Multiple ring-enhancing lesions of the brain are one of the most commonly encountered abnormalities on neuroimaging. These can be caused by a variety of infectious, neoplastic, inflammatory or vascular diseases. Distinguishing non-neoplastic causes from neoplastic lesions is extremely important because a misdiagnosis can lead to unwarranted neurosurgery and exposure to toxic chemotherapy or potentially harmful brain irradiation. Diligent clinical evaluation and a battery of tests are required for making a definitive diagnosis. Newer advanced diagnostic techniques, such as diffusion-weighted magnetic resonance imaging (MRI), perfusion-weighted MRI, magnetic resonance spectroscopy, single-photon emission tomography and positron emission tomography may help in establishing the etiology. However, early brain biopsy is often needed because several of these diseases are potentially life-threatening.

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Purpose:Prostatic lesions on routine staining sometimes cause a diagnostic dilemma, especially when malignant tissue is limited and is mixed with benign prostatic glands or because of the presence of benign mimickers of carcinoma. The application of immunohistochemistry contributes a valuable differential diagnosis. This study aimed to evaluate a complete spectrum of various prostatic lesions and to supplement the histopathological diagnosis with immunohistochemistry in suspicious or atypical cases.Methods:A total of 364 consecutive prostatic specimens were evaluated. Routine hematoxylin and eosin staining and immunohistochemical staining against 34βE12 cytokeratin and proliferative marker (alpha-methylacyl-CoA-racemase, AMACR) were performed by use of the peroxidase antiperoxidase method.Results:Benign prostatic hyperplasia was the most frequent finding and involved 285 patients (78.3%). Prostatitis (majority nonspecific) formed the predominant subgroup in nonneoplastic lesions (n=119, 32.7%). The incidence of carcinoma was low (n=73, 20.1%). Of the 26 atypical or suspicious cases, 18 cases were positive for high molecular weight cytokeratin (high molecular weight cytokeratin, HMWCK) only, 4 cases were positive for AMACR only, and 4 cases showed positivity for both HMWCK and AMACR.Conclusions:Biopsy remains the gold standard. However, as an adjunct to biopsy, proliferative markers and basal cell markers have value for resolving suspicious or atypical cases.

Aims:To compare the efficacy, complications, cost analysis and hospital stay between two methods of drainage of the kidney: double J (DJ) stent versus nephrostomy tube following open pyeloplasty for ureteropelvic junction obstruction hydronephrosis.Patients and Methods:This was a prospective randomized study of 20 patients in each group over 14 months. Pre and post-operative (3 months) function and drainage were assessed by ethylenedicysteine scan and intravenous urogram.Results:Both groups showed similar good improvement in function and drainage. Nephrostomy group had significantly longer hospital stay (P < 0.001) but incurred less cost. Complications with nephrostomy included tube breakage (n = 1) and urine leak after tube removal (n = 2). DJ stents were associated with stent migration (n = 4), increased frequency of micturition (n = 9), dysuria (n = 4) and urinary tract infection (n = 1).Conclusion:Both methods of drainage did not interfere with improvement after pyeloplasty. Minor complications were more with DJ stent (P = 0.0003). Although overall cost of treatment was more with stents, they reduced length of hospital stay. Optimal length of stent is essential to reduce complications secondary to migration and bladder irritation.