Wandering spleen presenting as an evanescent abdominal mass.
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Abdomen↗
Biomedical subjects
S K Gupta
Publications and source records attributed to S K Gupta.
The interaction of barbiturates and analeptics.
The interaction of pentobarbitone sodium with three analeptics viz. micoren, pentylenetetrazol and methedrine was studied in mice. Micoren prolonged pentobarbitone sleeping time. pentylenetetrazol shortened the sleeping time. Methedrine also shortened the sleeping time, but clonic convulsions of mild to severe intensity were noticed 45-60 minutes after the drug injection.
Aminobutyrates↗
Electrophysiological studies in newborns with reference to gestation and anthropometry.
Fourteen full term appropriate for gestational age (FT-AGA) and 11 preterm appropriate for gestational age (PT-AGA) newborns and their mothers constituted study subjects. The mothers were subjected to hemoglobin and serum albumin estimations. Offsprings were subjected to measurements of weight, crown heel length and head circumference along with motor nerve conduction velocity (MNCV) and H-reflex latency (H-RL) at right median nerve. The MNCV was found to be significantly lower and H-RL significantly higher in PT-AGA babies compared to FT-AGA babies. The gestation, crown heel length of baby and maternal serum albumin status were found to be significant independent variables. Multiple regression equations have been derived using these parameters as determinative variables. These equations explained much higher per cent variation than explained by simple regression equations.
Action Potentials↗
Ventricular septal defect with aortic regurgitation: a hemodynamic and angiographic profile in Indian subjects.
The records of 362 patients of Ventricular Septal Defect (VSD) were analysed to find out the incidence of aortic regurgitation (AR) and their hemodynamic and angiographic features. Thirty-seven patients (10.2%) were found to have AR, whose mean age was 13.4 years (range: 2-45) and male to female ratio was 5:1. Of the 37 cases 31 (84%) had infracristal and 6 (16%) had supracristal VSD. In 31 patients with infracristal VSD the prolapsing cusp was Right Coronary Cusp (RCC) in 14 (48%), Noncoronary Cusp (NCC) in 12 (41%) and both RCC and NCC in 3 (11%). Of the 6 patients with supracristal VSD the prolapsing cusp was RCC in 5 (83%) and NCC in 1 (17%). In two patients the AR was due to bicuspid aortic valve. The pulmonary artery pressure was normal in 26 of 37 (70.2%) patients and the left to right shunt was 1.5:1 or less in 23 of 37 (62%) patients. Nineteen of the 37 patients (51.3%) had grade I or II AR and the remaining 18 (48.7%) had grade III or IV AR. There was no relationship between the severity of AR and the location of the VSD. In conclusion, in this series, the incidence of VSD+AR is relatively higher and that of supracristal VSD is lower. In majority of patients the left to right shunt is small and pulmonary artery pressure within normal limits. The prolapse of RCC is more common in supracristal VSD and there is no relation between the severity of AR and the location of the VSD.
Adolescent↗
Initial experience with the "Smart" laser in the treatment of atherosclerotic occlusions.
A dual laser system capable of distinguishing atherosclerotic plaque from components of normal arterial wall was used to deliver laser energy to cut a channel through occluded vessels. This system was used to facilitate balloon angioplasty of short (3-17 cm) total occlusions of the superficial femoral or popliteal arteries in 17 patients. In 10 patients the occluding lesion was traversed by the laser wire and patency was effectively restored by balloon angioplasty. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in 9 cases; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all 3 cases with occlusions over 10 cm and in 4 others. There were no clinically important complications. This experience suggests that most patients who presently require interventional treatment can be managed by standard angioplasty methods and/or require a bypass operation. The "Smart" laser is safe and effective short-term in facilitating angioplasty in some patients in whom standard angioplasty techniques are not feasible. The implications of these findings are discussed.
Angiography↗
Crush preparations of gastroesophageal biopsy specimens in the diagnosis of malignancy.
The diagnostic value of crush preparations of endoscopic biopsy samples from gastroesophageal malignancies was studied. Forty-two patients with esophageal or gastric carcinomas were subjected to endoscopic biopsy and brushing. Half of each of two biopsy pieces from each case was crushed between two glass slides for cytologic evaluation. A positive yield (a diagnosis of malignancy) was achieved by histologic study of biopsy samples in 38 cases and by cytologic study of brushing smears in 37 cases and crush preparations in 40 cases. The advantages of the cytologic study of crush preparations were: (1) it expedited the workup of the patients and (2) it gave a positive yield in cases whose biopsy specimens were otherwise inadequate for making a definitive histologic diagnosis. Crush preparations thus combined the usefulness of biopsy and brushing techniques for the diagnosis of gastroesophageal malignancies.
