Plasma cell leukemia masquerading as ALL-L3--a case report

Plasma cell leukemia (PCL) is a rare type of plasma cell dyscrasia. It is diagnosed when circulating plasma cells (PC) are more than 20%. We present a case of PCL in a 62-year-old female. Peripheral smear revealed more than 80% atypical vacuolated plasma cells (Mott cells) almost mimicking Burkitt cells of Acute Lymphoid Leukemia-L3 (ALL-L3). Bone marrow aspirate revealed few mature myeloma cells for which a diagnosis of PCL was thought of. Serum electrophoresis showed a positive M-band and X-ray revealed lytic lesions over femur & pelvic bones. A final diagnosis of PCL was given.     

Frontline: Inhibition of allergen-induced pulmonary inflammation by the tripeptide feG: a mimetic of a neuro-endocrine pathway

Interactions between the neuro-endocrine system and immune system help maintain health. One interaction involves the superior cervical ganglia (SCG), which regulate the prohormone submandibular rat 1 (SMR1) produced by the submandibular gland (SMG). A peptide derived from SMR1, feG, has anti-inflammatory activity, and modification to D-isomer feG enhances bioactivity. We tested feG as a therapeutic agent for airways inflammation, using rats sensitized by OVA or Nippostrongylus brasiliensis (Nb). Treatment with feG but not fdG down-regulated OVA-challenge-induced increases in bronchoalveolar lavage (BAL)-derived macrophages, eosinophils and PMN (neutrophils) by 44%, 69% and 67%, respectively, at 24 h. We found that feG also reduced ICAM-1 on BAL-derived macrophages and eosinophils by 27% and 65%, and L-selectin on PMN by 55% following OVA challenge. Furthermore, feG but not fdG reduced the OVA-induced TNF increase in BAL fluid. We showed that feG also down-regulated both hyper-responsiveness to methacholine (by 27%) and microgranulomata formation in the lung parenchyma. In Nb-challenged rats, feG treatment inhibited ex vivo allergen-induced contraction of tracheal smooth muscle by up to 73%. In conclusion, feG, which is a mimetic of a peptide derived from a rat salivary gland prohormone, has anti-inflammatory properties in allergic airways inflammation in Brown-Norway rats. The role of the SCG-SMG neuro-endocrine pathway in allergic asthma and other inflammatory diseases requires additional study.     

Efficacy of a modified ultrafast Papanicolaou (UFP) stain for breast aspirates

Rapid assessment of fine needle aspiration smears has become popular. The goal is minimal time required and fastest turn around time for test results in breast aspirates. In the present study, fine needle aspiration smears from 100 cases of breast lump were stained by modified ultrafast Papanicolaou stain which consisted of the following changes from ultrafast Papanicolaou stain: (i) Use of Gill 's haematoxylin instead of Richard Allan haematoxylin, (ii) omission of orange G from cytostain. Wet fixed smears subjeted to May-Gruenwald and Giemsa stain and an air dried smear subjected to modified ultrafast Papanicolaou stain were compared. Smears stained by modified stain showed transparent cells with crisp nuclear features in a blood free background. Total time required in this staining was 130 seconds. Out of 100, diagnosis was inadequate in 5 cases. In 95 cases cytological diagnosis was as follows: 60 benign, 27 ductal malignancy and 8 of inflammatory lesions. There was 100% agreement in cytologic diagnosis offered on smears stained by May-Gruenwald and Giemsa and modified ultrafast Papanicolaou stain.     

Comparison of developmental endothelial locus-1 angiogenic factor with vascular endothelial growth factor in a porcine model of cardiac ischemia

