Biomedical subjects
Publications and source records attributed to K L Gupta.
We have reported a typical case of extra-adrenal pheochromocytoma. The tumor, located in the posterior mediastinum was diagnosed five years after onset of classic symptoms and signs. Our case illustrated the usefulness of computerized tomography in locating pheochromocytomas. A high index of suspicion is required to detect such a unique tumor and avoid unnecessary delays in diagnosis and treatment.
Percutaneous transluminal angioplasty (PTA) was used to dilate stenotic lesions in 38 brachiocephalic arteries in 36 patient. Complete evaluation of the central nervous system blood supply is a prerequisite for the brachiocephalic PTA when cerebral symptoms are present. The femoral artery is the best vascular entry site; use of digital subtraction angiography equipment for arterial mapping is helpful. Balloon diameter should be the same as or slightly wider than the diameter of the normal artery adjacent to the stenotic segment. Spasm was successfully treated with intraarterial injection of nitroglycerin. The only drug therapy consistently used with PTA was aspirin. Complete dilation of the stenosis is the best prevention of thrombotic or embolic complications. In properly selected cases, proximal subclavian artery stenoses can be safely dilated, and the balloon can eventually be placed across the origin of the vertebral artery. Because of potential complications associated with brachiocephalic PTA, indications must be well established, and interventions should not be performed on marginal or asymptomatic stenoses.
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An inexpensive digital subtraction angiography (DSA) apparatus that can perform live subtraction, processed subtraction, and road mapping is described. The apparatus can be used in any standard x-ray room with fluoroscopic capability, with a simple connection to the existing TV chain. It is especially useful in therapeutic neuroangiography.
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Explore the source record for details and available documents.
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Systemic lupus erythematosus (SLE) is an autoimmune disease with varied clinical manifestations. Children and adolescents comprise one-fourth of affected patients with SLE and 40-80% of them have renal involvement. Lupus nephritis (LN) may present with mild urinary abnormalities or fulminant acute nephritis and renal failure. Diffuse proliferative glomerulonephritis (WHO class IV) is the predominant histological presentation in children and more common in boys than girls. This probably is one of the main reasons for the high mortality reported in the initial studies. Early diagnosis and aggressive treatment have led to improvement prognosis in these children. Cytotoxic therapy including intravenous cyclophosphamide has a definite role in the management WHO class IV and occasionally class III lupus nephritis. Prolonged steroid and cytotoxic therapy may lead to significant toxicity.
To investigate the advantage and limit of contrast enhancement in the examination of orbital mass lesions, precontrast T1- and T2-weighted, and postcontrast T1-weighted spin-echo images were retrospectively compared by two experienced observers. Using contrast material, intraocular tumors were well detected and characterized, and several orbital tumors were characterized as to whether cystic or necrotic and intracranial involvement was better evaluated. On the other hand, tumor-fat interface lost conspicuity when tumors showed enhancement. We conclude that gadopentetate-dimeglumine-administered T1-weighted images were helpful in detecting, differentiating and characterizing tumors of the orbit. However, the loss of contrast with fatty tissue is a disadvantage to be considered.
Incidental peripheral lesions found during neuroradiological MR examinations with surface coils are reviewed. These include intracranial metastases during orbital examinations, cerebellar and thyroid lesions during cervical spine examinations, and dissecting and saccular abdominal aneurysms, as well as renal and intrapelvic abnormalities during lumbar spine examinations. Because of the reduced field-of-view and rapid signal drop-off in deeper portions of the body when examinations are performed with surface coils, peripheral and deep regions also need careful attention during routine evaluation.
Intraocular hemorrhage and mimicking lesions on precontrast spin-echo magnetic resonance images were examined with contrast material and/or gradient-echo pulse sequence. Twenty-two melanomas, nine retinoblastomas, four hemorrhages, one metastasis, and one toxocara endophthalmitis were examined. With contrast material, all tumors demonstrated enhancement, whereas hemorrhage did not. Retinoblastomas demonstrated a heterogeneous enhancement pattern. Computed tomography demonstrated corresponding intratumoral calcifications at the areas of no enhancement. Gradient-echo images demonstrated a heterogeneous pattern in the majority of the lesions compared to spin-echo images. However, relatively characteristic small round areas of signal drop-off representing calcification were observed in about half of the retinoblastomas.