Adenocarcinoma↗
Fine needle aspiration cytodiagnosis of Hodgkin's disease and its subtypes. I. Scope and limitations.
The fine needle aspiration (FNA) smears and paraffin-embedded sections from 89 cases with a cytologic and histologic diagnosis of Hodgkin's disease (HD) and 27 cases with minor or major cytohistologic discrepancies were reviewed. The accuracy of the initial cytologic study was found to be 91.8% for diagnosing HD and 58.1% for classifying its subtypes. Following review, 87 of the 89 agreement cases remained classified as HD. Of the 27 cases with initial cytohistologic discrepancies, 12 were classified as HD and 10 were categorized as lymphocytic or non-Hodgkin's lymphoma by both cytology and histology upon review. Following review, the accuracy of FNA cytology for the diagnosis of HD improved to 98.0%, with 71.4% correct subtyping. The greatest limitation of cytologic subtyping was in cases of nodular sclerotic HD: only 3 of 17 cases could be subtyped even after review. The cytomorphologic features of the HD subtypes are described, and the difficulties encountered in the cytodiagnosis of HD are discussed at length. The results of this study indicate that FNA cytology is a useful tool not only for the diagnosis of HD, but also for its subtyping.
Adult↗
Fine needle aspiration cytodiagnosis of Hodgkin's disease and its subtypes. II. Subtyping by differential cell counts.
Differential cell counts were performed on fine needle aspiration (FNA) smears from 96 cytologically diagnosed and subsequently biopsy-proven cases of Hodgkin's disease (HD). Reed-Sternberg cells and Hodgkin cells showed a definitely increasing trend in three major HD subtypes (as diagnosed on the smears): lymphocytic predominance (LP), mixed cellularity (MC) and lymphocytic depletion (LD). Lymphocytes, on the other hand, showed a decreasing trend between these subtypes. The differences in the percentages of Hodgkin cells, Reed-Sternberg cells and lymphocytes were highly significant (P less than .001). No trends (increasing or decreasing) were observed in the smear content of other reactive components (non-neoplastic histiocytes, eosinophils, plasma cells and neutrophils). In 88.0% to 95.0% of the cytologically diagnosed cases of LP, MC and LD subtypes, the percentages of Hodgkin cells plus Reed-Sternberg cells fell within a distinct range: less than 1.5% for LP, greater than or equal to 1.5% to less than 7.5% for MC and greater than or equal to 7.5% for LD. Analysis of the data based on histopathologic subtyping of the cases showed similar significant trends in the proportions of Hodgkin cells, Reed-Sternberg cells and lymphocytes, with 70.0% to 80.0% of the LP, MC and LD subtype cases within these ranges. These results demonstrate the validity of the subjective subtyping of HD on FNA smears in most cases.
Adult↗
Correlation of 12 lead ECG QRS score with severity of aortic stenosis.
The hemodynamic data and electrocardiograms of thirty-three patients of moderate to severe aortic stenosis were analysed retrospectively to find out if there was any correlation between 12 lead ECG-QRS score and left ventricular peak systolic pressure (LVPSP) and/or peak systolic gradient (PSG) across the aortic valve. The mean age of the study population was 33.33 (+/- 15.02SD) years, with the male to female ratio being 9:2. The mean 12 lead ECG-QRS score in these 33 patients was 281 mm (+/- 46.02SD), the mean LVPSP 203.52 mmHg (+/- 46.62SD) and the mean PSG across the aortic valve was 81.0 mmHg (+/- 41.62SD). There was good correlation of 12 lead ECG-QRS score with LVPSP (r = 0.47, P less than 0.001) and with PSG across the aortic valve (r = 0.58, P less than 0.001), latter being more significant. The best correlation was however found between 12 lead ECG-QRS score and PSG across the aortic valve in patients over 35 years of age (r = 0.88). In conclusion there is a direct relationship between 12 lead ECG-QRS score and peak systolic gradient across the aortic valve and the latter can be approximately calculated non-invasively with the help of regression equation- Peak systolic gradient (in mmHg) = 12 lead ECG-QRS score/3 - 10.6
Adolescent↗
Burkitt-type lymphoma. Diagnosis by fine needle aspiration cytology.
