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Biomedical subjects

N Khandelwal

Publications and source records attributed to N Khandelwal.

At least 55 records · Page 3Linked to original sources
PubMed2000

Histopathological and biochemical changes in the sutural region in craniosynostosis.

OBJECT: Histopathological observations and biochemical analysis of sutural bones in nine patients with craniosynostosis were compared with control subjects of the same age range. METHODS: Microscopic examination in craniosynostosis showed formation of an active osseous front, with higher osteoblastic activity than in controls. Biochemical analysis revealed higher calcium, phosphorus, alkaline phosphatase, phospholipids and chondroitin sulphate-A contents in sutural bones of the same patients. CONCLUSIONS: The present study systematically establishes a premature increase in osteogenesis in the sutures of craniosynostosis patients.

Alkaline Phosphatase↗
PubMed2000

Clinical spectrum of 500 children with neurocysticercosis and response to albendazole therapy.

Neurocysticercosis is a major cause of neurologic illness worldwide. Its manifestations are variable, and somewhat different when it occurs in children. Controversy exists regarding anticysticercal therapy. The clinical, laboratory, and radiographic features of 500 consecutive children with neurocysticercosis were studied; the children were then followed prospectively and their response to albendazole therapy was analyzed. Diagnosis of neurocysticercosis was based primarily on neuroimaging. Computed tomographic (CT) scans, neurocysticercosis serology, chest radiographs, and Mantoux tests were done in all children, and magnetic resonance imaging scans in 10%. All children with multiple lesions, and some randomly allocated children with single, small, enhancing CT lesions received albendazole. CT scans were repeated after 3 to 6 months. There were 272 boys and 228 girls, age range 1 6/12 to 12 6/12 years. Seizures were present in 94.8% of cases; 83.7% had focal seizures. Features of raised intracranial pressure were seen in 30% of patients and focal neurodeficit in 4%. Single lesions were seen in 76% of the children, with perilesional edema in 57.4%. Thirty-four children who had multiple cysts and received albendazole underwent serial CT evaluation. Four showed disappearance of lesions and 22 had reductions in the size or number, to give an overall improvement rate of 76%. Serial CT studies were available on 176 children with single lesions, 90 of whom received albendazole. Improvement (disappearance or reduction in the size of lesions) was observed in 91% (82 of 90) of albendazole-treated children versus 85% (73 of 86) of untreated children. This difference was not significant. No significant side-effects of albendazole were reported. These data indicate that partial seizures and single parenchymal cysts are the most frequent clinical and neuroradiographic manifestations of neurocysticercosis in children. Although albendazole therapy should be considered, especially in children with multiple lesions, many children with isolated neurocysticercosis will improve without antiparasitic therapy.

Albendazole↗
PubMed2000

A mathematical outcome prediction model in severe head injury: a pilot study.

103 patients of head injury, with a Glasgow coma scale (GCS) score of 8 or less, were studied prospectively. GCS score, brain stem reflexes, motor score, reaction level scale, and Glasgow Liege scale were evaluated as prognostic variables. Linear logistic regression analysis was used to obtain coefficients of these variables and mathematical formulae developed to predict outcome in individual patients.

Adult↗
PubMed2000

Calcified falx meningioma.

A totally calcified mid third falcine meningioma in an elderly male patient is presented. An uneventful enmasse excision was performed. Advantages of positioning on ipsilateral side for paramedian extracerebral lesions are highlighted.

Calcinosis↗
PubMed1999

Orbital mass lesions: US-guided fine-needle aspiration biopsy--experience in 37 patients.

PURPOSE: To evaluate the safety and effectiveness of using ultrasonographic (US) guidance for performing fine-needle aspiration biopsies of orbital mass lesions. MATERIALS AND METHODS: Thirty-seven patients with mass lesions in the orbit underwent US-guided fine-needle aspiration biopsy. Computed tomographic scans were available in all patients. In 19 patients, the lesions were located in posterior orbit, whereas in 18 patients the lesions were located in (n = 3) or extended up to (n = 15) the anterior compartment. Fine-needle aspiration biopsy was performed with 22-25-gauge needles and use of the freehand technique. RESULTS: Needle biopsies were performed safely and easily, and real-time US monitoring of the needle position was used to avoid injury to the eyeball. No major complications were encountered. Diagnostic specimens were obtained in 29 (78%) of the 37 patients, and 19 benign and 10 malignant disease processes were diagnosed. In eight patients (22%), an appropriate diagnosis could not be made, as aspiration samples yielded insufficient tissue. CONCLUSION: US provides safe and effective guidance for performing fine-needle aspiration biopsy in orbital mass lesions and is especially useful in deep-seated nonpalpable retrobulbar lesions.

Adolescent↗
PubMed1999

CT-guided fine-needle aspiration biopsy of spinal lesions.

