Crouzon's syndrome with hydrocephalus.
Explore the source record for details and available documents.
Craniofacial Dysostosis↗
Biomedical subjects
R K Gupta
Publications and source records attributed to R K Gupta.
Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging.
BACKGROUND AND PURPOSE: MR imaging features are nonspecific with respect to the causative organism for patients with brain abscesses. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain abscesses can be differentiated from tuberculous brain abscesses by use of magnetization transfer (MT) MR imaging and in vivo proton MR spectroscopy. METHODS: Twenty-seven patients with a total of 33 pyogenic brain abscesses and three patients with a total of 12 tuberculous abscesses were evaluated with in vivo MR spectroscopy and MT MR imaging. The diagnosis in all cases was based on the culture of the causative organisms and histopathology whenever done as a part of clinical management. RESULTS: All 27 patients with pyogenic brain abscesses had lipid and lactate levels of 1.3 ppm and amino acid levels of 0.9 ppm with or without the presence of succinate, acetate, alanine, and glycine, while the three patients with tuberculous abscesses showed only such lipid and lactate levels. The MT ratio from the wall of the pyogenic abscesses was significantly higher (P <.001) than that from the tuberculous abscess wall. CONCLUSION: It might be possible to differentiate tuberculous abscesses from pyogenic abscesses by using MT MR imaging and in vivo MR spectroscopy, which could be of value in influencing the management of such cases.
Adolescent↗
Soldier acceptability of a camouflage face paint combined with DEET insect repellent.
Under operational conditions, current doctrine requires separate application of the standard military insect repellent and camouflage face paint. Working with an industrial partner, Amon Re, Inc., we developed a combined camouflage face paint and insect repellent that offers excellent protection from arthropod disease vectors. We undertook a study to determine whether the new product was acceptable to soldiers under field conditions. A new formulation of camouflage face paint containing the insect repellent N,N-diethyl-3-methyl-benzamide (DEET) was tested for user acceptability during a joint-service, multinational, military field training exercise (Operation Cobra Gold 1999) in Thailand. Soldiers testing the camouflage face paint were members of one of three companies (A, B, and C) of 1st Battalion, 21st Infantry Regiment, 25th Infantry Division. Soldiers in A company (N = 98) received standard military camouflage face paint and the U.S. military's Extended Duration Topical Insect and Arthropod Repellent containing 33% DEET, soldiers in B company (N = 75) received a new formulation of camouflage face paint without DEET, and soldiers in C company (N = 88) received the new formulation of camouflage face paint containing 30% DEET. Every soldier who volunteered to participate completed the study and submitted responses to the questionnaire. The different treatments were evaluated while soldiers spent 4 days conducting simulated combat exercises in a hot, tropical environment in central Thailand. Soldiers were provided the test materials, given a briefing on the study, and completed an initial questionnaire on May 19, 1999. Soldiers completed a final questionnaire after they returned from the training exercise on May 24, 1999. Results of the study indicated that soldiers found the new formulation of 30% DEET camouflage face paint easier to apply (88% of respondents) and remove (77%) than the current standard issue camouflage face paint. Soldiers liked the new 30% DEET camouflage face paint formulation better (61%) and were more likely to recommend it (67%) than the old camouflage face paint formulation. Although the addition of DEET to the camouflage face paint occasionally caused minor irritation after application for a short period (less than 15 minutes), the new camouflage face paint formulation with 30% DEET was evaluated most often (72%) as either good or excellent. The new 30% DEET camouflage face paint formulation offers significant operational advantages: protection from disease-transmitting arthropods, elimination of the need to carry separate insect repellent and camouflage face paint, and reduction in the time required to apply repellent and camouflage face paint separately.
Adolescent↗
Omental cyst in children presenting as pseudoascites: report of two cases and review of the literature.
An omental cyst is a rare intra-abdominal lesion. Absence of characteristic clinical findings make the diagnosis difficult. These cases are reported because of its rarity. The brief review of the features of omental cyst is included in order to increase awareness of this entity.
