Biomedical subjects
Publications and source records attributed to P Gulati.
Hemobilia in children is rare and has so far been described only as a complication of blunt abdominal trauma. A case of hemobilia secondary to liver abscess treated successfully by selective arterial embolization is described. Hemobilia should be considered in any case of gastrointestinal hemorrhage before any operative intervention is undertaken.
A case of neurocysticercosis in an 11 year old female manifesting only as myoclonic seizures is reported. The diagnosis was based upon ELISA test, computed tomography, and biopsy of a subcutaneous nodule. The patient responded to anticysticerci drug treatment. Neurocysticercosis has not to our knowledge been previously reported to have presented with myoclonus.
Six term newborns, presenting with seizures, in whom cranial sonogram showed isolated periventricular hemorrhage (SEH) are described. Age of onset of seizures ranged from day one of birth to day twenty-one. Seizures appeared spontaneously in previously healthy newborns in three cases. All but one survived, and three have near normal development. Isolation of hemorrhage to the periventricular area suggests germinal matrix to be the source of hemorrhage in these cases. These cases also emphasize the need to consider diagnosis of IVH in term-newborns presenting with seizures.
Forty infants with proven pyogenic meningitis were evaluated by real time cranial sonography. A spectrum of sonographic abnormalities was observed which included echogenic sulci, focal or diffuse increase in parenchymal echoes, ventriculitis, ventriculomegaly with or without aqueductal block, subdural collection, parenchymal infarcts, abscess and subdural empyema. There were two infants with normal sonogram while encephalomalacia was seen in another two patients. An excellent correlation was observed between clinical profile, cerebrospinal fluid biochemistry and sonographic findings.
One hundred and seventy children of chronic seizures with strong clinical suspicion of an underlying intracranial lesion as its cause were studied by Magnetic Resonance Imaging (MRI). Maximum number of patients were between 6-12 years, males outnumbering females. Structural abnormalities were seen in 158 of the 170 patients. The study revealed tuberculoma as the commonest lesion in this series (n = 64) followed by cysticercosis (n = 27). Three patients were seen to have glioma. An interesting finding was disappearing lesion in 6 children. MRI proved to be an excellent modality in demonstrating and characterising the intracranial lesion.
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Endoscopic retrograde cholangiopancreatograms of 49 patients with chronic pancreatitis (alcohol related 18; idiopathic 31) were assessed retrospectively. Thirteen (72%) of 18 patients with alcohol-related chronic pancreatitis had separate openings of the common bile duct and the main pancreatic duct into the duodenum. This was significantly more frequent (p less than 0.01) than in previously studied controls (37%). Although this finding was seen more frequently in patients with alcohol related chronic pancreatitis than in those with idiopathic chronic pancreatitis (14 of 31, 45%), the difference was not statistically significant. It is concluded that alcohol-related chronic pancreatitis, but not idiopathic chronic pancreatitis, is associated with the presence of separate openings of the common bile duct and main pancreatic duct into the duodenum.
This study was carried out to assess pancreatic duct abnormalities in gall stone disease. Endoscopic retrograde cholangiopancreatograms of 50 patients with gall stone disease were analysed and the results compared with those obtained in 33 patients investigated for cholestatic jaundice who were found to have a normal biliary tree (control group). Abnormal pancreatograms were obtained in 24 (48%) patients with gall stone disease and in only two (6%) in the control group; the differences were statistically significant (chi 2 = 14.3; p less than 0.001). The patients in the control group showed mild abnormalities as did those in the gall stone group. The frequency of various abnormalities were: mild 16 (32%), moderate five (10%), and severe three (6%). Pancreatic duct abnormalities were more severe and occurred more frequently in patients with gall stones who had stones in the biliary tree than in patients with a normal biliary tree (postcholecystectomy patients, 55% v 25%) but the difference between the two groups just failed to be significant (chi 2 = 3.34). In conclusion, nearly half of all patients with gall stone disease have pancreatic duct abnormalities and in 16% these were severe enough to be labelled as chronic pancreatitis.
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A patient with Burkitt's lymphoma who had nervous system involvement at multiple levels is presented because of the rarity of this condition in India. A high index of suspicion and a rapidly evolving multiple neuraxial involvement led to the diagnosis.
Insulin exerts a marked effect on hepatic steroid metabolism both in vivo and in vitro (on isolated rat hepatocytes). The mechanism by which insulin gives this action is, however, unclear. In this study, we have extracted a mediator from a hepatic membrane fraction after treatment with insulin and tested the effects of this mediator on steroid metabolism in isolated rat hepatocytes. It is seen that the mediator has a similar effect to insulin (i.e. a stimulation of enzyme activity) and that the maximum effect of the mediator is seen at physiological concentrations of insulin (10(-9)M) and at 30 min preincubation time. There appears to be a differentiation between the effects on the male-specific (6 beta- and 16 alpha-hydroxylases and 17-oxosteroid oxidoreductase) and the female-specific (7 alpha-hydroxylase and 5 alpha-reductase) enzyme activities in that the male-specific activities appear more responsive to the mediator. This would agree with findings in vivo. It would appear, therefore, that many of the actions of insulin on hepatic steroid metabolism may be mediated by the generation of an insulin mediator, similar to that controlling mitochondrial pyruvate dehydrogenase activity, derived from the plasma membrane of the hepatocyte.
