IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
ABSTRACT- Introduction- Follicular hyperplasia of the gall bladder is an extremely rare and benign entity characterized by hyperplastic lymphoid follicle with germinal center consisting of the lymphoid population.
Methods and Materials- We were reported a rare case of follicular hyperplasia of gall bladder in a 36 yrs old female presented into the department of surgery with a right side upper abdomen pain then she was diagnosed as cholecystitis and managed by cholecystectomy and specimen was received and processed for histopathological examination.
Results- Due to chronic cholecystitis patient present with right upper abdominal pain and upon histopathological examination diagnosed incidently as follicular cholecystitis.
Conclusion- Histopathological examination reveals a rare case of follicular cholecystitis.
Key-words- Follicular cholecystitis, Gall Bladder, Pseudolymphoma
02 Presentations Ii Vs (14 4 Mb) (3 30 08)vshidham
Part II of Four part symposium: “Diagnostic Cytopathology of Serous Effusion” on April 19, 2007 at Neenah, WI, USA
(2008 Wisconsin Society of Cytology, 40th Anniversary)
ABSTRACT- Introduction- Follicular hyperplasia of the gall bladder is an extremely rare and benign entity characterized by hyperplastic lymphoid follicle with germinal center consisting of the lymphoid population.
Methods and Materials- We were reported a rare case of follicular hyperplasia of gall bladder in a 36 yrs old female presented into the department of surgery with a right side upper abdomen pain then she was diagnosed as cholecystitis and managed by cholecystectomy and specimen was received and processed for histopathological examination.
Results- Due to chronic cholecystitis patient present with right upper abdominal pain and upon histopathological examination diagnosed incidently as follicular cholecystitis.
Conclusion- Histopathological examination reveals a rare case of follicular cholecystitis.
Key-words- Follicular cholecystitis, Gall Bladder, Pseudolymphoma
02 Presentations Ii Vs (14 4 Mb) (3 30 08)vshidham
Part II of Four part symposium: “Diagnostic Cytopathology of Serous Effusion” on April 19, 2007 at Neenah, WI, USA
(2008 Wisconsin Society of Cytology, 40th Anniversary)
Primary Follicular Lymphoma of the spleen: A Case report and literature reviewiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Spindle cell neoplasms usually occur in head, neck, orbit, soft tissues of scalp and along the upper aerodigestive tract. They are relatively uncommon in lower gastrointestinal tract and represent a distinct clinical entity. Increased awareness is required among colorectal surgeons and pathologists due to their benign nature & uncertain etiology, to avoid misdiagnosis of rectal cancer. Definitive diagnosis necessitates immunohistochemical analysis. We present an unusual case of spindle cell neoplasm of rectum in an asymptomatic elderly gentleman, detected on screening colonoscopy. Following thorough evaluation with MRI pelvis, CT scan thorax, abdomen, pelvis with contrast and multidisciplinary meeting discussion (MDT) at our institution, he was successfully treated with a specialized minimally invasive approach (TAMIS). Histopathology with immunohistochemistry confirmed the diagnosis of spindle cell neoplasm. As they are uncommon in colorectum & non-invasive, management and long-term follow-up is still under study. These lesions should be differentiated from other stromal tumours in GIT.
Primary Follicular Lymphoma of the spleen: A Case report and literature reviewiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Spindle cell neoplasms usually occur in head, neck, orbit, soft tissues of scalp and along the upper aerodigestive tract. They are relatively uncommon in lower gastrointestinal tract and represent a distinct clinical entity. Increased awareness is required among colorectal surgeons and pathologists due to their benign nature & uncertain etiology, to avoid misdiagnosis of rectal cancer. Definitive diagnosis necessitates immunohistochemical analysis. We present an unusual case of spindle cell neoplasm of rectum in an asymptomatic elderly gentleman, detected on screening colonoscopy. Following thorough evaluation with MRI pelvis, CT scan thorax, abdomen, pelvis with contrast and multidisciplinary meeting discussion (MDT) at our institution, he was successfully treated with a specialized minimally invasive approach (TAMIS). Histopathology with immunohistochemistry confirmed the diagnosis of spindle cell neoplasm. As they are uncommon in colorectum & non-invasive, management and long-term follow-up is still under study. These lesions should be differentiated from other stromal tumours in GIT.
