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Biomedical subjects

S Bhardwaj

Publications and source records attributed to S Bhardwaj.

54 records · Page 3Linked to original sources
PubMed1985

Current clinical patterns of typhoid fever: a prospective study.

This paper reports on a prospective study comprising 125 consecutive adult cases of typhoid fever diagnosed on the basis of positive cultures for typhoid organisms. Salmonella typhi infection was found to be more frequent (89.6%) than S. paratyphi A & B (10.4%). Onset of the disease was usually insidious and the classical step-ladder pattern of fever was uncommon (12%). Rose spots were observed in 9.6% cases. Gut perforation was more common, while typhoid toxaemia and peripheral circulatory failure were less frequent than in most of the series reported from India. Both these variations are ascribed to the widespread use of corticosteroids in our patients. Gut perforation alone accounted for three-quarters of the deaths.

Adolescent↗
PubMed1982

Chemotherapy of metastatic cancer in bone.

A harmonious cooperation between the oncologist, orthopedist and radiotherapist can result in a more comfortable, more functional, and in some instances, longer life for the patient. Chemotherapy is an effective and important component of the total management of a patient with metastatic cancer. It provides a mode of therapy for all of the manifestations of disseminated cancer, including bone metastases. Combination chemotherapy has been demonstrated to be of important benefit in metastatic bone disease secondary to carcinomas of the breast, prostate and lung (small cell). The results with other types of lung cancer are less impressive. The chemotherapy of metastatic thyroid and renal carcinomas remains disappointing. Of the tumors that metastasize less frequently to bone, testicular and ovarian neoplasms have demonstrated significant responsiveness to combination chemotherapy. Results with Hodgkin's disease, other lymphomas and multiple myeloma are reproducible and may provide palliation and extended survival. Metastatic melanoma, colon cancer and miscellaneous other carcinomas in bone are ordinarily refractory. The limitations of the current modes of assessing response to therapy in osseous lesions impede the ability to recognize and thus, capitalize on effective treatments. New drugs and new combinations of drugs hold promise for the future.

Androgens↗
PubMed1981

Treatment of invasive or metastatic thymoma: report of eleven cases.

The clinical presentation and therapeutic modalities of 11 patients with invasive or metastatic thymoma are presented. Two patients had myasthenia gravis, and five had extrathoracic metastases. Survival exceeded five years in five patients, and four patients remain free of recurrence between 2.1 and 9.0 years after diagnosis. Surgery, with an attempt at complete resection, is the first step of therapy. A second thoracotomy for local relapse or attempt at curative resection was carried out in four patients. Radiotherapy to the mediastinum and/or metastatic sites was given to ten patients with doses ranging from 3600-6000 rads (median = 4500 rads) in the nine nonmyasthenic patients. Inclusion of supraclavicular fossae in the radiotherapy field is recommended because it was a site of relapse in two patients. Systemic therapies were given to eight patients. Objective responses were seen with two of various chemotherapeutic regimens. A combination of bleomycin, Adriamycin, cisplatin, and prednisone ("BAPP") produced a partial remission in two of five patients, during 12 and 4 months, respectively. Two of three patients responded to maytansine as a single agent after failure of other agents. Immunotherapy with intravenous Corynebacterium parvum or intradermal Methanol-Extraction Residue of bacillus Calmette-Guérin (MER-BCG) was ineffective in one patient each. The importance of combined modalities in the management of the disease is emphasized.

Adult↗
PubMed1980

Interaction of human serum albumin with anticancer agents in vitro.

The influence of human serum albumin (HA) on the biological effects of 13 chemotherapeutic agents was studied in vitro in the human leukaemia cell line MOLT-3. On the basis of changes in biological activity influenced by HA, these drugs may be divided into three types. Type I agents include cis-diamminedichloroplatinum (II), 4'-(9-acridinylamino)methanesulphon-m-anisidide, neocarzinostatin, nitrogen mustard, adriamycin, daunorubicin and mitomycin C--drugs whose biological activities are reduced in the presence of HA. The biological activities of Type II drugs (cytosine arabinoside, fluorouracil and actinomycin D) are not influenced by HA. The biological activities of Type III drugs (bleomycin, vincristine and vinblastine) are increased in the presence of HA. These results indicate that serum HA interferes in vitro with certain anticancer agents in terms of biological activity and, probably, clinical effectiveness. HA-drug interaction may be a major factor governing the pharmacology of Type I anticancer agents in man.

