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Biomedical subjects

F E Udwadia

Publications and source records attributed to F E Udwadia.

18 recordsLinked to original sources
PubMed1992

Haemodynamic studies during the management of severe tetanus.

Detailed invasive haemodynamic studies were performed in 27 of 32 patients with severe tetanus. Nineteen had severe uncomplicated tetanus and eight had associated major complications, chiefly infection and pulmonary complications. The results were compared with those obtained from 15 healthy male volunteers who served as controls. There were two deaths in 32 patients (mortality 6.25 per cent). Severe tetanus without major complications was characterized by a high output hyperkinetic circulatory state with tachycardia (heart rate 131 (19.2) beats/minute), increased stroke volume index (43.1 (10.7) ml/m2), increased cardiac index (5.48 (0.94) l/min/m2) and a normal left ventricular stroke work index (60.5 (15.9) g/m/m2). Volume loading demonstrated a significant haemodynamic response and increased vascular capacitance. Even so the maximum percent rise from baseline values of these indices after volume load was significantly higher in controls (p < 0.001). Autonomic cardiovascular disturbances affected both sympathetic and parasympathetic activity. Hypertension and tachycardia alternating with hypotension and bradycardia were related to sudden fluctuations in systemic vascular resistance. Our studies suggested some degree of myocardial dysfunction in patients with severe uncomplicated tetanus. The haemodynamics of severe tetanus were masked and altered by complicating infection, pneumonia, and atelectasis.

Acute Disease↗
PubMed1992

The lung in tropical eosinophilia compared to that in pulmonary hypertension. Fine structural basis of respiratory disability.

Light and electronmicroscopic changes in lung biopsies were studied in six patients with tropical pulmonary eosinophilia, aged 20 to 37 years, of varying duration, and with severe haematologic (blood eosinophil count of 3,600 to 18,200 per mm3), and respiratory changes. On light microscopy the main pathologic reaction consisted of large mononuclear cells and eosinophils in and around the alveoli and blood vessels, and proliferated reticulin. Fine structural changes probably being described for the first time, included the presence of many alveolar macrophages characterised by abundant cytoplasm, irregular or stunted microvilli, increased phagolysosomes with ingested debris, and depletion of other organelles. Eosinophils bearing typical old and young granules, were encountered in and around the alveoli and blood vessels in all case, and collagenosis around alveolar cells in a few. Subacute pneumonitis producing compression and disorganisation of alveoli and blood vessels, and lack of normal apposition of air and blood spaces, appear responsible for the respiratory disability. The detection of mycobacteria, cocci or chlamydia-like bodies in two specimens and of intranuclear virus-like particles in another, could either indicate secondary infection or have an immunogenic significance, in the absence of detection of filarial elements in any of the specimens. Lung biopsies from two additional patients (aged 13 & 32) who had mitral stenosis probably due to rheumatic heart disease, and secondary pulmonary hypertension, were studied as "control" specimens. Both at light and electronmicroscopy these specimens did not show any eosinophils or neutrophils, and fewer macrophages in the lung parenchyma. In contrast to tropical eosinophilia and, as expected, there was considerably more fibrosis of the lung parenchyma, especially in the alveolar subepithelial region and in the vessel walls. This, together with fibroblasts full of endoplasmic cisterns, noted particularly in the younger patient with shorter duration, probably represented an earlier change in this condition.

Adolescent↗
PubMed1989

Human rabies: clinical features, diagnosis, complications, and management.

A case of rabies was treated with intensive medical support. This led to a prolongation of life to 25 days. The neurologic progression of the disease was monitored clinically and with serial EEG. This prolonged course enabled us to witness and manage a wide variety of unusual complications including the adult respiratory distress syndrome, hypothermia, myocarditis, and diabetes insipidus. This report documents the clinical features, diagnostic problems, complications, and management.

Coma↗
PubMed1988

Penile hyperexcitability with recurrent ejaculations as the presenting manifestation of a case of rabies.

A patient with rabies presented with penile hypersensitivity and recurrent ejaculation. This preceded the more classical manifestations such as hydrophobia and aerophobia by approximately 8 hours. A review of the literature reveals that a variety of urogenital symptoms may rarely occur in rabies. Ours is however the first report documenting the occurrence of these symptoms at the onset of the disease in an autopsy proven case of rabies. Damage to the amygdaloid nucleus has been postulated to be the basis of these urogenital symptoms. This correlates well with our autopsy findings of extensive neuronal damage and Negri bodies in the temporal poles.

Ejaculation↗
PubMed1987

Tetanus and its complications: intensive care and management experience in 150 Indian patients.

A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%. Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature (greater than 107 degrees F, 41.7 degrees C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt) in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.

Adolescent↗
PubMed1986

The maximal expiratory flow-volume curve in normal subjects in India.

Data on pulmonary function, with particular reference to flow-volumes, were obtained in 760 normal healthy Indians in Bombay, who had never smoked and who had no symptom or history of cardiorespiratory disease. Prediction equations were derived for spirometric parameters and for maximal expiratory flows. The maximal expiratory flow-volume curves showed considerable intersubject variability. Both flow and volume decreased with advancing age, with the flow-volume curve appearing increasingly convex towards the volume axis in its second half with increase in age. The maximal expiratory flows in our study were significantly lower compared to values reported by workers in the West.

Adolescent↗