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
Multiple Hepatic and Osseous Focal Lesions without Splenomegaly and/or Lymph ...JohnJulie1
Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in diagnosis of hepatic focal lesions.
Papillary Hidradenoma is a rare benign tumor of apocrine glands. Very limited number of case reports are available in the literature detailing the cytological features of papillary hidradenoma. Such a rare case specimen came in notice here at Pathology Department of SMS Medical College, Jaipur (Raj.) India. So, one such a rare case of papillary hidradenoma was explored with its cytological findings. A 30 year old female presented with a vulval cyst. Fluid from this cyst was sent for cytology with a clinical diagnosis of Bartholin cyst. The cytology suggested it to be a benign adnexal tumour by the presence of Biphasic pattern of cell arrangement which was further confirmed histologically. So whenever an middle aged female presents with a nodular lesion in the anogenital area, hidradenoma papilliferum should be kept in mind along with other conditions.
Leiomyomas are smooth muscle tumors that are common to the uterus. These lesions include a range of presentations and extensions ranging from within the uterus to anywhere in the body, including parasitic leiomyoma, intravenous leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. However, these atypical locations of these tumors present a diagnostic dilemma regarding their nature and benignity. Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease of unknown etiology of women in reproductive age group. A few reported cases of association with endometriosis have been described, suggesting a possible origin from submesothelial multipotent cells. Here, we present a case of a reproductive age group woman with history of uterine fibroids, now presenting with vague abdominal symptoms and multiple benign leiomyomas scattered throughout the peritoneal cavity. A diagnostic laparoscopy was done and the lesions sampled, which confirmed the imaging diagnosis of disseminated peritoneal leiomyomatosis. We stress the importance of picking up this rare benign pathology and avoiding labeling them as malignant peritoneal disease.
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Dehradun #ℂall #gIRLS Oyo Hotel 9719300533 #ℂall #gIRL in Dehradun
Histopathological Correlation of Lymph Nodes Imprints
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. IV (Nov. 2015), PP 101-105
www.iosrjournals.org
DOI: 10.9790/0853-14114101105 www.iosrjournals.org 101 | Page
Histopathological Correlation of Lymph Nodes Imprints
Dr. Piyali Kundu1
, Dr. Debarati Pathak2
, Dr. Seema Mondal3
, Dr. Moulik
Debnath4
, Dr. Sanchita Saha5
, Dr. Tushar Kanti Saha6
1
(Demonstrator, Dept. of Pathology, I.P.G.M.E&R.); {2
(Demonstrator) 3
(Asst. Prof.) Dept. of Pathology,
Burdwan Medical College & Hospital}; {4
(Asst. Prof.) Dept. of Anatomy, 5
(Asst. Prof.) Dept. of Medicine}
Murshidabad Medical College & Hospital; 6
(Asst. Prof.) Dept. of Community Medicine, North Bengal Medical
College & Hospital6
Abstract:
Introduction: This study was done to evaluate the role of imprint smear cytology in various diseases affecting
the lymph nodes. A correlation was done between the imprint smear cytology and histopathology to assess the
accuracy and reliability of the imprint cytology in different lymph node lesions. Methods: From 52 cases of
lymph node excision, imprint smears were taken and stained with PAP, H & E and MGG. The findings in
imprints were compared with those of histopathology. With the help of sensitivity, specificity & kappa (k) score,
the agreement between the two methods was determined. Results: Among the total 52 cases of imprint smears,
44 cases from breast carcinoma were reactive, among them 8 cases turned positive in histopathological section
but negative in imprint. So, total reactive cases were 36.Out of the cases suspected to be Non-Hodgkin’s
lymphoma in imprint, 1 small cell lymphoma in imprint was finally diagnosed as mantle cell lymphoma in
histology, & 1 large cell lymphoma in imprint was finally diagnosed as diffuse large B cell lymphoma in
histology, 4 other cases were turned to be reactive in both imprint and HP. Hence the total reactive cases were
40.One (1) metastatic carcinoma from colon & 1 from gallbladder carcinoma were correctly diagnosed by
imprint. Interpretation and Conclusion: Imprint smears showed almost perfect agreement in majority of the
lesions. The technique was simple, rapid and can be used routinely as an adjunct to histopathology of lymph
node lesions.