Animals↗
PubMed1980

Phase I study of m-AMSA in patients with solid tumors and leukemias.

m-AMSA is a synthetic aminoacridine DNA intercalator found to have experimental murine antitumor activity. A phase I investigation was undertaken in 71 patients with solid tumors and acute leukemia. Using an intermittent every 3-week schedule in solid tumors, toxicity encountered was primarily hematologic, predominantly leukopenia with relative platelet sparing. The recommended dose for phase II evaluation in patients with solid tumors is 90 mg/m2 every 3 weeks; patients with minimal prior therapy could be treated at 120 mg/m2 and patients with hepatic dysfunction or marginal bone marrow reserve should have an initial dose reduction to 70 mg/m2. Therapeutic activity was seen in Hodgkin's disease, hepatoma, and epidermoid carcinoma of the esophagus. Various dose schedules were studied in leukemia. The recommended dose for phase II evaluation is 120 mg/m2 daily for 5 days as a daily 30-minute infusion. At this dose, nausea, vomiting, mucositis, alopecia, and hepatic toxicity were noted. Therapeutic activity was seen in AML, blastic CML, and CLL. Further clinical trials with this agent are warranted.

Acute Disease↗
PubMedDate not supplied

Aortoarteritis presenting with hypoparathyroidism.

Clinical manifestations of aortoarteritis (Takayasu's arteritis) are varied, depending on the involved segment of the aorta and its branches. A case of a young Indian woman with aortoarteritis presenting primarily with hypoparathyroidism is reported. Aortogram showed total occlusion of the arch arteries. To the best of our knowledge, the occurrence of hypoparathyroidism in aortoarteritis has not been reported. Possible mechanisms of such an involvement are discussed.

Adult↗
PubMedDate not supplied

Transcatheter closure of atrial septal defect using buttoned device--Indian experience.

Transcatheter closure of secundum atrial septal defect (ASD) < 21 mm in diameter with adequate septal margins, assessed by transthoracic echocardiography (TTE) was attempted using Sideris buttoned device under fluoroscopic and TTE guidance in 27 patients (age range 5-35 years). The stretched diameter of ASD estimated by balloon sizing at cardiac catheterization was, on an average, 3 mm larger than assessed on TTE. A 25 to 50 mm second-generation Sideris device could be successfully implanted in 24 patients, with disappearance of left-to-right shunt, assessed by colour flow mapping on TTE in 17 patients. Residual shunt of 0.12-0.54 L/min/m2 was seen on day one in 7 patients which increased on follow-up in 3 patients over a period of 12 months. The maximum shunt in one patient was 1.1 L/min/m2. On follow-up (14.5 +/- 3.8 months), the device was in a stable position in all patients evaluated by fluoroscopy and TTE, and intracardiac ultrasound study in two patients. The procedure was unsuccessful in 3 patients, due to unbuttoning of the device in one and recurrent slippage of the device through the ASD in two patients. Mitral regurgitation was detected in 5 patients on follow-up (mild in 4 and moderate in 1). There was no mortality and none of the patients required any surgical intervention. It is concluded that transcatheter closure of some selected cases of secundum ASD can be safely and effectively done using Sideris buttoned device through a small sheath; however, a centering device is likely to close larger defects with less interference with mitral valve function.

Adolescent↗
PubMedDate not supplied

Post-cardiotomy intra-aortic balloon counter pulsation: application and prognostic evaluation.