Ascites↗
Cervical thymic cyst: report of a case and review of the literature.
Congenital thymic cysts are uncommon and often misdiagnosed as either branchial cleft or cystic hygromas. This paper presents the case of a male child, who presented with a soft, fluctuating mass in the left side of his neck. Surgical excision revealed an ectopic thymic cyst. The histopathologic features of thymic cysts are diagnostic. Ectopic thymic tissue may be an infrequent finding, but it should be included in the differential diagnosis of neck masses, especially in children.
Child, Preschool↗
Fine-needle aspiration cytology of the breast in a case with abundant acellular calcific material indicative of soft-tissue calcinosis.
Since calcific deposits in soft tissue may clinically resemble a tumor, it is feasible to investigate them by fine-needle aspiration (FNA) cytology. In this presentation we describe a case in the breast with extensive accumulation of acellular liquid calcific material which was sampled by the noninvasive technique of FNA, and which was indicative of nonfamilial soft-tissue calcinosis. A 48-yr-old, perimenopausal woman on a routine mammogram showed a well-defined, 1-cm partially cystic opacity in the left upper quadrant of the breast. All other investigations were normal, and no significant family or medical history was present. Under ultrasound guidance FNA was done, and about 1 ml of thick whitish fluid was obtained. Cytopreparations only showed abundant acellular calcium. The patient refused any further treatment and elected to be under the care of her family physician, according to whom she was clinically well with no changes in mammograms for the last 2 yr. The case is interesting, since the cytohistologic findings in aspirate sample appeared to be strongly indicative of soft-tissue calcinosis, which to our knowledge has not been previously reported.
Biopsy, Needle↗
Incidence of apocrine cells in fine-needle aspirates of gynecomastia: a study of 100 cases.
While the presence of apocrine cells in fibrocystic conditions of the female breast is a common finding in a fine-needle aspirate (FNA) of the breast, such a finding in gynecomastia has only been reported recently in a single case report. This study was undertaken in 100 cases with adequate cellular samples which had been diagnosed as gynecomastia from aspirates which were obtained using a 22-gauge needle and a 5-ml syringe maintaining negative pressure. The material was collected as needle and syringe washings in 30% ethyl alcohol in physiologic saline and the cytologic preparations were made on 3-microm Schleicher and Schuell filters and were stained by the Papanicolaou method. In 3 of the 100 cases, sheets of apocrine cells were noted in addition to clusters of hyperplastic ductal cells. The findings were further confirmed histologically in cell blocks which were made in the 3 cases. Based on our findings, it was concluded that apocrine cells in gyneco- mastia are found in about 3% of cases, and such a finding should be regarded as nonneoplastic, thus avoiding the need of surgical excision.
Adult↗
Does endogenous immune response determine the outcome of surgical therapy for metastatic melanoma?
BACKGROUND: Although the presence of tumor cells in the blood of patients with metastatic melanoma suggests widely disseminated disease, many of these patients enjoy prolonged survival or cure after surgical resection. Our previous study of adjuvant vaccine therapy after complete resection of metastatic melanoma revealed a strong correlation between postoperative survival and elevated antibody titers to a 90-kDa tumor-associated antigen (TA90) expressed by melanoma cells of the vaccine. We hypothesized a similar correlation between postoperative survival and endogenous anti-TA90 antibody titers induced by the patient's melanoma in the absence of postoperative adjuvant immunotherapy. METHODS: From 1970 to 1996, 64 patients underwent complete resection of distant melanoma metastases and did not receive postoperative adjuvant immunotherapy. Serum collected within 4 months after surgery was tested in a coded and blinded fashion for anti-TA90 IgG and IgM by enzyme-linked immunosorbent assay, and for total IgG and IgM (controls) by radial immunodiffusion. RESULTS: Median follow-up for the study population was 19 months (range, 3-147 months). There was no significant correlation between anti-TA90 IgG titer and total IgG level (P = .4785), or between anti-TA90 IgM and total IgM (P = .0989). Univariate analysis showed that postoperative anti-TA90 IgM titer as a continuous variable was significantly associated with overall survival (OS); i.e., the higher the anti-TA90 IgM titer, the longer the OS. Using an established cutoff titer of 800, median OS was 42 months for patients with high anti-TA90 IgM titers (n = 28) vs. 9 months for patients with low titers (n = 36) (P = .0001). There was no significant correlation between total IgG/IgM and survival (P = .4107 and .4044, respectively). Multivariate analysis identified anti-TA90 IgM as the most significant independent variable influencing OS after complete resection of distant melanoma metastases (P = .0001). CONCLUSIONS: We conclude that the endogenous immune response to metastatic melanoma determines the outcome after surgical therapy. Enhancement of this specific immune response may prolong the survival of patients with distant melanoma metastases.