Keywords: Imprint smear, Lymph node, Non-Hodgking’s lymphoma
I. Introduction
The imprint cytology had been in use as a rapid and standard method for diagnosing lymph
adenopathies since several years. Forkner was the first person to utilize imprint technique for cyto-diagnosis in
lesions of excised lymph nodes.
In the later half of the 19th century various studies published on imprint cytology of lymph nodes had
proved it to be an useful adjunct for histopathological diagnosis of inflammatory, granulomatous, lymphomatous
and metastatic lesions of lymph nodes.
II. Materials & Methods
The material for this study was taken from 52 patients in R.G. Kar. Medical College who underwent
lymph nodes excision biopsy. Clinical data collected in each case were: Age and sex, Signs and symptoms, Sites
of lymph nodes involved, associated clinical findings, relevant investigation.
The excised lymph nodes were transported immediately to the laboratory. The gross features of the node were
noted like: Size & Appearance of outer surface.
After describing the gross features, it was sliced into two halves. The sliced half was held gently either
with forceps or with one hand so that the flat cut surface faced upwards; with the other hand, using grease free
clean glass slides, four imprint smears were prepared. The lymph node was then fixed in neutral formalin and
processed for histopathological examination. Wet fixed smears were stained with PAP and H & E. The air dried
smear was stained by MGG stain. Special stains such as AFB stain, reticulin were also done in certain cases.
The stained smears were assessed for the following features:
1. Cellularity: Hypo-cellular - if number of lymphocytes < 50/smear
Moderately cellular - if number of lymphocytes = 50/smear
Hypercellular - if number of lymphocytes > 50/ smear
2. Distribution: Monotonous or Polymorphous
3. Cell Types: Reactive lymphoid cells, Tingible body macrophages, Atypical lymphophoid cells, Granuloma,
Foreign cell.
According to the finding as noted the lesions were classified into a particular type of lesion .The
accuracy of imprint diagnosis was determined by comparing with the corresponding histopathological diagnosis.
2. Histopathological Correlation of Lymph Nodes Imprints
DOI: 10.9790/0853-14114101105 www.iosrjournals.org 102 | Page
The diagnosis that agreed with the histopathological diagnosis was considered accurate and overall accuracy
rate or sensitivity & specificity was calculated. The sensitivity for each condition of lymph nodes was
calculated. The agreement between the imprint smear diagnosis and histopathological diagnosis was calculated
using kappa score.
III. Results
In our study, out of 52 cases – 2 were metastatic and another 2 were lymphoma. Grossly the metastatic
lymph nodes were enlarged in size. Outer surface was grey, cut surface chalky white in colour. The signs and
symptoms of two metastatic diseases were nonspecific, mimicking chronic cholecystitis (pain, anorexia,
elevated alkaline phosphatase). Upper abdominal pain and increased serum alkaline phosphatase level were the
most common findings at presentation in case of gallbladder carcinoma metastatic (Fig 1 &2).12
Colorectal cancer was also asymptomatic for years; symptoms developed insidiously and frequently
had been presented for months, associated with clinical attention by the appearance of fatigue, weakness, and
iron deficiency anemia, occult bleeding, changes in bowel habit, or crampy left lower quadrant discomfort. Both
the cases were associated with enlarged lymph nodes (Fig 3&4).12
Most patients presented with fatigue and lymphadenopathy and were found to have generalized disease
involving the bone marrow, spleen, liver, and (often) the gastrointestinal tract, in mantle cell lymphoma.12
Total case = 52Actual reactive = (44 – 8) + 4= 36 +4= 40(8 cases in metastatic carcinoma were +ve in
histology but –ve in imprint.4 cases suspected of NHL turned to be reactive both in histology & imprint.).