PURPOSE: A retrospective study of CT-guided fine-needle aspiration biopsies (FNABs) of spinal lesions performed over a period of 6 years was carried out with the aim of assessing the safety and efficacy of the procedure and to analyse the various approaches used. MATERIAL AND METHODS: Ninety-three FNABs were performed in 87 patients, 4-70 years of age, under CT guidance. Lytic or mixed vertebral lesions with or without a paraspinal soft tissue component were included in the study. The approach depended on the anatomic region and part of the vertebra involved. RESULTS: A definite cytological diagnosis was obtained in 77 patients (88.5%); of these, 47 patients had benign lesions and 30 patients had neoplasms. The most common pathologies encountered were tuberculosis (n=33) and metastases (n=17). There were 10 inconclusive FNABs; these showed blood only, necrotic material or scanty material insufficient for diagnosis. There were no procedure-related complications. CONCLUSION: CT-guided FNAB is a safe and effective technique for the evaluation of spinal lesions and is helpful in planning therapy. Choosing the appropriate approach results in a low complication rate.

Adolescent↗
PubMed1999

Ultrasound-guided fine needle aspiration biopsy of gall bladder malignancies.

PURPOSE: To establish the safety and efficacy of US-guided fine needle aspiration biopsy (FNAB) in gall bladder malignancies. MATERIAL AND METHODS: 142 patients suspected to have gall bladder malignancies underwent FNAB under real-time US guidance. The most common sonographic appearances were a mass filling or replacing the gall bladder (n=98), focal or diffuse wall thickening (n=25) and intraluminal polypoidal mass (n=19). FNAB was performed with a 0.7-mm spinal needle using a free-hand technique. RESULTS: On initial FNAB, 115 patients were diagnosed to have malignancy. In the remaining 27 patients, aspirates on first FNAB showed either inflammatory pathology (n=14) or the sample was suspicious of malignancy (n=7), or the aspirates were non-representative (n=6). Of these 27 patients, 13 underwent repeat FNAB because of the high suspicion of malignancy and 12 of them showed malignancy. The FNAB diagnosis of inflammatory disease of 7 patients was confirmed on subsequent surgery and 8 patients were lost to follow-up. Thus, a total of 127/142 were diagnosed to have gall bladder malignancy. Adenocarcinoma was the most common malignancy (89.76%). No procedure-related complications were encountered. CONCLUSION: US-guided FNAB is a safe and accurate technique to diagnose gall bladder malignancy. Either a repeat FNAB or surgical biopsy is recommended when the suspicion of malignancy is high and the initial FNAB is negative.

Adult↗
PubMed1999

Clinical profile of multiple sclerosis in north-west India.

A total of 100 patients were enrolled in this study with the clinical diagnosis of multiple sclerosis (MS). This included prospective analysis of 35 patients and retrospective analysis of 65 patients from their medical records spanning a period from January 1986 to March 1998. They were divided into 3 groups (i) overall group (ii) MRI group (where MRI was available) (iii) No MRI group (where MRI was not available). Data in terms of clinical features and laboratory investigations were compared in the three groups. MS was found to constitute 2.54% of neurology admission between January 1993 to December 1997. It was higher as compared to previous data from our institute (1.58%). Cerebellar symptoms were higher in the MRI group as compared to the non MRI group. The clinical spectrum of MS in the MRI group was comparable to that in the west. Obviously the MRI helps in early diagnosis of milder and atypical cases. Oligoclonal bands were found in 30.5% of cases only.

Adult↗
PubMed1999

Midline and far lateral approaches to foramen magnum lesions.

Twenty patients with foramen magnum lesions were operated upon in the last 5 years at Postgraduate Institute of Medical Education and Research, Chandigarh. The common presenting features were quadriparesis, quadriplegia, diminished sensations, neck pain and respiratory insufficiency. The lesions encountered were meningiomas, neurofibromas, posterior inferior cerebellar artery aneurysms, neurenteric cyst and chordoma. Patients with posterior or posterolaterally placed lesions were operated by the midline posterior approach while those with anterior or anterolateral lesions were managed by the far lateral approach. All mass lesions were excised completely and the aneurysms were clipped. Seventeen patients made good neurological recovery while three died. The latter three patients presented very late. The merits of various surgical approaches to the foramen magnum are discussed.

Adolescent↗
PubMed1999

Non-compressive myelopathy: clinical and radiological study.

Fifty seven patients (42 males and 15 females) with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM) was the commonest (31) followed by Vit B12 deficiency myelopathy (8), primary progressive multiple sclerosis (5), hereditary spastic paraplegia (3), tropical spastic paraplegia (2), subacute necrotising myelitis (1), radiation myelitis (1), syphilitic myelitis (1) and herpes zoster myelitis (1). 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL) and pleocytosis (mean 20.78/cumm, range 0-200 mm3). Oligoclonal band (OCB) was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM.

Adolescent↗
PubMed1999

Neurological complications of eclampsia.

