Transfusion transmitted CMV infection in a neonate.
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Blood Transfusion↗
Biomedical subjects
D Gupta
Publications and source records attributed to D Gupta.
Near total transection of the trachea following percutaneous dilatational tracheostomy.
The bedside procedure of percutaneous dilatational tracheostomy (PDT) in the intensive care unit continues to gain popularity. Percutaneous dilatational tracheostomy is recommended as simple, safe and cost-effective. The procedure can be associated with serious life-threatening complications. We report a case of near total transection of the trachea following PDT.
Aged↗
Risk factors of lung cancer in Chandigarh, India.
BACKGROUND & OBJECTIVES: There is a paucity of data from India on the risk factors for lung cancer. In the present paper results of a case-control study on lung cancer undertaken at Chandigarh, north India, are described. METHODS: Two hundred and sixty five (235 men, 30 women) histologically confirmed patients of lung cancer and 525 (435 men, 90 women) hospital controls matched for age and sex were interviewed according to a pre-designed questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, indoor and outdoor air pollution and occupational exposures were assessed using unconditional logistic regression models. RESULTS: Eighty nine per cent of men and 33 per cent of women among the patients were ever-smokers as compared to 60 per cent of men and 20 per cent of women among controls. The Odds Ratio (OR) for ever-smoking was 5.0 (CI 3.11-8.04) among men and 2.47 (CI 0.79-7.75) among women. Among the patients, men were found to smoke a higher average number of cigarette-equivalents per day, for longer duration and started at an earlier age as compared to controls. Smoking of bidi and hooka as well as cigarettes had similar ORs for cumulative consumption. ORs for female smokers were lower than those for male smokers. Cumulative exposure of > 45 yr in women to indoor air pollution from use of coal or wood for cooking or heating showed an OR of 1.43 (CI 0.33-6.30). Residence in urban areas did not entail an increased risk for developing lung cancer. Very few subjects studied were employed in high-risk occupations. INTERPRETATION & CONCLUSIONS: Smoking (cigarettes or bidis) was the principle risk factor for causation of lung cancer among men. In women there could be several other risk factors besides smoking, as the association with smoking was not as strong.
Adult↗
Vocal cord dysfunction presenting as recurrent acute severe asthma.
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Asthma↗
Intraoperative scrape cytology: comparison with frozen sections, using receiver operating characteristic (ROC) curve.
The diagnostic role of intraoperative cytology (IC) has been demonstrated by many comparative studies. These studies have used sensitivity and specificity as statistical tools, based on binary principles. Statistical methods based on binary principles appear to be inappropriate for comparing anatomic pathology studies which involve significant human judgment with a range of subjective nonbinary result patterns. In this study, we applied the receiver operating characteristic (ROC) curve, which is based on probabilistic principles for the comparison of diagnostic accuracy with IC and frozen sections (FS). Seven observers studied a variable number of IC alone, FS alone, and IC/FS together from a pool of 446 specimens. The results were analyzed by ROC curve, using the MEDCALC software program (MedCalc Software, Mariakerke, Belgium). The accuracy with IC alone and FS alone was comparable. IC alone was diagnostic for many lesions, offering the choice of not freezing the tissue, and thus avoiding the introduction of artifacts. This strongly favors the routine practice of preparing IC during intraoperative consultation.
Area Under Curve↗
Fine-needle aspiration findings in nodular myositis: a case report.
Fine-needle aspiration (FNA) is frequently the initial diagnostic modality for the workup of suspected metastatic disease in subcutaneous or deeper soft tissues. The technique is less well-accepted for the diagnosis of primary soft-tissue lesions. Occasionally during the investigation of suspected metastatic disease, primary processes of the soft tissues will undergo FNA. Thus, familiarity with the cytomorphology of soft-tissue reparative and neoplastic lesions is important. A variety of reparative and degenerative entities exist within the soft tissues, one of which is localized nodular myositis. This lesion may be a precursor of generalized polymyositis, including polymyositis associated with graft vs. host disease, or it may remain a localized process. Aspirates from localized nodular myositis demonstrate fragments of striated muscle including degenerating and regenerative myocytes, a mixed inflammatory background, and necrotic debris. Cytologic identification of this lesion can be therapeutically important, particularly in post-bone marrow transplant patients.
