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Biomedical subjects

R Naik

Publications and source records attributed to R Naik.

87 records · Page 5Linked to original sources
PubMed1992

Testicular biopsy in male infertility.

A total of 134 testicular biopsies from infertile men were studied. The potentially treatable causes of infertility viz. Normal spermatogenesis with post-testicular obstruction, maturation arrest and hypospermatogenesis together constituted about 54 percent of all cases. The incurable causes viz., germ cell aplasia, tubular fibrosis and Klinefelter's syndrome together constituted about 42 percent of all cases. Testicular biopsy in male infertility is a very useful procedure since it gives a lot of information on the diagnosis and helps in planning treatment.

Biopsy↗
PubMed1990

Proliferating trichilemmal tumours.

Twelve cases of a peculiar, relatively uncommon, benign but locally invasive proliferating trichilemmal tumours are reported. The origin of these tumour appears to be outer root sheath of hair. In order to avoid an erroneous diagnosis of squamous cell carcinoma, an adequate knowledge of these tumours is necessary.

Adult↗
PubMed1984

Renal function during lithium treatment.

Renal function tests were performed in 101 unselected patients who had been on lithium for two weeks to 12 years. None had a recorded episode of lithium intoxication. The glomerular filtration rate (GFR), was not correlated with the cumulative dose of lithium or the duration of use of other psychotropic drugs. Nine patients had creatinine clearances lower than predicted; in six of these, no cause was identified and the small reductions in GFR may have been related to lithium use. Urinary concentrating ability (Umax) declined with age, and total dose of lithium received. Although the concurrent use of neuroleptics did not significantly reduce the Umax, the total duration of treatment with these drugs showed a negative correlation. The results suggest that prolonged use of neuroleptics, particularly in patients treated with lithium, may be responsible for an irreversible reduction in urine concentrating ability. Microalbuminuria was present in 40 per cent of the patients, although the rate of albumin excretion was not correlated with duration of use of psychotropic drugs. beta 2 microglobulin excretion was only raised in nine of these patients, suggesting that increased glomerular permeability rather than impaired proximal tubular protein reabsorption was responsible for the proteinuria. The urinary excretion of beta 2 microglobulin and N-acetyl-beta-glucosaminidase were slightly increased in small numbers of patients, indicating little evidence for proximal tubular damage. Increased NAG excretion did not correlate with reduced distal tubular function. However, there was a tendency to higher urinary beta 2 microglobulin excretion in patients with a reduced Umax.

Adult↗
PubMed1979

Treatment of renal bone disease with 1 alpha-hydroxylated derivatives of vitamin D3. Clinical, biochemical, radiographic and histological responses.

Forty patients with severe bone disease and chronic renal failure were treated with 1 alpha-hydroxycholecalciferol (1 alpha-OHD3) or 1,25-dihydroxycholecalciferol (1,25(OH)2D3) for 7--49 months (total = 738 patient months). There were symptomatic, biochemical and radiographic improvements in the majority of patients (greater than 70 per cent). Paired bone biopsies, taken before and during treatment in 26 patients, showed no change in bone matrix area, whereas matrix area decreased in a control group of 26 patients over the same period. There were small but consistent decreases in bone marrow fibrosis and in bone cell (osteoblast and osteoclast) counts in treated patients but not in controls. However, the proportion of patients who showed histological 'cure', in the sense of complete reversal of marrow fibrosis or excess osteoid was no greater in the treated than in the control group...

Adolescent↗
PubMedDate not supplied

Uterine inversion by a mixed müllerian tumor of the corpus.

Mixed müllerian tumors (MMT) of the uterus have been reported following the use of tamoxifen. Rarely, these tumors lead to an uterine inversion. The surgical approach of a uterine inversion forms a therapeutic challenge. In this article, a case of uterine inversion due to a MMT is reported, together with a literature review regarding the developing mechanisms and management.

Aged↗
PubMedDate not supplied

"True" versus "apparent" stage I epithelial ovarian cancer: value of frozen section analysis.

