Biomedical subjects
Publications and source records attributed to B Ramakrishna.
A case is presented of a bile duct hamartoma (von Meyenburg complex) in a 44 year old man being evaluated for abdominal pain. The computed tomography findings suggested micro-abscesses in the liver and a biopsy showed von Meyenburg complex.
A case of diclofenac-induced hepatitis, in a 53-year-old Indian woman with recurrent jaundice, is presented. The diagnosis was suspected from the appearance of the liver biopsy and was confirmed by the temporal association with drug usage and cure on withdrawal of the drug.
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We report the pattern of childhood liver disease revealed by a study of 134 biopsies obtained from 128 infants and children below the age of 16 years seen in this hospital during a 3-year period. The most common histological diagnoses were neonatal hepatitis syndrome in 23, storage disorders in 11, and cirrhosis in 26 children. Less common diagnoses included Reye's syndrome in four, fatty liver in seven, granulomas in four, and chronic active hepatitis, fulminant hepatitis, congenital hepatic fibrosis and neoplasms in two children each. Miscellaneous specific diagnoses were made in 16 cases. Twenty-three per cent of the liver biopsies were non-diagnostic. The study has provided background information on the occurrence of specific histological diagnoses in liver biopsies in infants and children in this tropical region and identifies a group with cirrhosis and copper deposition which was not typical of either Indian childhood cirrhosis or Wilson's disease.
A case of a 17-year-old Indian male with disseminated tuberculosis is reported. While on chemotherapy, he was detected to have splenic abscesses. The patient remained unresponsive to antituberculous drugs until a splenectomy was performed.
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The pathological findings in a multinodular malignant oncocytoma of the parotid gland in a male 62 years of age, with tumour infiltration into the adjacent skin and skeletal muscle and with regional lymph node metastasis is presented.
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Acral lentiginous melanoma in situ is a rare entity in the broad spectrum of melanoma. Although acral lentiginous melanoma is not uncommon, the in situ variant seems to have been reported only twice in the literature. An additional case is described.
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We have reviewed the clinicopathologic features of Kimura's disease, angiolymphoid hyperplasia with eosinophilia, epithelioid hemangioma of the testis, epithelioid hemangioendothelioma, spindle cell hemangioendothelioma, malignant endovascular papillary angioendothelioma of childhood (Dabska's tumor), epithelioid angiosarcoma, angioblastoma of Nakagawa, bacillary angiomatosis, verruga peruana, and other inflammatory angiomatoses. On the basis of our experience and reading of the literature, we conclude that angiolymphoid hyperplasia with eosinophilia, histiocytoid hemangioma of the testis, epithelioid hemangioendothelioma, and probably spindle cell hemangioendothelioma, constitute a group of related conditions best called the histiocytoid hemangiomas. Kimura's disease, Dabska's angioendothelioma, epithelioid angiosarcoma, and the inflammatory angiomatoses are not histiocytoid hemangiomas. Angioblastoma of Nakagawa is not related to lobular capillary hemangioma (pyogenic granuloma).
A case of small-intestinal leiomyoma presenting as a large intra-abdominal cyst is reported. Cystic degeneration is a common feature of leiomyoma, but presentation of this tumour as a giant cyst is uncommon.
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Between 1971 and 1976 eight patients underwent excision of the carpal lunate for pain from Kienböck's disease. The bone was replaced by a silicone rubber implant. An average of 84 months had elapsed when they were reviewed in December 1980. All eight were very satisfied with their operations. Objectively, the clinical results were good, but radiographs showed the presence of degenerative change in the region of the wrist and alteration of the position of the prosthesis on ulnar deviation of the hand. No implant has had to be removed.
This is a review of 77 partial replacement and interposition arthroplasties in which Silastic implants were used. The operations were carried out between 1971 and 1977 on the metatarsophalangeal joints of the great toes of 62 patients. Twenty-six of the operations were for painful hallux rigidus and 51 for hallux valgus. The patients were reviewed 12 to 92 months after operation, the average follow-up being 60 months. The analysis of results indicated that while the procedure may be suitable for hallux rigidus its use for hallux valgus is not fully satisfactory in the long run.
We have studied 50 cases of endocarditis and 54 cases of bacteremia due to Staphylococcus aureus to ascertain the clinical significance of the newly described phenomenon of tolerance. In 32 of the patients with endocarditis and 35 of those with bacteremia strains were classified as tolerant (minimum bactericidal concentration/minimum inhibitory concentration greater than or equal to 16). Patients with endocarditis due to a tolerant strain responded less favorably than did patients with a sensitive strain. A larger number of patients with a tolerant strain had prolonged fever (58% versus 19%), a higher mean number of complications (1.6 versus 0.73), a greater number of intensive-care unit admissions (66% versus 33%), and a higher mortality (25% versus 11%). In contrast there was no difference in response to therapy in bacteremic patients without endocarditis having sensitive and tolerant strains. We conclude that infection with a tolerant organism adversely influences the outcome of staphylococcal endocarditis.
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Five hundred children below the age of 12 years suffering from lung tuberculosis viz., primary complex (PC) or progressive primary complex (PPC) were studied. Diagnosis was based on Kenneth Jones criteria; selected cases having score of 5 or more. One hundred and eighty cases of PC were given A-1 (6 RH) regimen, while 312 cases of PPC were given A-2 (2SHRZ/4 RH) or A-3 (2 SRH/4 RH) or A-4 (2 RHE/4 RH) regimen. Follow-up was done for 6 months after completing the treatment to observe the relapse rate. In cases of PC, 6 RH regimen appeared adequate and cheaper with no relapse rate. In cases of PPC with short course chemotherapy, compliance of patients had been very good. Relapse rate was up to 13% which is acceptable. Drug toxicity was very low.