Biomedical subjects
R Tandon
Publications and source records attributed to R Tandon.
Catatonia as a manifestation of paraneoplastic encephalopathy.
The psychopathological, electrophysiological, and pathological features of a 58-year-old woman suffering from anaplastic lung carcinoma with paraneoplastic encephalopathy are presented. The predominant behavioral manifestation was a catatonic syndrome that was partially responsive to clonazepam. Although a variety of neurological, psychiatric, and other causes of catatonia have been reported, this is the first reported case of catatonia caused by paraneoplastic encephalopathy.
Concurrent lithium therapy prevents ECT-induced switch to mania.
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Treatment of negative schizophrenic symptoms with trihexyphenidyl.
In an effort to investigate reports of possible benefits of trihexyphenidyl on residual schizophrenic symptoms, the drug was administered to five chronic schizophrenic patients with predominantly negative symptoms. These patients were simultaneously receiving various antipsychotic agents without extrapyramidal side effects. There was a marked improvement in four of the five patients, mainly in the areas of affective flattening, anhedonia-asociality, and avolition-apathy. Three of these four patients also reported a reduction in excessive dreaming and nightmares experienced prior to the introduction of trihexyphenidyl. Common pathogenetic mechanisms for negative schizophrenic symptoms and excessive dreaming are discussed. In view of these findings, an investigation of the therapeutic benefits of anticholinergic agents in the treatment of negative schizophrenic symptoms, and the use of decreased dreaming as a possible marker of response, is warranted.
Hemochromatosis with episodic confusion.
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Coronary artery anomalies in tetralogy of Fallot.
Coronary angiograms of 296 patients with Fallot's tetralogy were reviewed. Group I abnormalities in the origin and distribution of the coronary arteries, found in 32 (11.8%) cases, consisted of a single coronary artery from the left sinus of Valsalva in 7 cases, left anterior descending artery from the right coronary artery in 7 cases, and an accessory left anterior descending from the right coronary in 18 cases. Of the 7 cases with a single coronary artery, the right coronary branch was anterior to the aortic root, crossing the right ventricular outflow in two cases. Group II acquired abnormalities were found in 11 cases and consisted of an enlarged conus artery in 9 cases and 1 case each of coronary bronchial collateral and right ventricular branch from the left anterior descending artery. Except in 12 patients requiring selective coronary angiography, aortic root angiography was sufficient to outline the coronary anatomy. Awareness of a coronary anomaly helps in deciding the time and type of operative procedure to be performed, especially in infants, since injury to a large vessel perfusing the left ventricle usually results in increased morbidity and mortality.
Differentiation of patients with rheumatic fever from those with inactive rheumatic heart disease using the artificial subcutaneous nodule test, myocardial reactive antibodies, serum immunoglobulin and serum complement levels.
Thirty patients with acute rheumatic fever, and 20 with inactive rheumatic heart disease were studied in order to determine parameters which differentiate the two groups. Subcutaneous nodules developed following the subcutaneous injection of autologous blood in 16 of 26 patients with rheumatic fever but in none of the 20 with inactive rheumatic heart disease (P = 0.00001). Myocardial reactive antibodies were found in 14 of 30 patients with rheumatic fever, and in 4 of 20 with inactive rheumatic heart disease (P = 0.0505). Significantly higher values of IgG (P less than 0.001), IgA (P less than 0.01), C3 (P less than 0.001) and C4 (P less than 0.001) were observed in rheumatic fever patients. There was no significant difference in IgM levels. A combination of three variables (artificial subcutaneous nodules, IgA, and C3) had a sensitivity of 87% and a specificity of 100% for rheumatic fever. A combination of two variables (artificial subcutaneous nodules and IgA) had a sensitivity of 84% and a specificity of 100% for rheumatic fever.
Schneiderian first rank symptoms: reconfirmation of high specificity for schizophrenia.
The prevalence of Schneiderian first-rank symptoms (FRS) in 294 consecutive admissions to a research unit was evaluated with reference to their diagnostic distribution (SADS/RDC). Thirty-five of 58 patients with schizophrenia had FRS, as compared to nine of 190 patients with major depressive disorder. All patients with two or more FRS received a diagnosis of schizophrenia. In the absence of organic or toxic etiology, the specificity of FRS for schizophrenia was 95% and their predictive value was 90%. These findings indicate that FRS should be regarded as strongly suggestive of schizophrenia in the absence of an organic syndrome.
Variety of effects of trihexyphenidyl (THP) on schizophrenic and non-schizophrenic abusers.
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Evaluation of biting force in mentally retarded children.
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Unilateral upperlimb oedema with ipsilateral tubercular axillary lymphadenitis and miliary tuberculosis.
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Imipramine and tinnitus.
Although tinnitus is listed among the rare neurologic side effects of tricyclic antidepressants, little is known about its prevalence, mechanism of development, course, and management. A chart review of 475 patients treated with tricyclic antidepressants indicated that tinnitus occurred in about 1% of the patients. The case vignettes of 5 patients who developed tinnitus in the course of imipramine therapy are presented. Each developed tinnitus in the second or third week of treatment with imipramine at daily dosages of 150-250 mg and at combined plasma imipramine-desipramine levels between 200-450 ng/ml. In each patient, tinnitus subsided spontaneously within 2-4 weeks of onset without any specific treatment, even though the daily dosage of imipramine and the plasma tricyclic levels were constant or increased. Possible mechanisms of development of tinnitus and implications for tricyclic antidepressant therapy are discussed.
Scimitar syndrome in neonates: report of four cases and review of the literature.
Four neonates with scimitar syndrome are presented. Three of the cases had congenital cardiovascular abnormalities not usually regarded as part of the scimitar syndrome, namely, ventricular septal defect, abnormalities of the aortic arch, and abnormal relationship of the pulmonary arteries and bronchi. Review of the literature indicates that among subjects of all ages the incidence of additional congenital heart disease is 24%; in patients within the pediatric age group the incidence is about 36% and is highest (75%) among those subjects having diagnostic studies while neonates.
Ventricular inversion with normally connected great vessels in situs solitus (atrioventricular discordance with ventriculoarterial concordance).
A patient with ventricular inversion, normally connected great vessels, and aortic valvular atresia is presented. The case represents an association of two rare situations. The first of these is normally connected great vessels with ventricular inversion. The second is the association of commonly occurring aortic valvular atresia with ventricular inversion.
Single papillary muscle of the left ventricle associated with persistent common atrioventricular canal: variant of parachute mitral valve.
Six cases of single papillary muscle of the left ventricle in persistent common atrioventricular canal (AVC) are described. Except for one case with double outlet right ventricle and AVC, in the other five cases AVC occurred with normally related great vessels. Down's syndrome was present in two cases. The mitral valvular condition in AVC is not the classic parachute mitral valve since the separation between the common anterior and the common posterior leaflet leaves a space (cleft) oriented toward the ventricular septum. This mitral valve in AVC may or may not be obstructive. The common anterior leaflet fixed to the ventricular septum may result in obstruction. Clinically, single left ventricular papillary muscle should be suspected if the AVC is associated with coarctation of the aorta or tubular hypoplasia of the aortic arch. This type of mitral valve in AVC may also be associated with double outlet right ventricle. Preoperative recognition of the single papillary muscle by echocardiogram or left ventriculogram will prevent postoperative mitral obstruction following closure of the mitral cleft.
The diagnosis of rheumatic fever--evolution of the Jones criteria.
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Sertoli-cell tumour of the testis in a child.
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