Adult↗
Expression of DNA topoisomerase I in neoplasms of the kidney: correlation with histological grade, proliferation, and patient survival.
Renal cell carcinoma is an inherently chemotherapeutically resistant neoplasm. Because of this, new drugs targeting this tumor are needed. One class of new anticancer drug targets the enzyme DNA topoisomerase I. Laboratory data indicate that cells sensitive to topo I targeting drugs contain high topo I levels. To determine whether some renal cell carcinomas contain elevated topo I and might therefore be targets of topo I active antitumor agents, we used a new immunohistochemical stain for topo I to determine the expression of the enzyme in 51 tumors of the kidney. Increased topo I expression was found in 4 of 11 (36%) grade 3 renal cell carcinomas and in 8 of 8 (100%) grade 4 renal cell carcinomas. Normal topo I expression was observed in all adenomas, oncocytomas, and grade 1 and grade 2 renal cell carcinomas. Because topo I targeted anticancer drugs are S-phase specific, topo II-alpha and MIB-1 proliferation indices also were performed. Topo II-alpha correlates well with MIB-1 (correlation coefficient = 0.96). Of the 12 tumors with elevated topo I, only 3 had topo II-alpha proliferation indices greater than 40, indicating a tumor with elevated topo I expression and a large growth fraction. We hypothesize that these tumors might be susceptible to topo I anticancer drug therapy. In addition, we found that the average topo II-alpha proliferation index of tumors from patients who died of disease was 27.4 +/- 19.8, which was statistically different from the average topo II-alpha index of 5.8 +/- 6.5 observed in tumors from patients who remained alive during our follow-up.
Adenoma↗
Clinical significance of patent paraumbilical vein in patients with liver cirrhosis.
A patent paraumbilical vein (PUV) is a frequent finding in patients with cirrhosis when studied by duplex Doppler ultrasound. There is controversy regarding the clinical significance of this finding. We studied 50 patients with cirrhosis and portal hypertension as evidenced by the demonstration of esophageal varices on endoscopy. All 50 patients were evaluated for a significant PUV (diameter of > or =3 mm) using duplex Doppler sonography. The patients were divided into two groups based on the size of esophageal varices (group A with small varices, N = 30; group B with large varices, N = 20). A significant PUV was seen in 21 (42%) patients. The patients with portosystemic encephalopathy had a significantly greater prevalence of PUV (70%) than those without (32%, P < 0.02). Of the group with large esophageal varices, 6 (30%) had a significant PUV, while in the group with small varices, 15 (50%) had a significant PUV (P > 0.05). In no patient with large varices did the PUV diameter exceed 6 mm, while in as many as six patients with small varices, the PUV diameter exceeded 6 mm. A significantly enlarged PUV seen on duplex Doppler ultrasound in cirrhotics may have important hemodynamic consequences. Besides predisposing the patient to portosystemic encephalopathy, it may also offer some protection against formation of large varices. In particular, a very large patent PUV (> or =6 mm) might identify a subgroup of patients with small varices and thus a lesser likelihood of variceal bleeding.
Adolescent↗
Small lymphocytic lymphoma with perifollicular, marginal zone, or interfollicular distribution.
