Malignant potential of the odontogenic keratocyst.
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Carcinoma, Squamous Cell↗
Biomedical subjects
V K Anand
Publications and source records attributed to V K Anand.
Hepatic manifestations in typhoid fever.
Thirty one children with typhoid fever aged 2 months to 12 years and blood culture positive for multidrug resistant S. typhi were prospectively studied for their hepatic functions at the time of hospitalization and 2-3 weeks after completion of antibiotic therapy. Hepatic manifestations included hepatomegaly (51.6%); jaundice (16.1%); raised levels of serum glutamic oxaloacetic transaminase (SGOT) (61.3%), serum glutamic pyruvic transaminase (SGPT) (48.4%), alkaline phosphatase (AP) (22.6%) and serum bilirubin (SB) (6.1%); reduced levels of serum albumin (SA) (41.9%); prolonged prothrombin time (PT) (9.7%) and abnormal ultrasound abdomen (19.3%). Hepatic dysfunction was a notable feature even in those cases without hepatomegaly, with raised levels of SGOT (60%), SGPT (40%), AP (20%), SB (6.7%), decreased SA (53.3%) and prolonged PT (6.7%). There was no correlation between the degree of hepatic enlargement or hyperbilirubinemia with abnormalities in liver functions. Hepatic dysfunction was noticed to be transient, as all these parameters returned to normal within 2-3 weeks after successful antibiotic therapy.
Child↗
ARI control programme: results in hospitalized children.
One hundred cases of pneumonia with chest indrawing were treated according to the treatment protocol of the ARI control programme. The majority of children were > 2 months old (85 per cent) with male predominance (61 per cent). All cases with severe pneumonia survived. A mortality rate of 7.7 per cent was seen in cases of very severe pneumonia. Three children in the severe pneumonia group deteriorated on benzyl penicillin to very severe pneumonia but subsequently improved on chloramphenicol. Six patients were treated as cases of Staphylococcal pneumonia and one of them died. Thirteen children (21.3 per cent) in the severe pneumonia group required oxygen for breathing rates > 70 per minute. Seventy-four per cent in the very severe pneumonia group required administration of IV fluids. Blood counts did not prove to be of help in differentiating the children at risk of dying. There was no significant difference in roentgenographic findings in the two groups. Congestive cardiac failure was the most common complication, seen in 33.3 per cent of cases of the very severe pneumonia group. The duration of stay was significantly less in cases of severe pneumonia (4.21 +/- 1.59 days) as compared to very severe pneumonia (9.35 +/- 2.39 days). The data from this study suggest that the treatment protocol for the ARI control programme for hospitalized children is reasonably effective and can be implemented in small hospitals.
Acute Disease↗
Infiltrative clival pituitary adenoma of ectopic origin.
An ectopic pituitary adenoma is a rare entity that may occur in several anatomic locations, the sphenoid sinus being the most common. Many of these tumors are amenable to surgical resection by means of a transsphenoidal approach. A more aggressive surgical approach is needed to attempt resection of extensive tumors that involve the clivus and the nasopharynx. Complete resection in these areas cannot always be guaranteed or determined, necessitating postoperative radiotherapy. Many different tumors of the sphenoid sinus and skull base can resemble ectopic pituitary adenomas on radiologic assessments. Because of this, preoperative endocrine assessment is recommended.
Adenoma↗
Subtotal petrosectomy in the management of advanced parotid neoplasms.
Circumferential growth of parotid neoplasms may involve the external auditory meatus posteriorly, the floor of the middle cranial fossa superiorly, and the neurovascular structures of the jugular foramen medially. Inadequate tumor resection in these anatomically complex regions will result in local disease recurrence at the lateral skull base. A subtotal petrosectomy approach has been combined with a standard total parotidectomy in the management of 27 patients with aggressive parotid tumors. Twenty-two patients had malignant lesions and 10 individuals had recurrent disease. The resultant conductive hearing loss is outweighed by the following advantages of this technique: (1) the ability to obtain tumor-free bony margins, (2) proximal intratemporal facial nerve identification, (3) vascular control of the jugular bulb and petrous carotid artery, and (4) the dissection and protection of cranial nerves IX through XII. Our series of 27 patients will be detailed with an emphasis on surgical technique and overall patient results.
Adult↗
Significance of MRI changes after surgery of the skull base.
