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Biomedical subjects

R S Dhaliwal

Publications and source records attributed to R S Dhaliwal.

At least 19 recordsLinked to original sources
PubMed2001

Role of physiological lung exclusion in difficult lung resections for massive hemoptysis and other problems.

OBJECTIVES: Pulmonary tuberculosis and bronchiectasis are the major causes of massive hemoptysis in developing countries. Lung resection remains the surgical treatment of choice. This may not always be possible and may even be hazardous in some patients due to fibrosis and dense vascular adhesions between the lung and the chest wall. This leads to marked blood loss and control of hilar vessels becomes dangerous. METHODS: A series of 20 cases is described here. Nineteen presented with massive hemoptysis where control of bleeding was obtained by physiological lung exclusion. One patient had traumatic left main bronchus transection not suitable for repair or resection. Physiological lung exclusion was performed by surgical interruption of the bronchus and pulmonary artery of the involved lobe or lung, keeping pulmonary veins intact. RESULTS: Hemoptysis could be controlled in all these patients without any significant morbidity. There was no mortality. There was no postoperative empyema and recurrence of hemoptysis on long-term follow-up. No patient required anatomical lung resection later on. CONCLUSIONS: Physiological lung exclusion is a safe and effective method for control of massive hemoptysis in cases where lung resection is technically hazardous or difficult. This should be kept as an alternative or adjunct to anatomical lung resection.

Adolescent↗
PubMed2001

Role of Indian Council of Medical Research (ICMR) in advancement of ophthalmic research.

Blindness accounts for almost 7 million Disability Adjusted Life Years (DALYS). Considering its importance ICMR has been continually conducting research in ophthalmology starting from the first nationwide blindness survey in 1970s till date. In addition ICMR also has mechanisms of sponsoring research by interested individuals which involve adhoc research schemes and fellowships. The details of these mechanisms and some of the results of major ICMR projects are presented. The identified new thrust areas and the coordinators for these are also listed.

Academies and Institutes↗
PubMed1998

Diffuse anterior retinoblastoma.

PURPOSE: The authors describe the clinicopathologic features of an anterior variant of diffuse retinoblastoma. METHODS: The clinical history of a child with an anterior chamber infiltrate and cells in the anterior vitreous was reviewed. An anterior chamber aspirate was processed by a Millipore filter technique. The eye was enucleated and routinely processed for light and transmission electron microscopic examination. RESULTS: An 8-year-old girl was treated for anterior uveitis in her right eye that failed to resolve. Examination of an anterior chamber aspirate showed cells suggestive of retinoblastoma. The eye was enucleated, and the enucleation specimen showed retinoblastoma confined to the iris, ciliary body, and anterior vitreous with one microscopic focus of tumor in the peripheral retina. CONCLUSION: This variant of diffuse retinoblastoma involved only anterior ocular structures with minimal involvement of the retina.

Anterior Chamber↗
PubMed1998

Indocyanine green angiography patterns of zones of relative decreased choroidal blood flow in patients with exudative age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To investigate the incidence and patterns of posterior zones of relative decreased choroidal blood flow in patients with exudative age-related macular degeneration. PATIENTS AND METHODS: Digital indocyanine green (ICG) angiograms from 100 patients with exudative age-related macular degeneration were reviewed for the presence of posterior zones of relative decreased choroidal blood flow. The patterns of these zones and their location relative to the choroidal neovascular process were noted. RESULTS: Ninety-five percent of the angiograms displayed the presence of either a complete or an incomplete zone of relative choroidal hypoperfusion. The zone was most apparent in the early frames of the angiogram. Five different patterns of relative decreased choroidal blood flow were identified: horizontal (32%), vertical (14%), bipartite (9%), tripartite (31%), and quadripartite (9%). The choroidal neovascular process was located within or at the edge of the zone of relative choroidal hypoperfusion in all cases. CONCLUSION: Most cases of choroidal neovascularization localize to areas of relative choroidal dye nonfilling on ICG angiography. These patterns of choroidal nonfilling may have implications in the pathogenesis and management of choroidal neovascular membranes in age-related macular degeneration.

Choroid↗
PubMed1997

One-stage surgical procedure for bilateral lung and liver hydatid cysts.