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) typically involves nodal or extranodal tissues as a diffuse proliferation with pseudofollicular growth centers obliterating normal architecture. We describe 16 cases of CLL/SLL in which the neoplasm was confined to the marginal zone, perifollicular, or interfollicular regions surrounding benign lymphoid follicles in either nodal or extranodal sites. Twelve of 12 (100%) patients with adequate staging data had disseminated disease (Stage III or IV) at presentation. Eight of the 16 (50%) patients had absolute peripheral lymphocytosis (range, 5 to 30 x 10(9)/L). Pseudofollicular growth centers were identified in 14 of 16 cases (87.5%). Immunophenotypic studies revealed that the tumor cells were positive for CD20 (16/16) and CD5 (11/11) in all cases examined. CD23 was positive in 12 of 14 (86%) interpretable cases. IgM and IgD were positive in 13 of 14 (93%) and 10 of 10 (100%) interpretable cases, respectively. All cases were negative for CD3 (16/16), CD45RO (16/16), CD10 (15/15), and cyclin D1 (15/15). We conclude that CLL/SLL can have unusual patterns of involvement, including marginal zone, perifollicular, and interfollicular patterns that can be difficult to recognize histologically. Thirteen of 16 (81%) cases in this study were misinterpreted by the referring pathologists. Recognition of proliferation centers coupled with demonstration of a CD5+ CD23+ B-cell immunophenotype establishes the correct diagnosis of CLL/SLL.
Adult↗
The central domain of bovine submaxillary mucin consists of over 50 tandem repeats of 329 amino acids. Chromosomal localization of the BSM1 gene and relations to ovine and porcine counterparts.
We previously elucidated five distinct protein domains (I-V) for bovine submaxillary mucin, which is encoded by two genes, BSM1 and BSM2. Using Southern blot analysis, genomic cloning and sequencing of the BSM1 gene, we now show that the central domain (V) consists of approximately 55 tandem repeats of 329 amino acids and that domains III-V are encoded by a 58.4-kb exon, the largest exon known for all genes to date. The BSM1 gene was mapped by fluorescence in situ hybridization to the proximal half of chromosome 5 at bands q2. 2-q2.3. The amino-acid sequence of six tandem repeats (two full and four partial) were found to have only 92-94% identities. We propose that the variability in the amino-acid sequences of the mucin tandem repeat is important for generating the combinatorial library of saccharides that are necessary for the protective function of mucins. The deduced peptide sequences of the central domain match those determined from the purified bovine submaxillary mucin and also show 68-94% identity to published peptide sequences of ovine submaxillary mucin. This indicates that the core protein of ovine submaxillary mucin is closely related to that of bovine submaxillary mucin and contains similar tandem repeats in the central domain. In contrast, the central domain of porcine submaxillary mucin is reported to consist of 81-amino-acid tandem repeats. However, both bovine submaxillary mucin and porcine submaxillary mucin contain similar N-terminal and C-terminal domains and the corresponding genes are in the conserved linkage regions of the respective genomes.
Amino Acid Sequence↗
Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results.
BACKGROUND: Thrombolytic therapy (TT) has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT), but its utility in patient management is still debated and the long-term results are not available. METHODS: From 1990 through 1999, we treated 110 consecutive patients (52 men, mean age 35.4 +/- 10.8 years) of left-sided obstructive PVT (96 mitral, 14 aortic) with TT (streptokinase in 108, urokinase in 2) according to a specified protocol of prolonged infusion. Serial echo Doppler parameters were monitored in all patients to guide the duration of TT and to quantify its efficacy. Ninety of the 102 survivors of the index episode were followed up for a mean period of 31.3 +/- 27.8 months (range 1-112 months). RESULTS: Complete hemodynamic response (on cinefluoroscopy and echo Doppler criteria) was seen in 90 (81.8%) episodes, partial response in 11 (10%), and failure in 9 (8.2%). The mean duration of TT was 42.8 +/- 20.4 hours. Five of the 7 patients who were initially seen in cardiogenic shock/overt pulmonary edema died during therapy. After these patients were excluded, the rate of complete response did not differ among patients with New York Heart Association class I/II (80%), class III (86.3%), or class IV (81.5%). The response rate also did not vary with the type, position of prosthesis, duration of symptoms, or time lag since surgery. There were 21 (19.1%) embolic episodes during therapy, including 6 strokes. These were significantly more frequent in patients with atrial fibrillation (AF) (odds ratio on multivariate analysis 2.3, 95% confidence interval 1.3-3.9, P =.01). On follow-up, there were 25 recurrences of PVT, of which 20 again received TT with a complete response in 14 (70%). At 5 years the actuarial survival was 85.2% and the event-free survival was 61.5%. The presence of chronic AF was a significant predictor of recurrence of PVT (odds ratio 2.2, 95% confidence interval 1.2-3.9, P =.008). CONCLUSIONS: TT is effective in the majority of patients with PVT but is associated with a high rate of embolism, especially in patients with AF. Excluding patients with cardiogenic shock/overt pulmonary edema (in whom TT is largely ineffective), the success of TT does not vary with the New York Heart Association class, duration of symptoms, or other patient variables. The recurrence rates of PVT are high after even successful TT, especially in patients with AF.