In vivo studies have established that continuous infusion of male rats with growth hormone (GH) results in the feminisation of hepatic steroid metabolism. In this study, however, no feminising effects were observed in response to GH treatment alone in isolated hepatocytes. Combined incubations with insulin and GH or with dexamethasone and GH showed that GH antagonised the stimulatory effects of insulin and dexamethasone respectively. Pretreatment of hepatocytes over 30 min with thyroxine and GH also resulted in a decrease in enzyme activity as compared to the response with thyroxine alone. Thus no feminisation effects were seen with any of the combinations of hormones noted above. Preincubation of hepatocytes with dexamethasone, thyroxine and GH, however, resulted in the expression of the feminisation effect noted in vivo. It therefore appears from this study that dexamethasone and thyroxine may play a permissive role in mediating the feminising effects of GH in isolated hepatocytes, and that GH may be interacting with these hormones in vivo to produce such effects.
We have previously reported that antibody secretion by B.22 hybridoma cells can be suppressed in an MHC-restricted manner, by idiotype-specific T cells. It was shown that T cells of both helper and suppressor phenotypes are involved, and that the suppression is mediated by soluble factors. In the present paper, we have characterized the effects of T-cell-mediated suppression at the level of B.22 antibody mRNA expression and stability. Nuclear run-on analysis comparing suppressed and control B.22 cells indicates no change in the transcription rates of heavy and light chains. Northern blot analysis demonstrates that steady-state levels of heavy and light chain mRNAs are also unchanged. Thus, the suppression of antibody secretion by B.22 cells probably occurs at the levels of translation or secretion.
To assess whether the anatomy of the pancreaticobiliary ductal drainage into the duodenum has any relationship with biliary diseases we analyzed 259 endoscopic retrograde cholangiopancreatograms. These included 102 normal examinations (control group), 95 patients with gallstone disease, and 21 patients with carcinoma of the gallbladder. In the control group, 64 (63%) subjects had a common channel and 38 (37%) had separated openings for the common bile duct and the main pancreatic duct. By contrast, the prevalence rate of a common channel was significantly lower in gallstone disease [28 (30%); p less than 0.001]. No such difference, compared with controls, was observed in patients with carcinoma of the gallbladder. The length of the common channel in the control group (mean +/- SD, 4.7 +/- 2.5 mm) was similar to that in gallstone disease (4.6 +/- 2.6 mm). However, patients with carcinoma of the gallbladder had a significantly longer common channel (8.3 +/- 4 mm; p less than 0.001) compared with the control group. An abnormally long common channel (greater than or equal to 8 mm) was seen more frequently in carcinoma of the gallbladder (8 of 21; 38%) compared with normal subjects (3 of 102; 3%) and patients with gallstones (1 of 95; 1%); the difference was highly significant (p less than 0.001 for each). These observations suggest a close association between the anatomy of the distal ends of the common bile duct and main pancreatic duct and the development of gallstones and carcinoma of the gallbladder.
We report a case of spontaneous expulsion of a lipoma in a 32 year old male patient who presented with recurrent attacks of subacute intestinal obstruction. During one such episode the patient developed unusually severe abdominal pain and expelled a fleshy mass per rectum which, on histopathology, was found to be a lipoma attached to a necrosed portion of the small intestine. The pain disappeared immediately; a subsequent barium meal examination revealed normal appearances and the patient has remained completely symptom free 10 months after the incident.
In this study, we have demonstrated that antibody secretion by hybridoma cell lines can be down-regulated by idiotype-specific immune spleen cells or by nylon wool nonadherent spleen cells. This suppression of antibody secretion can be abolished by treating the idiotype-specific immune spleen cells with anti-Thy 1.2 plus complement. The hybridoma we used for most of our experiments secretes IgM specific for the cross-reacting haptens 2,4,6-trinitrophenyl (TNP) and 2,4-dinitrophenyl (DNP). Suppression was achieved by direct coculture of hybridoma cells with immune cells from animals which were injected with affinity-purified hybridoma antibody-coupled syngeneic spleen cells. The suppressed and control cultures contained similar numbers of viable hybridoma cells, suggesting that a simple cytotoxic effect is not responsible. Idiotype specificity was established in experiments showing that two idiotype immune animals immunized with antibody from two different IgM anti-TNP hybridomas could suppress the hybridoma to which they were immunized but could not affect the other hybridoma. Immune spleen cells required 3-4 days of coculture with hybridoma cells before maximum suppression was achieved. The kinetics of the response suggest that the final effector suppressor cell is generated during the coculture period and that a second signal, perhaps a product of the hybridoma cells, may be required.
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