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Biomedical subjects

R R Varma

Publications and source records attributed to R R Varma.

At least 37 records · Page 2Linked to original sources
PubMed1981

Percutaneous liver biopsy in difficult cases simplified by CT or ultrasonic localization.

Repeat liver biopsy guided by CT and ultrasound was performed in ten prospectively selected patients with chronic liver disease, small liver size, and a previous unsuccessful biopsy. Biopsy sites selected by both radiographic techniques were essentially similar and within 1 cm of each other. The bulk of the liver was located more posteriorly and superiorly than expected, explaining the failure of the previous unsuccessful biopsies. Adequate cores of liver 1-2.5 cm in length were easily obtained with radiologic guidance. This technique is especially useful in patients with chronic active hepatitis complicated by cirrhosis.

Biopsy↗
PubMed1979

Reye's syndrome in nonpediatric age groups.

Reye's syndrome (encephalopathy and fatty liver) is generally considered a disease of children. Four patients, aged 16, 18, 19, and 23 years, with Reye's syndrome were initially seen by internists. A viral prodrome followed by vomiting and encephalopathy without focal neurological signs or jaundice clinically suggested Reye's syndrome. Normal findings of CSF examination (except for increased opening pressure), abnormal findings of liver function tests, and increased blood ammonia further supported the diagnosis. None was hypoglycemic. Reye's syndrome was related to influenza B virus in three patients and to Varicella in another. Three patients survived. Reye's syndrome may be seen intially by general practitioners, emergency room physicians, internists, or psychiatrists. The importance of considering this syndrome in the differential diagnosis of unexplained encephalopathy in adults is stressed.

Adolescent↗
PubMed1979

Chronic-persistent hepatitis and pregnancy.

The course and possible risks of pregnancy in 7 women between the ages of 20 and 30 yr with chronic-persistent hepatitis (CPH) were evaluated. Ten pregnancies occurred in these women during the follow-up period which ranged from 3 to 8 yr. Four of the fetuses were aborted electively for nonmedical reasons. The other six pregnancies resulted in normal spontaneous vaginal deliveries at term. Each of the women experienced uneventful pre- and postnatal courses, and the neonates were all healthy and developmentally normal at birth. There was no biochemical or clinical evidence to suggest worsening liver disease during pregnancy. Normal menstrual patterns when not pregnant and normal biphasic basal body temperature patterns in 4 women suggested that ovulation and fertility were not impaired significantly. Pregnancy in women with CPH appears safe to both mother and fetus alike. This finding contrasts with the morbidity and mortality some authors have found to be associated with cirrhosis and with portal hypertension. We speculate that our findings may be relevant to women with other portal lesions resembling CPH such as resolving acute hepatitis and chronic active hepatitis in sustained remission.

Chronic Disease↗
PubMed1977

Computerized evaluation of electroencephalographic changes accompanying exchange transfusion in Reye's syndrome.

The EEGs of 7 children with Reye's syndrome (fatty liver and encephalopathy) were continuously recorded on magnetic tape for times ranging from 12 to 80 h. During these times the major therapy consisted of exchange blood transfusions. The tapes were automatically processed on a LINC-8 computer using a peak-detection algorithm. The main parameters investigated were the delta and theta indices, the mean EEG frequency, the mean peak-to-peak amplitude, and the frequency versus amplitude characteristics of the delta waves. In 5 patients who responded to therapy, a marked decrease in the delta activity and an increase in mean frequency were noted subsequent to exchange transfusions. In all 5 cases the delta waves exhibited a similar pattern of decreasing amplitude and increasing frequency following therapy. However, in 2 patients with a fatal outcome, no favorable EEG response was observed during treatment, and a simultaneous decline in both delta frequency and delta amplitude was noted as the clinical condition worsened. The results of this study indicate that continuous EEG monitoring in Reye's syndrome may be an important clinical adjunct in evaluating the effectiveness of exchange transfusion therapy and in signaling the need for further treatment.

Adolescent↗
PubMed1977

Pregnancy in cirrhotic and noncirrhotic portal hypertension.

The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. Both women experienced massive upper gastrointestinal bleeding from esophageal varices. Bleeding was difficult to control and required variceal ligation in 1. Both patients manifested features suggesting cerebral edema indicating the need for caution with fluid and electrolyte therapy. Recovery of the woman with CAH after termination of pregnancy was slow. Review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.

Adult↗
PubMed1977

Clomiphene citrate therapy in a patient with Laennec's cirrhosis.

