Biomedical subjects
Publications and source records attributed to J Wadhwa.
We report the case history of a patient with ovarian carcinoma and bilateral breast metastases. The presence of metastases to the breast from a primary ovarian carcinoma, diagnosed at initial presentation, is a rarity.
Acute myeloid leukaemia is an uncommon but an important cause of soft tissue swellings. Such extrameningeal, extramedullary leukaemic infiltrates are called extramedullary myeloid cell tumours. Despite their large size they may respond well to chemotherapy and local radiotherapy, as is demonstrated in this case.
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Brain death is the irreversible cessation of all brain functions. Brainstem death is the 'physiological core' of brain death. The Indian Parliament has given legal recognition to brain death though it applies only in the context of performance of organ transplantation. Brain death is diagnosed if there is irreversible loss of consciousness, absence of brainstem reflexes and apnoea. Care and diligence in the application of the criteria for brain death provide important safeguards for Individual patients and the community in general. These criteria also allow death to be diagnosed with certainty prior to the occurrence of circulatory arrest. Solid organ transplantation has become possible through the diagnosis of brain death but is not the primary consideration; the management of a potential organ donor, who is brain dead, is also vital. If optimal preservation of organs for transplantation is to be achieved the clinician needs to understand the pathophysiology and consequences of changes occurring in various organs after brain death and active management is required to reverse or control these changes. Discussions about organ donation with relatives of brain deed patients are never easy. These should always be frank and sympathetic. It has been suggested that those whose interests lie in transplantation must bear the responsibility of educating the general public. This will help intensivists who expose themselves knowingly to the unpleasant aspects of organ donation.
The simultaneous dysfunction of several organs represents a challenging task for the intensivist. Systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are expressions of an inappropriate generalized inflammatory response of the host to a variety of infectious or non-infectious stimuli. In recent years, MODS is being encountered frequently in critically ill patients due to several causes. Experimental and clinical evidence suggests that the gut, endothelium and immune system interact to produce altered metabolic and cardiorespiratory patterns. It is thus possible that a target-oriented approach, including correction of intestinal hypoperfusion, supply of specific nutrients and downregulation of the inflammatory cascade, can act as either a preventive measure for subjects as risk or as the treatment for patients with full-blown MODS.