OBJECTIVE: A prospective study was conducted to evaluate the various neurological (clinical, radiological and EEG) complications in patients of eclampsia. METHODS: Thirty nine patients of eclampsia were studied regarding neurological findings at presentation and electroencephalographic (EEG) tracings were recorded in each patient. Patients with an abnormal neurologic examination and/or focal or lateralizing findings on EEG, underwent a CT scan (n = 18). Foetal and maternal outcome were recorded. RESULTS: The age of the patients ranged from 19-30 (mean +/- SD, 24.2 +/- 3.5) years thirty six patients (92%) had seizures in the antenatal period, 2 (5.4%) patients developed post partum eclampsia and 1 (2.6%) patient had seizures before and after delivery. A diffuse encephalopathy was seen in 9 patients (23.1%), 4 patients (10.2%) had hemiparesis and 1 patient (2.6%) had papilledema. EEG abnormalities were seen in 29 cases (74%) and included generalized slowing (n = 19), generalized sharp waves (n = 9), focal slowing (n = 4), focal sharp waves (n = 2) and spikes (generalized and focal) were seen in 1 patient each. Abnormal CT scan was seen in 10 cases (n = 18). Five patients had generalized infarct was seen in 1 patient each. There were 8 (20.5%) still births and 31 (19.5%) live births and no maternal mortality. CONCLUSIONS: Antenatal seizures occur in > 90% cases of eclampsia and less than 10% cases have seizures after delivery. A diffuse encephalopathy is the commonest clinical abnormality along with generalized slowing on EEG. Although cerebral oedema is common focal infarcts may be seen on CT scan.

Adult↗
PubMed1998

Albendazole therapy in children with focal seizures and single small enhancing computerized tomographic lesions: a randomized, placebo-controlled, double blind trial.

BACKGROUND: Single small enhancing computerized tomographic (CT) lesions (SSECTLs) are common in children with focal seizures. These are considered to represent solitary cysticercus granulomas. Controversy exists regarding their treatment. OBJECTIVE: To evaluate the efficacy of albendazole in cases of focal seizures with SSECTLs. DESIGN: Randomized, placebo-controlled, double blind trial. SETTING: Pediatric service of Nehru Hospital, PGIMER, an urban tertiary care teaching hospital. SUBJECTS: 63 children between 2 and 12 years of age with focal seizures for <3 months and SSECTLs. INTERVENTION: All children were randomly assigned to receive either albendazole (15 mg/kg/ day) or placebo for 28 days. CT scan was done at 1 and 3 months after beginning treatment. Codes opened after 6 months of inclusion in the study showed that 31 had received albendazole and 32 had received placebo. All children were followed up for at least 15 months. RESULTS: Disappearance of lesions on CT scan was noted in 41% of albendazole vs. 16.2% of placebo patients after 1 month of follow-up (P < 0.05) and 64.5% of albendazole- vs. 37.5% of placebo-treated patients after 3 months of follow-up (P < 0.05). During the first 4 weeks of therapy seizure recurrence was seen in 9.7% of albendazole vs. 3.2% of placebo-treated children (odds ratio, 3.32; 95% confidence interval, 0.33 to 33.8). After 4 weeks seizure recurrence was seen in 31.3% of placebo-treated children vs. 12.9% of albendazole-treated children (odds ratio, 3.07; 95% confidence interval, 1.18 to 11.15). CONCLUSIONS: Albendazole therapy results in significantly faster and increased resolution of solitary cysticercus lesions (SSECTLs) and appears to reduce the risk of late seizure recurrences.

Adolescent↗
PubMed1998

Spontaneous intracranial hematomas: role of dynamic CT and angiography.

Forty-five patients with spontaneous intracerebral hemorrhage (ICH) were studied prospectively by dynamic CT and cerebral angiography. The accuracy of dynamic CT in demonstrating the underlying vascular cause in ICH was evaluated. Dynamic CT correctly predicted 90% of aneurysms, 83% of AVMs and 100% of normal studies as compared to angiography. Cerebral angiography can be obviated in patients where dynamic CT does not show any obvious vascular anomaly.

Adolescent↗
PubMed1996

Cranial cystic epidermoid: report of two cases and review of the literature.

Intercranial epidermoid tumours are benign lesions of congenital origin that are potentially curable. Although computerized axial tomography (CT) and magnetic resonance imaging (MRI) are usually diagnostic, a few atypical features sometimes make pre-operative diagnosis difficult. Two cases of cystic epidermoids with peripheral ring enhancement are reported. Relevant literature has been reviewed.

Adult↗
PubMed1996

Morphologic changes in pulmonary vasculature with arteriographic correlation.

During fetal life the pulmonary circulation is one of high resistance. Soon after birth with the onset of breathing and thereafter, sequential structural changes in pulmonary vasculature take place. Several authors have reported differently on this structural remodeling. This study describes the changes in the pulmonary vasculature occurring following birth. Twenty-five cases submitted to autopsy with ages ranging from newborns up to fourteen years were studied. Postmortem arteriography was undertaken in most of the cases and arterial morphology was quantitated by histomorphometry. It was found that the thick-walled pulmonary arteries of the newborn show a reduction in medial thickness over a period of one month, the reduction being most rapid in the first three days. After one month there is no significant change in medial thickness until fourteen years of age.

Adolescent↗