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Biomedical subjects

R Malhotra

Publications and source records attributed to R Malhotra.

At least 19 recordsLinked to original sources
PubMed2006

Complications of keratosis obturans.

Three patients with extensive keratosis obturans were treated during a 12-month period. One presented with an idiopathic sensorineural hearing loss and was found to have keratosis obturans in the contralateral, asymptomatic ear. The disease process had resulted in a horizontal semicircular canal fistula in what was now, effectively, the only hearing ear. The second patient had an extensive dehiscence of the tegmen tympani. The third presented with a facial palsy. An automastoidectomy cavity was present, with circumferential skeletonization of the descending facial nerve over a length of 1.5 cm and dehiscence of the temporomandibular joint and jugular bulb. All three patients were successfully treated by surgical formalization of their automastoidectomy cavities. They appeared to represent cases of keratosis obturans rather than external auditory canal cholesteatoma, on the basis of previously published reports.These complications and patterns of bone erosion have not previously been described in keratosis obturans. The third patient is believed to have the most extensive case of keratosis obturans yet described.

Aged↗
PubMed2006

Small incision subperiosteal and trans-blepharoplasty forehead and browlift.

The purpose of the study is to evaluate the safety and efficacy of non-endoscopic, small-incision subperiosteal forehead and browlift in patients undergoing associated upper eyelid blepharoplasty. This is a retrospective, non-comparative case series of 14 consecutive patients in 12 months. Eleven patients underwent bilateral and three unilateral surgery. Unilateral surgery was performed in patients with facial palsy and was augmented with cable suspension. The technique involves five small scalp incisions to create a single subperiosteal and deep temporal cavity. Superior arcus marginalis release and direct visualisation of the supraorbital nerve was achieved via a trans-blepharoplasty approach. All patients achieved a desirable browlift and contour. Follow up ranged from 2 to 40 weeks. Minor complications included transient diplopia (1), reduced upper eyelid sensation (1), and brief postoperative bleeding from one of the small incision sites (1). Small incision and trans-blepharoplasty forehead and browlift is a safe and effective method to achieve a cosmetically desirable browlift in patients that require associated upper eyelid blepharoplasty, using standard oculoplastic equipment without the need for an endoscope.

Aged↗
PubMed2006

Linear basal cell carcinoma: A distinct clinical entity.

The purpose of the study is to describe linear basal cell carcinoma (BCC) as a distinct clinical entity, and highlight its existence to the plastic surgery literature. A Medline and PubMed literature search was conducted, and 33 reported cases of linear BCC were analysed. Of these 33 cases, the most common site for linear BCC was the periocular region, accounting for 49% (n= 16). The most common histologic subtype, was nodular BCC, accounting for 50% (n= 17). Of the 33 reported cases the postoperative defect size was mentioned in five cases only. None of these would have been completely excised if a 2 mm margin was applied, and only one out of five if a 4 mm margin was applied. Linear BCC is a distinct clinical entity. Presence of the tumour along relaxing skin tension lines, increase in subclinical extension, and aggressive tumour behavior are reported observations. Because of these observations it is suggested that margin-controlled excision should be considered for linear BCC.

Adult↗
PubMed2006

Comparison of total knee arthroplasty in stiff and ankylosed knees.

We compared the results of total knee arthroplasties in patients with stiff or ankylosed knees. We retrospectively reviewed 90 total knee arthroplasties in 52 patients with minimum 2 years followup who had less than a 50 degrees arc of flexion preoperatively. Preoperative and intraoperative data were retrieved from a computerized database. Patients were followed for an average of 6.5 years at an outpatient department. Knee Society knee scores improved from 34.6 points preoperatively to 89.5 points postoperatively in the stiff knees and from 47 points preoperatively to 75 points postoperatively in the ankylosed knees. The arc of flexion improved from 35 degrees -69 degrees preoperatively to 1 degrees -94 degrees postoperatively in the stiff knees and from 0 degrees to 3 degrees -77 degrees in the ankylosed knees. There were major complications in four of the 26 ankylosed knees and in two of the 64 stiff knees. The data suggest results of total knee arthroplasty are better in patients with stiff knees than in patients with ankylosed knees.

Adult↗
PubMed2006

An unusual presentation of eosinophilic granuloma in an adult: a case report.

Eosinophilic granuloma is the most common and benign form of a rare proliferative disorder: Langerhans' cell histiocytosis. Spinal involvement is rare and only 15 adult cases have been reported. We present an unusual variant of eosinophilic granuloma in a 25-year-old woman with radiological evidence of vertebra plana. Plain radiography, magnetic resonance imaging, bone scan, and blood tests were carried out, and a specimen was taken from L4 using computed tomography-guided biopsy. Gram staining, acid fast bacillus smear, bacterial and fungal cultures were negative. Histological examination of the biopsy showed features of eosinophilic granuloma with aggregates of Langerhans histiocytes. The patient was treated with low-grade radiotherapy at 150 cGy per day for 7 days. She was asymptomatic at one-year follow-up although the radiological picture was unchanged.