Adolescent↗
Management of biliary tract disease in heart and lung transplant patients.
BACKGROUND: Preexisting gallstones and pharmacologic alterations in both bile lithogenicity and immune function may predispose organ transplant recipients to the complications of biliary calculi. METHODS: Records of all 178 patients undergoing heart, lung, or heart-lung transplantation at our institution between 1980 and 1998 were reviewed. Patients with biliary tract disease were grouped as follows: group I, pretransplantation diagnosis and treatment; group II, pretransplantation diagnosis and posttransplantation treatment; group III, normal pretransplantation biliary tree with posttransplantation diagnosis and treatment; group IV, unknown pretransplantation biliary status with posttransplantation diagnosis and treatment. Comparison among groups was made with regard to ultrasound findings, presentation, indication for operation, procedure, and outcome. RESULTS: Of the 141 patients undergoing pretransplantation and/or posttransplantation ultrasound surveillance, the prevalence of abnormal ultrasonography was 36%. All patients in group I (n = 11) underwent elective intervention without complication. Of the 14 patients (groups II through IV) undergoing posttransplantation operation, intervention was mandated by acute complications of biliary tract disease in 7. The mortality rate in these 7 patients was 29%. CONCLUSIONS: Cholecystectomy in the posttransplantation period is often required emergently and has a high mortality. Posttransplantation surveillance of the biliary tree is crucial because of the high rate of de novo stone formation. All biliary calculi should be eradicated electively in stable patients before transplantation and on diagnosis after transplantation.
Adolescent↗
High-resolution CT in renal transplant patients with suspected pulmonary infections.
OBJECTIVE: This prospective study was carried out to assess the usefulness of high-resolution CT (HRCT) of the chest in immunocompromised renal transplant patients with suspected pulmonary infections. MATERIAL AND METHODS: Twenty-one consecutive renal transplant patients with clinically suspected pulmonary infections underwent chest radiography, HRCT and other tests including bronchoalveolar lavage (BAL). HRCT was performed using a high spatial frequency algorithm with 2-mm-thick sections at 10-mm intervals from apices to domes of the diaphragm. The findings on chest radiography and HRCT were interpreted by two thoracic radiologists and the usefulness of HRCT was evaluated. The images were interpreted independently by two radiologists, who were blinded to the findings of other imaging modalities and the final diagnosis. Any differences regarding the imaging findings were resolved through consensus. RESULTS: Final diagnosis was obtained in 17 patients, and no cause for symptomatology was established in 4 patients. The spectrum of infections included pulmonary tuberculosis (TB) in 11 patients, cytomegalovirus pneumonia (CMV) in 2 patients, cryptococcal and streptococcal pneumonia, pulmonary aspergillosis and esophageal candidiasis in 1 patient each. Compared to chest radiography, HRCT revealed additional findings in 11 patients. HRCT findings were suggestive of underlying infection in 11 patients. The final diagnosis coincided with HRCT diagnosis in all but 1 patient. HRCT findings were non-specific in 3 patients and normal in 7. The findings were concordant in 19 cases. The results were not in agreement in only 2 cases. CONCLUSION: HRCT can provide useful information and suggest the diagnosis in a significant proportion of renal transplant patients with pulmonary infection.
Adult↗
Prevalence of inter-institutional anatomic pathology slide review: a survey of current practice.