Antigens, Neoplasm↗
Knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff.
The present study was undertaken to evaluate the knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff dealing with newborn care. A total of 160 subjects were assessed (40 pediatric medicine residents, 40 obstetric residents, 40 private practitioners and 40 paramedical staff working in labor room and postnatal wards) A pre-tested structured questionnaire was used. Only 47.8% of the subjects defined neonatal hypothermia correctly. As many as 52.2% of the interviewees considered it to be an uncommon problem. Lethargy, refusal for feed and cold to touch were mentioned as common symptoms of neonatal hypothermia by 97.5%, 80% and 77.5% of the respondents respectively. Decreased body temperature, cyanosis, apnea and edema of feet were found as common signs. Only 18.6% of the interviewees had knowledge about correct method of recording the temperature in a newborn. The present study reveals the gross lacunae in the knowledge regarding various aspects of neonatal hypothermia among pediatric and obstetric residents and paramedical staff working in labor room and postnatal wards. To reduce the neonatal morbidity and mortality due to neonatal hypothermia, greater emphasis should be laid on this problem while designing curriculum for training of undergraduate and postgraduate doctors, paramedical staff and traditional birth attendants.
Allied Health Personnel↗
Air or nitrous oxide for loss-of-resistance epidural technique?
PURPOSE: To compare the spinal-epidural spread of gas following loss of resistance (LOR) technique for detection of the epidural space using air or nitrous oxide (N2O). METHODS: Comparison of the spread of air and N2O in the epidural space following LOR technique was performed by using Magnetic Resonance Imaging (MRI). Ten adult patients ASA grade I served as their own control in this prospective study. A control MRI (MRI Contr-1) of the dorsolumbar spine was performed. Then, an 18 gauge epidural needle was introduced at the L3-4 intervertebral space using 0.14 ml x kg(-1) N2O for LOR and the MRI (MRI-N2O) was repeated. Forty eight hours later, an MRI scan (Contr-2 MRI) was performed and, subsequently, an 18 gauge epidural needle was introduced, using 0.14 ml x kg(-1) air for LOR followed by an MRI (MRI-Air) scan. The volumetric measurements of gas pockets were done using a formula. RESULTS: Gas bubbles after N2O were few and small compared with larger gas pockets occupying up to three vertebral segments after the use of air for LOR. The volume of air in the epidural space was 2.96+/-0.93 ml compared with 0.35+/-0.32 ml N2O. CONCLUSION: The use of N2O for LOR technique of detecting the epidural space produced very small bubbles detected by MRI compared with the use of air under similar conditions.
Adult↗
Early versus late-onset idiopathic focal segmental glomerulosclerosis.