Cardiac assistance by intra-aortic balloon counter pulsation was studied in 113 cardiac surgical cases comprising 91 male and 22 female patients. This included 82 percent of patients having coronary artery bypass surgery, while 18 percent were operated for valvular lesions. It was observed that the time of institution of cardiac assistance by intra-aortic balloon counter pulsation, following cardiac surgery, was of prime importance to decrease patient mortality. It was lowest (16%) when the balloon was inserted for assistance before termination and highest (50%) when there was delay of more than 15 minutes following termination of cardiopulmonary bypass. Early balloon assistance significantly lowered the pulmonary capillary wedge pressure and usually 1:2 augmentation was more effective, probably because of existing tachycardia in most patients. Advances in catheter technology have reduced the vascular complication at the insertion site. Percutaneous insertion had less local complications (13.3%) than open arteriotomy technique (31.2%). Similarly with sheathless insertion, complications were less (6.6%) in comparison to sheathed insertion (21.7%). Proper placement of balloon avoided position-related complications and there was no compromise of blood flow through left internal mammary artery as noticed in our series.

Adolescent↗
PubMedDate not supplied

Primary bronchogenic carcinoma: clinical profile of 279 cases from mid-west Rajasthan.

The present retrospective study was undertaken to study the clinical profile of primary bronchogenic carcinoma seen during last eight years in a teaching hospital. Out of a total of 279 diagnosed cases, 86% were males with an average age of 57 years, smoking was the risk factor in 81.6%. Forty percent of female patients were smoker with a significant overlap in use of smoking objects. Twenty four (8.8%) patients were less than 40 years of age at the time of diagnosis. Average duration of illness was 4.5 months. Weight loss (77%) and fever (34%) were the commonest general symptoms. Other chest symptoms include cough (68%), dyspnoea (59%), chest pain (22%), hemoptysis (20%) and dysphagia (6%). Fiberoptic bronchoscopy (FOB) (75%) and fine needle aspiration cytology (FNAC) (74.8%) were found to be the most efficient diagnostic procedures. Histologically, squamous cell carcinoma, adenocarcinoma, large cell carcinoma and small cell carcinoma were seen in 42%, 20%, 18% and 14% cases, respectively. Six percent patients showed malignant cells only and marked as unclassified. Radiologically, obstructive pneumonitis was the commonest presentation (59.5%) followed by mass lesion (31.8%) and rib destruction (5.1%). Inspite of its limitation, this study for the first time reports lung cancer pattern from mid-west Rajasthan.

Carcinoma, Bronchogenic↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defect with atrial septal defect occlusion system (ASDOS): initial experience and short-term follow-up.

Transcatheter closure of secundum atrial septal defect is a well known alternative to surgery. It was attempted in seven patients (age range 7-34 years, mean 20.1 +/- 6.5 years) with the double umbrella nitinol device (ASDOS, Dr. Ing Osypka, Germany). The interatrial septal anatomy and blood flow were examined by transthoracic and multiplane transoesophageal echocardiography. The size of atrial septal defect varied from 1.25-2.4 cm (mean 1.75 +/- 0.3 cm), minimal septal rim 0.5-1.0 cm (mean 0.75 +/- 0.20 cm), and Qp/Qs 1.6-3.2:1 (mean 2.4 +/- 0.6). One patient had an atrial septal defect following surgery for left atrial myxoma. The procedure which involved the use of monorail system for deployment of device under transoesophageal echocardiography guidance, was successful in six (86%) of the seven patients. The size of the implanted device ranged from 30-45 mm. In two patients, the right atrial umbrella had to be oversized in comparison to the left atrial umbrella for stability and adequate occlusion of the defect. The patient in whom the procedure failed had a defect size of 1.7 cm, with minimal septal rim (anterosuperior) of 5 mm; however, the device could be easily retrieved. Immediately after and at follow-up of one year, transoesophageal echocardiography-guided colour flow mapping revealed complete abolition of left-to-right shunt in five (83%) of the six patients. One patient had a small residual flow at the posterior rim of the defect; none had atrioventricular valve regurgitation. Although the procedure is complex, it is safe with the advantage of excellent control on the monorail system for proper positioning, repositioning and, if required, retrieval of the device.

Adolescent↗