Clomiphene citrate therapy was initiated in a male with Laennec's cirrhosis complicated by gynecomastia, testicular atrophy, impotence, and loss of libido. The patient had abstained from alcohol and had stable hepatic function tests for 1 year before starting therapy. Luteinizing hormone and endogenous testosterone levels were maximally elevated with low dose therapy (50 mg per day). Follicle-stimulating hormone was maximally elevated with a dose of 100 mg per day and the elevation of total estrogen levels was not affected by increasing the dose. During treatment increase in testicular size was noted with resolution of impotence and improvement of libido which continued for 6 months after cessation of therapy. Gynecomastia remained unchanged despite the increased serum testosterone. Serum prolactin was normal before and after the clomiphene citrate. Semen initially unobtainable was analyzed after completion of therapy. The patient relapsed 8 months after the course of clomiphene citrate therapy.

Adult↗
PubMed1976

Hepatitis B surface antigen carrier state in neonates. Prophylaxis with large doses of conventional immune human serum globulin.

Acute type B viral hepatitis developed near the term of pregnancy in seven women. All had signs of acute hepatitis at delivery, and hepatitis B surface antigenemia persisted two to four weeks after delivery. Two milliliters of conventional immune human serum globulin was administered to the neonates within a week of birth, after preexisting type B viral hepatitis infection was excluded. The antibody against hepatitis B surface antigen (anti-HBs) content of two of the administered batches of immune human serum globulin was 1:32 and 1:64. None of the babies became hepatitis B surface antigen carriers, and anti-HBs developed without obvious clinical hepatitis in one baby. Conventional immune human serum globulin in larger doses may be a relatively safe and effective prophylaxis against the development of hepatitis B surface antigen carrier state even if the anti-HBs content in the administered dose is relatively small.

Acute Disease↗
PubMed1976

Venereal transmission of hepatitis B virus. The possible role of vaginal secretions.

The presence of Type B viral (Australia antigen related serum) hepatitis in vaginal specimens was investigated and compared with that in saliva specimens in a group of patients during the acute phase of their illness. Hepatitis B surface antigen was detectable in most vaginal and salivary secretions during the phase of antigenemia and not in hepatitis B surface antigen-negative controls. Despite care in collection, occult blood was detected in the majority of specimens, but the positivity for hepatitis B surface antigen did not depend on the presence of occult blood. Recovery studies were performed in both vaginal fluids and saliva to determine if inhibitors to hepatitis B surface antigen were similar to those observed in stool samples. Significant inhibition was not observed. Although infectivity of the specimens was not established from this study, handling of these specimens as potentially infective material is recommended.

Female↗
PubMed1975

Reye syndrome. A correlated electron-microscopic, viral, and biochemical observation.

Liver biopsy specimens of two patients with Reye syndrome were examined for ultrastructural features, viral isolation, and urea-cycle enzyme activity. Concurrent presence of herpes-like virus and myxovirus/paramyxovirus was demonstrated by electron microscopy, and viral infections were confirmed by isolation or serologic tests. A concomitant hepatic ornithine transcarbamoylase deficiency was also noted. The pathogenesis in these instances seems to consist of an initial synergistic insult on the liver by mixed types of viruses and subsequent breakdown of urea cycle, Krebs cycle, and possible other hepatic functions. An exodus of glycogen granules into the hepatic spaces of Disse and sinusoids suggests that the viruses have injured the plasma membranes as well as the mitochondria of hepatocytes. Since Kapila et al reported similar disorders five years before Reye et al, the name of Kapila-Reye disease is suggested.

Adolescent↗
PubMed1975

Exchange transfusion in hepatic coma: factors affecting results, with long-term follow-up data.

1. Exchange transfusion in our experience has produced a response in 42 per cent of the patients. 2. Complicating factors, primarily sepsis, have been responsible for a 50 per cent mortality in those patients who initially respond, yielding a survival rate of 21 per cent. 3. In a select group of patients with infectious hepatitis under the age of twenty-five years, the survival rate was 37.5 per cent. 4. Excess bilirubin and ammonia rebound after exchange transfusions indicates a grave prognosis. 5. All survivors have normal results on liver function studies.

Adolescent↗
PubMed1975

Long-term effects of vasectomy on pituitary-gonadal function in man.

Plasma concentrations of testosterone (T), follicle stimulating hormone (FSH), and luteinizing hormone (LH) and percent binding of T to plasma protein (TB) were studied in 16 normal fertile men and in 81 men who had undergone vasectomy from 1 to 5 yr earlier. No significant difference from the control values to T = 582 plus or minus 39.5 (SE) ng/100 ml; FSH = 15.09 plus or minus 2.18 (SE) mIU/ml; LH =10.03 plus or minus 1.13 (SE) mIU/ml and TB = 92.99 plus or minus 0.285 (SE) % binding was detected in any group of the vasectomized men in any of the parameters studied.

Adult↗