Biomedical subjects
Publications and source records attributed to A Goel.
Various surgical approaches have been described to deal with extensive nasopharyngeal angiofibromas. These lesions, particularly those with a large intracranial extension and involving the cavernous sinus, pose a formidable surgical challenge. An extended transcranial approach was employed to resect successfully 2 such lesions.
We report a large trigeminal neurinoma in an 18-month-old child involving the Gasserian ganglion and all three divisions in a plexiform pattern. The tumour in the ophthalmic division extended all the way to the supraorbital nerve. The child presented with proptosis which had been observed since she was 4 months of age. There was a family history of neurofibromatosis.
The use of an extended vascularized temporalis muscle flap is described. The deep layer of the temporalis fascia is partially everted over the temporalis muscle preserving its vascularity. A composite flap comprising temporalis muscle and its fascia attached along its superior border, is rotated for reconstruction of postoperative defects in the middle cranial fossa floor and mastoidectomy cavities. The versatility of this flap is discussed.
A transoral plate and screw fixation of the clivus to the body of the cervical vertebra is described. The procedure was successfully performed in a patient with congenital basilar invagination after odontoidectomy.
Fasting and 2 hours post-prandial serum insulin levels were estimated in 100 hypertensive subjects and 25 matched, healthy controls, by radio-immuno assay (RIA). Seventy four of the 100 hypertensives exhibited fasting hyperinsulinaemia. Post-prandial hyperinsulinaemia was present in 85 hypertensives. None of the healthy individuals demonstrated hyperinsulinaemia. Although, most hyperinsulinaemic patients exhibited an abnormal lipo-protein profile, there was no statistical correlation between absolute values of lipo-protein and insulin.
A simple microassay and computer program are described for determining the erythrocyte hemolytic potency of drugs in vitro. This microassay is sensitive for both micro as well as macro ranges of hemoglobin concentration. An ELISA reader has been adapted to read erythrocyte lysis (hemolysis), which reduces the number and culture of replicates. A computer program was developed that calculates parameters such as C50 (concentration of drug causing 50% hemolysis), C100 (concentration of drug causing 100% hemolysis) and beta (slope of the curve) and graphically expresses the hemolytic patterns of various drugs simultaneously. The program can obtain optical densities directly from a 96-well plate ELISA reader by interfacing the microplate reader to the computer or by using a keyboard. This method is useful for screening a large number of hemolytic drugs and requires lower amounts of test compounds. It may also be applicable to quantitative functional assays, such as complement-mediated hemolysis and enumeration of antibody-secreting cells. The program can be obtained from the authors on request.
Sixty five (65) hypertensive, 91 non-insulin dependent diabetes and 50 matched, healthy controls were examined for the presence of microalbuminuria, using the Micral strip test. Microalbuminuria was observed in 25 per cent of diabetics and 21.54 per cent of hypertensive subjects. None of the controls demonstrated microalbuminuria. Diabetics with microalbuminuria were poorly controlled and demonstrated significantly higher systolic pressure. In hypertensive subjects, microalbuminuria was seen more in patients with severe disease. In both diabetics and hypertensives, presence of microalbuminuria was significantly influenced by the disease duration.
Vein graft reconstruction of the cervical portion of the vertebral artery has been commonly used for the treatment of atherosclerotic arterial disease. In this article, we describe two instances of vein graft replacement of the distal portion of the vertebral artery. In the first case, the vein graft was placed from C2 transverse foramen to the intradural portion of the vertebral artery to replace an artery abnormally encased and involved by meningioma. The grafting was done in this case to preserve the cerebrovascular reserve in a young patient. In the second case, a vein graft was placed from the extradural C1 portion to the intradural artery beyond the posterior inferior cerebellar artery. This was done to replace a segment of the artery involved by a giant aneurysm, which could not be clipped without occluding the parent artery. In this case, the vein graft replacement was necessitated by changes of somatosensory evoked potentials after the aneurysm was clipped, demonstrating the need to preserve the patency of the artery. Vein graft replacement of the proximal intradural vertebral artery is feasible by the combination of standard cerebro-vascular techniques and the exposures afforded by skull base surgery.
