Serum immunoglobulin levels during acute infection in children.
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Biomedical subjects
Publications and source records attributed to R Gondal.
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BACKGROUND: Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of the liver that can be clinically confused with a malignant process. CASE REPORT: A 28-year-old male presented with fever and a palpable, firm liver. Ultrasonography and computed tomography revealed a mass in the right lobe of the liver. Fine needle aspiration biopsy (FNAB) under ultrasonographic guidance showed inflammatory cells, fibroblasts and a few hepatocytes. A diagnosis of inflammatory pseudotumour was suggested and confirmed on a true-cut biopsy. CONCLUSION: The cytologic appearance of IPT is characteristic. FNAB under ultrasonographic is a quick and easy technique for its diagnosis and differentiation from malignant space-occupying lesions.
OBJECTIVES: The present study was designed to evalutate the association of various risk factors such as smoking, alcohol, NSAIDs, inadequate dietary intake of fibres and consumption of spicy foods with chronic duodenal ulcer using a case-control design and to establish the association of Helicobacter pylori and duodenal ulcer using different diagnostic techniques in Indian subjects. MATERIALS: A total of 16 consecutive patients with endoscopically proven duodenal ulcer (DU) constituted the test group while 160 subjects with non-ulcer dyspepsia (NUD) were recruited as controls. METHODS: All subjects were interviewed based on a standard questionnaire and underwent an upper gastrointestinal endsocopy wherein multiple biopsies were taken for rapid urease test (RUT), histology and culture for detection of H. pylori. The serum samples of all the subjects were tested for the presence of antibodies against H. pylori using ELISA. RESULTS: There were significantly greater number of smokers (80%) and alcoholics (58%) in the male population of DU group as compared to the controls (49% smokers & 15% alcoholics). Similar trend was seen in relation to history of chronic exposure to NSAIDs (29% in DU & 11% in NUD) and inadequate intake of fibre in diet (66% and 39% respectively). The overall prevalence of H. pylori was 82.5% in DU and 50.6% in NUD [p < 0.001]. CONCLUSIONS: In North Indian subjects, alcohol consumption, smoking, inadequate intake of fibre in diet and use of NSAIDs are the risk factors associated with doudenal ulcer disease. Further, infection with H. pylori is strongly associated with DU in the North Indian population.
Many studies have shown that steatosis, lymphoid aggregates or follicles and bile duct injury on histology are more consistently associated with chronic hepatitis C than chronic hepatitis B. We compared liver biopsies of 30 patients of chronic hepatitis B with an equal number of age matched patients with chronic hepatitis C. Steatosis, lymphoid aggregates or follicles and bile duct injury were noted in 66.6%, 36.6% and 26.6% cases respectively of chronic hepatitis B as compared to 70%, 33.3% and 30% cases respectively of chronic hepatitis C. Thus none of the features were considered distinctive of HCV infection.
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Primary biliary cirrhosis (PBC) is believed to be rare in India. We analyzed our data pertaining to patients with PBC seen in a tertiary referral center over a 5-year period. The diagnosis of PBC was based on liver biochemistry, histology and antimitochondrial antibodies, in the absence of biliary obstruction. Five patients, all women, were diagnosed to have PBC. Pruritus, jaundice and fatigue were the most common initial symptoms. Hepatomegaly was seen in 4 of 5 patients. Associated autoimmune diseases were present in 2 patients. All patients presented with mild hyperbilirubinemia (< or = 6 mg/dL) with disproportionately raised serum alkaline phosphatase level. AMA was positive in 4 patients. Liver biopsy showed stage III-IV disease in 3 of 4 patients. The clinical presentation and course of PBC in India are similar to the experience in the West.
A rare case of oral myoepithelioma is reported. The tumour was composed of plasmacytoid type of myoepithelial cells. These plasmacytoid cells or hyaline cells exhibited a diffuse positivity for pancytokeratin, S-100 and vimentin in their cytoplasm. Studies have to be performed in order to find out whether the myoepithelial cells M.E. of plasmacytoid type are true M.E. cells of not.
A 10-year-old boy was admitted with cardiac tamponade. Initial pericardiocentasis yielded pus. A subxiphoid tube-pericardiostomy was done and thick, purulent material was drained out. Subsequently, pericardiectomy was undertaken as features of pericardial constriction persisted. At surgery, however, an intrapericardial mass was discovered. Successful excision was performed and the patient made an uneventful recovery. Histopathology of the mass revealed features of an intrapericardial teratoma. Rarity of the lesion, and a hitherto unreported mode of presentation make this case worthy of documentation.
