Dysplastic alteration of mucosa may occur in flat or raised mucosal lesions. Over 95% of dysplastic foci occur in flat mucosa. Flat dysplasia is occasionally visible macroscopically as areas of discolouration, velvety-villous appearance, or peculiar fine nodular thickening. The prevalence of macroscopically visible flat dysplasia is unknown. Raised dysplasia or DALM (dysplasia associated lesion or mass) occurs in less than 5% of patients with dysplasia. DALMs are polypoid structures of firm consistency, discoloured mucosa and irregular nodularity. DALMs cannot be distinguished endoscopically from early malignancy. The presence of DALMs has an ominous significance.

Colitis, Ulcerative↗

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Recurrent polyps in the ileo-anal pouch or rectum in familial adenomatous polyposis.

Most small bowel polyps in familial adenomatous polyposis (FAP) occur in the peri-ampullary region, and distal small bowel adenomas and carcinomas are comparatively less common. As standard therapy in FAP consists of proctocolectomy with ileal pouch anal anastomosis, or ileorectal anastomosis, it is essential to be aware of the potential for adenomatous polyp formation in the terminal ileum and rectum. Ileal adenomas are found in 9-20% of patients with FAP, and new polyps may develop after colectomy. Ileal lymphoid hyperplasia and polyps are 2-4 times more common than adenomas, may be indistinguishable from adenomas on examination (requiring biopsy for diagnosis), and tend to regress after colectomy. Adenomas may arise in pouches, usually after an interval of several years, and have been documented to occur in the terminal ileum up to 25 years after colectomy. At pouch construction, rectal mucosectomy may theoretically fail to remove all mucosa at risk. Small islets of rectal mucosa may remain after this technically difficult operation, and the late development of cancer, up to 20 years postoperation has been noted. A stapled anastomosis may arguably have a better physiological result, but a greater amount of residual rectal mucosa may increase late cancer risk. Annual endoscopic follow-up of pouches is recommended. All polyps or suspicious lesions should be biopsied, excised or destroyed, preserving a sample for histology. After ileorectal anastomosis, cancer risk in the rectal stump increases with chronological age, with risk ranging from 5-10% at age 50 years, to 14-29% at age 60 years. Surveillance of the rectal stump in FAP is recommended every 4-6 months. There may be a role for prostaglandin synthesis inhibitors in some patients.

Adenomatous Polyposis Coli↗

PubMedDate not supplied

An epidemiological study of blood pressure in school children (5-14 years) in Delhi.

Distribution patterns of blood pressure were studied in a randomised sample of 10,215 school children (5,709 boys 4,506 girls) in the age group 5-14 years in Delhi. The mean values of systolic and diastolic blood pressure (SBP and DBP) increased with age in both sexes. The cut-off points for high blood pressure were based on average SBP and/or DBP values of 95th percentile or greater for each age. The values for SBP ranged from 70 mm Hg to 140 mm Hg and for DBP from 36 mm Hg to 100 mm Hg for the age group 5-9 years. In the age group 10-14 years, the values for SBP and DBP ranged from 72 mm Hg to 160 mm Hg and from 46 mm Hg to 120 mm Hg, respectively. The prevalence of hypertension (systolic, diastolic or both) was 11.9 percent in boys and 11.4 percent in girls, an insignificant difference. Anthropometric variables like height, weight and body mass index showed positive correlation with systolic as well as diastolic blood pressure but the waist-hip ratio showed negative correlation coefficient with blood pressure. Family history of hypertension in one or both the parents was present in 20.4 percent children with high blood pressure compared to 6.8 percent in normotensives. Family history or diabetes was also significantly higher in hypertensive children (5.4%) than in normotensives (3.1%).

Age Distribution↗

PubMedDate not supplied

Age- and height-specific reference limits of blood pressure of Indian children.

BACKGROUND: Blood pressure in childhood is the most powerful predictor of hypertension in adults. Norms for blood pressure in children are based on the age- and height-specific distribution of blood pressure in a reference sample of healthy children. METHODS: We performed a cross-sectional survey of school-children in the age group 5 to 14 years in south Delhi and studied the distribution of systolic and diastolic blood pressure in 8293 children (4623 boys and 3670 girls). Blood pressure was measured in all children with a mercury column sphygmomanometer using a standardized technique. The first and the fourth Korotkoff sounds were taken as indicative of the systolic and the diastolic blood pressure, respectively. Height percentiles were computed for the study sample for every one-year sex-pooled group. Multiple linear regression was then performed for every one-year group in order to estimate the 90th and 95th percentiles of systolic and diastolic blood pressure according to percentiles of height. RESULTS: Age and height, but not gender, emerged as the principal determinants of systolic and diastolic blood pressure in multivariable linear regression analyses. Age- and height-specific 90th and 95th percentile values of systolic and diastolic blood pressure were estimated, which enabled us to categorize children into 'normal', 'high normal' and 'high' blood pressure groups. CONCLUSIONS: We present age- and height-specific reference values for blood pressure of Indian children based on a large study sample. The use of these standards should aid the identification of children with high blood pressure.

Adolescent↗

PubMedDate not supplied

Asymptomatic coronary heart disease detected on epidemiological survey of urban population of Delhi.

