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Biomedical subjects

G Jayaram

Publications and source records attributed to G Jayaram.

At least 19 recordsLinked to original sources
PubMed2001

Congenital esophageal stenosis: report of three cases, literature review, and a proposed classification.

The aim of this paper is to report three cases of congenital esophageal stenosis (CES) of different anatomical varieties: (1) stenosis due to tracheobronchial remnants (TBR) involving the lower third of the esophagus; (2) fibromuscular stenosis (FMS) of the middle third; and (3) a membranous diaphragm (MD) involving the lower third. The first two patients were treated by segmental resection of the esophagus and end-to-end anastomosis with dramatic relief of symptoms. The third responded to dilatation. CES is a rare lesion, and about 500 cases are reported in the literature. CES due to TBR and fibromuscular hypertrophy is considered a segmental stenosis, as it involves a length of the esophageal wall, whereas the MD consists of mucosal folds and does not involve its muscular layer. The clinical presentation is varied, and a high index of suspicion is essential to arrive at an early diagnosis. Management depends on the type and severity of the stenosis. Stenosis due to TBR requires segmental resection. FMS may respond to dilatation, but severe degrees of stenosis require segmental excision. MDs usually respond to dilatation or may require endoscopic excision. Segmental stenosis can occur as an isolated lesion or in association with esophageal atresia or stenosis due to a MD. Based on this observation, a classification of CES is proposed.

Anastomosis, Surgical↗
PubMed2001

A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis.

INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder. CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis. TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements. CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.

Adenoma↗
PubMed2001

Evaluation of fine needle aspiration cytology of salivary glands: an analysis of 141 cases.

141 salivary gland lesions that were subjected to fine needle aspiration (FNA) cytology at the University Hospital, Kuala Lumpur, from January 1993 to October 2000 were reviewed with a view to assess the sensitivity and utility of cytological diagnosis in diseases of salivary glands. The highest number of cases was seen in the sixth decade of life. There was no gender preponderance in salivary gland neoplasms except in Warthin's tumours that occurred predominantly in males. The parotid gland was the most frequent salivary gland needled. Seven cases (5%) presented with bilateral salivary gland enlargement. Cytological study yielded a neoplastic diagnosis in 74.5% cases. Of the neoplastic lesions, 71.4% could be definitely designated as benign and 25.7% as clearly malignant. Pleomorphic adenoma and acinic cell carcinoma were the most common benign and malignant neoplasms diagnosed respectively. 53 cases had histological correlation; of these, 49 (92.5%) were neoplastic. The overall diagnostic accuracy of FNA cytological diagnosis in salivary gland lesions was found to be 73.6%.

Adult↗
PubMed2000

Cytology of columnar-cell variant of papillary thyroid carcinoma.

Columnar cell variant of papillary carcinoma (CCV-PC) thyroid is a rare and aggressive tumor composed of tall columnar cells that form papillae, glands and solid structures. This paper describes fine needle aspiration (FNA) cytologic features in a case of CCV-PC occurring in the right thyroid lobe of a 27-year-old female. Smears showed tall columnar cells in monolayered, three-dimensional, acinar and occasional papillary clusters. Nuclei were oval or elongated and monomorphic. Nuclear pseudostratification, resembling that seen in respiratory epithelial cells, was present in some of the cell clusters. Occasional cells showed squamous or Hurthle cell metaplasia. Nuclear grooves and intranuclear cytoplasmic inclusions were not seen. Sections of the right lobectomy specimen showed an well-encapsulated CCV-PC with capsular and vascular permeation. Tall cell variant of papillary carcinoma (TCV-PC) can be distinguished from CCV-PC by the oxyphilia of the tumor cells and the absence of nuclear pseudostratification. Colorectal and endometrial adenocarcinomas metastatic to the thyroid may be difficult to distinguish from CCV-PC.

Adult↗
PubMed2000

The value of cytology in granulomatous mastitis: a report of 16 cases from Malaysia.

BACKGROUND: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis. METHODS: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3-year period in the University Hospital, Kuala Lumpur, are described. RESULTS: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation. CONCLUSION: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.

Breast Neoplasms↗
PubMed2000

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness.

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education--but not schizophrenia--to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability.

Activities of Daily Living↗
PubMed2000

The experience with fine needle aspiration cytology in the management of palpable breast lumps in the University Hospital Kuala Lumpur.

