Biomedical subjects
S Bhandari
Publications and source records attributed to S Bhandari.
Value of physical and pharmacological tests in predicting intrinsic and extrinsic sick sinus syndrome.
We studied 13 patients with sick sinus syndrome using various physical (postural reflex testing. Valsalva manoeuvre, carotid sinus massage), pharmacological (intravenous isoprenaline, atropine, neostigmine and total autonomic blockade) and electrophysiological tests in order to identify simple non-invasive markers of intrinsic sick sinus syndrome. Following autonomic blockade, 6 patients had normal and the remaining 7 had an abnormal intrinsic heart rate. Electrophysiological testing revealed abnormal sinus node parameters in 8 (62%) subjects in the basal state and 11 (85%) after autonomic blockade. Carotid sinus massage was abnormal in all patients (100%) with an abnormal intrinsic heart rate, and in only 2 of the 6 (33%) with normal intrinsic heart rate (P less than 0.05). The heart rate response to isoprenaline was abnormal in 5 of the 6 (83%) patients with normal as compared to only 1 of the 7 with abnormal intrinsic heart rate. With isoprenaline there was a significantly (P less than 0.05) higher increase in heart rate in patients with abnormal as compared to those with normal intrinsic heart rate. The other physical and drug tests were not helpful to differentiate between intrinsic and extrinsic mechanisms. Thus, carotid sinus massage and, to some extent, isoprenaline administration appear simple bedside tests which may be helpful in identifying the underlying mechanism of sick sinus syndrome.
Permanent pacemaker complications: a 16 years experience.
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Echocardiographic detection of tricuspid valve vegetations in a child with ventricular septal defect.
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Incidence of anti-thyroid antibodies in diverse thyroid disorders--an application of indirect-immunofluorescence technique.
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Coronary artery fistulae without audible murmur in adults.
Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36-69 years). No murmur was audible in any of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary artery and the left anterior descending artery (LAD) in two, the LAD in six, and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease, and that the diagnosis is mostly incidental during routine coronary arteriography.
Infective endocarditis in children.
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Screening for abnormal illness behaviour.
A screening test for detecting abnormal illness behaviour in patients with somatic symptoms is described here along with its psychometric properties. This screening version of the Illness Behaviour Questionnaire (SIBQ) is derived from two subscales of the Illness Behaviour Questionnaire and has 11 items. The study was carried out on 78 consecutive patients with prominent somatic complaints and 22 normal volunteers. The SIBQ was administered to the subjects and the sensitivity, specificity and hits positive rates were computed for different cut-off scores. A score of 7 and above gave a sensitivity of 86%, a specificity of 83% and a hits-positive rate of 0.7537, and this seems the optimal cut-off score. The SIBQ may prove to be a sensitive screening instrument to detect probable cases of abnormal illness behaviour and especially useful for busy clinics or centres.
CAPD peritonitis due to Serratia plymuthica.
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Eptifibatide-induced profound thrombocytopenia.
We report a case of profound thrombocytopenia, 2 hours following eptifibatide therapy which got reversed within 12 hours of discontinuation of eptifibatide.
Echocardiographic demonstration of pulmonary valve vegetation in a child with infundibular pulmonic stenosis and closed VSD.
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Carotid sinus syncope: is pacing required in all patients? Report of two cases and review of literature.
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Critical evaluation of the coronary risk factors profile in patients with myocardial infarction.
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Pictures in medicine 6. Extensive infiltrate of poorly differentiated metastatic adenocarcinoma.
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Percutaneous intraaortic balloon pulsation for management of life threatening emergencies in an intensive coronary care unit.
The indications for the outcome of use of intraaortic balloon pulsation (IABP) in 66 patients (65 males, 1 female), in addition to the usual conventional medical therapy, are reported here. IABP was used for treatment of cardiogenic shock (5 patients), acute myocardial infarction with rupture of interventricular septum (2 patients), acute myocardial infarction with refractory left ventricular failure (2 patients), resistant ventricular tachyarrhythmias (5 patients), refractory angina (50 patients) and for hypotension following high risk coronary angiography (2 patients). A Datascope 10.5 F percutaneous balloon was inserted in all, mostly using the left femoral artery. Either definitive treatment (coronary artery bypass surgery or coronary angioplasty) was offered when feasible or the balloon was weaned off. Twelve patients underwent coronary angiography on IABP; while 31 patients had undergone the angiography earlier. Surgery was possible in 33 patients with 90% survival rate. The non surgical group showed 30% survival rate. The complications of IABP encountered were: leg ischaemia (2 patients), septicemia (4 patients) and balloon rupture (2 patients). Our experience suggests that percutaneous IABP is a very useful management procedure for seriously sick high risk patients prior to definitive therapy. Patients who could have a definitive treatment while on IABP, especially the group with refractory angina, did best on a short term follow up. Vascular complications are minimal while on IABP.
Serum zinc, copper, magnesium, proteins and superoxide dismutase in leprosy patients on multidrug therapy--a follow-up study.
Serum zinc, copper, magnesium, total proteins and albumin-globulin fractions and superoxide dismutase (SOD) were estimated in 80 untreated patients with TT/BT/BL/LL type of leprosy and in 40 controls. The investigations were repeated on day 30, 60 and 120 after starting multidrug therapy (MDT-WHO) on the patients. Serum zinc was significantly lowered in all types of leprosy on days 0 and 30. Serum copper was significantly raised in all types of leprosy. This was not significant in BT/TT cases on 60, 120 days. There was a correlation between serum zinc and copper levels and the severity and type of leprosy. The lowering of serum magnesium values were not significant. With therapy, there was a shift of all the three elements towards normal values. Serum total proteins reduction was not significant. Serum albumin was significantly lowered in all types of leprosy. Serum globulin was significantly raised in all types of leprosy. This rise in TT/BT was not significant on day 60 and 120 after starting treatment. Serum SOD was significantly reduced in all the untreated cases. It gradually increased with the clinical improvement under MDT.
Reticulocyte indices in patients with end stage renal disease on hemodialysis.
The diagnosis of iron deficiency anaemia in haemodialysis patients is difficult. Two states of deficiency occur, storage (absolute) and functional iron deficiency. Conventional measures, lack precision in assessing both storage and functional iron deficiency. This study investigated the accuracy of reticulocyte indices in comparison to the conventional haematological measures in the identification of haemodialysis patients with iron deficiency. A cross-sectional study of 72 haemodialysis patients was performed. Mean haemoglobin was 9.6 +/- 0.16 g/dl. Mean haemoglobin content of reticulocytes (CHr) was normally distributed and correlated with MCV, MCH and red cell ferritin. Mean haemoglobin concentration of reticulocytes (CHCMr) correlated with MCH. CHr and CHCMr had positive predictive values of 0.61 and 0.54 respectively. A low CHr or CHCMr identified 5 and 4 and 17 and 21 further patients with iron deficiency with normal serum ferritin or transferrin saturation respectively. Reticulocyte measures provide a direct measure of adequacy of haemoglobin synthesis in haemodialysis patients. In this study their usefulness was somewhat limited, but requires further investigation.