in congestive cardiac failure, the authors mention the possibility that an as yet unidentified pyrogenic steroid allied to etiocholanolone may play an important role. However, the oruy study of lHaSI1lU levels ul trus steroid in patients with congestive cardiac failure as yet published gave no support to this suggestion. The only original work of the authors appears to relate to a study of intestinal absorption in 22 patients with congestive cardiac failure. Although demonstrating some evidence of malabsorption, the results are difficult to interpret because of a markedly deranged circulatory state and impaired renal ru nctrun. The question of protein-losing gastroenteropathy is briefly mentioned. After spending an hour with this little book, one wonders why it was published as a monograph and not merely as a paper on \"Intestinal Absorption Studies in Congestive Cardiac Failure\".

Bailey & Love's Short Practice of Surgery

Working at night results in a misalignment between the sleep-wake cycle and the output of the hypothalamic pacemaker that regulates the circadian rhythms of certain physiologic and behavioral variables. We evaluated whether such physiologic maladaptation to nighttime work could be prevented effectively by a treatment regimen of exposure to bright light during the night and darkness during the day. We assessed the functioning of the circadian pacemaker in five control and five treatment studies in order to assess the extent of adaptation in eight normal young men to a week of night work. In the control studies, on the sixth consecutive night of sedentary work in ordinary light (approximately 150 lux), the mean (=SEM) nadir of the endogenous temperature cycle continued to occur during the night (at 03:31 ±0:56 hours), indicating a lack of circadian adaptation to the nighttime work schedule. In contrast, the subjects in the treatment studies were exposed to bright light APROXIMATELY 7.3 million Americans work at night, either on permanent shifts or on schedules, requiring a rotation of day, evening, and night work.' These workers forgo nocturnal sleep and then attempt :o sleep during daylight hours. Yet, as Benedict first noted at the turn of the century, a complete physiologic adaptation of endogenous circadian rhythms to such inversion of the daily routine does not occur=; even after years of permanent nighttime work.' -6 Physiologic maladaptation to an inverted schedule results in diminished alertness and performance during nighttime work, with attendant increases in the number of fatigue-related accidents during nighttime hours.' Then, despite the nocturnal depri From the Center for Circadian and Sleep Disorders Medicine, Division of Endocrinology, Department of Medicine. Harvard Medical School, Brigham and Women's Hospital. Boston (C.A.C., M.P.J., J.F.D., E.N.B., J.M.R.); and the Division of Applied Sciences. Harvard University, Cambridge, Mass. (R.E.K.). Address reprint requests to Dr. Czeisler at the Center for Circadian and Sleep Disorders Medicine, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA 02115. Supported in pan by research and raining grants (DRR-GCRC-5-MO1RR00888, DRR-BRSG-2-S07-RR05950. N1A-1-ROl-AG06072. NIMH-1-R01MH45130, N1DDK-5-T32-OK-07529) from the National Institutes of Health, by Brigham and Women's Hospital, and by the Center for Design of Industrial Schedules, a nonprofit service organization directed by Dr. Czeisler. 12,000 lux) at night and to nearly complete darkness during the day, and the temperature nadir shifted after four days of treatment to a significantly later, midafternoon hour (14:53±0:32; P<0.0001), indicating a successful circadian adaptation to daytime sleep and nighttime work. There were concomitant shifts in the 24-hour patterns of plasma cortisol concentration, urinary excretion rate, subjective assessment of alertness, and cognitive performance in the treatment studies. These shifts resulted in a significant improvement in both alertness and cognitive performance in the treatment group during the night-shift hours. We conclude that mal aidaptation of the human circadian system to night work, with its associated decline in alertness, performance, and quality of daytime sleep, can be treated effectively with scheduled exposure to bright light at night and darkness during the day. (N Engl J Med 1990; 322:1253-9.) vation of sleep, these workers typically experience daytime insomnia. 10-14 Long-term exposure to variable work schedules that include work at night is also associated with an increased risk of cardiovascular disease, gastrointestinal illness, reproductive dysfunction in women, and sleep disorder.' 5-18 Improvements in performance and well-being have been achieved as a result of modifications in work-schedule design, 14 but true physiologic adaptation to night work under field conditions has not previously been demonstrated. During the past 20 years, considerable progress has been made in understanding the underlying neurophysio!ogic processes that regulate adaptation to the periodic aspects of the external environment. Studies involving ablation, transplantation, and other procedures have demonstrated that the suprachiasmatic nuclei of the hypothalamus serve as the principal pacemaker of the circadian timing system in mammals. l9-21 A specialized retinohypothalamic tract links the retina to these nuclei, forming a nonvisual photoreceptive system that mediates the synchronization, or entrainment, of the circadian pacemaker with the light-dark cycle.22 Even though corresponding structures subserving rhythmicity and photic entrain