BACKGROUND: This study compared the angiogenic effects of developmental endothelial locus-1 (DEL-1), vascular endothelial growth factor (VEGF), as well as the negative control, beta-galactosidase (beta-gal), in a porcine model of cardiac ischemia. METHODS: Twenty pigs underwent left circumflex artery occlusions. After 3 weeks, the animals received myocardial injections of adenovirus expressing beta-gal (n=6), DEL-1 (n=7), or VEGF (n=7). At 7 weeks, animals were assessed for both function and coronary flow and compared with baseline measurements. RESULTS: Regional wall motion index and global ejection fraction showed deterioration in function in the beta-gal group and no change in the VEGF and DEL-1 groups between the treatment and harvest time points. Preload recruitable stroke work suggested functional improvement in the VEGF group (35.8 +/- 8.6 vs 56.4 +/- 17.8, p = 0.033). The increase in the DEL-1 group was not statistically significant (27.3 +/- 9.8 vs, 40.2 +/- 19.4, p = 0.067). The beta-gal group exhibited minimal change (30.7 +/- 14.8 vs 35.9 +/- 12.1, p = 0.96). Regional blood flow as assessed by fluorescent microspheres was improved under stress conditions in the VEGF group (1.00 +/- 0.15 vs 1.15 +/-0.22, p = 0.03). CONCLUSIONS: Treatment with VEGF led to a modest improvement in regional blood flow and cardiac function in previously ischemic myocardial tissue.     

Adsorption of nickel on flyash in natural and acid treated forms

Studies on removal of Ni2+ by adsorption on flyash and acid treated flyash have been carried out at room temperature (30+/-1 degrees C). The adsorption isotherm of Ni2+ on flyash and acid treated flyash was obtained in a batch reactor. Various parameters such as pH, initial concentration of adsorbate and adsorbent dose were studied. The experimental adsorption data fitted reasonably well to Langmuir, Freundlich and Redlich - Peterson isotherms for both the adsorbents. The adsorption follows Lagergren first order kinetic model. The monolayer adsorption model are found to be 41.7 and 62.9 mg/g respectively. Acid treated flyash has been observed to have greater adsorptive capacity than flyash in natural form.     

Acute Renal Failure after Cesarean Section

Urinary ascites is a rare diagnosis, commonly associated with bladder rupture. We present a case of intraperitoneal bladder injury following a Cesarean section with subsequent development of urinary ascites. Initial laboratory data with elevated serum creatinine and blood urea nitrogen (BUN) raised the suspicion for acute kidney injury due to the recent obstetrical procedure. This case highlights the importance of including intraperitoneal bladder injury with urinary ascites as a key differential in the workup of acute renal failure, particularly in the obstetric surgical setting. The rapid development of ascites with elevated serum BUN and creatinine should prompt work up for evaluating intraperitoneal bladder injury. Early diagnosis and treatment can yield gratifying results and avoid unnecessary workup of other causes of renal failure.     

Cervical carcinogenesis and contraception

Cytologic evaluation of cervical smears has been carried out in 3,374 women who used different modes of contraception (Lippes loop, copper T200, copper T220, copper devices containing higher copper content than the copper T200, Cu T380 Ag, levonorgestrel IUD, injections of noresthisterone oenanthate, and subdermal implants of levonorgestrel) under the Contraceptive Testing Programme of Indian Council of Medical Research for periods ranging from 6 months to 15 yr. While no case of severe dysplasia or malignancy was noticed with any type of contraceptive, 113 dysplastic smears (99 mild and 14 moderate) were encountered on follow-up, giving an incidence of 3.3%, which was statistically insignificant compared with the pretreatment incidence of 1.4% (47 of 3,374). The highest incidence of dysplasia was seen with devices containing a high copper content (9.2%), followed by CuT200 (6.1%) and levonorgestrel implants (4.2%), and was lowest with Lippes loop (1.8%), injection of noresthisterone oenanthate (1.7%), and CuT380 Ag (1.5%), but statistics higher than the pretreatment incidence of 1.4% were seen only with CuT200 and devices containing high copper content. Retrogression of dysplasia was seen in 85 of the 94 posttreatment dysplasia cases and in all 47 pretreatment dysplasia cases, whereas in the remaining nine posttreatment cases of dysplasia the lesion persisted for 6-12 mo, necessitating discontinuation of contraception. The accumulated follow-up data indicate that the CuT380 Ag device is a promising IUD for the future in view of its low incidence of dysplasia determined during its use up to 5 yr. However, more prolonged follow-up in larger numbers of subjects is required to confirm its innocuosness on long-term retention.