Imprint smears of reactive lymph nodes showed mixed population of cells representing the whole range of
lymphocyte transformation, tingible body macrophages & associated with predominance of small lymphocytes
in cases of reactive lymph nodes.7
Histological section of reactive nodes showed follicles with different size and shape, the margins of
which were sharply defined, surrounded by mantle of small lymphocytes arranged circumferentially as an onion
skin pattern and consisting of admixture of small, large lymphoid cells with irregular nuclei, numerous mitosis
& tingible body macrophages(Fig & 6).8
NHL = 2 (Both histology & imprint +ve)
In imprint small cell lymphoma showed pleomorphic small cells with coarse clumped chromatin,
inconspicuous nucleoli, scanty cytoplasm and few prolymphocytes .7
Histology showed lymphoid cells
infiltrated as diffuse, vaguely nodular or nodula pattern where cells proliferated as broad mantles around
residual reactive germinal centres with coalescence and extention into the interfollicular regions. Proliferative
centres were absent butepitheloid histiocytes were seen.9
Imprint smear of DLBCL showed pleomorphic large cell population dominated by round nuclei,
unevenly distributed nuclear chromatin, prominent usually single central nucleoli, occationally multiple nucleoli
with moderate to abundant bluish cytoplasm.7
Histology of DLBCL showing lymphoid structure had been effaced by diffuse pattern of growth of
large cells, which had round to oval nucleus that appeared vesicular due to margination of chromatin to the
nuclear membrane, but large multilobated or cleaved nuclei Cells had moderately pale or basophilic cytoplasm
and prominent centrally or eccentrally placed nucleoli.10
Metastatic carcinoma = 2 (Both histology & imprint +ve)
Imprint smear of mucinous metastatic colonic adenocarcinoma (Figure-6) showed discohesive three
dimensional aggregates of tumor cells. Branching papillary fragments and microacinar areas might be present in
the pool of mucin. Cell groups showed loss of polarity
with crowded disorderly arrangement.
Tumor cells had round, oval or cigar shaped nuclei, and many single cells. There was a prominent
“dirty” tumor diathesis.14
Histologically metastatic lymph node of colonic adenocarcinoma showed glands or
irregular cluster of cells which were round to oval in shape, nuclei were uniform retained a basal location and
surrounded by mucus. 9
Imprints of gallbladder adenocarcinoma (Figure - 4) showed loosely structured clusters
of cancer cells with irregular large nuclei and very prominent nucleoli.11
Histologically metastatic lymph node
of gallbladder adenocarcinoma showed the cells which were arranged in nests, sheets, cords or tubular pattern
and had irregular shaped hyperchromatic nuclei, scanty ill defined cytoplasm with inconspicuous nucleoli.9
IV. Discussion
Imprint smear study was simple, speedy and provided excellent cytomorphological details. The imprint
smears were prepared from 52 freshly excised lymphnodes in ours study, we got 2 NHL and 2 metastatic deposit
out of 52 total cases. There were no cases of Hodgkin’s disease in the present study. The smears except for few
were adequate when assessed by quality of stain, cellularity and dispersion of cells.1,2,3
In our study among two cases (4%) : one was small cell lymphoma in imprint which was finally
diagnosed as Mantle zone lymphoma and other large cell lymphoma in imprint was identified as diffuse large B
cell lymphoma. Only two cases were too small for any comments. More number of cases needed to be studied.
