Biomedical subjects
Publications and source records attributed to S Sharma.
We report a young woman with Ebstein's anomaly of tricuspid valve and rheumatic mitral stenosis who successfully underwent mitral valvotomy using double balloon technique. The clinical and haemodynamic benefits are sustained at 1 year followup.
Explore the source record for details and available documents.
A rare case of primary plasmacytoma of the stomach is reported. The diagnostic value of gastroscopy leading to non-surgical management is highlighted. Radiation therapy is an effective alternative mode of treatment and should be employed as the primary modality of therapy.
One hundred and ninety five patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) for single vessel disease and have been followed up for more than 6 months are being reported. Angiography was done routinely in first 20 patients (Group 1) 8 to 15 weeks (mean 9.6 weeks) after PTCA. Restenosis (loss of 50% of the initial improvement in luminal diameter) was seen in 4 patients (20%). The remaining 175 patients (Group II) have been followed up clinically and subjected to serial exercise testing. Coronary angiography was performed only if symptoms and/or objective evidence of ischemia recurred. In this group, restenosis suspected clinically and confirmed by angiography occurred in 37 patients (21%), 2 to 23 weeks (mean 12.5 weeks) after PTCA. The restenosis rate for the entire patient population was 21%. In general the restenosed lesions were longer and tighter than the lesions before PTCA. A comparison of 41 patients with restenosis with those who did not have clinical restenosis revealed a proximal left anterior descending artery (LAD) involvement (66% vs 31%, p = 0.01), crescendo unstable angina (37% vs 16% p = 0.05), length of pre PTCA stenotic lesion greater than or equal to 1 cm (41% vs 27.5%, p less than 0.05), absence of intimal haziness in immediate post PTCA angiogram (27% vs 16%, p less than 0.05) and residual stenosis greater than or equal to 25%, (34% vs 14% p less than 0.05) in the restenosis group. Repeat PTCA was done in 30 patients with a 96% success rate; 4 patients required coronary artery bypass grafting (CABG). Restenosis after PTCA is a significant problem in our experience.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
Radiation therapy, although a prime treatment modality for malignant disease, has few definitive indications for some benign ocular diseases too. Orbital pseudotumour, Graves ophthalmopathy and pterygium are the conditions where the radiation oncologist has got an important role to play. This article reviews the current status of the role of radiation and its effectiveness in the management of these diseases.
In case of lymphoid malignancies of B cell origin and Epstein-Barr Virus (EBV) transformed B cells, it is invariably found that these cells proliferate in the apparent absence of signals from T cells. Many of transformed B cells tested appear to be refractory to the proliferative effects of a number of defined cytokines including IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, TNF alpha, lymphotoxin and IFN gamma. We have recently reported on the molecular cloning of a T cell derived human B cell growth factor, BCGF-12kD. In this study, we show that recombinant BCGF-12kD induces proliferation in EBV negative undifferentiated lymphoma B cell line, MC116 and Burkitt's lymphoma B cell line, P3HR1. A mouse monoclonal antibody produced against a BCGF-12kD synthetic peptide neutralizes the BCGF activity present in the MC116 conditioned media as well as inhibits the in vitro growth of MC116. The PCR analysis of the BCGF-12kD gene transcription provides further evidence that MC116 cells express the BCGF-12kD gene, whereas this gene is silent in resting and anti-IgM activated normal human B cells. These data clearly suggest an immunoregulatory role of BCGF-12kD in transformed human B cells.
Computed tomography (CT) has been suggested as an alternative to surgery for predicting the stage and resectability of primary gastric lymphoma. It is our policy to perform CT scan on all patients and the decision to explore is based upon CT findings. We reviewed our experience to see if any changes were warranted. 12 patients with primary gastric lymphoma underwent CT scanning. The CT findings were compared with the pathological findings available for 10 patients. CT correctly staged 90 per cent of the patients and it obviated unnecessary exploratory surgery in 42 per cent of the patients. It permitted the planning of non-excisional therapy in 75 per cent of the patients and was useful as an indicator of response to therapy and as a follow up measure.
