the patients with intrathoracic disease. About one-third of the intrathoracic lesions first developed at the time of relapse after successful initial therapy. There was a better response to therapy when intrathoracic disease was part of the initial presentation than when it was a manifestation of relapse. If it did not respond to therapy it was always indicative of a poor prognosis.     

Comparison of viral load and duration of virus shedding in symptomatic and asymptomatic neonatal rotavirus infections

A single rotavirus strain causing asymptomatic infections as well as severe gastrointestinal disease has been described in the neonatal nurseries of the Christian Medical College, Vellore. In this study, quantitative real‐time RT‐PCR was used to determine the association of viral load with the presence of gastrointestinal symptoms in neonates. Viral load was estimated in terms of the crossing point [C(t) value] at which the amplicon could be detected in the real‐time PCR assay. The study was carried out on 103 neonates, including 33 asymptomatic neonates and 70 neonates with different gastrointestinal symptoms. The duration of virus shedding was also compared between five symptomatic and four asymptomatic neonates using real‐time RT‐PCR. There was no significant difference in viral load between symptomatic and asymptomatic neonates (P = 0.087). Among neonates with different gastrointestinal symptoms, those presenting with feed intolerance and abdominal distension had a significantly higher viral load than those with other gastrointestinal symptoms (P = 0.02). For the study on virus shedding, nine neonates were followed up for a median duration of 53 days, with a median of 31 samples tested per child. Extended shedding of low copies of rotavirus was found, with no significant differences in pattern of shedding between symptomatic and asymptomatic neonates. The lack of correlation between viral load and gastrointestinal disease demonstrates yet another difference between neonatal rotavirus infection and infection in older children where higher viral load correlates with severe disease. J. Med. Virol. 82:1803–1807, 2010. © 2010 Wiley‐Liss, Inc.