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Biomedical subjects

A Pathak

Publications and source records attributed to A Pathak.

At least 19 recordsLinked to original sources
PubMed1998

Amphotericin B use in a community hospital, with special emphasis on side effects.

The purpose of this study was to analyze the usage of amphotericin B desoxycholate in a small community hospital, with special emphasis on its side effects and need for premedication. We performed a retrospective chart review for patients who received intravenous amphotericin B from January 1993 to May 1996. Temperature elevation, clinical symptoms during infusion, need for premedication, and fluctuations in serum potassium and creatinine values were especially noted. Statistical analysis showed that toxicity indicated by laboratory values (laboratory toxicity) increased with increasing amphotericin B dose, but clinical side-effects decreased with advancing age. Clinical side effects were not associated with total amphotericin B dosage; laboratory toxicity in our study was not more prevalent in elderly patients. The main finding of this study was that most patients tolerate amphotericin B well and only 23% of patients needed premedication. Our fungal cure rate was 83%. New, expensive preparations of amphotericin B should be reserved for the small subset of patients who either are intolerant of amphotericin B desoxycholate or need high doses for systemic fungal infections.

Adult↗
PubMed1997

Growing skull fractures: a clinical study of 41 patients.

Growing skull fractures are rare complications of head injury, occurring almost exclusively in infants and children under the age of three. A retrospective review at our Institute yielded 41 patients with this entity over a period of 20 years (1975-1995). The age at presentation ranged from less than 1 year to 62 years, with 33 (80.5%) patients being less than 5 years of age. The cause of injury was either a fall from a height (93%) or a road traffic accident. The most common location of a growing skull fracture was either parietal or frontoparietal (56%). One patient had a posterior fossa growing skull fracture. CT scan was performed in 19 patients which demonstrated an underlying porencephalic cyst, hydrocephalus or a cyst communicating with the ventricle. In 5 children, a ventriculo-peritoneal shunt alone was performed. Twenty four patients underwent a duro- and cranioplasty while a duroplasty alone was performed in 8 patients. The material used for cranioplasty included acrylic, wire mesh, steel plates or autologous bone. Three patients died, one due to an anaesthetic complication and two as a result of postoperative meningitis. Post-operative CSF leaks occurred in 3 patients, which were managed by a lumbar drain. Six patients had local wound infection.

Adolescent↗
PubMed1997

Intracranial fungal granuloma.

BACKGROUND: Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear. METHODS: Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material. RESULTS: Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions. CONCLUSION: Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.

Adolescent↗
PubMed1996

Radiosurgery: a minimally interventional alternative to microsurgery in the management of acoustic neuroma.

We report the results of treatment with radiosurgery of 29 tumours in 27 patients with acoustic neuromas between 1986 and 1989. The median follow-up was 6.6 years. The treatment appears to be an effective alternative to surgery for patients with tumours of 3 cm diameter or less. The mortality and morbidity of the treatment and the presentation of cranial nerve function is comparable to the very best surgical results. Every patient with an acoustic neuroma should be informed about this alternative to direct surgery.

Adolescent↗
PubMed1995

Western blot analysis of cerebrospinal fluid for detection of Aspergillus antigens.

Western-blot immunoassay of cerebrospinal fluid (CSF) specimens of patients with central nervous system (CNS) aspergillosis (3), CNS candidosis (1) and bacterial meningitis (2) was carried out using pooled serum from histopathologically proven deep-seated aspergillosis cases to detect unique antigenic fractions for aspergillosis in CSF. No reactivity was observed in patients with non-fungal meningitis. Four cross-reactive bands (40, 90, 200 and > 200 KD) were detectable in CSF from patients with both aspergillosis and candidosis of the CNS. Four additional bands (90-200 KD) were consistently present only in patients with aspergillosis. One prominent band (110 KD) was found only in the patient with aspergillosis who had a fatal outcome and raised the possibility of being a poor prognostic marker.

Adolescent↗
PubMed1995

Multiple pyogenic brain abscesses.

Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered "sensorium" at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome. Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.

Adolescent↗
PubMed1994

Supratentorial tumours in infants.

Three hundred and ninety-six paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours were located supratentorially. These 82 patients included 14 infants (below 1 year of age), who made up 3.5% of all paediatric patients with brain tumours and 17% and those with brain tumours in a supratentorial location. There was a male preponderance, and two-thirds of the 14 patients were within their first 6 months of life. Increasing head size, vomiting and failure to thrive were the common presenting features. One infant presented with asymmetric skull growth. The tumours tended to be large, occupying almost the entire affected cerebral hemisphere; histological types included astrocytomas, malignant astrocytomas, glioblastoma multiforme, primitive neuroectodermal tumours, malignant choroid plexus papillomas and malignant teratomas. Two children had congenital tumours and another two tumours, in children with associated lobar agenesis, were thought to be congenital in origin. Associated hydrocephalus was present in seven patients, but precraniotomy shunt was required in only two patients. The perioperative (within 1 month) mortality was 57%. Only 30% of the patients survived for more than 1 year after surgery and chemotherapy. The longest survival was 20 months. Delay in diagnosis, poor general condition prior to surgery, and the high vascularity and malignant nature of these tumours accounted for the poor results.

Astrocytoma↗
PubMed1993

Complete dislocation with burst fracture of the lower cervical spine. Case report.