We studied 16 patients of abdominal aortic occlusion by digital subtraction angiography (DSA) in order to assess the advantages and limitations of Intravenous (IV) and Intra-arterial (IA) imaging in this rare clinical setting. All the patients had systemic hypertension and 14 patients (87.5%) also had associated coronary artery disease. Ten patients underwent IV-DSA and all were diagnostic. Eight of them had "stable" angina and, of these three patients (37.5%) developed clinical features of angina pectoris 5 to 10 minutes after the study. The remaining 6 patients who had "unstable" angina underwent an uneventful IA-DSA by transbrachial route. Intravenous DSA should be performed with caution since both the central venous contrast injection and Buscopan injection, used to control intestinal peristalsis, result in a transient increase in the cardiac workload, increase the myocardial oxygen demand and can precipitate myocardial ischaemia in the "high-risk" coronary patients. These patients should be electively studied by IA-DSA by transbrachial route inspite of the fact that IV-DSA examinations, if done, are usually diagnostic.
Many authors have previously advocated the use of intravenous digital subtraction angiography (IV-DSA) in the pre-operative evaluation of coarctation of aorta with excellent results and good surgical correlation. We have studied 20 patients with coarctation of aorta by IV-DSA and compared the angiographic findings with those seen at surgery in nine patients. The IV-DSA examinations were performed by utilizing small-volume (25 ml), bolus injections of an ionic, iodinated water soluble contrast medium delivered in the mid-right atrium. Good quality diagnostic arterial images were obtained in 14 patients (70 per cent). Associated cardiac decompensation and inability to profile the coarct segment due to overlap by surrounding dilated blood vessels were responsible for the unsuccessful examinations. Whereas most IV-DSA findings were confirmed at surgery, the calibre and length of the coarct segment at IV-DSA were found to be unreliable predictors of the actual severity of the coarctation. The IV-DSA images failed to detect a localized diaphragm at the coarct site in two patients. Even though IV-DSA is useful for the diagnosis of aortic coarctation, the surgeon must be aware of its pitfalls in assessing the calibre and length of the coarct segment.
Records of 326 patients were analysed to determine the prevalence of coronary heart disease (CHD) in patients with valvular heart disease (VHD) and to identify the group in whom coronary arteriography is essential. Significant CHD (60% or more luminal narrowing) was found in 7 per cent of cases, and its prevalence was 3 per cent in mitral, 10 per cent in aortic, and 6 per cent in combined mitral and aortic valve disease. Angina was present in 14 per cent of patients with mitral, 39 per cent with aortic, and 21 per cent with combined mitral and aortic valve disease. Seventy-three per cent of patients with CHD had angina whereas only 19 per cent with angina had CHD. The prevalence of CHD was higher in patients above 50 years (13%) and in males (98%) as compared to those below 50 years (3%) and females (none). We conclude that the prevalence of CHD is low in our patients with VHD. Routine coronary arteriography is recommended only in males over the age of 50 years.
We analysed coronary arteriographic profile in 125 young patients (below 40 years, mean age 37.3 years) with clinical evidence of ischaemic heart disease (IHD) (Group I) and compared it with 125 older patients with IHD (more than 40 years, mean age 52.8 years) (Group II) studied during the same period. Left anterior descending coronary artery was the most frequently involved vessel in both the groups, 102/125 (81.6%) in Group I and 120/125 (96%) in Group II (P less than 0.001). The incidence of left main coronary artery involvement was 5/125 (4%) in Group I and 15/125 (12%) in Group II (P less than 0.05) and coronary artery calcification was 17/125 (13.7%) in Group I and 72/125 (57.6%) in Group II (P less than 0.001). Triple vessel disease was the most common form of involvement, 56/125 (44.8%) in Group I and 65/125 (52.8%) in Group II (P = NS). The incidence of diffuse disease was 35/125 (28%) in Group I vs 39/125 (31.2%) in Group II (P = NS), ectasia was observed in 13/125 (10.1%) in Group I vs 15/125 (12%) in Group II (P = NS) and coronary collaterals were found in 42/125 (33.6%) in Group I and 56/125 (44.8%) in Group II (P = NS). Thus left main and left anterior descending coronary artery disease and coronary calcification were more common in the older age group. Our findings suggest that in young Indian patients with IHD, multivessel and extensive coronary artery involvement in frequently seen. This pattern of involvement has many features resembling the disease pattern in their older counterparts.
