Performance of the preliminary definition of improvement in juvenile idiopathic arthritis patients treated with methotrexate: experience from Bangladesh

Objective: To evaluate the performance of Preliminary Definition of Improvement (PDI) in juvenile idiopathic arthritis (JIA) patients treated with methotrexate (MTX). Methods: This was a prospective observational study done in the paediatric department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during April 2005–August 2006. All the patients fulfilling the International League of Associations for Rheumatology classification criteria had the American College of Rheumatology core set of variables assessed at baseline and follow‐up at the 4th, 12th and 24th week of treatment. Variables in the core set are: (1) physician's global assessment of disease activity; (2) parents’ or patients’ global assessment of disease activity; (3) functional ability; (4) number of joints with active arthritis; (5) number of joints with limited range of motion; and (6) erythrocyte sedimentation rate. Patients were classified as improved or not improved according to PDI. The following definition of improvement was selected: 30% improvement from baseline in three of any six variables in the core set with no more than one of the remaining variables worsening by > 30%. Results: A total of 40 children with JIA, completed 6 months treatment. At the end of 6 months, most of the patients (92.5%) had been declared as improved according to PDI. Among the core set variables, active arthritis, physicians’ and patients’ global assessment of disease activity, detected the highest percentage of patients improved (92.5%) and functional assessment detected the lowest (37%). Conclusion: The PDI identified that a maximum number of JIA patients treated with MTX had improved.     

Plastic embedding in routine histology I: Preparation of semi-thin sections of undecalcified marrow cores

The preparation of sections of bone marrow cores in a routine histology laboratory requires decalcification and paraffin embedding, which produces shrinkage and considerable loss of cellular detail. This may be avoided by using plastic embedding procedures. This report describes a simplified routine procedure for using methylmethacrylate as a plastic embedding medium for the preparation of semi-thin sections of undecalcified bone marrow cores. A modification of the May-Grunwald-Giemsa stain is also given which provides good colour differentiation of various haematopoietic cells in the marrow. The method is simple, reproducible, requires no expensive equipment, and is suitable for routine processing of bone marrow biopsy cores in any histopathology laboratory.     

Prostatic adenocarcinoma with marked neuroendocrine differentiation

A case is presented of prostatic cancer with marked neuroendocrine differentiation. Double-labeled immunohistochemical staining was performed with prostate-specific antigen and Chromogranin A. Both antibodies were localized to some of the cancer cells with Paneth cell-like features. Furthermore, most of the cancer cells were positively stained with luminal cell marker CAM 5.2, suggesting that neuroendocrine cells originated from the prostatic luminal cells.