The aim of this prospective study was to determine the clinical benefits of introducing peroperative frozen section analysis into the surgical management policy of women referred with an adnexal mass suspicious of ovarian cancer. All women surgically managed at the Northern Gynaecological Oncology Centre, Gateshead, UK, between July 1, 2002, and June 30, 2003, where frozen section analysis had been utilized were included for analysis. Correlation was determined between cases surgically staged following the frozen section result and the clinical need for staging based on the pathologic diagnosis from the paraffin section. During the 12-month period, 130 women underwent frozen section analysis. Paraffin section diagnoses included 74 benign tumors, 11 borderline tumors, 34 primary epithelial cancers, 5 nonepithelial cancers, and 6 metastatic tumors. All primary epithelial ovarian cancers were correctly identified as requiring a staging procedure based on the frozen section result. Four of seventy-four cases reported as benign on frozen section analysis were underdiagnosed; two were later diagnosed on paraffin section as borderline tumors and a further two as malignant (one low-grade adenosarcoma and one primary peritoneal cancer). Of the 130 cases, 55 (42.3%) underwent a staging procedure based on the frozen section result. The value of frozen section analysis in determining the need for the performance of a staging procedure had the following statistical test results: sensitivity = 92%, specificity = 88%, positive predictive value = 82%, and negative predictive value = 95%. Excluding the borderline tumors, metastatic tumors, and primary peritoneal tumor where staging did not impact subsequent clinical management, the statistical test results for frozen section analysis in determining the need for a staging procedure were sensitivity = 97%, specificity = 95%, positive predictive value = 90%, and negative predictive value = 99%. The clinical benefits of introducing frozen section analysis in the surgical staging policy of women with an adnexal mass suspicious of ovarian malignancy included avoidance of a surgical staging procedure in 95% of cases identified on paraffin section analysis to be benign. This benefit was without compromising the avoidance of chemotherapy in true stage I epithelial ovarian cancer cases. Additional benefits included the confirmation of malignancy where extraovarian lesions were suggestive but not indicative of malignant disease, and the intraoperative identification of metastatic disease of nonovarian origin.

Female↗
PubMedDate not supplied

Pelvic floor dysfunction and radical hysterectomy.

Although the survival outcome for treated, early-stage, node-negative cervical cancer is excellent, the operation of radical hysterectomy conveys major morbidity, particularly with respect to bladder and bowel function. There may be some degree of spontaneous recovery, but a significant proportion of postoperative women will have to live with the disabling effects of surgery for decades, and few seek help for their distress. As such, quality of life issues have become highly relevant in the management of this disease, and attention has turned to reducing morbidity, especially to the pelvic viscera. This review presents an overview of the surgical mechanisms presumed to be responsible for pelvic floor denervation and describes subsequent bladder and bowel dysfunction, together with future possibilities for minimizing morbidity, including less radical, more individual surgery, and nerve-sparing techniques.

Adult↗
PubMedDate not supplied

Unilateral groin and pelvic irradiation for unilaterally node-positive women with vulval carcinoma.

It is essential that any patient with resected vulval cancer and significant nodal disease receive optimal adjuvant treatment with radiation. Adequate radiotherapy for such patients with unilateral positive groin nodes has not been defined. Whether both groins and pelvic sidewalls should be irradiated or only the affected (node positive) side remains unclear. From our registry, we identified all patients with primary, previously untreated squamous cell carcinoma of the vulva undergoing bilateral inguinofemoral lymphadenectomy (superficial and deep nodes) and having unilaterally positive groin nodes treated with unilateral groin and pelvic radiotherapy (44 Gy in 22 fractions). Clinical and pathologic records were reviewed to identify the anatomical site and timing of recurrences in these patients and determine whether unilateral groin and pelvic irradiation was sufficient for disease control on the node-negative side. From 1983 to 2002, 20 patients with unilateral positive nodes treated with unilateral groin and pelvic irradiation were identified. Nineteen patients were classed as having FIGO stage III disease and one as FIGO stage IV due to involvement of the rectal mucosa. There were nine patients with disease recurrences in this group (45%). The disease-free interval ranged from 4 to 31 months (median time to recurrence, 9 months). All nine patients had local or regional failures, the most common site being the ipsilateral groin (six of nine patients). One patient was also found to have distant metastases. There were no recurrences noted in the contralateral (nonirradiated) groin or pelvic sidewall. Recurrence was generally fatal. Eight of the nine patients subsequently died of their disease. The ninth patient died of another cause. There was a high incidence of regional failure after unilateral groin and pelvic radiotherapy, but there were no recurrences on the nonirradiated, node-negative side. Although a small series, we speculate that there is no apparent disadvantage to administering unilateral adjuvant radiotherapy for unilaterally positive groin nodes and encourage further studies in order to more confidently determine whether the tendency observed in our center holds true.