From New England

This Practical Guidance for Clinical Microbiology document on the laboratory diagnosis of parasites from the gastrointestinal tract provides practical information for the recovery and identification of relevant human parasites. The document is based on a comprehensive literature review and expert consensus on relevant diagnostic methods. However, it does not include didactic information on human parasite life cycles, organism morphology, clinical disease, pathogenesis, treatment, or epidemiology and prevention. As greater emphasis is placed on neglected tropical diseases, it becomes highly probable that patients with gastrointestinal parasitic infections will become more widely recognized in areas where parasites are endemic and not endemic. Generally, these methods are nonautomated and require extensive bench experience for accurate performance and interpretation.

Practical Guidance for Clinical Microbiology Laboratories: Laboratory Diagnosis of Parasites from the Gastrointestinal Tract

Wheater's Functional Histology: A Text and Colour Atlas

Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous tumor that present considerable challenges due to its size and deep location. As a consequence, the majority of patients with high-grade RLS will develop locally recurrent disease following surgery, and this constitutes the cause of death in most patients. Here, we review current insights and controversies regarding histology, molecular biology, extent of surgery, (neo)adjuvant treatment, and systemic treatment including novel targeted agents in RLS.

https://biblio.ugent.be/publication/7098540/file/7098573.pdf

Retroperitoneal liposarcoma: current insights in diagnosis and treatment.

Oncocytes are epithelial cells with abundant, granular, eosinophilic cytoplasm due to presence of numerous large mitochondria of varied sizes. The presence of oncocytes in salivary glands can occur in a variety of conditions. Here, we present a rare case of a 68 year old male patient who presented with a 6 cm diameter swelling in the right parotid region. A fine needle aspiration cytology done from the lesion showed a cellular oncocytic lesion. A possibility of oncocytoma was entertained. Histopathology of the mass showed a rare entity called diffuse hyperplastic oncocytosis. Originally believed to be a metaplastic process, oncocytes can occur in various lesions ranging from hyperplastic conditions to malignant neoplasms. However, diagnosis on cytological smears can be very challenging for the cytopathologist.

Oncocytic lesion of parotid gland: A dilemma for cytopathologists.

Background : An ailing, unresponsive health system and the existing social complexities, with considerable contextual differences, are all pervasive in India. In health, these are manifested as differences in morbidity and mortality, severely affecting child health and survival. Objectives: To find out the possible factors affecting the health-seeking behavior of mothers with regard to their children, in a rural community of Darjeeling district, and the reasons for not seeking curative care for perceived sick children. Materials and Methods: A cross-sectional, community-based study among the mothers of the Naxalbari Block was undertaken, using a multistage random sampling technique, from June to August 2011, by using the questionnaire method. A total of 256 mothers (sample size) were studied. Results: Joint family structure, mass media exposure, literacy status, socioeconomic status of mothers, and gender differences among children were found to be significantly associated with the healthcare-seeking behavior of the mothers. Conclusion: Increasing maternal education, intensified awareness generation through the mass media approach, implementing gender-sensitive interventions, and counseling, may have positive implications in future, leading to better health outcomes and favorable health indicators.

