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Biomedical subjects

A K Sarda

Publications and source records attributed to A K Sarda.

At least 19 recordsLinked to original sources
PubMed1990

Duodenal tuberculosis: a review of the clinicopathologic features and management of twelve cases.

A retrospective analysis of twelve cases of duodenal tuberculosis is presented herein. The average age of the patients was 31.4 years with a male to female ratio of 2:1. The presenting complaints were duodenal obstruction in six patients and subacute intestinal obstruction in three. None of the patients had associated pulmonary tuberculosis. Eight patients had isolated duodenal tuberculosis, two of whom were successfully treated with antitubercular drugs. In four patients, the diagnosis was established at laparotomy by the presence of tubercles over the duodenum. Five patients required a bypass procedure for obstruction caused by the duodenal tuberculosis and one patient was operated on for uncontrollable bleeding from a tubercular duodenal ulcer. All patients remained symptom free after treatment, whether medical or surgical. Thus, in areas where tuberculosis is endemic, even in the absence of pulmonary tuberculosis, duodenal tuberculosis should be suspected in patients with upper gastrointestinal obstruction or in patients with peptic ulcer like symptoms not responding to medical therapy.

Adult↗
PubMed1990

Thyroid carcinoma. A report of 206 cases from an area with endemic goitre.

A retrospective analysis of 206 cases of thyroid carcinoma treated at a single surgical service in a region with endemic goitre is presented. In contrast to the marked female preponderance in surgically treated benign thyroid disorders, the frequency of thyroid carcinoma was almost equal in the two sexes (males/females = 100/106). The duration of symptoms was, as a rule, short and there was a predominance of advanced lesions (T3N3M1) even among the well-differentiated tumours. Papillary carcinoma was the most common histologic type (45%) but its proportion was considerably lower than usually reported from non-endemic regions. The average TSH level was significantly elevated in the carcinoma group and associated adenomatous changes were found in 40/100 cases which might suggest an etiologic role of increased TSH stimulation. Since most thyroid carcinomas had a very malignant clinical behaviour, surgical treatment aimed at near-total thyroidectomy which was performed in 62% of the cases. During a follow-up of up to eleven years recurrence in the remaining contralateral lobe occurred in 23% of patients with hemithyroidectomy and loco-regional recurrence was seen in 29% of patients with near-total thyroidectomy. Mortality was high in all histologic types, further underlining the aggressive biologic behaviour of thyroid cancers in an endemic area.

Adenocarcinoma↗
PubMed1990

Non-occlusive ischaemic enteritis.

Non-occlusive infarction of the intestine without any associated medical disorder responsible for prolonged hypotension, is a rare clinical entity. A retrospective analysis of 46 cases revealed that the disease occurred predominantly in young, healthy, male patients. The classical presentation was of abdominal pain and persistent tachycardia out of proportion to the abdominal signs of distension, mild tenderness and reduced bowel sounds. The presenting features were of peritonitis due to perforation (63%) and intestinal obstruction (37%). A preoperative diagnosis was suspected only in six cases. Operative findings revealed that the bowel was infarcted without involvement of the mesenteric vessels, which were pulsatile up to the bowel wall. The characteristic findings of the disease, which mainly affected the jejunum (69.6%), were: (i) infarcted area of the bowel surrounded by skip lesions of purple, constriction bands; (ii) multiple small perforations in a paper-thin bowel: or (iii) a long linear perforation. Histologically, ischaemic changes were found to affect the mucosa and submucosa beyond the macroscopic limits. Mortality was high (19.6%).

Adult↗
PubMed1990

Fine needle aspiration cytology as a preliminary diagnostic procedure for asymptomatic cervical lymphadenopathy.

Fine needle aspiration cytology (FNAC) was used as a preliminary diagnostic procedure in evaluating discrete, asymptomatic cervical lymphadenopathy of more than four weeks duration. Benign pathologies were encountered in 294/359 patients (82%); of these 86% had tuberculosis. Even in the elderly, a large number of patients (25/78) harboured tubercular lymph glands. FNAC obtained adequate material for cytologic diagnosis in 97.5% and had an overall accuracy rate of 97%. Malignancy was correctly diagnosed in 100%; in tuberculosis the accuracy rate of 96% with a 3.5% false negative results. FNAC is reliable as the initial evaluating procedure even in benign disorders; it is also cheap, speedy and easy to perform, with no complications, making it suitable for wider application in developing countries with scant resources.

Adenocarcinoma↗
PubMed1989

Near-total thyroidectomy for carcinoma of the thyroid.

There is controversy about the most appropriate treatment for patients with thyroid cancer. This study analyses our experience with 206 cases of thyroid cancer from an endemic goiterous area. There were 100 males and 106 females; patients presented at an earlier age with a short history. Thyroid cancers demonstrated an aggressive biological behaviour with an advanced stage at presentation (overt cancers in 51 per cent) and a relentless course with a mortality rate of 24.2 per cent for the well-differentiated tumours. Near-total thyroidectomy was performed in 126 patients. Multicentric foci of tumour were seen in 17.2 per cent of the well-differentiated cancers and 25.2 per cent of the cases of well-differentiated cancers who underwent near-total thyroidectomy developed loco-regional recurrence. Hemithyroidectomy was performed in 35 patients who refused completion total thyroidectomy at a second stage; 16.7 per cent of these patients developed a recurrence in the remaining contralateral lobe. Thus in our patients from an endemic goiterous area, near-total thyroidectomy is the treatment of choice particularly because of the frequent occurrence of follicular and anaplastic cancers (in 44.2 per cent) and because the course of the disease is more virulent.

