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Biomedical subjects

S Varma

Publications and source records attributed to S Varma.

At least 145 records · Page 8Linked to original sources

Role of immunophenotyping in characterisation of blast crisis of chronic myeloid leukemia--a study of 25 cases.

The blast cell populations of 25 patients of chronic myeloid leukemia in blast crisis (CML-BC) were studied for morphological, cytochemical and immunophenotypic features. The patients were divided into 6 broad groups based upon the pattern of surface marker positivity-myeloblastic, mixed myeloblastic, megakaryoblastic, mixed lineage, lymphoid and undifferentiated blast crisis. Myeloperoxidase (MPO), Sudan Black B (SBB) and Chloroacetate esterase (CAE) stains showed 100% specificity for the myelomonocytic lineage but the sensitivity was low. Periodic acid Schiff (PAS) stain was neither specific nor sensitive for the lymphoid lineage. Immunophenotyping as compared to morphologic and cytochemical assessment, was seen to be most useful for assigning a lineage to leukemic cells in CML-BC.

Adult↗

Aplastic anaemia versus hypocellular myelodysplastic syndrome.

It is important to differentiate non-dyplastic aplastic anaemia from hypocellular myelodysplastic syndrome (MDS). Four patients presenting with hypocellular bone marrow and different evolution patterns are being described. Certain morphological features and variable hypocellularity were found to be useful indices for this purpose.

Adolescent↗

Paraproteins and plasma cell dyscrasias.

Serum protein electrophoresis done on 1100 patients with various diseases in one year demonstrated M-band in 31 patients. Most (87%) had the classical features of plasma cell dyscrasia (PCD), however a few had unusual presentations which are highlighted. A 22-year-old male operated for a massive tumour of the scapula clinically diagnosed as chondrosarcoma revealed plasmacytoma with amyloid on histology. Another case of kala-azar presented with features akin to that of PCD and one case had dual malignancies. Such a high incidence of PCDs with varied picture in a short time is not usually seen in other parts of this country; a fact which may be due to lack of awareness.

Adult↗

Morphology of spleen in steroid resistant idiopathic thrombocytopenic purpuras.

Twenty spleens of steroid resistant cases of idiopathic thrombocytopenic purpuras were studied by light and electron microscopy. Weights of the spleen were within normal range and were unremarkable grossly. On light microscopy reactive lymphoid follicles were seen in the five of the cases. Prominent and dirty looking sinusal histiocytes contain phagocytosed materials. Prominence of plasma cells were seen in the red pulp and also in the marginal zone. The three cases which failed to respond to splenectomy did not show any morphological variation from the others who had responded.

Adolescent↗

Endomyocardial biopsy--technical aspects experience and current status. An Indian perspective.

Our study ellucidates the utility of endomyocardial biopsy (EMB) in various cardiac-muscle disorders seen in a tropical country like India. The procedure has been successfully performed in 501 patients (572 procedures) at our centre from April 1985 to December 1992. This included 60 infants and children. The indications were dilated cardiomyopathy (DCM) in 214, non-specific aortoarteritis in 91, rheumatic heart disease in 75, restrictive cardiomyopathy in 45, constrictive pericarditis in 14 and miscellaneous in 62 patients. There was no mortality, however, one patient developed cardiac tamponade and another sustained ventricular tachycardia requiring cardioversion. There was transient atrial fibrillation in six patients and all these had acute rheumatic heart disease. Transient complete heart block occurred in six patients with underlying left-bundle branch-block. Histological examination of EMB revealed myocarditis in 34/214 (15.4%) patients in DCM group and helped in following up these cases on immunosuppressive treatment. In the presence of restrictive haemodynamics it could identify amyloidosis in four patients. It was also helpful in differentiating between endomyocardial fibrosis and chronic constrictive pericarditis. In patients with non-specific aorto-arteritis significant histological changes of inflammatory myocarditis were observed in patients especially in congestive heart failure. Furthermore, it was helpful in identifying the nature of cardiac tumour in one patient. Its utility has also been evaluated in disorders, including rheumatic heart disease, peripartum cardiomyopathy and systemic disorders like systemic lupus erythematosis. Even in the absence of cardiac-transplant programmes at national level we have found EMB to be a useful investigation in a tropical country like India.

Adolescent↗

Thrombolytic therapy in infants and children.