BACKGROUND: Echinococcus disease is endemic in areas where livestock are raised in association with dogs. The majority of patients reporting in the Department of Cardiovascular and Thoracic Surgery at Postgraduate Institute of Medical Education and Research have unilateral pulmonary hydatid disease. METHODS: From March 1988 to May 1996 we came across 58 patients with pulmonary hydatidosis, of which 5 patients presented with combined bilateral pulmonary and hepatic hydatid cysts. In these patients, to avoid three-stage operation of two thoracotomies and a laparotomy, we proceeded with simultaneous combined resection of hydatid cysts in one stage through midsternotomy along with laparotomy or transdiaphragmatic removal of liver cysts. RESULTS: Results indicate that combined resection of pulmonary and hepatic hydatid cysts is feasible with minimum morbidity and no recurrence. CONCLUSIONS: We conclude that a one-stage surgical procedure for bilateral lung and liver hydatid cysts is superior to the classic three-stage approach as it decreases morbidity, hospital stay, and cost.

Adult↗
PubMed1996

Closed mitral valvotomy for mitral restenosis: experience in 113 consecutive cases.

The costs of heart operations and the problems related to anticoagulation after prosthetic valve replacement are among the limitations faced by patients in nonindustrialized countries with mitral stenosis caused by chronic rheumatic heart disease. The young age at which these patients are seen also compels the surgeon to preserve the native valve. The least costly and optimal way to achieve this objective is by closed mitral valvotomy. After closed mitral valvotomy, mitral restenosis is commonly encountered. We report here our 10-year experience with operation on 113 consecutive patients with mitral restenosis. Closed transventricular revalvotomy was performed with Tubbs dilator in 105 of 113 patients. Mean age was 343 years, with a male to female ratio of 1:1.5. Most patients were in New York Heart Association functional classes III and IV (74.3% and 19.4%, respectively). Mean interval between first and second valvotomy was 9.4 years, Hospital mortality rate was 2.8%, trivial postoperative mitral regurgitation occurred in 16.1%, and moderately severe regurgitation occurred in 1.9%. Early postoperative systemic embolism occurred in 3.8% of the cases. Moderate to excellent symptomatic improvement was noted in 89.4% of the cases and poor results were seen in 10.2%. Late follow-up of 76 patients ranged from 2 to 10 years (mean 3.8 years), with 39.4% patients in New York Heart Association class I and 50% in class II. Close mitral revalvotomy is thus an economical, simple, and safe palliative procedure that carries good long-term results.

Adolescent↗
PubMed1995

A comparison of peribulbar and retrobulbar anesthesia for vitreoretinal surgical procedures.

OBJECTIVE: To compare the efficacy of retrobulbar and peribulbar anesthetic techniques for vitreoretinal surgical procedures. DESIGN: Prospective, randomized, double-blind study. SETTING: A large university teaching hospital. PARTICIPANTS: One hundred sixteen consecutive patients who were scheduled for vitreoretinal surgical procedures. METHODS: Patients who were undergoing vitreoretinal surgical procedures were divided into four separate groups, depending on the type of surgical procedure planned. Equal numbers of patients in each group of patients who were undergoing a surgical procedure were randomly assigned to either the retrobulbar or peribulbar block-treated group. Anesthesia, akinesia, need for block supplementation, and patient acceptance were measured. RESULTS: Both retrobulbar and peribulbar anesthetic techniques provided equal levels of akinesia and analgesia, with each requiring intraoperative supplementation in 32%. CONCLUSION: Peribulbar block can be expeditiously and efficiently used for a full range of vitreoretinal surgical procedures.

Anesthesia, Local↗
PubMed1995

Geographical variations in the presentation of ruptured aneurysms of sinuses of valsalva: evaluation of surgical repair.

From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninety percent were in the 20- to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.

Adult↗
PubMed1994

Orbital-tuberculosis.

Three cases of orbital tuberculosis are presented, two as cold abscess in the orbit and one as a chronic indolent sinus. A simple clinical test like Fine Needle Aspiration Cytology (FNAC) can demonstrate some or all of the characteristic pathological features like caseating necrosis, epitheloid cells and Langhan's giant cells. Important corroborative evidence can be obtained from the Tuberculin test and a positive therapeutic trial. While there are many other causes or orbital swelling and abscess, tuberculosis should be considered an important differential diagnosis in endemic areas. Simple tests like the tuberculin reaction and Fine Needle Aspiration Cytology should be considered among the routine diagnostic investigations for orbital swellings.

