Biomedical subjects
Publications and source records attributed to A Bhalla.
Two patients who presented with recurrent gross haematuria are described. Both underwent extensive invasive investigations including renal biopsies before it was discovered that they had factitious haematuria produced by contaminating urine with blood from self inflicted skin wounds.
Five patients who developed acute renal failure due to acute tubular necrosis following multiple hornet (Vespa orientalis) stings are described. All of them had intravascular hemolysis. Evidence for rhabdomyolysis was present in 2 patients. Two patients had elevated transaminase and alkaline phosphatase levels and in 1 of these, liver biopsy showed centrilobular necrosis. Two patients had thrombocytopenia in the absence of disseminated intravascular coagulation. Two patients died of infections while the remaining 3 recovered completely. Acute renal failure following multiple hornet stings appears to result mainly from intravascular hemolysis or rhabdomyolysis although a direct nephrotoxic effect of venom cannot be excluded.
Explore the source record for details and available documents.
Bizarre behaviour disturbances in four patients occurring during incomplete recovery from herpes simplex encephalitis are described. Some aspects of their behaviour were similar to that originally described by Klüver and Bucy in monkeys following bilateral temporal lobectomy. Previous reports of behavioural disturbances in man after herpes simplex encephalitis are reviewed and attention drawn to the aggressive and disruptive behaviour that is often seen. With the reduced mortality in herpes simplex encephalitis in recent years it is possible that behaviour disturbances such as those described here will be seen more frequently.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Metastasis to thyroid gland are rare. The primary sites which metastasize to thyroid gland include the breast, lung, kidney and stomach. Among lung cancer metastasizing to the thyroid, adenocarcinomas are the commonest followed by squamous, small cell and large cell carcinomas. The bronchioloalveolar carcinoma has not been reported to metastasize to the thyroid. In this case report we document this rare occurrence.
Previous reports have shown that unrecognized or incidental bile duct varices have been reported as being related to hazardous complications and difficulties during surgery or other interventional procedures. A 32-year-old Indian female patient with no previous symptoms and signs suggestive of portal hypertension was admitted for an elective laparoscopic cholecystectomy for biliary colic. Bile duct varices were incidentally recognized during the operation. For the sake of safety, the surgery was converted to a conventional approach. Postoperatively, a detailed history revealed catheterization of the umbilical vein during the newborn period. Subsequently, contrast-enhanced computer tomography scanning showed extrahepatic portal vein thrombosis and cavernous transformation, while an upper gastrointestinal tract endoscopy did not reveal any evidence of esophageal varices. Bile duct varices should be excluded in patients with symptoms and signs suggestive for portal hypertension. Moreover, the present case addresses the fact that bile duct varices should also be suspected in asymptomatic patients with a history suggestive for extrahepatic portal vein thrombosis. Intraoperative recognition of bile duct varices requires a careful anatomical approach to the hepatoduodenal ligament to avoid hazardous complications.
Endoscopic brush cytology is a valuable technique for the evaluation of biliary strictures. The sensitivity of this technique varies from 30% to 83%, however, it can have specificity of 100%. We retrospectively evaluated the usefulness of wire-guided biliary brush cytology in biliary strictures in our hospital over a 3 years period from 1997 to 2000. Brushings from 58 biliary strictures were obtained during endoscopic retrograde cholangiography. They were compared with histological proof obtained by surgical biopsy or percutaneous fine-needle aspiration cytology and/or clinical findings. These were reported as benign or malignant. Eleven patients were excluded due to incomplete data. Eighteen patients had benign brushings. Fourteen of the 29 patients in whom histological confirmation of malignancy brushings was obtained were also reported as malignant. The sensitivity of endoscopic brushings was 48.2%, specificity 100% and diagnostic accuracy 55.2%. No major complications were seen in our study group.
Jaundice is a common clinical presentation in severe malaria, seen in approximately 2.5% patients with falciparum infection but hepatitis is unusual. Although hepatic dysfunction is unusual and hepatic encephalopathy is almost never seen in malaria, yet, cases of hepatic dysfunction are being increasingly reported in patients with P.falciparum infection, from different parts of world. The extent of hepatocellular dysfunction varies from mild abnormalities in liver function tests to hepatic failure. Patients with hepatocellular dysfunction in malaria are more prone to develop complications, but have a favorable outcome if hepatic involvement is recognized early and managed properly. It is important to meticulously look for hepatic dysfunction in patients with severe malaria, distinguish it from fulminant hepatic failure and manage it aggressively.
Explore the source record for details and available documents.