Adult↗
PubMed2006

One- or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population.

We compared the safety and outcome of one-stage bilateral total hip arthroplasty with those of a two-stage procedure during different admissions in a prospective, randomised controlled trial in an Asian population. Of 168 patients included in the study, 83 had a single- and 85 a two-stage procedure. Most of the patients (59.9%) suffered from inflammatory arthritis. The intra-operative complications, early systemic complications, the operating time, positioning of the components, the functional score, restoration of limb length and survival rates at 96 months were similar in the two groups. The total estimated blood loss was significantly lower in patients undergoing a one-stage procedure than in patients who had a two-stage procedure, but the transfusion requirements were significantly higher in the former group (p=0.001). The hospital stay was significantly shorter in the one-stage group, 7.25 days (sd 1.30; 5 to 20) compared with 10 days (sd 1.65; 8 to 24) in the two-stage group (p=0.023). We believe that a one-stage procedure is safe and appropriate in our population.

Adult↗
PubMed2005

Rituxan (anti-CD20 antibody)-induced translocation of CD20 into lipid rafts is crucial for calcium influx and apoptosis.

Rituxan, a chimeric anti-CD20 antibody, is the first antibody approved for immunotherapy in non-Hodgkin's B-cell lymphoma and other B-cell lymphoproliferative disorders. Additionally, efficacy of Rituxan treatment has been reported in nonmalignant autoimmune diseases such as rheumatoid arthritis. Crosslinking of CD20 molecules by Rituxan induces therapeutic B-cell depletion. CD20 is a B-lymphocyte specific integral membrane protein, proposed to function as a store-operated calcium channel, which is activated upon receptor-stimulated calcium depletion of intracellular stores. Crosslinking of CD20 by antibodies has been reported to induce a redistribution of CD20 molecules to specialized microdomains at the plasma membrane known as lipid rafts. Here, we report that in the absence of Rituxan, CD20 exhibits a low affinity to lipid rafts. However, binding of Rituxan significantly increases the affinity of CD20 for lipid rafts resulting in its redistribution to a fraction resistant to Triton X-100 solubilization. Furthermore, we demonstrate that disturbing the raft integrity by cholesterol extraction results in dissociation of CD20 from a Triton X-100 resistant fraction followed by complete inhibition of Rituxan-induced calcium entry and apoptosis. The integrity of lipid rafts seems to play a crucial role for CD20-induced caspase activation. These data show, for the first time, that Rituxan-induced translocation of CD20 to lipid rafts is important for increased intracellular Ca(2+) levels and downstream apoptotic signalling.

Antibodies, Monoclonal↗
PubMed2005

Bilateral anterior dislocation of the shoulders with proximal humeral fractures: a case report.

Bilateral simultaneous anterior dislocation of the shoulders with bilateral 3-part fracture of the proximal humeri is unusual. A 42-year-old man presented with pain and restriction of movement on both shoulders. He was injured by a heavy object falling over his back while he was leaning forward holding an overhead bar. His arms were abducted and externally rotated. The injury was not correctly diagnosed, and the patient was treated with repeated manipulations and splintage for 2 weeks. Radiological examination revealed bilateral anterior dislocation of the shoulders with displaced 3-part fractures of the proximal humeri involving the shaft, greater tuberosity, and head. The patient was treated with open reduction and internal fixation through a deltopectoral approach using multiple Kirschner wires. The shoulders were kept immobilised for 3 weeks until the removal of the wires. The patient was able to resume work 3 months after surgery. He had an excellent and comfortable range of motion in both shoulders at one-year follow-up.

Adult↗
PubMed2005

Haemarthroses after total knee arthroplasty caused by an isolated platelet factor 3 availability defect.

We present seven patients with recurrent haemarthroses after total knee arthroplasty, caused by an inherent platelet function defect. These patients developed painful knee swelling, persistent bleeding and/or wound breakdown, a platelet factor 3 availability defect being identified in all cases. Surgical exploration, with joint debridement, lavage and synovectomy, was performed in four patients who did not improve with conservative therapy. Histopathological examination of synovium revealed a focal synovial reaction with histiocytic infiltration, and occasional foreign-body giant cells. One patient required an early revision because of aseptic loosening of their tibial component. The condition was treated by single-donor platelet transfusions with good results. The diagnosis, management, and relevance of this disorder are discussed.

Aged↗
PubMed2005

A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years.

BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II.

Adult↗
PubMed2004

Aberrant facial nerve regeneration (AFR): an under-recognized cause of ptosis.

INTRODUCTION: Aberrant facial nerve regeneration (AFR) following facial nerve palsy may give rise to ptosis because of increased orbicularis tone. We describe a series of patients presenting with ptosis where the underlying aetiology of AFR was often not recognized by the referring clinicians. METHODS: Retrospective case review. RESULTS: A total of 15 cases with ptosis, secondary to AFR, were seen at the Royal Adelaide Hospital Oculoplastic Clinic between 2000 and 2002. Of these, 10 (67%) were referred by general ophthalmologists. Ptosis was the only reason for referral in 11 patients (73%) and features of AFR or a past history of facial nerve palsy were not mentioned in seven referrals (overall 46%). All patients reported a previous facial palsy. The palpebral aperture was reduced on the affected side with reduction in both upper and lower margin reflex distance (MRD) by a mean of 1.5+/-0.7 mm (P<0.001) and 1.0+/-0.3 mm (P<0.001), respectively. The orbicularis tone was increased and strength reduced on the affected side in all patients. However, none had lagophthalmos. Signs of AFR were demonstrated in all patients with either an increase in ptosis or eyelid closure on the affected side during cheek puffing. CONCLUSION: Patients with AFR following facial nerve palsy may present with ptosis without recognition of the underlying aetiology. Signs of AFR ptosis include a decreased palpebral aperture with a reduced upper and lower MRD. The diagnosis can be established with demonstration of an increase in ptosis during cheek puffing. Recognition of AFR is important in these cases owing to the implications for management and post-operative patient satisfaction.

Adult↗
PubMed2004

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement.

PURPOSE: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS: Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS: A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION: ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.

Adolescent↗
PubMed2004

The implications of NICE guidelines on the management of children presenting with head injury.

BACKGROUND: NICE guidelines for the management of head injury were published in June 2003. Their recommendations differ markedly from previous guidelines published by the Royal College of Surgeons (RCS). In place of skull radiography and admission, computed tomography (CT) is advocated. The impact of these guidelines on service provision in the UK is unknown. METHODS: Data on all clinical correlates of children presenting with any severity of head injury was collected in three hospitals in the northwest of England. The current skull radiograph (SXR), CT scan, and admission rates were determined. The rates of SXR, CT scan, and admission that should have occurred when following either the RCS or NICE guidelines were then determined. RESULTS: Data from 10 965 patients who attended three hospitals between February 2000 and August 2002 was studied. Twenty five per cent of patients received a SXR, 0.9% a CT scan, and 3.7% were admitted. Strict adherence to the RCS guidelines would have resulted in a 50% SXR rate, a 1.6% CT scan rate, and a 7.1% admission rate. Adherence to NICE guidelines would result in a 0.3% SXR rate, an 8.7% CT scan rate, and a 1.4% admission rate, although the CT rate would drop to 6.3% if vomiting three or more times in the under 12s was used instead of more than one vomit. CONCLUSIONS: The new NICE guidelines do not increase the workload caused by patients attending with head injury but they move their management from the observation ward to the radiology department.

Adolescent↗
PubMed2003

Collectins and their role in lung immunity.

The collectins are a small family of secreted glycoproteins that contain C-type lectin domains and collagenous regions. They have an important function in innate immunity, recognizing and binding to microorganisms via sugar arrays on the microbial surface. Their function is to enhance adhesion and phagocytosis of microorganisms by agglutination and opsonization. In the lung, two members of the collectin family, surfactant proteins A and D, are major protein constituents of surfactant. Another collectin, mannan-binding lectin, is also present in the upper airways and buccal cavity and may protect against respiratory infections. Recent work has shown that collectins have roles in resistance to allergy and in the control of apoptosis and clearance of apoptotic macrophage in the lung.

Cell Adhesion↗
PubMed2003

Results of rotating-platform, low-contact-stress knee prosthesis.

Low-contact-stress (LCS) rotating-platform knee arthroplasties in 31 consecutive patients with 50 deformed knees were evaluated at a mean follow-up of 4.5 years (range, 4-6 years). Overall results were good in 72% of 22 osteoarthritic knees and 71.4% of 28 rheumatoid knees. None of the knees showed any change in component position and alignment, osteolysis, or cement-bone radiolucency during follow-up. LCS prosthesis takes care of some rotational component mismatch. Complications included 2% dislocation, 4% anteroposterior instability, and 10% subluxation of the rotating platform. The overall reoperation rate of 10% was significantly higher than reported for the fixed bearing series, and we feel that LCS prosthesis is unsuitable for severely deformed knees.

Arthritis, Rheumatoid↗