A community based epidemiological study of coronary heart disease (CHD) was carried out in a random sample of 13723 adults in the age group of 25-64 years in the urban population of Delhi. The electrocardiogram (ECG) of all clinically detected CHD cases and of a sample of 5621 persons (selected on the basis of alternate household screened) without clinical manifestations of CHD, was obtained. Out of 5621 persons labelled as asymptomatic, CHD evidence of Q wave myocardial infarction (MI) was present in 80 ECGs (1.4%). Another 296 ECGs had ST & T changes vide Minnesota Code 4-1-1, 4-1-2, 5-1 and 5-2 acceptable as evidence of probable CHD. The overall prevalence rate of asymptomatic CHD was 6.7% (male 5.6%, female 7.6%). Silent MI was more common in the male patients (1.7% vs 1.1%, p < 0.001). However, ST-T changes were more common in female patients (6.5% vs 3.9%, p < 0.001). The ST-T changes showed a steady factor in asymptomatic CHD cases was hypertension in both sexes (male-45.2%, female-43.5%) p = NS. Obesity was present in 24% of male & 46.1% of female patients (p < 0.001). Family history was found in 20% cases of both sexes. Smoking was recorded in 34.9% male and 10.9% female patients with asymptomatic CHD (p < 0.001).

Adult↗

PubMedDate not supplied

Use of rice bran oil in patients with hyperlipidaemia.

BACKGROUND: The quantity and type of dietary fat is known to affect plasma lipid concentration and hence the choice of cooking oil is important to lower the risk of coronary heart disease. Rice bran oil, which was not popular worldwide, is slowly being recognized as a 'healthy' oil in India. We assessed if rice bran oil had hypolipidaemic effects in subjects with elevated lipid levels. METHODS: The study had a cross-over design with subjects (n = 14) randomly assigned to consume either rice bran oil or refined sunflower oil in their homes, for a period of 3 months (period 1). After a washout period of 3 weeks, they were crossed over to the other oil (period 2). The serum lipid values were estimated at the beginning, on day 45 and day 90 of each phase. Additional parameters assessed included anthropometry, dietary and physical activity patterns. RESULTS: The use of rice bran oil significantly reduced plasma total cholesterol and triglyceride levels compared with sunflower oil. The reduction in plasma LDL-cholesterol with rice bran oil was just short of statistical significance (p = 0.06). HDL-cholesterol levels were unchanged. CONCLUSION: The use of rice bran oil as the main cooking oil significantly reduced serum cholesterol and triglyceride levels. The use of rice bran oil together with dietary and lifestyle modifications may have implications for reducing the risk of cardiovascular disease.

Adult↗

PubMedDate not supplied

Mediastinal tumors and cysts.

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Adolescent↗

PubMedDate not supplied

Assessment of incompetence in canine aortic and pulmonary valve grafts and comparison of some methods of valve preservation.

A new method has been devised to assess the competence of the canine aortic valves, before implantation. This method would provide a better selection of aortic valves before their insertion and may reduce the incidence of postoperative incompetency. Comparison of canine pulmonary and aortic valve function, at various pressures, revealed that the pulmonary valves were regurgitant at higher pressures, in comparison to aortic valves. Formalin preserved valves were found to be significantly regurgitant.

Animals↗

PubMedDate not supplied

Permanent pacemaker infections: their characterization and management--a 15-year experience.

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Adolescent↗

PubMedDate not supplied

Echinococcosis of the heart presenting as ventricular tachycardia: recovery after surgical treatment.

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Adult↗

PubMedDate not supplied

A 5-year follow-up study of hypertension in a rural community.

A follow-up study of hypertension was carried out among adults, in the age group between 25 to 64 years, in a rural population of Gurgaon district, Haryana, five years after an initial community based epidemiological survey of the same population. The progress of 77 out of 98 hypertensives detected at the initial survey could be reassessed. The treatment and severity of hypertension found at the initial survey has been compared with that observed on follow-up. The percentage of cases with blood pressure (BP) controlled on treatment increased from 2.6 percent to 45.4 percent on follow-up. An electrocardiogram could be obtained in 66 out of 77 subjects reexamined and was abnormal in 21 cases (31.8%). The electrocardiographic abnormalities found were: myocardial infarction in one, left ventricular hypertrophy in 5, left ventricular hypertrophy with ischaemic ST-T changes in 6, isolated ST-T abnormalities in 5 and conduction defects or arrhythmias in 4 cases. In a cohort of 1,334 subjects who were normotensive at the initial survey, 19 new cases were detected to have hypertension. The overall annual incidence of hypertension was 2.8/1000 (male: 3.8/1000 and female: 2.4/1000). In these hypertensives, a family history of hypertension was present in 10.5 percent and obesity in 42.1 percent.

Adult↗

PubMedDate not supplied

What is 'desirable' lipid profile.

The lipid profile of subjects with and without coronary heart disease (CHD) was studied in two epidemiological studies conducted in an urban and rural population. The prevalence of CHD was 96.7/1000 in the urban area and 27.1/1000 in the rural area. The lipid levels of the rural population, with an entirely different life style, was significantly lower compared to the urban normal population. The data suggest that if the prevalence of CHD is to be reduced in the urban population, the desirable levels of lipids should be those obtained in the rural normal population rather than the urban, CHD free, population.

Adult↗