Biomedical subjects
Publications and source records attributed to A Goel.
An analysis of injuries sustained during fell walking in Cumbria and seen at the West Cumberland Hospital over a 3-year period is presented. There were 90 patients, including 19 multiple injuries and four deaths. This report focuses attention on the seriousness and magnitude of injuries associated with a pastime often thought to be harmless and risk-free.
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Brain abscess caused by the fungus Cladosporium trichoides is rare. Only 20 cases of brain abscess caused by this fungus are reported in the literature. We report a case of brain abscess caused by Cladosporium trichoides in a healthy adult male. The relevant literature on this subject is reviewed.
A subgaleal collection of blood or cerebrospinal fluid (CSF) is commonly encountered after craniotomy. In spite of the placement of subgaleal drains by many neurosurgeons, a collection at this site is frequent and occasionally can result in complications. 'Tenting' scalp stitches are described. Three to four (or more) stitches are inserted between the galea and the pericranium or between the pericranium and the craniotomy flap at the end of the surgical procedure. This simple manoeuvre was seen significantly to reduce collections in these spaces. To our knowledge, this technique has not been reported in the neurosurgical literature, and we strongly advocate its use.
The late course of preserved hearing and tinnitus following retrosigmoid transmeatal surgery for acoustic neurilemoma is reported. Over a period of 5 years, useful hearing was preserved in 15 patients after preservation was attempted in 42 patients. In five patients the hearing was better than the preoperative level; in three it was worse. Three patients developed delayed worsening and fluctuations of hearing in the surgically treated ear during a median follow-up period of 2 1/2 years. While the exact reason for such worsening was not clear in two patients, in one patient it appeared that the muscle graft placed in the internal auditory canal after tumor resection resulted in fibrosis and compromise of the cochlear nerve. The causes of delayed worsening of hearing in the absence of tumor recurrence are analyzed, and possible treatment and methods of prevention of worsening are suggested. In six patients, tinnitus persisted after surgery in the ear with successful preservation of hearing, but hearing was not worsened and the tinnitus was not bothersome to the patient. In one patient with preoperative tinnitus, hearing was not preserved and tinnitus persisted sufficiently to necessitate reexploration and cochlear nerve section.
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A 26 year old female, a case of chronic renal failure secondary to chronic pyelonephritis with renal osteomalacia, came with dimunition vision as the presenting complaint. She was found to have bilateral cataracts. All other known causes of cataract were excluded. Cataracts due to hypocalcaemia in chronic renal failure are a rare phenomenon.
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The relationship between heterotopic bone formation and the morphological type of osteoarthritis was examined after 43 hip replacements. Of the 43 hips studied, nine were atrophic, 19 were normotrophic, and 15 were hypertrophic. The incidence of heterotopic bone formation in the atrophic type was 11%, in the normotrophic type 32%, and in the hypertrophic type 87%. The difference between each type was statistically significant (p less than 0.001).
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An anomalous subarcuate loop of the anterior inferior cerebellar artery is described in which the artery is adherent to or penetrates the posterior fossa dura in the subarcuate fossa. When encountered during acoustic neurilemoma surgery, the artery should be carefully mobilized along with a sleeve of dura to prevent its injury.
Transcription of the alpha 2-macroglobulin gene (alpha 2M) in rat hepatocytes is strongly induced during acute inflammations by interleukin 6 (IL6). An IL6-response region has previously been mapped in the promoter upstream sequence of this gene. The region consists of two adjacent elements (IL6-REs), the IL6-RE core (CTGGGAA, -164 to -158 bp) and the core homology (CTGGAAA, -184 to -178 bp), elements, that are located 20 bp apart. Both elements bind nuclear factors with very similar protein-DNA contact patterns when they are contained in their original sequence context. A protein-DNA complex III was obtained in gel mobility shift experiments using a probe individually representing the core site. With probes containing both the core and core homology sites, a hormone inducible complex II of slower mobility was obtained. Complex II consisted of multiple copies of the same protein or proteins with very similar molecular masses bound at both sites. The core homology site was the weaker binding site. With a probe containing two tandem copies of the core site, binding at the second site occurred with 81 times greater affinity when the first site was occupied, than when it was free. Thus, the factor binding at the IL6-REs, the IL6-RE binding protein (IL6 RE-BP), was capable of co-operatively interacting with itself. Another factor, IL6-DBP/LAP, has recently been shown to be involved in the regulation of a major subgroup of acute phase genes by IL6. Using recombinant IL6-DBP/LAP and corresponding antisera, we demonstrated here that the IL6 RE-BP of the alpha 2M gene was distinct from IL6-DBP/LAP and from the related factor DBP. Thus, two major IL6-response elements can be distinguished: type 1 elements occurring in the human C-reactive protein, hemopexin and haptoglobin genes and utilizing IL6-DBP/LAP; and type 2 elements occurring in the rat alpha 2M, and alpha 1-acid glycoprotein genes, and utilizing a different IL6 RE-BP. The IL6 RE-BP of the alpha 2M gene was also shown to be distinct from the transcription factor NF kappa B. The IL6RE-BP had relative molecular mass of Mr = 46,000, distinct from IL6-DBP/LAP (Mr = 32,000) and NF kappa B (Mr = 50,000) and its overall DNA binding capacity was induced under acute phase conditions.
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Short-course chemotherapy is well established for the treatment of pulmonary tuberculosis but not for extrapulmonary disease. We present a series of 35 cases in which chemotherapy for tuberculous meningitis was given for a period of less than 2 years. Short-term therapy was associated with recrudescence of tuberculous meningitis and, in some cases, with the development of deep cerebral infarcts and permanent neurological deficits. We think short-term chemotherapy for tuberculosis of the central nervous system is inadequate.
One hundred and thirty-six cases of encysted pleural effusions were studied and investigated to reach an etiological diagnosis. The clinical profile of encysted pleural effusions differed little from that of free pleural effusions. Of the four sites of encystments seen (costoparietal, interlobar, subpulmonic, and mediastinal), costoparietal effusions were the commonest and resulted most often from infections. Interlobar encystments came next in frequency and most often resulted from congestive cardiac failure. Of the various causes of encysted pleural effusions, tuberculosis was the commonest, followed by pyogenic infection and congestive cardiac failure, in this order. Conventional radiographic techniques were adequate in diagnosing most cases of encysted pleural effusions.
Pituitary tumours originating primarily from sites other than the sella turcica are rare. A case of an ectopic pituitary tumour in the region of the lesser wing of the sphenoid is reported. The patient presented with signs and symptoms of a progressive increase in intracranial pressure. CT scan appearances resembled those of a sphenoid wing meningioma. The vascular lesion was partially excised. Histology showed it to be a pituitary tumour.