Factors affecting the healthcare-seeking behavior of mothers regarding their children in a rural community of Darjeeling district, West Bengal

Context: Computerized tomography (CT) guided fine needle aspiration cytology (FNAC) of lung lesions has rapidly emerged as a less-invasive, cheap, rapid and fairly accurate diagnostic aid in lung lesions. Aims: The purpose of this present study was to evaluate the effectiveness of CT-guided FNAC in the diagnosis of pulmonary mass lesions (both benign and malignant) and to determine the complication rate of this procedure. Settings and Design: We conducted an institution-based, prospective study on 127 patients who presented with pulmonary mass lesions. Materials and Methods: After proper consent was obtained, CT-guided transthoracic fine needle aspiration was done and their diagnoses were confirmed by appropriate methods. The results were analyzed statistically. Results: Out of 127 cases selected for the study, 59.8% were males while the rest were females. Cough was the most common symptom present in 71.2% cases, followed by weight loss (62.4%). 21.2% cases were cytologically benign. Adenocarcinoma (54.2%) was the commonest malignant tumor. FNAC provided at least 96% sensitivity and 100% specificity in diagnosing lung tumors. Among the benign lesions, specific diagnoses were obtained in 48.1% cases. Thus, altogether a specific diagnosis was obtained in 109 of 127 cases, i.e. 85.8%. No major complication was noted. Conclusions: CT-guided FNAC is an extremely valuable and fairly accurate diagnostic aid of intrathoracic mass lesions, with a reasonable rate of complication.

Computed tomography guided fine needle aspiration cytology of mass lesions of lung: Our experience

Background and Objectives: Beta-thalassemia continues to be a cause of significant burden to the society particularly in the poorer developing countries. Although sophisticated methods of screening have become available, a hunt for a cheap, rapid, objective screening method still remains elusive. Thus, the objectives are to study the validity of Naked-Eye-Single-Tube-OsmoticFragility-Test (NESTROFT) in detection of beta-thalassemia carrier state, to assess the prevalence of beta-thalassemia trait among antenatal mothers in the region and also to find out the effect of concurrent iron deficiency on the hematological parameters in these cases. Materials and Methods: A total of 500 antenatal mothers in a rural tertiary care hospital were selected for the study. Their blood samples were subjected to NESTROFT, complete hemogram, reticulocyte counts and hemoglobin variant studies by electrophoresis and by high pressure liquid chromatography (HPLC). Serum ferritin estimation was done in cases diagnosed as beta-thalassemia trait. The results were analyzed statistically. Results: A prevalence of 3.4% of beta-thalassemia trait and 0.6% of E-beta-thalassemia were observed among the study population. NESTROFT showed an overall sensitivity and specificity of 95% and 95.8% respectively in detection of heterozygous and double heterozygous states of beta-thalassemia. The various RBC indices were significantly (P <0.05) lower in carriers with concurrent iron deficiency. A co-existent iron deficiency did not preclude a diagnosis of betathalassemia carrier state. Conclusions: NESTROFT appears to a valid test in rural setting with financial constraints. The hematological parameters in iron deficient beta-thalassemic carriers significantly differed from their iron replete counterparts but did not cause problem in diagnoses.

https://ijp.iranpath.org/article_8399_db997dabcfb868dd9db46f56d0ec0757.pdf

Beta-Thalassemia Carrier Detection by NESTROFT: An Answer in Rural Scenario?

Ascariasis is the commonest helminthic infection in humans, caused by the nematode Ascaris lumbricoides. The adult worms usually reside in the small intestine. Rarely, they migrate into the bile duct and pancreatic ducts, but involvement of the gall bladder and/or liver parenchyma is extremely rare. Here, we describe a case of a 32-year-old woman who presented with fever, anorexia, right upper quadrant pain and mild hepatomegaly. Ultrasonography revealed a liver abscess and a concurrent moving adult worm in the gall bladder. Fine-needle aspiration cytology (FNAC) from the liver abscess showed presence of fertilized eggs of Ascaris lumbricoides. A diagnosis of gall bladder and hepatic ascariasis was made. The patient responded well to conservative management. Ascaris-induced liver abscess with concurrent living adult worm in gall bladder has rarely been reported. Ultrasonography and FNAC are important diagnostic modalities for detection of such lesions. Conservative management appears to be the treatment of choice for hepatobiliary ascariasis.

Indranil Chakrabarti

Papers

Oncocytic lesion of parotid gland: A dilemma for cytopathologists.

Factors affecting the healthcare-seeking behavior of mothers regarding their children in a rural community of Darjeeling district, West Bengal

Computed tomography guided fine needle aspiration cytology of mass lesions of lung: Our experience

Beta-Thalassemia Carrier Detection by NESTROFT: An Answer in Rural Scenario?

Radio-pathological diagnosis of hepatobiliary ascariasis: A rare entity