A total of 676 palpable breast lumps seen in the Breast Clinic, University Hospital, Kuala Lumpur from August 1993 to August 1994 were subjected to fine needle aspiration cytology. Fifty-four were reported as inadequate, 501 benign, 95 malignant and 26 suspicious. One hundred and eighty-seven aspirates had histological correlation, while 34 of the malignant aspirates had clinical correlation. The majority of the other 455 patients were followed up for a period of 60 to 72 months without any malignancies becoming apparent. For analysis, only the 221 cases with histological or clinical correlation were included, (the suspicious category was included into the positive group and the inadequate cases were excluded), giving a sensitivity of 91.7%, a specificity of 91.7% and a diagnostic accuracy of 91.7%. Breast cytology was an accurate and rapid method of diagnosis of breast diseases, and in a busy surgical unit with limited operating time, it allowed for the triage of patients with breast complaints in deciding which cases needed early open biopsy. A negative cytology does not exclude the possibility of cancer, as there was a false negative rate of 11%. However by utilising a diagnostic triad of clinical examination, radiological assessment and fine needle aspiration cytology, the risk of missing a malignancy is small.

Biopsy, Needle↗
PubMed2000

Localised nodular pulmonary amyloidosis in a patient with sicca syndrome.

A 52 year old Chinese woman with a 25 year history of sicca syndrome (primary Sjogrens syndrome) was investigated for 3 episodes of haemoptysis. Clinical examination was unremarkable except for the presence of dry eyes and xerostomia. Computed tomography of the chest revealed a lobulated mass in the posterior basal segment of the left lower lobe. Histopathological examination of this resected nodule confirmed the diagnosis of nodular amyloidosis. The normal radiolabelled serum amyloid P component scintigraphy and the absence of monoclonal plasma cell dyscrasia in the bone marrow strongly support the diagnosis of localised nodular pulmonary AL amyloidosis in this patient. Nodular pulmonary amyloidosis can be associated with sicca syndrome and often simulates bronchogenic carcinoma, bronchiectasis or pulmonary tuberculosis.

Amyloidosis↗
PubMed2000

Cytology of mucinous carcinoma of breast: a report of 28 cases with histological correlation.

Pure mucinous carcinoma (MC) of the breast is a relatively uncommon variant of breast carcinoma with distinctive histological and cytological features. In this study we have analysed fine needle aspiration (FNA) cytological material from 28 cases of MC of breast and correlated the cytomorphological features with histopathology. The 28 patients consisted of 27 females and one male patient. 14 patients were Chinese, 10 were Indian and four were Malay. Their ages ranged from 38 to 90 with a mean at 52 years. The left breast was involved in 17 and the right in 11 cases. The duration of the lump varied from two weeks to 10 years. The cytological picture was characterized by abundant extracellular mucin giving a "sea of mucin" or "whirlpools of mucin" effect, in which were seen floating clusters of tumour cells with relatively bland cytological features. Myxo-vascular fragments were seen in 12 cases. Dissociated tumour cells showed a plasmacytoid appearance with eccentric nuclei. In four cases, the mucin was scanty in amount and the cellularity was high while in two cases, the cellularity was very low. Psammoma bodies were seen in cytological smears in one case. Histological study of excision or mastectomy specimens confirmed all 28 cases to be pure MC. Knowledge of the distinctive cytomorphological appearance of MC would enable correct identification of these lesions as malignant and prompt treatment that could further enhance the survival of these prognostically good breast cancers.

Adenocarcinoma, Mucinous↗
PubMed1999

Fine needle aspiration cytology of the thyroid--a review of experience in 1853 cases.

1853 thyroid lesions subjected to cytological sampling (either by the fine needle aspiration or fine needle capillary sampling technique) from January 1992 to December 1997 at the University Hospital, Kuala Lumpur, were reviewed. Nodular goitre was the most common thyroid lesion needled (67.35%). Among the neoplastic lesions, follicular neoplasms predominated (64%), followed by papillary carcinoma (29.4%). In 325 cases, partial or total thyroidectomy had been done, providing material for histological review and cyto-histological correlation. Cytological diagnosis was found to have high sensitivity and specificity rates of over 75%. Besides, most non-neoplastic thyroid lesions could be diagnosed on cytology. The scope of cytology in the diagnosis of lymphomas, anaplastic and metastatic tumours rendered diagnostic biopsies (or thyroidectomy) unnecessary in these cases. Being a cost-effective technique and having the capacity to provide exact morphological diagnosis in a large variety of thyroid lesions, cytology is obviously the method of choice in the assessment of thyroid nodules.

Biopsy, Needle↗
PubMed1999

MRI appearances of peritoneal mesothelioma--a case report.

