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Biomedical subjects

P S Jairaj

Publications and source records attributed to P S Jairaj.

At least 19 recordsLinked to original sources
PubMed1995

Raised serum IgE levels in chronic inflammatory lung diseases.

OBJECTIVE: To study the serum IgE response in nonallergic subjects with chronic inflammatory lung diseases. SETTING: Christian Medical College Hospital, Vellore. SUBJECTS: Twenty six patients with bronchiectasis, five with pulmonary mycosis referred from all over India and 30 healthy subjects. MAIN OUTCOME MEASURES: Serum IgE value (determined by radioimmuno assay) above the upper limit of normal control range (136 to 948 iu/ml) was considered as raised level. RESULTS: Of the 26 patients with bronchiectasis 13 had pyogenic infections, six had pulmonary tuberculosis; in six patients sputum culture was sterile while another patient had herpes zoster. Five cases of mycosis included one each of actinomycosis, aspergillosis, blastomycosis, cryptococcosis and nocardiasis. The serum IgE levels were raised in 20 (65%) of the 31 patients. CONCLUSION: Associated bacterial, fungal and parasitic infections were probably responsible for inducing an hyper-IgE response in these non-allergic subjects.

Adult↗
PubMed1994

alpha 1-Antitrypsin deficiency in Indian patients with chronic obstructive airways and other pulmonary diseases.

OBJECTIVE: To determine alpha 1-antitrypsin (A1AT) deficiency in patients with chronic obstructive airways disease (COAD) and other pulmonary diseases. DESIGN: Observation study. SUBJECTS: 45 patients with COAD, 20 with bronchiectasis, 11 with pulmonary tuberculosis, 25 with chest malignancies and 42 healthy subjects. SETTING: Christian Medical College Hospital, Vellore, India. MAIN OUTCOME MEASURE: Serum A1AT level of 10% or less of the mean serum value of the control group was recognised as severe deficiency and A1AT level between 10 and 60% was considered as intermediate deficiency. RESULTS: 26 patients (18 with COAD, 2 with bronchiectasis, 3 with tuberculosis and 3 with chest malignancies) had intermediate A1AT deficiency. CONCLUSION: The finding of an A1AT deficiency in over a quarter of the patients comprising various categories of pulmonary diseases emphasises the need to explore the possibility of an underlying acquired cause existing either alone or in association with genetic defect in patients showing such a deficiency.

Adolescent↗
PubMed1993

Unruptured aneurysm of the sinus of Valsalva: a potential source of cerebrovascular embolism.

An unruptured aneurysm of the right sinus of Valsalva with intraluminal thrombus that displaced the right coronary artery ostium was diagnosed in a 30 year old Omani man who was investigated for uncontrolled grand mal epilepsy and residual left hemiparesis caused by occlusion of the right middle cerebral artery. Surgical intra-aortic closure of the aneurysm, which necessitated a saphenous vein graft to the right coronary artery, was successful. An aneurysm of the sinus of Valsalva is an unusual cause of a thromboembolic cerebrovascular accident.

Adult↗
PubMed1993

Mitral valve replacement for an annular submitral aneurysm of the left ventricle.

Successful surgical repair of an annular submitral aneurysm of the left ventricle in two patients is described. In both cases the diagnosis was made at surgery and they were treated successfully by transatrial closure of the aneurysm with Teflon felted sutures and mitral valve replacement. This is the first report of the use of mitral valve replacement for this condition.

Adult↗
PubMed1993

Chest malignancies & serum immunoglobulin E.

Serum IgE levels were measured by the radioimmunoassay technique in the sera of 53 patients with neoplastic chest diseases. Forty seven patients had malignant chest tumours and another 6 had benign tumours or mediastinal cysts. They included 33 smokers and 20 non-smokers. For comparison, 30 normal non-smoking controls matched for age and sex were included. The serum IgE levels in patients with chest malignancies showed an increase as compared to controls. The IgE levels increased significantly in adenocarcinoma (P < 0.01) and squamous cell carcinoma (P < 0.001), while they were not raised in poorly differentiated carcinoma. There was no significant difference between the serum IgE levels of 32 smokers and 15 non-smokers with malignant chest tumours.

Adolescent↗
PubMed1993

Clinical spectrum of pulmonary hydatidosis and raised serum IgE levels in the Indian southern peninsula.

Fifteen patients with surgically proven hydatid disease of the lung aged between 4 and 51 years were studied. The disease spectrum varied from single to multiple cysts of different sizes, with associated pyogenic chest infections or parasitic infestations of the gut. The serum IgE level varied widely in these cases and very high levels were found in 60% of the patients. This high IgE response was related to the vitality of the cysts, associated bacterial infection of the chest, infection with helminths and smoking habit.