Abscess↗
PubMed1994

Visual results after surgical removal of subfoveal choroidal neovascular membranes.

PURPOSE: The authors report their experience with the surgical removal of subfoveal choroidal neovascularization. Correlations between preoperative characteristics and final postoperative visual acuity are explored. METHODS: A retrospective study of 159 consecutive patients was performed between February 1990 and August 1993. Follow-up of 2 or more months was available for 147 eyes: presumed ocular histoplasmosis syndrome, 67 eyes; age-related macular degeneration, 41 eyes; myopia, 10 eyes; multifocal choroiditis, 9 eyes; idiopathic, 8 eyes; angioid streaks, 4 eyes; and miscellaneous, 8 eyes. RESULTS: Sixty-seven eyes had presumed ocular histoplasmosis syndrome: mean follow-up was 10.5 months. Visual acuity was stable or improved in 56 (83%) eyes and 20/40 or greater in 21 (31%) eyes. Mean interval to best visual acuity was 3 months. A recurrence rate of 37% had no significant effect on final visual outcome (P = 0.952). Forty-one eyes had age-related macular degeneration: mean follow-up was 15 months. Visual acuity was improved in only five (12%) eyes and was 20/40 or greater in only two (5%) eyes. The interval to best visual acuity was 5 months. A recurrence rate of 27% had not significant effect on final visual outcome (P = 0.31). The visual results and recurrence rates for eyes with less common disorders are presented. CONCLUSION: The surgical excision of subfoveal choroidal neovascularization may stabilize or improve visual acuity in selected cases. Patients with focal disorders of the retinal pigment epithelium-Bruch's membrane complex appear to have a better surgical outcome than those with diffuse disease.

Adult↗
PubMed1993

Acute posterior multifocal placoid pigment epitheliopathy. An indocyanine green angiographic study.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an idiopathic posterior segment inflammatory disorder of young adults. The pathophysiology is poorly understood, and debate persists as to whether it represents a primary pigment epithelial disorder or a choroidal vascular disease. Indocyanine green angiography was used to study choroidal blood flow in two patients with typical APMPPE. The authors demonstrate profound delayed choroidal filling in addition to extensive areas of choroidal vessel nonperfusion in the acute stage of this disease. Recovery of choroidal blood flow was evident during clinical resolution. Choroidal blood flow abnormalities are present in APMPPE and suggest that the clinical findings of this disease reflect a primary choroidal vascular disease.

Acute Disease↗
PubMed1987

Intrabronchial schwannoma. A case report.

A 17-year-old male presented with clinical features of left lung collapse. The diagnosis of isolated intrabronchial schwannoma was obtained by endoscopic biopsy and confirmed after pneumonectomy.

Adolescent↗
PubMed1980

Cattle horn injuries.

The successful management of a patient with potentially lethal intrathoracic trauma resulting from bull horn injury and involving the intrapericardial and extrapericardial portions of the right inferior pulmonary vein is described. To the best of our knowledge this particular injury has not previously been reported. Irrespective of the external appearance of the wound, hospitalization and close observation are essential. Exploration if required should be under optimal operative conditions. Popularization of disbudding and dehorning will prove an effective preventive measure.

Adult↗
PubMed1979

Half and total body radiation for carcinoma of the prostate.

Despite recent advances in the treatment of stage D carcinoma of the prostate many patients become refractory to all therapeutic modalities. Progressive and incapacitating pain is one of the most difficult symptoms to manage. Ten patients with severely symptomatic metastatic adenocarcinoma of the prostate have been treated with either single or sequential doses of half body radiation using 800 rad delivered by a Linac 10 mV linear accelerator. There were 15 courses of half body radiation delivered and a good to excellent response was noted in 11 instances. Results often were immediate and the duration of the response was variable. Treatment was well tolerated with no fatal complications. Half and total body radiation appears to offer significant palliation and its use with other forms of therapy warrants further investigation.

Humans↗
PubMed1976

Further progress in CT scanning and computerized radiation therapy treatment planning.

Total body computed tomography has introduced a unique method of obtaining body contours as well as anatomical representations for radiation therapy treatment planning. CT scanning combined with computerized radiation therapy treatment planning has improved accuracy and contributed greatly to the solution of complex treatment problems. CT scans can also be used to evaluate the progress of patients undergoing radiation therapy.

Computers↗