A rare case of diffuse malignant peritoneal mesothelioma in a 71 year-old Malay man with no previous history of asbestos or radiation exposure is described. The clinical manifestation was a large abdominal mass. At laparotomy he was found to be in the advanced stage of the disease. The tumour was not resectable and patient was sent home. He gradually deteriorated and died three months after diagnosis was made. The magnetic resonance imaging (MRI) features of peritoneal mesothelioma which has not been previously reported are described.

Aged↗
PubMed1999

Follicular adenoma with squamous metaplasia and cystic change: report of a case with fine needle aspiration cytological and histological features.

Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.

Adenoma↗
PubMed1998

Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma.

Over a 32-month period at the University Hospital, Kuala Lumpur, we were able to study the cytological appearance of metastatic nasopharyngeal carcinoma (NPC) in 17 cases. This comprised 14 males and three females of which 13 were Chinese, three were Malay, and one was Indian. Their ages ranged from 27 to 64 years. Histological correlation was available in all the patients in the form of nasopharyngeal biopsies, and they were classified as per the World Health Organization classification into types I, II, and III NPC. Smears from type II NPC showed good cellularity with mainly clustered and occasionally dissociated cells, with focal columnar appearance, vesicular nuclei, prominent nucleoli, and variable amounts of cytoplasm. Clusters of malignant cell closely associated with lymphoid cells and dissociation of malignant cells were more characteristic of type III NPC. FNA cytology is now applied extensively to the diagnosis of head and neck tumours and knowledge of the cytomorphology of NPC would greatly aid in pinpointing the primary of this tumour which is notorious for presenting with early nodal metastasis.

Adult↗
PubMed1998

Duplication of the rectum: report of four cases and review of the literature.

Rectal duplications are rare anomalies. Recently, we observed four cases of rectal duplication, each presenting with different clinical features including chronic constipation, a prolapsing rectal "polyp, " a "growth" from the vulva, and acute retention of urine. The variety of clinical presentations may lead to delay in diagnosis and multiple operations.

Biopsy, Needle↗
PubMed1998

Mucoepidermoid carcinoma of the thyroid: a case report.

Primary mucoepidermoid carcinoma (MEC) of thyroid is an uncommon tumour and reports on its' cytology are consequently scanty. A 46-year-old male presented with a thyroid nodule of nine months duration. Fine needle aspiration (FNA) cytology of the nodule showed features of a malignant tumor that was different from the usual types of thyroid carcinoma. Monolayers and syncytial clusters of round and spindle tumour cells with large vesicular nuclei and single macronucleoli were present. A diagnosis of carcinoma was given with the comment that this was unlike any of the usual types of thyroid cancer and that a metastatic malignancy should be ruled out. The cytological picture of MEC may not always be distinctive enough for accurate tumour typing. Nevertheless the cytological features are usually sufficiently different to rule out all of the usual types of thyroid carcinoma. This distinction may be important from the point of view of differing prognosis in MEC of thyroid (as compared to differentiated thyroid cancers) and the need to exclude a metastatic carcinoma, especially from a primary in one of the salivary glands.

Biopsy, Needle↗
PubMed1998

Relating competency status to functional status at discharge in patients with chronic mental illness.

This study assessed performance on a screening test of competency to consent to treatment, the Hopkins Competency Assessment Test (HCAT), in a population diagnosed with chronic mental illness, and examined the relationship between HCAT performance and functional status at discharge. We hypothesized that patients with chronic mental illness who failed the HCAT would also have problems in performing activities of daily living at the time of discharge. Forty-three patients on a short-stay psychiatric service were administered the following screening tests: (1) Mini-Mental State Exam (MMSE), on admission; (2) the HCAT, approximately four to five days after admission; (3) At discharge, the Milwaukee Evaluation of Daily Living Skills (MEDLS), and the Occupational Therapy Task Observation Scale (OTTOS). Analyses included correlation between the competency measure HCAT and the functional measures; sensitivity, specificity, and positive and negative predictive values of the HCAT score; and odds ratio and chi-square analysis. The HCAT was highly correlated with the MEDLS and OTTOS. The HCAT was not sensitive in identifying impairment on either functional measure, but when patients failed the HCAT, they were likely to be functionally impaired at discharge. The negative predictive value of the HCAT was greater than the positive predictive value. Patients who failed HCAT were significantly more likely to have an MMSE score lower than 27 and less than 12 years of school. Seven of forty-three (16.3%) patients failed a screening measure of competency, indicating that there is a subgroup of chronically mentally ill patients who may not understand issues of informed consent. Patients who failed the HCAT were more likely to be functionally impaired at discharge. Cognitive impairment and low education are important factors in failure to pass competency screening. Competency screening along with screening for cognitive impairment can be useful in identifying patients at risk for poor functional status at discharge.

Activities of Daily Living↗