Adolescent↗
PubMed1990

Valve replacement in the young patient with rheumatic heart disease. Review of a twenty-year experience.

During a 20-year period 303 young subjects between 9 and 20 years of age (mean, 16.2 +/- 2.72 years) with rapid and relentlessly progressive valvular disease from rheumatic fever underwent valve replacements. The Starr-Edwards ball valve prosthesis remains the device of choice, although other valves have been implanted. The overall hospital mortality rate was 9.6% in the mitral valve, 3.5% in the aortic valve, and 4.2% in the double valve replacement groups. Actuarial survival at 10, 15, and 20 years was 78.4% (+/- 3.3%), 70.0% (+/- 5.8%), and 59.3% (+/- 11.1%), respectively, for patients with mitral valve replacement. The rates for aortic valve replacement were 85.9% (+/- 4.6%) at 10 and 15 years and 72.7% (12.8%) at 20 years. In the double valve replacement group the survival rates after 5 and 10 years were 79.9% (+/- 5.1%). The incidence of thromboembolism was 0.41, 0.59, and 1.04 per 100 patient-years for the mitral, aortic, and double-valve prostheses, respectively. The prospect of childbearing seems promising in those young women who were subsequently married. Our favorable and gratifying experience in this review bears testimony to the physiologic advantages of the Starr-Edwards valve as the device of choice in the rehabilitation of patients with advanced and severe valvular disease after rheumatic fever.

Adolescent↗
PubMed1989

Relapsing polychondritis--a case report and review of literature.

A case of relapsing polychondritis with aortic aneurysm is presented and relevant literature reviewed. Only one case of relapsing polychondritis has been previously reported in Indian literature. Increased awareness of this relatively rare, multi-system disease is warranted, to facilitate the diagnosis.

Adult↗
PubMed1988

Early and late results of pericardiectomy in 118 cases of constrictive pericarditis.

The medical records of 118 patients (86 male, 32 female, age 10-50 (mean 27) years) who underwent pericardiectomy for constrictive pericarditis at the Christian Medical College Hospital, Vellore, from 1954 to 1985 were reviewed. All had appreciable pericardial constriction. Preoperatively 97 of the 118 were in class III or IV of the New York Heart Association classification and 100 had peripheral oedema or ascites. Tuberculosis was proved as the cause in 72 patients. Pericardiectomy was accomplished through a standard anterolateral thoracotomy (107 cases), median sternotomy (3 cases), or bilateral thoracotomy (8 cases). Postoperatively an apparent low cardiac output state was seen in 34 patients, 12 of whom died. Hospital mortality in the last 12 years was 11%. Mortality was higher in NYHA class III and IV patients. The improved surgical results recently may be related to increased use of inotropic support and prolonged ventilation. At follow up there were 72 patients in whom functional capacity could be assessed; 63 were in class I or II. The poor results of pericardiectomy in some patients are likely to be related to advanced preoperative disability and early pericardiectomy is therefore recommended.

Adolescent↗
PubMed1987

Coexistent mitral valve disease with left-to-right shunt at the atrial level: clinical profile, hemodynamics, and surgical considerations in 67 consecutive patients.

Between January, 1963, and June, 1985, 67 patients underwent corrective surgery for this complex anomaly. Symptoms and signs of atrial septal defect were dominant in the majority of subjects. History of rheumatic fever (46%), paroxysmal nocturnal dyspnea (33%), presence of an opening snap, mitral diastolic murmur, or pansystolic murmur provided clinical clues to document associated mitral valve disease. Open mitral valvotomy was accomplished in 39 subjects, while in the remainder (28 subjects) the valve required replacement. Partial anomalous venous connection was encountered in 12 subjects. Recognition and attention to the associated tricuspid incompetence is a high priority, and 21 subjects underwent concomitant annuloplasty. The overall hospital mortality was 13.4%, with no deaths in the last 22 consecutive patients. The period of follow-up ranged from 1 year to 22 years, with a mean +/- SD of 9.34 +/- 6.61 years. We believe, with other authors, that since the hemodynamic and therapeutic considerations are very similar, both the stenotic and regurgitant lesions should be included in the same syndrome.

Adolescent↗
PubMed1987

Development of a coagglutination (COA) technic to detect Candida antigenemia. I. COA versus Candida isolation.

