Accurate diagnosis and typing of renal amyloidosis is critical for prognosis, genetic counseling, and treatment. Laser microdissection and mass spectrometry are emerging techniques for the analysis and diagnosis of many renal diseases. Here we present the results of laser microdissection and mass spectrometry performed on 127 cases of renal amyloidosis during 2008–2010. We found the following proteins in the amyloid deposits: immunoglobulin light and heavy chains, secondary reactive serum amyloid A protein, leukocyte cell–derived chemotaxin-2, fibrinogen-α chain, transthyretin, apolipoprotein A-I and A-IV, gelsolin, and β-2 microglobulin. Thus, laser microdissection of affected areas within the kidney followed by mass spectrometry provides a direct test of the composition of the deposit and forms a useful ancillary technique for the accurate diagnosis and typing of renal amyloidosis in a single procedure.

SummaryBackground and objectives Organized deposits are present in amyloidosis, fibrillary GN, and immunotactoid glomerulopathy. However, the constituents of the deposits are not known.Design, setting, participants, & measurements Laser microdissection of glomeruli followed by mass spectrometry was performed to determine the composition of the deposits. The results were compared with cryoglobulinemic GN. ResultsThe results are divided into four major groups: amyloidogenic proteins, structural/other proteins, complement proteins, and Igs. With regards to amyloidogenic proteins, large spectra numbers of apolipoprotein E are noted in amyloidosis (41.8620.9) compared with fibrillary (15.6612.5) and immunotactoid (12.3612) glomerulopathy. Apolipoprotein E was absent in cryoglobulinemic GN. Serum amyloid P component is present in large spectra numbers in amyloidosis (14.166.7) and small spectra numbers in immunotactoid glomerulopathy, but it is absent in fibrillary and cryoglobulinemic GN. However, large spectra numbers of Ig g-1 chain C region are present in immunotactoid glomerulopathy (47.3634.6) compared with fibrillary (16.25619.7) and cryoglobulinemic (13.364.9) GN. All cases of Ig light chain-associated amyloidosis showed spectra for the respective Ig light-chain C region (mean=1061.7).Conclusions Based on the spectra numbers, the study shows that the relative amount of apolipoprotein E to Ig light-chain C region/amyloidogenic proteins or Ig g-1 chain C region is associated with the organization of the deposits in amyloidosis, fibrillary GN, and immunotactoid glomerulopathy. However, the absence of apolipoprotein E correlates with the lack of fibrillar deposits in cryoglobulinemic GN.

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

Genital Elephantiasis is an important medical problem in the tropics; usually affects young and productive age group and is associated with physical disability and mental anguish. It is one of the bizarre & nipping diseases and has a long history of worldwide distribution. Most of the reported cases occur as an end result of lymphatic obstruction due to various diseases like Filariasis, sexually transmitted diseases (LGV & Donovanosis) as well as malignancies. Few cases may remain of unknown etiology. We are reporting a case of huge vulval elephantiasis, etiology of which remained unknown.

Background: Diagnostic laparoscopy has been in the armamentarium of the surgeon and gynaecologist for many years as a useful technique for evaluating pelvic pathology and it is now one of the most frequently performed laparoscopic procedures. The purpose of this study is to evaluate the role of diagnostic laparoscopy in undiagnosed pain abdomen. The Objectives of this study is to evaluate laparoscopy as a diagnostic tool in cases of undiagnosed abdominal pain where clinical symptoms and investigations are not conclusive and to evaluate benefits and complications of diagnostic laparoscopy.Methods: The study was done in 60 patients, presenting with chronic undiagnosed pain abdomen to a tertiary care hospital. All the patients were operated under general anesthesia in supine position. Diagnostic laparoscopy was done using 3 ports, one umbilical 10 mm, other two depending upon possible pathology. After the study, the data was analyzed to evaluate the role of laparoscopy in undiagnosed abdominal pain.Results: Out of 60 patients, 44 were female and 16 males. On diagnostic laparoscopy, findings were- chronic appendicitis - 31, chronic appendicitis with left ovarian cyst - 1, endometriosis with adhesions - 3, PID - 5, PID with adhesions - 3, suspected TB (GI/Genital) - 4, adhesions - 12, negative diagnostic lap - 1. So it may be concluded that diagnostic laparoscopy is a very useful tool to establish diagnosis in patients with undiagnosed abdominal pain with the following benefits are, superior diagnostic ability, better visualization of the abdominal cavity including the paracolic gutters and the pelvis, able to pin point the sites of adhesions with adhesiolysis during the same procedure, retrieval of specimen for histopathological examination, management of the pathology during the same procedure, avoiding unnecessary laparotomy, low complication rate.Conclusions: Laparoscopy is an efficient tool in the armamentarium of the surgeon to diagnose the patients of undiagnosed pain abdomen with numerous benefits and minimal complications.