Adult↗
PubMedDate not supplied

A randomized phase II trial of indole-3-carbinol in the treatment of vulvar intraepithelial neoplasia.

The aim of this study was to determine the potential therapeutic benefits of indole-3-carbinol (I3C) in the management of vulvar intraepithelial neoplasia (VIN). Women with histologically confirmed high-grade VIN were randomized to receive 200 and 400 mg/day of I3C. Symptomatology by visual analog scale and vulvoscopic appearance were assessed at recruitment, 6 weeks, 3 months, and 6 months. Tissue biopsy to determine histologic response was obtained at completion of the study period. Urine samples were obtained at each visit to determine 2-hydroxyestrone to 16-alpha-hydroxyestrone ratios. Data from 12 women were suitable for analysis. There was a significant improvement in symptomatology with the introduction of I3C (itch, P= 0.018; pain, P= 0.028). Lesion size and severity were also significantly reduced (size, P= 0.005; appearance, P= 0.046). In addition, there was a significant increase in 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio following commencement of I3C, P= 0.05. However, tissue biopsy from the worst-affected vulval areas revealed no improvement in grade of VIN during the 6-month period, P= 0.317. There were no significant differences in results between those women taking 200 mg/day of I3C and those on 400 mg/day. This study has shown significant clinical improvement in symptomatology and vulvoscopic appearance of VIN with I3C therapy. Further clinical and scientific investigations are required to support these preliminary findings.

Adult↗
PubMedDate not supplied

Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: does it identify the correct cases?

Characterization of adnexal masses to identify patients with malignant ovarian tumors preoperatively for referral to a cancer center for treatment has been extensively studied. A simple algorithm called "risk of malignancy index" (RMI) reported by Jacobs incorporated the serum CA125 level, menopausal status, and ultrasound morphologic features. This algorithm has subsequently been tested on retrospective and prospective data with encouraging results. However, these studies did not include cases that had had both their serum CA125 measurements and ultrasound examinations from a diverse range of laboratories and sonographers. The purpose of this study was to determine the effectiveness of the RMI algorithm for identifying cases of ovarian malignancy presenting at cancer units for subsequent referral to a cancer center. All cases of suspected ovarian malignancy referred to the Northern Gynaecological Oncology Centre (NGOC) during an 18-month period were identified from the NGOC database. A case note review was performed, and the following data were extracted: patient demographics, the referring physician and the operating surgeon, ultrasound morphology, serum CA125 levels, and menopausal status. All patients had their ultrasound performed by sonographers at the peripheral unit according to local protocols. A total of 182 patients with a pelvic mass were referred to the center for surgery. A total of 24% patients had benign tumors, 6% had tumors of borderline malignancy, and 70% had invasive tumors. A total of 145 cases had an RMI >200; 125 of these had ovarian or peritoneal cancers. An RMI >200 had a sensitivity of 88.5% for diagnosing invasive lesions. The overall sensitivity of this algorithm for diagnosing all borderline, invasive ovarian, or primary peritoneal lesions was 87.4%, and the positive predictive value was 86.8%. Our data confirm the effectiveness of the RMI algorithm in clinical practice for the identification and subsequent referral to cancer centers of cases of potential ovarian malignancy. We therefore recommend its continued use.

Algorithms↗