Magnetic resonance (MR) imaging is commonly used in the followup of patients who have undergone surgical removal of tumors from the cranial base to assess the possibility of tumor recurrence, persistence, or surgical complications. Interpretations of this study must be cautious because postoperative enhanced signals are encountered frequently. Although technological improvements continue to enhance the usefulness of MR images for followup, problems remain in differentiating between fibrotic, reconstructive changes, and tumor recurrence. In this study, the hospital records and MR findings of 215 patients who had undergone skull base surgery were reviewed. The study was prompted by negative operative exploration in three patients in whom postoperative MR images strongly suggested tumor recurrence. One-year follow-up images were available in 174 patients. Of these, 94% showed signal enhancement on the 1-year follow-up study. Progressive changes were observed in 14% of patients. The correlation of preoperative MR findings and surgery, with regard to dural involvement, vascular involvement, cranial nerve infiltration, and extent of intracranial infiltration, was analyzed in 28 patients. Methods to facilitate the detection of tumor recurrence using MR images are reviewed.
Adult↗
Nasopharyngeal gliomas: diagnostic and treatment considerations.
Nasopharyngeal masses in newborns may produce life-threatening airway obstruction. Distinction between encephaloceles and gliomas is important for surgical planning, but cannot always be accurately assessed on the basis of high-resolution computed tomography or magnetic resonance imaging. Preoperative or intraoperative nuclide imaging or contrast injection studies may assist with selection of appropriate surgical approach.
Choristoma↗
Giant pseudoaneurysm of the extracranial vertical artery.
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Aged↗
Neurovascular considerations in surgery of glomus tumors with intracranial extensions.
Paragangliomas of the skull base, by virtue of their location, locally infiltrative behavior, and vascular nature, are difficult tumors to resect. Surgical removal is especially complicated when intracranial extensions are encountered. Our experience with a one-stage resection of intracranial extensions of glomus tumors in 20 patients is presented. These 20 patients had a total of 29 paragangliomas: 23 glomus jugulare or tympanicum tumors, 5 carotid body tumors, and 1 pterygopalatine lesion. Ten patients had intradural extension; the other 10 had intracranial extradural tumors. The primary complicating treatment factor was the loss of surgical planes in 6 patients with prior surgery and or radiotherapy. The presence of multiple paragangliomas (20%) and catecholamine secretion by the tumors (15%) complicated surgical treatment as well. Surgical morbidity was primarily related to deficits of lower cranial nerves (50%).
Adolescent↗
Duodenal string test in typhoid fever.
Twenty five children between 4-12 years of age hospitalized with a clinical diagnosis of enteric fever were studied for evaluating the practicality and sensitivity of duodenal string-capsule culture (DSCC) and compared with conventional cultures from blood (BC), urine (UC) and stool (SC). Duodenal string capsule (DSCC) was successfully inserted in 18 patients (72%). Insertion of DSCC failed in 7 patients (28%) and all of them were below 6 years of age. Salmonella typhi was isolated from DSCC and/or BC in 13 cases (72.2%). DSCC was positive in 11 out of 13 confirmed cases of typhoid fever (84.6%). BC was positive in 8 cases (61.5%). DSCC was successful in isolating the organism in about 30% more cases than BC. Duodenal string test was a simple, non-invasive and a reliable test which when used in combination with BC could identify almost all cases of enteric fever irrespective of duration of fever and prior use of antibiotics.
Bile↗
Inconsistencies in the correlation between loss of brain stem auditory evoked response waves and postoperative deafness.
This case underscores the difficulty of predicting postoperative hearing status from brain stem auditory evoked response (BAER) monitoring when wave I is preserved and all later waves are lost. During an operation involving the base of the skull, sudden and irreversible loss of all BAER waves beyond wave I occurred unilaterally. Wave I was preserved, with reduced amplitude and minimal latency shift. There was no permanent postoperative hearing sensitivity loss or speech discrimination loss.
Adolescent↗
Lower respiratory tract infection in hospitalized children due to respiratory syncytial (RS) virus during a suspected epidemic period of RS virus in Delhi.