OBJECTIVES: To assess the prevalence of gastrooesophageal reflux disease (GERD) as suggested by the symptom profile in babies ranging in age from 1 month to 2 years. METHODS: Six hundred and two babies were recruited from the well baby clinic for hospital delivered babies and from the childrens OPD of a tertiary care hospital. Children with acute severe illness needing hospitalization were excluded from the study. The primary care taker of each baby was interviewed using a questionnaire (IGERQ) designed by Orenstein et al and the I-GERD score obtained was used to assess for likelyhood of GERD. Upper gastrointestinal (GI) endoscopy was carried out and an oesophageal biopsy was taken in clinically suspected cases of GERD (IGERD > 5). RESULTS: Sixty one (10%) of the 602 subjects had an I-GERD score of > 5 suggestive of GERD. Regurgitation was present in 56 of these 61 subjects and also in 106 of the 541 normal subjects. 112 of 205 infants aged 1-6 months had regurgitation and 25 (22.2%) of these regurgitant infants had a score suggestive of GERD. Only 30 of the 202 infants aged 6-12 months and 20 of the 195 babies aged 12-24 months had regurgitation, however 14 of the 30 (46.5%) and 17 of the 20 (85%) regurgitant babies had an I-GERD score suggestive of GERD. Upper GI endoscopy was carried out in 31 babies with a score > 5 and endoscopic oesophagitis was detected in 16 (51.6%). Oesophageal biopsies were taken in 25 of these cases and showed histological evidence of reflux oesophagitis in 23 (92%). CONCLUSION: GERD is fairly common under 2 years of age as observed by symptom evaluation using the I-GERD score. Regurgitation when present beyond 6 months of age with no other identifiable cause needs evaluation. Upper GI endoscopy and oesophageal biopsy is a useful means of demonstrating reflux oesophagitis in babies with a symptom profile suggestive of GERD.
A 39 year old male presented with history of fever and jaundice for 3 months. A liver biopsy showed numerous ovoid fungal bodies around 5 mm in size in the macrophages and Kupffer cells. A diagnosis of hepatic histoplasmosis was made which is an uncommon entity in our country.
Histological features of resected thymuses of 18 patients with myasthenia gravis were evaluated. Thymoma were seen in 16.6% of the patients. In the non-thymomatous group, thymic hyperplasia with follicle formation was seen in 33.3%, involuted thymus with occasional lymphoid follicle formation in 11.1%, thymitis with B cell infiltration in 16.6%, involuted thymus in 11.1% and normal thymus in 11.1% of patients. Immuno-histological staining for B and T lymphocytes delineated the group labelled as thymitis with B cell infiltration. Mast cell and eosinophils were frequently seen in thymuses with thymic hyperplasia with follicle formation and thymitis with B cell infiltration. Thymic hyperplasia with follicle formation was more frequent in young patients and these patients had better prognosis.
Immunological changes in thirty patients undergoing various cardiac surgical procedures (twenty patients undergoing open heart surgery with either the bubble or the membrane oxygenator and ten patients undergoing closed surgical procedures) were studied. There was an activation of suppressor T cells and secretion of lymphokines in patients undergoing open heart surgery with activation of the classical complement pathway. The immunological alterations were similar in all patients irrespective of the type of oxygenator used.
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Out of 127 directional coronary atherectomy (DCA) procedures done in our laboratory, there were 81 patients who had completed a minimum of six months of follow-up. To study the factors predisposing restenosis after successful DCA, we analysed the clinical and angiographic profile of the patients and the histopathological findings of the excised tissue in 44 patients whose complete follow-up data was available with us. The indication of DCA was an extremely eccentric significant stenosis located in the proximal or midsegment of a large vessel (> or = 3 mm size) in 97 percent of the cases. Angiographic restenosis, defined as more than 50 percent luminal diameter stenosis was absent in 24 (54.5%, Group A) and present in 20 (45.5%, Group B) patients. On univariate analysis, the factors which predisposed to restenosis were: (i) left anterior descending location, (ii) longer lesion length (9.6 +/- 3.1 mm vs 5.2 +/- 1.6, p < 0.01) and (iii) greater post-procedure residual luminal diameter stenosis (13.1 +/- 10.8% vs 4.3 +/- 6%, p < 0.01). No significant difference was found between the two groups for other variables like unstable angina, the location and the morphological characteristics of the lesion and the ratio of the vessel diameter to the size of the Atherocath. Histopathological examination of the retrieved tissue revealed the presence of media with or without external elastic lamina in 8 (33%) patients in Group A--without restenosis compared to only 1 (5%) patients in Group B--with restenosis (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Thirteen patients with ruptured sinus of Valsalva aneurysm have been operated over a 3-1/2 year period. Right coronary sinus was predominantly involved and right ventricle was the most common site of rupture. Early surgery was performed in all cases. Both aorta and chamber of entry were explored for effective repair. Main repair was always done in the chamber of rupture either with a patch or interrupted pledgeted sutures followed by assessment at either end. Subannular ventricular septal defects in three cases were closed with a common patch with additional fixation in the middle at the aortic annulus to prevent aortic leak into the left ventricle. Three patients needed aortic valve replacement for gross aortic incompetence. Postoperative echocardiographic study revealed uniformly excellent results with good aortic valve or prosthetic function. One patient developed fatal pulmonary embolism two weeks following surgery. All other surviving patients are doing well and are in NYHA class I. We recommend dual exposure and repair technique for the repair of ruptured sinus of Valsalva aneurysms for optimal results.