Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL)

To evaluate proprioceptive potential in residual remnants, tissue harvested from ruptured ACLs in 63 consecutive patients was examined for evidence of residual proprioceptive fibres using H&E, and monoclonal antibodies to S-100 and NFP (neurofilament protein). Histological examination showed good subsynovial and intra-fascicular vascularity with free nerve endings in the majority. Morphologically normal mechanoreceptors (H&E) and proprioceptive fibres (positivity with monoclonal antibody for NFP) were found in 46% and 52.4% of stumps, respectively. A statistically significant correlation between injury duration and persistence of mechanoreceptors and proprioceptive fibres was noted. More fibres were seen where ACL remnant was adherent to PCL. Our study has shown that persistent residual proprioceptive fibres in injured ACLs (especially early cases with PCL adherence) are significant; not shaving ACL remnants may be of potential benefit during ACL reconstruction, as some re-innervation and recovery of proprioceptive potential may be possible, thus improving clinical outcomes.

Second branchial cleft cyst causing internal jugular vein thrombosis - A case report

The branchial cleft cyst also known as lateral cervical cyst is usually present in the lateral part of neck deep to sternocleidomastoid muscle at the junction of its upper third and lower two thirds. Branchial cysts are known for repeated infection with sudden increase in size and pain and for its recurrence. Thrombosis of major vessels of neck secondary to recurrent infection and inflammation of branchial cyst is extremely rare. Here we present the first case of internal jugular vein thrombosis; a rare complication seen with branchial cyst in a 54-year-old male. The patient was treated initially with antibiotics followed by excision of cyst and ligation of internal jugular vein without any complication.

Immunohistochemistry for core and surface antigens in chronic hepatitis

BACKGROUND

Hepatitis B virus infection constitutes a significant proportion of patients presenting with chronic hepatitis. Chronic hepatitis is said to be due to HBV if HBsAg is demonstrated in the serum with or without replication as determined by the presence of HBeAg in the serum. Immunohistochemical staining for HBsAg and HBcAg in liver tissue has been reported to improve the detection rate of HBV.

AIM

To study positivity of immunohistochemical staining of liver tissue for HBsAg and HBcAg in patients of chronic hepatitis and correlate it with histological activity index.

METHODS

One hundred consecutive patients of chronic hepatitis were selected for this study. Histological scoring of liver biopsies was done using Knodell's numerical scoring system. Immunohistochemical staining was done by the Indirect immunoperoxidase technique using goat polyclonal anti-HBsAg and rabbit polyclonal anti-HBsAg. ELISA was used to detect HBsAg in the serum.

RESULTS

Serum HBsAg was positive in only 40 patients whereas tissue HBsAg was positive in 48 patients. Thirteen of these forty-eight tissue positive HBsAg patients also showed HBcAg on immunohistochemical staining of liver tissue. Patients with higher grades of histological activity index (HAI) score had higher values of serum bilirubin and prothrombin time as compared to the patients with a low HAI score. Significantly higher levels of serum transaminases (AST/ALT) were observed in patients who were positive for both HBsAg and HBcAg when compared with patients positive for HBsAg or HBsAg negative patients. A mixed pattern (diffuse/focal cytoplasmic and membranous) of surface antigen expression was seen in 83.3% patients, whereas expression of core antigen was predominantly nuclear (77%). There was no significant correlation between the pattern of antigen expression and HAI score.

Non-cirrhotic portal fibrosis in a patient with rheumatoid arthritis

A 53-year-old man suffering from rheumatoid arthritis for 15 years presented with bleeding esophageal varices, hepatosplenomegaly and normal splenoportal venous axis. Liver biopsy revealed mild fibrosis, suggestive of non-cirrhotic portal fibrosis (NCPF). There are reports of the association of idiopathic portal hypertension, a condition similar to NCPF, with progressive systemic sclerosis, Hashimoto's thyroiditis and systemic lupus erythematosus.