Cardiovascular status was studied in 500 natives living at high to extreme altitudes (3000m to 5500m) of the Himalayas. No case of congenital heart disease, rheumatic heart disease, coronary artery disease, primary myocardial disease or hypertension was found. A significant rise, however, was noted in both the systolic and diastolic systemic arterial pressure with age. Serum lipid and lipoprotein profile estimation in 148 subjects showed that with increasing altitude, the HDL cholesterol increased, while the LDL cholesterol, total cholesterol/HDL cholesterol ratio and the LDL cholesterol/HDL cholesterol ratio decreased. Electrocardiograms of 160 subjects (120 males and 40 females) above the age of 25 years showed right ventricular hypertrophy in 8 (5%), 6 of whom (17.6%) lived above the altitude of 4800m. Echocardiographic examination showed normal left ventricular function in all, while 27 per cent of the natives at an altitude of 4500m-5000m had evidence of pulmonary hypertension and rise of normalised right ventricular preejection period.
Clinical, hemodynamic and fluoroscopic findings were analysed in 1123 patients with rheumatic mitral valve disease. The incidence of mitral valve calcification was 15 percent (mild 3 percent, moderate 9 percent, and severe 3 percent). There was a male preponderance (male 17 percent, female 5 percent). The presence of moderate to severe degree of calcification of mitral valve correlated with age, rhythm, transmitral gradient, associated mild mitral regurgitation, pulmonary artery pressure, systemic embolisation and previous commissurotomy. No correlation was found between the degree of calcification and presence or absence of other valve lesions.
Five out of 2930 (0.2%) consecutive patients developed ocular adverse reactions following intravascular administration of sodium-meglumine diatrizoate. The adverse reactions included bilateral blurring of vision (2), unilateral orbital oedema (2) and bilateral intense conjunctival congestion (one patient). The latter two phenomena responded to steroid and antihistaminic agents. Contrast medium-induced ocular anaphylactoid response is rare but clinically significant.
Acanthamoeba keratitis is not reported often in India. We reported the first case diagnosed in this country a year back. In this communication, four more cases of Acanthamoeba keratitis diagnosed since then are being reported along with a brief review of literature. Diagnosis in all these patients was based on observation of acanthamoeba cysts in 10% KOH wet mount of corneal ulcer scrapings and subsequent culture. The characteristic ring infiltration of cornea was seen in all of them. All cases were treated medically with the available antiamoebic drugs (Miconazole, Neosporin, Ketoconazole and Metronidazole) in different combinations. Only one out of four, responded with complete healing of the ulcer. Acanthamoeba keratitis is probably not as uncommon in India as it is thought to be. With increased awareness and performance of minimal laboratory tests the condition may be diagnosed more often.
Annular subvalvar aneurysms of the left ventricle initially described from Nigeria are considered to be rare in India. We report 6 such cases studied clinically and by noninvasive and invasive investigations during the last 8 years. In 4 cases morphologic documentation was available at surgery or autopsy. The clinical picture was dominated by congestive cardiac failure and mitral regurgitation and most of the patients were young. Echocardiographic studies provided the precise noninvasive diagnosis by demonstrating large aneurysms arising below the posterior mitral leaflet. In one case the submitral left ventricular aneurysm extended into the left atrium. The mortality was high in unoperated cases and operative repair under cardiopulmonary bypass is the most appropriate management.
Two dimensional echocardiographic measurements of the size of aortic and pulmonary valve annulus were made in 60 patients before balloon valvoplasty and compared to the angiographic measurements. Aortic valve annulus was measured in 34 patients (26 with valvar aortic stenosis and 8 with discrete subaortic stenosis) in the parasternal long axis or apical 5-chamber views. The pulmonary valve annulus was measured in 26 patients with valvar pulmonary stenosis (PS) in the parasternal short axis view of the right ventricular outflow view. The visualization of the annulus was good in all except 2 patients with valvar PS. Angiographic measurements of the aortic and pulmonary valve annulus were made in aortic root and right ventricular angiograms respectively, taken in both right and left anterior oblique views. There was an excellent correlation between the measurements of the annulus size by the two techniques (r value for pulmonary valve 0.91; for aortic valve 0.96; over all 0.94). Echocardiography can accurately measure valve annulus size and help in choosing balloon dilatation catheter of appropriate size before the valvoplasty procedure.