Forty cases of lymphoma were categorized as Burkitt-type lymphoma in a study of fine needle aspiration (FNA) smears. These constituted 14.3% of all cases of non-Hodgkin's lymphoma diagnosed between 1974 and 1982. The median age was 22 years in these cases, 81.8% of which had extranodal tumors. The majority of the cells in the smears (59.8% +/- 8.32%) were in the 11 micron to 15 micron size range and 60.3% +/- 10.3% had noncleaved nuclei. An average 71% of the cells contained cytoplasmic and/or nuclear vacuolizations. Nonneoplastic macrophages were present in the smears in 87.5% of the cases. A study of paraffin-embedded sections in 17 cases revealed the characteristic "starry-sky" appearance in 11; in 5 it was not clearly appreciated and in 1 the nonneoplastic macrophages were absent. FNA cytology was found to be quite reliable for arriving at a diagnosis of Burkitt-type lymphoma. More than 50% of the cases were managed without resort to subsequent surgical biopsy. Exploratory laparotomy was avoided in 69% of the cases having abdominal tumors.
Biopsy, Needle↗
Endoscopic suction cytology in upper gastrointestinal tract malignancy.
In 50 cases of radiographically suspected malignancies of the upper gastrointestinal (GI) tract, the lesions were sampled by suctioning following brushing and forceps biopsy. The cytologic smears prepared from the suctioned material were positive for malignancy in 48 cases (96%), as were the biopsy specimens; the cytologic smears from the brushings were positive in 92% of the cases. All 50 cases were diagnosed as malignant by one or more of the techniques. Suction cytology detected the ulcerated and stenotic growths that biopsy failed to diagnose in two cases. Endoscopic suction cytology, which is a simple and rapid procedure, seems able to assist in diagnosing lesions of the upper GI tract.
Adenocarcinoma↗
Results of 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in single and multiple vessel coronary artery disease (CAD).
Over the last 1-year period, we performed 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in 108 patients, 103 of them were males and 5 females. Their mean age was 50.9 +/- 6.83 years (range 33-70). All of them were symptomatic, manifested by acute infarction in 18 (17%), chronic stable angina in 30 (28%), unstable angina in 5 (5%) and post-myocardial infarction angina in 55 (51%) cases. Among these patients, single-vessel CAD was present in 42 (39%), double-vessel in 37 (34%) and triple-vessel CAD in 11 (10%) patients. Nine patients (8.3%) had total occlusion, and 18 (16.6%) had tandem or bifurcation lesions of target artery. Of the 112 PTCA procedures (excluding those in acute infarction), 53 (47%) were performed on LAD, 29 (26%) on RCA, and 30 (27%) on circumflex artery, with success rates of 86.7%, 83.3% and 82.7% respectively. The overall success rate was 85% (95 of 112). The PTCA was successful in 36 of 42 (85.7%), 32 of 37 (86.5%) and 9 on 11 (82%) patients with single, double and triple-vessel CAD respectively. The mean diameter stenosis reduced from 67.1 +/- 16.54% to 19.9% +/- 10.9%. PTCA was unsuccessful in 17 (15%) due to failure to cross the lesion in 11 (9.7%), failure to dilate in 1 (0.9%) and abrupt reclosure of dilated segment in 5 (4.4%). Four (3.5%) patients underwent CABG. Two patients had redo PTCA owing to restenosis at about 6 months of first PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Myocardial bridge (MB): an angiographic curiosity?
The coronary angiograms of 1,500 cases performed between 1981 and 1989 were analysed to find out the incidence of Myocardial Bridge (MB) and its significance as regards myocardial ischemia. Sixteen of these (1.06%) were found to have MB. Their ages ranged from 27-70 years (m = 49.2) and male:female ratio was 13:3. Out of 16 patients, 7 (group A) had associated coronary artery disease (CAD) (7 of 1421; 0.49%) and remaining 9 (group B) had no associated CAD (9 of 79; 11.39%). All the MB were found on left anterior descending artery (LAD) (3 on proximal LAD and 13 on mid LAD). No MB was found on right coronary artery (RCA) or circumflex arteries. The location of the MB did not affect the pattern of CAD. Chronic stable angina was the commonest presenting symptom in group A patients (5 out of 7) and atypical angina in group B patients (5 out of 9). Majority of group B patients had either normal or nonspecific ST-T changes in ECG (7 out of 9). However, the presence of previous myocardial infarction or ECG evidence of 'Q' wave infarction (2 out of 2) was always associated with significant CAD. Similarly, regional wall motion abnormalities on echocardiogram were always found in patients with significant CAD and old myocardial infarction. All 9 patients with MB and normal coronary arteries were managed conservatively with good relief of symptoms, whereas other seven patients were managed on the merits of the underlying CAD. In conclusion, the MB is a normal variant found incidentally on coronary angiography, and does not have any definite clinical correlations or pathological significance.