A coagglutination (COA) test to detect Candida antigenemia was developed using locally produced Candida antiserum and COA reagent. All 68 controls had normal results. Two patient groups were included in this study. In Group 1, consisting of eight patients, with definite systemic or deep candidiasis proved by repeat Candida isolation, COA detected antigenemia in 100% as against 50% by counterimmunoelectrophoresis (CIE). In Group 2, 9 of 19 patients had respiratory infection; 4 patients revealed antigenemia by COA, 2 of whom had no Candida isolation. In these 2 patients therapy was initiated based on COA results. Of another nine patients with hematologic and malignant diseases, five (56%) revealed antigenemia by COA, three of whom had no Candida isolation; two died and one was discharged against advice. Transient antigenemia was detected by COA in a single patient with ulcerative colitis with Candida isolation. Thus, the COA test was found to be rapid, sensitive, and specific for the detection of Candida antigenemia. Furthermore, it had early diagnostic (seven days) as well as prognostic value, as revealed by response to therapy and decrease in COA titer. Being highly cost effective, this test is recommended as a simple test within the reach of any routine diagnostic laboratory.

Adult↗
PubMed1986

Surgical treatment of ruptured aneurysms of the sinus of Valsalva.

Aneurysms of the sinus of Valsalva are usually congenital in origin. When they rupture, it is generally into the right atrium or the right ventricle. Signs of a left-to-right shunt, aortic runoff, and cardiac decompensation are the cardinal features. Early diagnosis and surgical correction result in cure. We report our experience with 28 patients. In all patients, we used a combined aortocameral approach, and we recommend a sandwich patch for the repair. Aortic valve replacement is needed only in patients with severe degenerative changes. The overall operative mortality was 21.4%, but in the last 10 years, mortality was only 11.7%. The causes of operative and late mortality are discussed.

Adolescent↗
PubMed1983

Pulmonary hypertension in isolated secundum atrial septal defect: high frequency in young patients.

Out of 709 consecutive patients with isolated secundum atrial septal defect, the pulmonary artery systolic pressure was greater than 50 mm Hg in 118 patients (17%). Pulmonary hypertension was present in 13% of patients under 10 years and in 14% aged 11 to 20 years. The Eisenmenger reaction was present in 9% of the 709 patients. The frequency of the Eisenmenger reaction was high in young patients and was not significantly different in patients in the first and second decades as compared to older patients. None of our patients with pulmonary hypertension resided at high altitude. The high frequency of pulmonary hypertension in our young patients cannot be satisfactorily explained. Autopsy studies suggest that in some, pulmonary hypertension is due to the persistence of the fetal pulmonary vascular pattern.

Adolescent↗
PubMed1983

Results of surgical treatment of ventricular septal defects with pulmonary hypertension.

Two hundred and twenty-five consecutive patients with interventricular septal defect and associated pulmonary hypertension have undergone corrective surgery at the Christian Medical College Hospital. The mean preoperative systolic pulmonary artery pressure was 70.5 (range 31-136) mm Hg and the calculated pulmonary vascular resistance ranged from 300 to 1680 dyn/s cm-5. A paracoronary right ventriculotomy was the approach of choice. Profound hypothermia and circulatory arrest were not used, even in 12 patients weighing under 10 kg. Among the older children and young adolescents there were 27 who had a calculated pulmonary vascular resistance of over 800 dyn/s cm-1 and their mortality was 22%, which is good when compared with that of other series. It is evident that both the early and the late death rate after surgery increase with the age of the patient, especially in those with associated pulmonary hypertension. In 69 patients studied after repair recatheterisation showed no residual defect by oximetry. The fall in the pulmonary artery pressures after surgery has been striking in most patients. The late death rate was 2.5%. The surviving patients are leading normal, active lives.

Adolescent↗
PubMed1983

Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients.

Between 1956 and 1980 closed mitral valvotomies were performed in 3724 consecutive patients (male:female ratio 1.1:1) with mitral stenoses. Their ages ranged from 6 to 69 years, with a mean (SD) of 27.3 (9.3). Mitral stenosis in the younger age group is a unique condition and a great majority of these patients rapidly develop significant pulmonary hypertension and congestive cardiac failure. In this study a large number of subjects belonged to functional class IV (41.5%). Hospital mortality was 1.5% over the last 5 years. After valvotomy, 11 patients (0.3%) developed severe mitral regurgitation that made valve replacement necessary in the immediate postoperative period. Early postoperative embolism occurred in 0.4% of those who were in atrial fibrillation and had preoperative anticoagulation whereas it occurred in 0.95% of those in sinus rhythm who had no anticoagulation. Late postoperative embolism occurred at a rate of 0.3 to 1.6 per 1000 patients per year over a 20 year period. Rheumatic reactivity occurred at a rate of 1.3 to 2.2 per 1000 patients per year during the same period. Rate of occurrence of restenosis varied from 4.2 to 11.4 per 1000 patients per year between the fifth and fifteenth year of follow-up. Closed transventricular revalvotomy for restenosis was accomplished in 130 subjects with a 6.7% mortality. Excellent symptomatic improvement was evident in 86% of long-term survivors at the end of 15 years. Actuarial survival was 95%, 93.1%, 89.5%, and 84.2% at 6, 12, 18, and 24 years, respectively, after closed mitral valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