Thrombolytic therapy is being increasingly used to treat various cardiac and other disorders in the pediatric population. The use of thrombolytic therapy in thrombosis following cardiac catheterization, aortic thrombosis, right atrial and caval thrombosis, pulmonary embolism, thrombosed prosthetic valves, thrombosed Blalock-Taussig shunts, and other disorders is delineated. Special issues of the newborn are discussed. A wider appreciation of the indications and contemporary experience would help in optimizing the use of thrombolytic therapy in children.

Adolescent↗

The role of ultrasound imaging in the diagnosis of breast implant rupture: a prospective study.

Breast ultrasound to assess possible implant rupture was performed on 24 consecutive patients (43 breasts) by the same radiologist immediately before revisional breast implant surgery. Comparison of the clinical, ultrasound and operative findings showed ultrasound to be three times as sensitive as clinical judgement in predicting implant rupture. The sensitivity of ultrasound in predicting impaired implant integrity was 70% (versus 23% for clinical examination) with a specificity of 96%. The ultrasound features indicating leakage are outlined later. The positive predictive value of an abnormal scan was 90% and that of a normal scan 87%. It is concluded that breast ultrasound is a simple, quick, non-invasive method which contributes significantly to the assessment of patients with suspected breast implant rupture.

Adult↗

Acute renal failure in a patient with HELLP syndrome--an unusual complication of eclampsia.

Acute renal failure occurring in a 24-year-old primigravida with eclampsia and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is described. She also had transient disseminated intravascular coagulation. Hemodialysis, fresh blood transfusions, and antihypertensive therapy were administered, and resulted in complete recovery. Kidney biopsy revealed acute tubular necrosis.

Acute Kidney Injury↗

Silicone breast implant rupture: common/serious complication?

Of the potential health risks of silicone breast implants it is the concern about implant durability, life span and the possible association with connective tissue disease which has attracted most attention. A prospective study addressing these factors was therefore undertaken over an 11 month period. 51 patients presenting with significant capsular contracture, suspected prosthesis rupture or unrelieved implant-induced anxiety underwent revisional breast surgery after biochemical, haematological and immunological screening. Of these 51 patients (83 breasts), 14 (19 breasts) had ruptured implants (23% incidence). These were all smooth prostheses belonging to a cohort manufactured more than 10 years ago; their mean in situ duration being 12 years vs. 5.5 years for the intact group (p = 0.0024; Kruskal-Wallis one-way ANOVA). There were no systemic complications from implant rupture and the mean blood silicon level was normal. One patient with pre-existing pernicious anaemia had elevated autoantibodies. The mean ESR in the ruptured implant group was 6 mm/hour. It is concluded that rupture of breast implants is not as uncommon as hitherto thought and is strongly correlated with their in situ duration. In this study implant gel leakage was not associated with serious systemic effects.

Adult↗

Growth hormone secretion by human peripheral blood mononuclear cells detected by an enzyme-linked immunoplaque assay.

In order to evaluate the secretion of GH from human peripheral blood mononuclear cells (PBMC) and its possible role as a modulator of lymphoproliferation, we have developed a hormonal enzyme-linked immunoplaque assay. This assay captures GH between a monoclonal and polyclonal antibody. This is followed by adding substrate and a horseradish peroxidase-conjugated antibody against the polyclonal antibody which produces violet colored plaques where GH has been secreted. This assay is sensitive, specific, highly reproducible, and can detect picogram quantities of GH. Using this assay we have detected GH secretion from approximately 1% of human PBMC under unstimulated conditions. Regression analysis showed a linear relationship between the number of cells plated and the number of GH plaques formed. Therefore, GH plaques were formed by single cells or its progeny and did not represent aggregation of secreting cells. Preincubation of PBMC with cycloheximide, a protein synthesis inhibitor, completely abolished the formation of GH plaques which suggests that the PBMC were responsible for the synthesis of the secreted GH. In addition, we have also observed that stimulation of human PBMC with T-cell mitogens, Concanavalin A and PHA and the cytokine IL-2 led to significant increases in GH plaque area and number whereas stimulation with LPS, a B cell mitogen, was ineffective. The PHA and IL-2 induced increase in plaque number suggests that they can recruit noncommitted lymphocytes to actively secrete GH which raises the possibility that this secreted GH may serve as a growth factor in T cell proliferation. We conclude that this immunoplaque assay may be useful in evaluating the secretion of other peptides from human immune cells.

Cells, Cultured↗