Biomedical subjects
S Govindan
Publications and source records attributed to S Govindan.
Inclusion body myositis and Sjogren's syndrome.
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Leptomeningeal carcinomatosis in small cell carcinoma of the lung.
Among 137 patients with small cell carcinoma of the lung (SCCL) treated on two consecutive protocols, leptomeningeal metastases were documented in 12 patients (9%), 10 antemortem by cerebrospinal fluid (CSF) cytology, one by myelogram, and one only at necropsy. Signs and symptoms included confusion in seven, limb weakness in six, paresthesias in three, headache in two, urinary incontinence in two, and nausea and vomiting, diplopia and neck pain in one patient each. Nine of the 12 patients had evidence of other metastases while three patients relapsed first in the CSF and one had disease only in the leptomeninges. Treatment for this complication including irradiation, intrathecal chemotherapy, or systemic chemotherapy was generally ineffective with a median duration of survival of 50 days (range 5 to 130) after diagnosis of leptomeningeal. Necropsies showed thick tumor deposits along cord, distal nerve roots, cauda equina, and in Virchow--Robbins spaces with deep invasion into adjacent neural substance in six of the seven. Leptomeningeal involvement appears to have become manifest as median survival has increased. CSF cytology should therefore be examined in patients who develop unusual neurological findings during the course of this disease and methods of prevention may need to be considered in future studies.
Inflammation of the temporal artery associated with subacute bacterial endocarditis and hepatitis B antigen.
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Extremity amputation: disseminated intravascular coagulation syndrome.
There are occasional reports in medical literature of peripheral gangrene and subsequent extremity amputation following systemic infection. Although the authors of these case reports speculated that the gangrene was due to septic embolization, pathologic study of the amputated tissue failed to reveal evidence of septic emboli. In reviewing reports of amputation following scarlet fever, varicella, pneumococcemia, and appendicitis, we found cases with clinical, hematologic, and pathologic evidence of disseminated intravascular coagulation (DIC). We describe 2 patients who required extremity amputation following an acute, systemic infection: transmetatarsal and Lisfranc amputation following meningococcal meningitis and bilateral below-knee amputation following pneumococcal meningitis. Both of these patients had clinical, hematologic, and pathologic evidence of DIC. Following amputation, both of these patients had significant problems with skin healing and prosthetic fitting. The presence of an acute systemic bacterial or viral infection, coagulation abnormalities and pathologic tissue indicative of DIC, and skin lesions of the extremities progressing to dry gangrene and ultimately requiring bilateral amputation are the key clinical features of this syndrome. We conclude that DIC is a major pathophysiologic mechanism responsible for peripheral gangrene following systemic infection.
Computer assisted tomography in rapidly growing brain tumor.
A case of undifferentiated astrocytoma with rapid increase in size of the tumor as documented by sequential computer assisted tomography (CAT) of the head is reported. The case also demonstrates the sensitivity of computer assisted tomography in the detection of intracranial pathology, in the presence of fals localizing neurological findings.
Intracranial choriocarcinoma.
A case of intracranial choriocarcinoma (probably primary), a rare variety of atypical teratoma, is reported. Diagnosis and treatment were based on radiological and hormonal studies. The usefulness of computed tomography (CT) in the follow-up and treatment of patients with tumors in areas not easily accessible for surgical exploration or biopsy is again documented. The CT findings correlated well with the documented hormonal changes as well as with the patient's clinical status.
Electromyographic abnormalities in osteosarcoma arising in Paget disease of the vertebral column.
The case of a patient with low back pain and Paget disease of the L5, S1 vertebrae is presented. Electromyography revealed dysfunction in both the paraspinal and gluteal muscles. Postmortem examination showed sarcomatous transformation of the vertebrae with nerve root compression and skeletal muscle infiltration by tumor. The electromyographic abnormalities are correlated with the pathologic findings. The clinical features of neurologic dysfunction in Paget disease of the vertebral column and in osteosarcoma arising in Paget disease of the vertebral column are reviewed. Electromyography can provide valuable information in the evaluation of the patient with Paget disease of the vertebral column who is suspected of having neurologic dysfunction.
Meningeal carcinomatosis from small cell carcinoma of the lung. Consequence of improved survival.
The cells of oat cell carcinoma of the lung can be identified in sputum because of their characteristic morphologic appearance. The cells from oat cell carcinomas can also be identified in other body fluids but are seen there less often. Spinal fluid involvement with oat cell carcinoma has been seen very infrequently, presumably because of a poor survival rate. Aggressive systemic chemotherapy has improved survival, and meningeal involvement is now being recognized as a complication. Of 62 patients treated by aggressive chemotherapy protocols, six (10%) were found to have leptomeningeal involvement by cytologic evaluation of cerebrospinal fluid (CSF). Involvement was found 6 to 13 months after the initiation of therapy. Two of the six patients had no evidence of CNS metastases by CAT brain scan. Necropsy was performed in three of the six cases and showed excellent histologic correlation with the cytologic findings. Because of most therapeutic drugs' poor penetration into the CSF, and because the spinal cord is not routinely irradiated, cytologic examination of the CSF from patients with oat cell carcinoma is necessary when there are new neurologic signs or symptoms to ensure proper, specific therapy.