Adenocarcinoma↗
PubMed1989

Intraperitoneal rupture of amoebic liver abscess.

A retrospective analysis of 23 cases of amoebic liver abscess with intraperitoneal rupture is presented. Group I consisted of 16 patients with clinical features of generalized peritonitis. Eight of these patients were treated surgically, and four died. Group II consisted of seven patients with features of localized peritonitis and all were treated conservatively. In all cases the diagnosis of liver abscess was established by liver scan or ultrasound examination; peritonitis was established either at operation or, in the conservatively managed group, by aspiration of pus from the peritoneal cavity. Amoebiasis was diagnosed by serology. Eight group I and all group II patients were managed conservatively by aspiration of the liver abscess, antibiotics and amoebicides. There were no deaths in this group. It is suggested that, if the diagnosis can be made early, conservative treatment offers the best chance of cure for patients of amoebic liver abscess with intraperitoneal rupture.

Adolescent↗
PubMed1989

A report of four cases of thyroid cancer occurring in thyrotoxicosis and review of the literature.

Four cases of thyroid carcinoma occurring in 140 cases of Graves' disease are presented herein. A standard workup of the patients was done to establish hyperthyroidism and all cases of cancer were diagnosed on receipt of histopathology. There were three cases of papillary carcinoma and one case of follicular carcinoma with one cancer being encountered in the 'cold' area of the thyrotoxic gland. The incidence of malignancy in thyrotoxicosis, however, was not found to be higher than that in other thyroid disorders.

Adenocarcinoma↗
PubMed1989

Autonomously functioning thyroid nodule.

We report 408 cases of autonomously functioning thyroid nodule (AFTN); 85.5% occurred in female patients, for a male-female ratio of 1:6. Eighty-nine patients (21.8%) were hyperthyroid, 76 of them being female, also yielding a male-female ratio of 1:6. There was a linear increase in the incidence of hyperthyroidism with age and with an increase in the size of the nodule, especially for nodules more than 3 cm in diameter. There was a significantly higher incidence of hyperthyroidism for nodules of the same size when they occurred in patients more than 40 years of age. There was a corresponding increase in hyperthyroidism with an increase in the length of time after the initial detection of the nodule; this finding was significantly greater in patients more than 40 years of age. Thus, the age of the patient was found to be a more important determinant in the production of hyperthyroidism associated with an AFTN than either the size of the nodule or the duration of symptoms.

Adult↗
PubMed1989

Hydatid disease of the thyroid gland--(a case report).

Hydatid disease of the thyroid gland, presenting as a solitary thyroid nodule, is being reported below. Pre-operative investigations, including thyroid isotope scanning and aspiration of the nodule, did not help in establishing the diagnosis which was later confirmed by histological examination. Post-operative investigations revealed it to be an isolated involvement of the thyroid gland.

Adult↗
PubMed1988

Squamous cell carcinoma of the thyroid.

Eight cases of squamous cell carcinoma of the thyroid are reviewed. The clinical features and natural history of our cases are presented. All tumours showed an aggressive biological behaviour. Two patients showed association with well-differentiated thyroid cancer. It is difficult to conclude whether these tumours are de novo occurrences or were a result of a complete replacement of a previously existing condition after a change in histologic character.

Adult↗
PubMed1988

Thyroid carcinoma in an endemic area presenting as solitary thyroid nodules.

A retrospective analysis of 66 cases of thyroid cancer presenting as a solitary thyroid nodule (STN) from an endemic area is presented herein. The workup included TSH estimation and radionuclide scanning and patients were divided into two groups. Group A included cases of STN carcinoma diagnosed histologically in patients clinically presenting as a benign STN. Of all the patients who presented with a benign STN, malignancy was found more frequently in 'cold' nodules (13.5 per cent), than in nodules with a different presentation on scintiscanning (0-9.5 per cent). Cancers occurred in 5 per cent of the females and in 19.5 per cent of the males. Group B included patients with overt signs of malignancy. In both groups, the clinical behaviour was determined by the stage at presentation according to TNM classification. TNM staging was found to be a good prognostic indicator, comparable to histopathology. Thus, locoregional recurrence and mortality were found to be higher in advanced T3 lesions and in Group B patients. On the basis of these findings it is suggested that STN cancers may either be an earlier stage of the disease or that the STN cancers in the two groups may be separate disease entities.

Adolescent↗
PubMed1988

Spontaneous regression of extramedullary plasmacytoma--a case report.

A case of extramedullary plasmacytoma in the soft tissues of the posterior chest wall of an 80-year old man is reported herein. Immunofluorescence study showed that the tumor cells produced IgG lambda. An M-component was also detected in the patient's serum by paper electrophoresis. Two months following the open biopsy done to establish diagnosis, the tumor underwent spontaneous regression and the M-component in the serum also disappeared. This is the first case report of spontaneous regression of an extramedullary plasmacytoma and the probable reasons for this spontaneous regression are discussed herein.

Aged↗