Glomerular diseases in children, although similar in histological appearance to those in adults, may have a better prognosis. There is much controversy regarding the prognostic factors in idiopathic focal segmental glomerulosclerosis (FSGS), especially the comparative prognosis of children and adults. A comparative analysis was carried out of 36 consecutive biopsy-proven cases of idiopathic FSGS presenting early in life ['early onset' as seen in children < or =12 years (group I)] and 36 cases presenting later ['late-onset' as seen in older children >12 years and adults (group II)]. Patients were compared for clinical, biochemical, and histopathological features, as well as disease outcome. A significantly higher prevalence of hypertension (P=0.002) and microscopic hematuria was seen in group II (P=0.02). There were no differences between the two groups in glomerular filtration rates corrected for body surface area at initial presentation (92+/-11 ml/min/1.73 m2 vs. 94+/-14 ml/min/1.73 m2). Patients with 'late-onset' FSGS had a significantly higher number of glomeruli with segmental sclerosis (P=0.007), more mesangial matrix expansion (P=0.009), greater mesangial cellularity (P=0.003), and significantly higher blood vessel involvement (P=0.03) than those with 'early onset' FSGS. There was a significantly higher response to steroids in group I (82.3%) than group II (36.4%) (P<0.02). At the end of the study period, 2 patients in group I and 11 in group II had developed persistent renal failure (P=0.01). Thus 'early onset' FSGS is more common in males, has significantly lower prevalence of hypertension and microscopic hematuria, with less-severe histopathological involvement, is more often steroid responsive, and has a better prognosis than 'late-onset' FSGS.
Adolescent↗
TA90-IC, a new marker for advanced colon cancer.
BACKGROUND: Although carcinoembryonic antigen (CEA) is the most frequently used marker for colon cancer, it is elevated in only 70% of patients with advanced disease and in even fewer patients with earlier stages of disease. We previously identified a 90-kDa glycoprotein, TA90, which is present in serum in the form of circulating immune complexes. TA90 is found in a variety of solid neoplasms but rarely in healthy controls (3.2%). We hypothesized that this new tumor-associated antigen may be a useful marker for colon cancer. METHODS: Serum samples from 59 patients with known colon adenocarcinoma were analyzed for the presence of CEA and TA90. Fifty-one (86%) patients had distant metastases; the remaining patients had clinically localized primary colon cancer. A murine monoclonal antibody-based enzyme-linked immunosorbent assay was used to measure concentrations of TA90-specific circulating immune complexes (TA90-IC). A positive value was defined as an optical density of more than 0.410 at 405 nm. Forty-seven (80%) of the 59 patients had serum samples for TA90 and CEA drawn at the same time. RESULTS: TA90-IC concentrations were elevated more frequently than CEA concentrations (82.9% vs. 70.2%; P = .134). The combination of both markers identified more patients with colon carcinoma than did either marker alone (93.6%; P < .001). CONCLUSIONS: Concomitant use of TA90-IC and CEA identified 93.6% of patients with advanced colon cancer. The role of TA90-IC in screening and monitoring progression of earlier disease deserves further investigation.
Adult↗
Hepatitis G virus (HGV) infection in voluntary and commercial blood donors in India.
The prevalence of hepatitis G virus (HGV) has been determined in commercial as well as voluntary blood donors from India by detecting viral RNA genome using reverse transcription polymerase chain reaction (RT-PCR) assay. 45 professional blood donors from private blood banks and 50 healthy controls who opted for voluntary blood donation were recruited for the study. Both the groups were also screened serologically for HBV and HCV infection. The prevalence of HGV in the general population in India was found to be 4% but significantly a higher frequency (46.6%; p<0.001) of HGV was observed in commercial blood donors.
Blood Donors↗
Relationships between choline magnetic resonance spectroscopy, apparent diffusion coefficient and quantitative histopathology in human glioma.
