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Biomedical subjects

V R Joshi

Publications and source records attributed to V R Joshi.

At least 37 records · Page 2Linked to original sources

Treatment of AA amyloidosis in rheumatoid arthritis.

Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. All had established but uncontrolled RA with a persistently raised ESR. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. One patient had deranged renal function and required dialysis. On chlorambucil, there was complete recovery, partial improvement and no improvement in one patient each. The fourth patient required haemodialysis, did not tolerate chlorambucil and succumbed to the illness. Therapy with chlorambucil can benefit some patients of RA with AA amyloidosis. Leucopenia is the most important dose limiting side effect.

Adult↗

Accidental self-injection with Freund's complete adjuvant.

The case of a research worker who accidentally injected herself with Freund's Complete Adjuvant (FCA) in the right forearm is reported. This resulted in a serious granulomatous inflammation of the hand an forearm. She was treated with corticosteroids and chloroquine with good result. The course of this reaction and the hazards of injection with FCA are emphasised and the relevant literature reviewed.

Accidents, Occupational↗

Pulmonary nocardial infection and pseudomonas infection of the tongue in a patient with dermatomyositis.

Opportunistic infections in immunocompromised patients are common. We report the case of a 63 year old female patient with dermatomyositis who while on oral steroids developed nocardial infection of the lung and pseudomonas infection of the tongue simultaneously. Nocardial infections are not very commonly seen in patients with dermatomyositis. Pseudomonas infection of the tongue is a rarity. We report this case for its rarity as regards the type and site of infections and review the relevant literature.

Dermatomyositis↗

Adrenal histoplasmosis.

A 60 year old diabetic was admitted with the history of low grade fever and weight loss of six weeks duration. After investigations, he was detected to have bilateral adrenal masses which on biopsy proved to be due to histoplasmosis. He was treated with itraconazole and made complete recovery.

Adrenal Gland Diseases↗

An unusual systemic presentation of gout.

An elderly female presented with a systemic febrile illness and acute polyarthritis as the first manifestation of gout. She improved dramatically with anti-inflammatory therapy.

Aged↗

'Sustained remission' in a case of SLE following megadose cyclophosphamide.

Cytotoxic therapy, especially with cyclophosphamide in the dose 8-20 mg/kg used as intermittent pulses, has been shown to improve both patient and renal survival in systematic lupus erythematosus (SLE), but to date there is no cure for the disease. Owing to the paucity of recognisable clones, the rationale and goal of cytotoxic immunosuppressive therapy in the treatment of immune-mediated diseases as against malignancies is to suppress the aberrant inflammation and immune-mediated reactions responsible for tissue damage, without dangerously suppressing the normal host defence mechanism(s). We report the case of a patient suffering from SLE with nephritis who has remained in sustained remission over the past 8 years without any maintenance therapy following an accidental administration of a single dose of 5000 mg of intravenous cyclophosphamide (44.2 mg/kg body weight). The patient recovered fully from pancytopenia following the injection. Presently, she is asymptomatic and working gainfully. Her laboratory parameters including blood counts, urine analysis, FANA and anti-dsDNA have reverted to normal. Cyclophosphamide in the dose of 30-160 mg/kg has been safely and effectively used in various neoplastic conditions with the aim of destroying every possible tumour cell. The experience of the present case suggests that such an approach may be applicable to SLE.

Adult↗