3. Histopathological Correlation of Lymph Nodes Imprints
DOI: 10.9790/0853-14114101105 www.iosrjournals.org 103 | Page
Agarwal et al1
, Patra et al 2
, Ultman et al 4
, Nagpal et al 3
etc. had observed the same type of pathology e. g. –
lymphomas.
Agarwal et al1
& Nagpal et al3
observed an incidence 0f 10 to 14 %. The sensitivity in NHL among
workers viz. Agarwal, Patra, Ultman and Nagpal ranged between 3-7%, which was comparable to the present
study though the number of cases was low. Nagpal et al3
found that smears had an even distribution of cells,
with fewer distortions and good coloration of all cellular components providing maximal cytological details.
The examination of smears in such cases revealed uniform results.
Suen et al5
compared imprints and frozen sections of 198 lymph nodes. Their accuracy rate was 93.6%.
They emphasized the usefulness of imprint smears over lesions missed by frozen sections.
Nagpal et al3
also gave the importance of imprint smears compared to that of histopathological sections
and commented that, lymph nodes being cellular organs, were poorly fixed, for which taking of thin sections
became very difficult. Moreover there might be shrinkage of the cells.
In the present study histopathological sections were adequate for comments concerning histological
types. But this investigation was invaluable to diagnose the various categories that could help in the further
management.Of the 10 cases of metastatic lesions in lymph nodes only 2 cases were picked up by imprint
smears. Here the accuracy rate of 2 metastatic deposit was 20%.
In another study by Ultmann et al3
the accuracy for metastatic was found as 94%. They found that
diagnosis of secondaries in a lymph node from tumour else where in the body did not present any diagnostic
problem unless it was a sclerotic lesion. This was also observed in the present study. As the abnormal cancer
cells were invariably present in the smears which were absolutely foreign to the lymphoid elements the
detection did not cause any difficulty3
.
Wood WS et al5
commented that hypocellularity and in adequate material were the most probable
cause of false negative diagnosis in imprint. It occurred generally due to one of the following two reasons:
A. Insufficient cells - there was a dense fibrous stroma in some tumors, such as the linitis plastic type
of gastric carcinoma, the breast carcinoma, the gall bladder carcinoma, some fibrous soft tissue tumors etc. In
these cases the number of neoplastic cells transferred to the slide was insufficient to enlable the observer to
make a correct diagnosis.
B. Interpretative errors – these occurred in cytological well differentiated tumors.
This present study showed that the detection of cancer cells were difficult in cases where there was
extensive fibrosis, which was discernable in the histopathological sections of the particular lymph nodes. 8 cases
failed to reveal metastatic deposit due to extensive fibrosis in lymph nodes.
Hasenburg et al6
, Tatomirovie Zet et all,2,3
reported a sensitivity rate of 90 to 93% and Jain et al15
reported 100% sensitivity where they had included histopathology along with imprint for such comments. The
present study showed 100% sensitivity when histopathology is included. The fact of extensive fibrosis was
indeed a case of concern when only imprint smears were available for interpretation. The diagnostic sensitivity
was hampered by the fact that small metastatic deposits confined to the sub capsular sinus and single cell
metastatic was missed. However early micro metastases rarely produced significant lymph node enlargement
and a lymph node if palpable was likely to contain enough tumor tissues to be detected.7
Among the metastatic
lesions seen in our study the incidences were of metastatic mucinous adenocarcinoma of colon & poorly
differentiated adenocarcinoma of gall bladder.
The 52 samples of lymph nodes biopsies included in the study. During the period of study, lymph
nodes were excised after clinical diagnosis of neoplastic lesions. Only 12 cases showed neoplastic changes, the
rest showed reactive changes and thus acted as controls in the study. It was needless to point out that not all
lymph nodes draining malignant lesions would show incidence of metastatic deposits. Many might show only
reactive changes. Provision for these different stains in a country like ours should help in diagnosing the
pathology in quite a few instances.
V. Conclusion
Imprint cytology is a type of applied cytology. The imprint smears reveal very subtle diagnostic
changes in the various lymphoid cells and make it possible to arrive at a diagnosis in shorter period of time.