This study sought to correlate quantitative presurgical proton magnetic resonance spectroscopic imaging (1H-MRSI) and diffusion imaging (DI) results with quantitative histopathological features of resected glioma tissue. The primary hypotheses were (1) glioma choline signal correlates with cell density, (2) glioma apparent diffusion coefficient (ADC) correlates inversely with cell density, (3) glioma choline signal correlates with cell proliferative index. Eighteen adult glioma patients were preoperatively imaged with 1H-MRSI and DI as part of clinically-indicated MRI evaluations. Cell density and proliferative index readings were made on surgical specimens obtained at surgery performed within 12 days of the radiologic scans. The resected tissue location was identified by comparing preoperative and postoperative MRI. The tumor to contralateral normalized choline signal ratio (nCho) and the ADC from resected tumor regions were measured from the preoperative imaging data. Counts of nuclei per high power field in 5-10 fields provided a quantitative measure of cell density. MIB-1 immunohistochemistry provided an index of the proportion of proliferating cells. There was a statistically significant inverse linear correlation between glioma ADC and cell density. There was also a statistically significant linear correlation between the glioma nCho and the cell density. The nCho measure did not significantly correlate with proliferative index. The results indicate that both ADC and spectroscopic choline measures are related to glioma cell density. Therefore they may prove useful for differentiating dense cellular neoplastic lesions from those that contain large proportions of acellular necrotic space.
Adult↗
The changing epidemiological pattern of hepatitis A in an urban population of India: emergence of a trend similar to the European countries.
The present study was undertaken to determine the seroprevalence of the antibody against hepatitis A virus (IgG anti-HAV) in an urban population sample from Delhi (India) and to assess any change in the epidemiological pattern of HAV infection in this part of the world. A total of 500 healthy subjects were enrolled and divided into groups on the basis of age, sex and per capita income and evaluated for the presence of IgG anti HAV antibodies using a commercially available kit. The mean age of all the subjects was 32.6 +/- 13.2 yr. and the male:female ratio was 1.5:1. The overall prevalence of IgG anti-HAV in all subjects was 71.2% (356/500). The prevalence in subjects >35 years (92.1% [186/202]) was significantly higher than that in subjects <35 years (92.1% [186/202]) was significantly higher than in subjects <35 years (57% [170/298]). No statistically significant difference was observed between male and female subjects (71.4% [217/304] vs. 70.9% [139/196]) or between subjects belonging to middle and low socioeconomic groups (68.9% [135/196] vs. 72.7% [221/304]). These findings when compared with the results that were obtained in 1982, showed a decreasing prevalence of IgG anti-HAV, most significantly in younger age groups (16-35 years). Thus, we may conclude that the seroepidemiology of hepatitis A virus infection in urban population of India seems to be changing with seroprevalence in the younger population approaching a figure similar to that of the more developed European countries.
Adolescent↗
Low-dose continuous chemotherapy (LBCMVD-56) for refractory and relapsing lymphoma.
BACKGROUND: Although lymphoid malignancies are generally chemosensitive, relapse is common. The use of high-dose therapy can make subsequent cytotoxic therapy intolerable. There is a need to develop regimens with low acute toxicity which are suitable for use in patients post-high dose therapy and following the failure of standard protocols. PATIENTS AND METHODS: Twenty-six patients with lymphomas, fifteen of whom had received high-dose therapy, were treated with a novel regimen consisting of low-dose lomustine, chlorambucil, daily subcutaneous bleomycin, vincristine and methotrexate with dexamethasone on an eight-week cycle (LBCMVD-56). A median of three cycles was given. RESULTS: The overall response rate at 12 weeks was 67% (21% complete remission (CR)) with a median overall survival of 13 months. A symptomatic response was seen in 72%. Previous high-dose therapy did not compromise the response rate. Toxicity was acceptable with grade 3-4 haematological toxicity seen in 27% of cycles, gastrointestinal toxicity seen in 11% and pulmonary toxicity seen in 8%. Thirty-one percent of patients required hospitalisation at some point during this treatment most commonly for neutropenic sepsis. CONCLUSIONS: LBCMVD-56 is an inexpensive, outpatient-based regimen with low acute toxicity and a high response rate in this heavily pre-treated group of patients.
Adolescent↗