Electrical burns of the scalp and calvarium are uncommon, but due to various conditions peculiar to India such injuries are seen frequently. The presentation of such patients at hospital is late because of the paucity of specialized care facilities and understanding of the disease process. Such injuries usually cause necrosis of the scalp and underlying calvarium with sequestered bone being retained in situ by the flimsy adhesions of underlying granulation tissue and overhanging edges of the scalp all around caused by secondary wound contraction. This paper gives our experience of 14 such cases, explaining the reasons for the chronic state and their subsequent clinical management.
A 40-year-old male presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhoea was found to have raised intracranial pressure due to an acoustic tumour. This report adds to the scant literature on an intracranial tumour causing markedly raised intracranial pressure leading to a non-traumatic CSF rhinorrhoea. After a ventricular shunt and resection of the tumour the CSF leak stopped.
A modified third/fourth ventriculoperitoneal shunt is described. This procedure was used to deal with postoperative cerebrospinal fluid fistulae refractory to treatment by simpler routine measures. The possible indications of the operation are discussed.
Some degree of hydrocephalus is present in almost all cases of medium to large posterior fossa tumours. The initial symptoms in such cases are usually due to the hydrocephalus and the consequent increased supratentorial pressure, and more often precede the symptoms primarily due to the local invasion and compression of the brain stem and cerebellum by a significant length of time. In our experience, based on 62 posterior fossa tumour operations, insertion of a cerebrospinal fluid (CSF) diverting shunt because of hydrocephalus makes the subsequent tumour excision more difficult and hazardous. The various problems presumed to be related to preoperative shunt surgery are discussed in this report. It is concluded that preoperative shunts for posterior fossa tumours are rarely indicated.
Specific prolactin (PRL) binding sites were demonstrated in the fine needle aspiration cytology (FNAC) specimens from 68 patients with benign and malignant diseases of the breast using highly sensitive technique of DNP hapten sandwich staining procedure and antibody against human PRL. In 16 patients, immunocytochemical staining was also carried out on paraffin embedded sections of corresponding lesions. FNAC specimens included 52 neoplasms and 16 non-proliferative and proliferative benign breast disease. The reaction varied in different lesions, being maximum (72%) in malignant tumours and 60 per cent in benign tumours. However, benign breast disease showed a reaction that varied with the lesion. The technique was found to be simple, sensitive and economical for demonstrating specific PRL binding sites in cytology specimens of breast lesions.
Our case report is used to describe a combined supratentorial and infratentorial approach to a giant pineal-region meningioma. The procedure involves section of the less dominent transverse sinus and the tentorium. After the cerebellum and the occipital lobe are retracted away from each other, the operative procedure is carried out. The brain stem and the large veins of this region are better exposed with minimal retraction of the cerebellum and occipital lobe. The transverse sinus is resutured at the end of the procedure to reestablish the blood circulation. The operative procedure is ideal for extensive lesions in the pineal region, providing wide and direct exposure.
High voltage electrical burns may involve intra-abdominal viscera with or without an abdominal wound. The risk of such an involvement is much higher when a wound is present. Depending upon the amount of heat produced vapourization of tissues may occur. If it includes part of the peritoneum, visceral damage is revealed immediately. If it does not occur to that extent, necrosed tissues remain in continuity and visceral involvement remains concealed until slough separates. The prognosis is related to early diagnosis of the associated visceral injury. It is recommended that the debridement should be undertaken at 2-3 days postburn. Laparotomy is indicated if part of the peritoneum is also debrided. Reconstruction of the abdominal wall may be a formidable task. Among the options available, pedicled muscle and musculocutaneous flaps seem to be ideally suited for the purpose.
Tongue strength and endurance (fatigue) were examined in subjects who have acquired high skill levels with their tongues (supranormal) and in subjects who use the tongue normally. The supranormal groups were trumpet players and high school debaters who were able to speak intelligibly at rates much faster than normal. Hand strength and fatigue were also assessed. Maximal strength was measured by recording how much pressure an individual could exert on an air-filled bulb. Endurance was measured by determining how long subjects could sustain 50% of their maximal pressure. Results showed that maximal strength of the tongue and hand did not differentiate the supranormal subjects from the normal subjects. Hand endurance did not differentiate the subjects either. However, the supranormal groups had significantly longer tongue endurance times than did the normal subjects.
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