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Nine fatal cases of systemic mucormycosis observed in association with renal failure are described. Four patients were hospitalized for chronic renal failure as a consequence of chronic glomerulonephritis, myeloma kidney, chronic pyelonephritis, and polycystic kidney disease, respectively; and five patients presented with acute renal failure. The underlying causes in three of these five patients were gentamycin nephrotoxicity, acute gastroenteritis, and allograft rejection, respectively, and in the remaining two, acute renal failure was the result of extensive renal vascular and parenchymal invasion by mucor hyphae. Tissue invasion with mucormycosis was documented during life in two patients and at autopsy in seven patients. The infection was disseminated in five patients, and isolated pulmonary and rhinocerebral involvement occurred in two patients each. Our observations have shown that patients with renal failure are prone to develop mucormycosis, which carries a grave prognosis if therapy is not instituted in time.
Three patients of disseminated mucormycosis are described. None had predisposing factors. Two of them presented with nonspecific symptoms along with acute renal failure and peritonitis. Third patient had fulminating primary cutaneous mucormycosis which disseminated later. Development of acute renal failure with smooth enlargement of both kidneys in an apparently healthy individual or appearance of mould in a wound should raise the suspicion of mucormycosis. The hallmark of the infection was vascular invasion and thrombosis. Antemortem diagnosis could be made in one patient only. All patients had progressive downhill course despite supportive treatment, antibiotic and amphotericin in-B in one patient.
Over a 16-year period, 205 patients with hypertension were shown to have a renovascular aetiology. Of these, 125 (61 per cent) had Takayasu's arteritis, 58 (28.3 per cent) had fibromuscular dysplasia, 16 (7.8 per cent) had atherosclerosis, five (2.4 per cent) had polyarteritis nodosa and one (0.5 per cent) had renal artery aneurysm. Among patients with Takayasu's arteritis, males were affected as commonly as females. The mean age of these patients at the time of detection was 26.8 +/- 8.6 years (range 5-52 years). Type I arteritis was seen in nine (7.2 per cent), Type II in 40 (32 per cent) and Type III in 76 (60.8 per cent) patients. The abdominal aorta was involved in 117 (93.3 per cent) patients. Takayasu's arteritis was associated with ulcerative colitis in two patients and with renal amyloidosis and focal segmental glomerulosclerosis with a nephrotic syndrome in one patient each. Surgical intervention consisting of bypass procedures, autotransplantation or nephrectomy was performed in 17 (13.6 per cent) and angioplasty in nine (7.2 per cent) patients. Cure and improvement in blood pressure was observed in 82.4 per cent and 77.8 per cent respectively. Adequate control of blood pressure was achieved with drugs only in 22 (22.2 per cent) patients. A definite cause and effect relationship could not be established between any infective or immunological disorder and Takayasu's arteritis. Takayasu's arteritis is a far more common cause of renovascular hypertension in Indian population than fibromuscular dysplasia or atherosclerosis, which are more common in the western population.
The CT and MR appearance of leiomyosarcoma in the left orbit in a 15-year-old girl is presented. This tumor developed after successful radiation therapy for bilateral retinoblastoma.
Pharmacokinetics of a sustained release (SR) and conventional formulations of theophylline plus hydroxyethyltheophylline was compared with tablet aminophylline. Time concentration curve of serum theophylline with the three formulations after single and multiple dosage schedules revealed significantly retarded absorption with the SR preparation. SR tablet was also seen to produce uniform steady state levels with fluctuation of serum concentrations within the therapeutic range for a duration of over 12 hours. In comparison, aminophylline and conventional theophylline hydroxyethyltheophylline tablets produced sharp swings in steady state levels with trough levels dipping to subtherapeutic concentrations within 4-6 hours. SR formulation, therefore, is likely provide consistent serum levels and better therapeutic control in comparison to the other two conventional tablets.