References
[1] Agarwal PK, Gosh M, Wahal KM, Mehrotra RML. Study of imprint smears of lymph nodes. Ind J. of Cancer. 1997; 14 : 157 – 163.
[2] Patra SP, Bhattacharya N, Mangal S. : FNAC, Imprint cytology and Histopathology for diagnosing diseases of lymph node. Journal
of cytology. 2003; 20 (3) : 124 – 128.
[3] Nagpal BL, Dhar CN, Singh A, Bahl RA. Evaluation of Imprint Cytodiagnosis in cases of Lymphadenopathy. Indian J. of Pathol
Microbiol. 1982; 25 : 35 – 39
[4] Ultmann JE, Koprowska I, Engle RL. A cytological study of lymphnode 18imprints Cancer, 1958; 11 : 507-24.
[5] Suen KC, Wood WS, Syed AA, Quenville NF, Clement PB : Role of imprint cytology in intra-operative diagnosis : value and
limitations. Journal of Clinical Pathology. 1978; 31 : 328 – 337.
4. Histopathological Correlation of Lymph Nodes Imprints
DOI: 10.9790/0853-14114101105 www.iosrjournals.org 104 | Page
[6] Hasenburg A, Ledet SC, Ardaman T, Levy T, Kieback DG. Evaluation of lymph nodes in squamous cell carcinoma of the cervix:
touch imprint cytology versus frozen section histology. International Journal of Gynecological Cancer. 1999; 9(4) : 337 – 341.
[7] Svante R. Orell, Gregory F. Sterrett, Darrei Whitaker. Fine Needle Aspiration Cytology. India: Elsevier; 2010.
[8] Juan Rosai. Rosai And Ackerman’s Surgical Pathology. China : Mosby Elsevier; 2011.
[9] Christopher D.M. Fletcher. Diagnostic Histopathology Of Tumors. China: Elsevier; 2007.
[10] Vinay Kumar, Abul K. Abbas et al. Robbins and Cotran Pathologic Basis Of Disease. India: Elsevier; 2010.
[11] Das DK. Tripathi RP, Bhambhani S et al. Ultrasound guided fine needle aspiration cytology diagnosis of gallbladder lesions : a
study of 82 cases. Diagn cytopathol 18 : 258- 264, 1998.
[12] N. Volkan Adsay, Geoffrey P. Altshuler et al . Sternberg’s Diagnostic Surgical Pathology. China : Wolters Kluwer Health; 2010.
[13] Feinberg MR., Bhaskar AG., Bourne P. Differential diagnosis of malignant lymphomas by imprint cytology. Acta Cytol. 1980;
24(1) : 16 – 25.
[14] Mans Akerman, Asmund Berner et al. Diagnostic Cytopathology. China : Elsevier; 2010.
[15] Jain P Kumar R, Anand M, Asthana S, Deo SV, Gupta R et al. Touch imprint cytology of axillary lymph nodes after neoadjuvant
chemotherapy in patients with breast carcinoma.Cancer. 2003; 99 (6) : 346 – 351
Figure – 1: Imprint Smear From Poorly Differentiated
Adeno Carcinoma, Gall Bladder ( MGGX400)
Figure – 2: H.P. Section From Poorly Differentiated
Adeno Carcinoma. Gall Bladder (H&E X 400)
Figure – 3: Imprint Smear In Metastatic Mucinous
Adeno Carcinoma Colon (MGGX 400)
Figure – 4: H.P. Section From Metastatic Mucinous
Adeno Carcinoma Colon (H&E X 400)
5. Histopathological Correlation of Lymph Nodes Imprints
DOI: 10.9790/0853-14114101105 www.iosrjournals.org 105 | Page
Figure – 5: Imprint Smear Of SLL (H & E X 400)
Cervical Lymph Node
Figure – 6: H.P. Section Showing Mantel Cell Lymphoma (H&EX400)