A patient with a complete fracture dislocation of the C6 vertebra without any neurological deficit is presented. The absence of neurological changes in an area of the spinal canal which is almost completely filled with the spinal cord is remarkable. The mechanism of injury in this patient is believed to be hyperextension associated with significant axial loading. Hyperextension first ruptured the anterior and the posterior longitudinal ligaments and then injured the pedicles of C6. The associated axial loading resulted in a 'bursting' of the posterior elements, thereby providing room for the spinal cord to move dorsally with the avoidance of a major neurological deficit.

Accidental Falls↗
PubMed1993

Growth of exclusively breastfed infants.

The weights and lengths of 120 boys and 81 girls were followed from birth to 12 months at Shree Maharani Shantadevi Hospital (SMSH), Baroda. The sample was selected by the following criteria: (i) birth weight 2.5 kg or more, (ii) no serious defect or serious/chronic illness, (iii) upper and middle socio-economic level, (iv) normal motor-mental development, (v) regular follow-up every month (by appointment within two days of birth date) for at least nine months, (vi) exclusive breastfeeding for at least four months. Mean and SDs and percentile values of weight, length and weight for length were computed separately for boys and girls. These were compared with those of National Centre for Health Statistics (NCHS) and of the Davis Area Research on Lactation, Infant Nutrition and Growth (DAR-LING) study in the USA. The breastfed babies were observed to be leaner by the currently accepted "standards" which have been established mostly on formula-fed babies. The growth pattern of the breastfed babies cannot be interpreted as 'faltering' since their motor-mental development was normal and they were thriving well. The study focuses attention on the need to have new growth charts on the basis of exclusively breastfed children.

Body Height↗
PubMed1993

Multicentric gliomas: report of 2 cases.

Two cases of multicentric gliomas with long survival are reported. One patient underwent multiple surgical procedures while another had two separate surgical procedures at the same time. Presence of calcification of CT scan in one case raised suspicion for a preoperative diagnosis of oligodendroglioma. Lack of direct continuity or subarachnoid enhancement on CT scan and low histological grade of the tumours suggested their primary multicentric origin. The incidence of multicentric gliomas in our experience is 0.4% amongst 500 glial tumours over a period of eight years.

Adult↗
PubMed1993

Posterior fossa extradural haematoma--experience of nineteen cases.

Twenty-four cases of posterior fossa extradural haematoma constituted 4.16% of all extradural haematomas (576) and 1.12% of all craniocerebral trauma requiring surgery (2150). Five cases were excluded from this study. Of the remaining nineteen cases (the study group), lucid interval was present in eight (42.10%) cases. In half of the cases, the clinical course was acute. Neck stiffness and drowsiness were the commonest clinical signs. Occipital bone fracture was present in 57.89% cases. CT scan was the most valuable investigation in the diagnosis and detection of the associated intracranial injury in 18 cases. Associated intracranial injury was present in seven (36.84%) of these cases. Two (11.1%) of these patients died despite emergency surgery. The Glasgow Coma Scale prior to operation and the presence of associated supratentorial injuries were important prognostic factors. It is concluded that posterior fossa extradural haematoma should be suspected in the presence of a fall on the back of the head, drowsiness, neck stiffness or an occipital bone fracture.

Adolescent↗
PubMed1992

Intramedullary spinal cord abscess: a case report.

An 11-year-old boy presented with pain in the back, urinary retention, paraplegia and loss of sensations below L1. Investigations revealed an intramedullary lesion. An intramedullary spinal cord abscess was found at surgery. The pus was evacuated and abscess was excised. Minimal recovery was seen following surgery. Early intervention and a high index of suspicion is required in such cases.

Abscess↗
PubMed1990

Controversies in the management of subdural empyema. A study of 41 cases with review of literature.

Forty one cases of subdural empyema treated between 1977 and 1988 at the Postgraduate Institute of Medical Education and Research. Chandigarh, have been analysed. The patients ranged from 9 days to 80 years of age. There were 22 children, including 11 infants. Fever, altered sensorium and seizures were the most common symptoms present for 1 day to 6 months. Otogenic infection was the commonest aetiological factor followed by postoperative and posttraumatic causes. Thirty seven patients had supratentorial empyemas, including 4 with parafalcine collections, three had infratentorial empyemas, and in one there was extension of the empyema from the supratentorial to the infratentorial compartment. Therapeutic modalities used included percutaneous needle aspirations in infants and burr hole evacuation and craniotomies in adults. A wide spectrum of organisms was detected. Mortality in this series was 24%, which was mainly attributable to the deteriorated neurological status prior to treatment. A detailed review of the literature has been given, highlighting various controversies in the management of SDE. Important prognostic factors and a treatment plan are suggested.

Adolescent↗
PubMed1990

Meningeal melanocytoma: report of two cases.

Two cases meningeal melanocytoma, one each at cranial and spinal location, are described. Neurological deficits in both cases improved following surgery. Pathological features of this rare tumour are discussed.

Adult↗
PubMed1989

Tension pneumocephalus following evacuation of chronic subdural haematoma.

Five cases of a rare complication of tension pneumocephalus following evacuation of chronic subdural haematoma are described. This occurred in 8% of all cases of chronic subdural haematoma treated following installation of a CT scanner. The chronically compressed brain contributes to the ingress of this intracranial air. The increase in the brain bulk and gradual re-expansion of the brain, in the early postoperative period, competes with the trapped subdural air resulting in a rise in intracranial pressure leading to neurological deterioration. Twist drill craniostomy and aspiration, using a brain cannula with a three-way connector, has produced excellent results.

Child↗