A study of 131 children below 5 years of age seeking hospitalization due to lower respiratory tract infections (LRTI), comprising 56 cases of bronchiolitis, 61 cases of bronchopneumonia, and 14 cases of other lower respiratory tract diseases showed significant occurrence of bronchiolitis in younger age groups (chi 2 = 79.21; P less than 0.001). Employing two rapid techniques, viz. immunofluorescent antibody technique (IFAT) and enzyme immunoassay (EIA) along with tissue culture, Respiratory Syncytial (RS) virus could be detected in higher percentage of bronchiolitis cases (54 per cent by both culture and IFAT, 70 per cent by EIA) compared to bronchopneumonia (36 per cent by both culture and IFAT, 49 per cent by EIA) and other LRTI cases (14 per cent each by culture, IFAT and EIA). The detection rate of RS virus was higher in the age group 0-6 months compared to the remaining age groups combined (7-60 months) in bronchiolitis cases irrespective of the technique employed while no such difference could be noted in bronchopneumonia. Eighteen (90 per cent) out of 20 specimens positive for RS virus by EIA, but negative by culture were found to be true positives as revealed by blocking test. In comparison to culture, sensitivities of IFAT, EIA, and EIA (by blocking test) were found to be 89, 94, and 94 per cent, respectively, while specificities of these techniques were found to be 92, 74, and 76 per cent, respectively. Higher detection rate of RS virus in the present study compared to earlier ones from India is attributed to application of EIA as well as selection of LRTI cases during a period of suspected epidemic of RS virus.
Age Factors↗
Odontogenic cervical necrotizing fasciitis with intrathoracic extension.
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Adult↗
Surgical considerations in tracheal stenosis.
From 1969 to 1990, 43 patients with tracheal stenosis were treated at the University of Mississippi Medical Center. Seventy-four percent of these patients (n = 32) had intrinsic tracheal stenosis, most frequently as a complication of prolonged endotracheal trauma. A total of 41 distinctly separate stenotic segments were identified in the 32 patients. The stenoses were considered moderate or severe in 33 (80%) of the 41 cases and the length of the stenotic segment was greater than 1 cm in 23 (56%) of the cases. An overall 70% success rate was achieved following 93 surgical procedures in this group. The concurrent presence of glottic/subglottic stenosis, multiple segments of stenosis, bilateral vocal cord paralysis, tracheoesophageal fistula, and a tendency to marked hypertrophic scar formation were found to be significant factors in the surgical management of this patient group.
Adolescent↗
Intracranial complications of mucormycosis: an experimental model and clinical review.
The clinical course of patients with mucormycosis of the paranasal sinuses can be unpredictable and is often determined by intrinsic host factors. The degree to and mechanism(s) by which these factors influence a patient's ability to survive the disease are poorly understood. Extensions to orbital and intracranial structures occur in some patients with paranasal sinus mucormycosis despite aggressive treatment. Controversies persist over adequate antifungal regimen, the precise role of hyperbaric oxygenation, and the appropriate extent of surgical debridement. We have developed an alloxan-induced immunocompromised murine model of mucormycosis in mice. Deferoxamine iron chelation produced rhinocerebral mucormycosis in these animals when challenged intraethmoidally with Rhizopus spores. The implications of our experimental studies in the content of our clinical experience in managing patients with intracranial extensions of paranasal sinus mucormycosis are discussed.
Adult↗
Multidrug resistant typhoid fever: therapeutic considerations.
Forty six blood culture positive cases were studied during the current outbreak of multidrug resistant typhoid fever (MRTF). The present outbreak was caused by E1 phage type and organisms were resistant to all commonly used drugs for the treatment of typhoid fever, viz., chloramphenicol (78%), co-trimoxazole (76%) and ampicillin (68%). Treatment failures with chloramphenicol (45.5%) corroborated well with in vitro resistance. No treatment failure was seen with chloramphenicol and ceftriaxone, when these drugs were used in cases infected with sensitive strains. Among the alternative drugs used in cases with in vitro sensitivity, successful clinical response was seen with ceftriaxone (4/4) and cefotaxime (8/9) as compared to cephalexin (3/5) or a combination of cephalexin and furazolidone (9/12).
Ampicillin Resistance↗
Open-door maxillotomy approach for lesions of the clivus.
The transpalatal route to the clival region has been used to approach both extradural and intradural lesions. Classic transpalatal surgery, however, entails a partial splitting of the soft palate or some form of palatal retraction, which leaves behind a bony palate that hinders surgical exposure. When necessary, operative exposure can be enhanced by an open-door maxillotomy approach that uses a combination of a Le Fort I osteotomy of the maxilla and a paramedian sagittal split of the hard palate. The nasal septum is translocated to create a wide contiguous oronasal aperture through which the clival region can be reached unobstructed. This technique was used in three patients. No significant complications were observed in any patient. Features of this extended transpalatal approach, including indications and adjunctive measures to minimize potential complications, are discussed.
Journal Article↗