Adult↗
Review of one hundred cases of empyema thoracis.
One hundred cases of empyema thoracic have been reviewed. Aetiology of empyema was tubercular in 21 per cent cases and non-tubercular in 79 per cent cases. Gram negative organisms were cultured in 84.6% cases, whereas gram positive organisms were cultured only in 15.4% cases. It was observed that management of cases of empyema differed considerably with the presence or absence of BPF, thick or thin pus and size of empyema. It was concluded that all cases of simple empyema with thin pus and only those cases of simple empyema with thick pus where size of empyema is small should be managed by aspiration/s. Cases failed by above method, all cases of simple empyema with thick pus and with moderate to large size of empyema and all cases of empyema with BPF should be straightway managed by intercostal drainage tube connected to water seal. On the whole, cases of empyema with BPF were difficult to manage and needed major surgery in 45.8 per cent cases in comparison to only 2.9 per cent cases of simple empyema.
Adolescent↗
Evaluation of enzyme immunoassays using purified protein derivative (PPD) and its pooled fractions 3 and 4 for diagnosis of pulmonary tuberculosis.
A critical evaluation of two enzyme immunoassays (EIAs) for diagnosis of pulmonary tuberculosis is reported. Purified protein derivative (PPD) or its pooled fractions 3 and 4 were used as antigens for detection of antibodies in sera from 53 patients with active pulmonary tuberculosis and 10 normal healthy individuals. The cut-off point for each EIA was based on the absorbance (mean + 3 SD) of normal sera with the respective antigens. All the normal sera were negative in both the assays. The positivity of tuberculosis patients in either assay was 86.8 per cent. Thus, for serodiagnosis of tuberculosis fractions 3 and 4 of PPD could serve as a good substitute for whole PPD. Sera from 45 leprosy patients were also analysed to assess the specificity of the EIAs. The mean reactivity of tuberculoid leprosy sera was comparable to that of normal sera. The ratio of the mean absorbance of lepromatous leprosy (LL) sera and normal sera was 16.73 with PPD, in comparison to 21.95 for pooled fractions 3 and 4. Out of 10 LL patients 9 (90%) were positive with fractions 3 and 4, in comparison to 10 (100%) with PPD. 71.1 per cent of leprosy patients belonging to different categories were positive in assay based on PPD in comparison to 64.4% in EIA using fractions 3 and 4. The high false positivity of leprosy sera in an assay designed for detection of pulmonary tuberculosis has immense implications in interpretation of results of the assay for diagnostic and epidemiological purposes.
Clinical Enzyme Tests↗
Tetralogy of Fallot with hypertrophic cardiomyopathy--an unknown combination.
A hitherto unknown association of Tetralogy of Fallot (TF) and Hypertrophic Cardiomyopathy (HCM) diagnosed by two dimensional echocardiography, cardiac catheterization and angiocardiography is reported. Patient underwent emergency aortopulmonary shunt successfully. The literature is reviewed in brief.
Adolescent↗
Detection of silent myocardial ischemia by Holter monitoring and its relation to severity of coronary artery disease.
Thirty-five patients of chronic stable angina, unstable angina and post MI angina, who were on medical treatment, underwent 24 hours Holter monitoring and coronary angiography to find out the incidence of Silent Myocardial Ischemia (SMI) and its relation to anatomic severity of coronary artery disease. Total duration of Holter monitoring was 835.32 hours (average 23.40 hours per patient) with 48 ischemic episodes out of which 16 were painful and 32 painless. Total duration of painful episodes was 189 minutes and that of painless episodes was 428 minutes (70% was constituted by SMI). Out of 35 patients, 6 (17.14%) had SMI; 2 of 17 (11.7%) of chronic stable angina, 2 of 8 (25%) of unstable angina, and 2 of 10 (20%) of post-infarction angina patients. On analysis of coronary angiogram, all 6 (100%) patients with SMI, and only 22 out of 29 (76%) without SMI, had severe multiple coronary artery disease. Thus, although the overall incidence of SMI in this series is low, its presence invariably indicates a severe degree of coronary artery disease.
Adult↗
Severe syphilitic aortic regurgitation with bilateral critical coronary ostial stenosis.
A forty-year-old male with syphilitic severe aortic regurgitation and critical bilateral coronary ostial stenosis, proved by cardiac catheterization and angiocardiography, is presented. He underwent successful aortic valve replacement and coronary artery bypass grafting with gratifying results.
Adult↗