Multiple studies have demonstrated discrepancy rates between original and review histopathologic diagnoses of up to 30% with a mean of approximately 10%. In view of these rates of discrepancy, several authorities, including the Association of Directors of Anatomic and Surgical Pathology, have recommended in-house review of all outside materials before commencement of therapy. We used a mail survey to determine the degree of compliance with these recommendations among pathology groups in the United States. Mail surveys were sent to six randomly selected hospitals from each state (300 total). The survey included demographic questions, including surgical pathology caseload, size of hospital (beds), and type of hospital (community-general, non-academic-tertiary care, or academic-tertiary care). The survey asked whether the hospital required review of all outside slides before the performance of surgery. If not, was such a policy encouraged but not required. The survey also asked whether in-house review of outside cases had disclosed any significant differences in pathologic diagnoses. Finally, the survey questioned whether any discrepancies between an internal and external surgical pathology diagnosis had been discovered following radical surgery. One hundred twenty-six usable responses were obtained. Fifty-five of these were from hospitals self-described as community-general, seven were from hospitals describing themselves as non-academic-tertiary care, and the remaining 61 hospitals described themselves as academic-tertiary care institutions. Sixty-three institutions stated they had a requirement for in-house review of outside material, with 46 of 61 academic-tertiary centers having such a requirement. Thirty-seven of 55 community-general hospitals did not require in-house review of outside material before surgery could be performed. One hundred ten of the 126 institutions returning surveys either encouraged or required review of outside material. Ninety-five institutions reported that they had at least one outside case in which their diagnosis was significantly discordant with that rendered by the referring pathologist. Sixty (48%) of the 126 institutions reported at least one case in which a discrepancy was found between the outside biopsy diagnosis and the internal diagnosis rendered on material obtained by radical surgery. Approximately half of all responding institutions have a requirement for in-house review of outside material prior to surgery. A majority of institutions requiring such review have found discrepancies between the in-house diagnoses and those rendered by referring laboratories.
Diagnostic Errors↗
Radioisotope bone scanning in pulmonary alveolar microlithiasis.
A 30-year-old woman was examined for a history of exertional breathlessness, swelling of her feet, and a mild dry cough of 4 to 5 months' duration. Her symptoms developed during the last month of her pregnancy, with gradually increasing dyspnea, swelling of the feet, and reduced urinary output. There was no history of expectoration, hemoptysis, chest pain, or tuberculosis. General physical examination showed no evidence of clubbing of the nails or lymphadenopathy. Chest auscultation revealed a few end-inspiratory crepitations at both lung bases. Bronchial alveolar lavage showed calcium particles, whereas results of the transbronchial lung biopsy were consistent with alveolar microlithiasis.
Adult↗
Analysis of static pulmonary mechanics helps to identify functional defects in survivors of acute respiratory distress syndrome.
OBJECTIVE: To assess the utility of static lung pressure-volume measurements in identifying and categorizing pulmonary function test defects in survivors of acute respiratory distress syndrome (ARDS). DESIGN: Cross-sectional. SETTING: Pulmonary function laboratory at a tertiary referral hospital in northern India. PATIENTS: Six survivors of ARDS reporting for their first follow-up visit after discharge. MEASUREMENTS AND MAIN RESULTS: Spirometry and whole body plethysmography were performed to evaluate lung volumes and to collect static lung pressure-volume data; the latter were subjected to monoexponential analysis. Three patients had a restrictive ventilatory defect as evidenced by diminished vital capacity and total lung capacity, but only one had reduced static lung compliance. The other two patients had reduced recoil pressure at total lung capacity, suggestive of respiratory muscle weakness. Two other patients with normal lung volumes had reduced static lung compliance. Exponential analysis of pressure-volume data in the three patients with reduced static lung compliance was consistent with reduced distensibility and loss of lung units in one patient each. Additionally, two patients had high values for shape constant of the exponential curve, indicative of air space distention. CONCLUSIONS: Detailed analysis of static pressure-volume data can identify pulmonary function abnormality and categorize the dominant mechanism responsible for restrictive ventilatory defects in survivors of ARDS, even in patients with normal lung volumes. In addition to lung fibrosis, neuromuscular weakness also contributes to decline in pulmonary function.
Adolescent↗