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Biomedical subjects

K Joshi

Publications and source records attributed to K Joshi.

At least 55 records · Page 3Linked to original sources
PubMed1999

Renal zygomycosis: an under-diagnosed cause of acute renal failure.

BACKGROUND: Invasive zygomycosis (mucormycosis) occurs predominantly in immunocompromised patients in whom it carries a grave prognosis. While renal involvement is not so uncommon in disseminated infection, isolated renal zygomycosis is rare. METHODS AND RESULTS: Forty-five patients with systemic zygomycosis were seen over a 12-year period from January 1986 to December 1997. Among these, 18 had renal involvement, nine with disseminated disease and nine with isolated renal zygomycosis. No underlying predisposing disease was identified in the majority of patients (72%). Renal involvement was confirmed at autopsy in 13 and by ante-mortem renal biopsy in five patients. The infection involved one kidney in five patients and was bilateral in the remaining. The manifestations included fever, flank pain, haematuria and pyuria with evidence of enlarged non-functioning kidneys on computerised tomography (CT). Of those with bilateral disease, 12 (92.3%) had anuric acute renal failure. Anti-fungal therapy was given to six patients (amphotericin B in mean total dose of 1.1 g) and of these only two with unilateral disease who also underwent nephrectomy survived while all the other 16 died. CONCLUSION: This study shows that renal zygomycosis has emerged as a cause of acute renal failure in the last decade since no patient with renal involvement was identified at our centre prior to 1986 even though autopsies have been done regularly in patients dying of unknown causes. Bilateral renal zygomycosis should be suspected in any patient who presents with haematuria, flank pain and otherwise unexplained anuric renal failure. Characteristic CT findings and an early renal biopsy can confirm the diagnosis and help in effective management of this serious disease.

Acute Kidney Injury↗
PubMed1999

Intraglomerular metastasis: a necropsy study.

Intraglomerular metastasis is a rare phenomenon. Four cases are reported here. The primary malignancies in these four cases were squamous cell carcinoma of the lung, adenocarcinoma of pancreas, haematological malignancy with a malignant intrapulmonary teratoma, and undifferentiated pleural mesothelioma. There was no significant renal functional impairment in any case except for mild proteinuria in one. Histopathology showed tumour cells in the mesangium, in the glomerular tufts replacing the endothelial cells, as well as in an extracapillary location replacing the parietal cells. In one case, tumour cells formed crescent-like structures. Such tumour deposits were better appreciated with special stains. The presence of intraglomerular metastasis indicates dissemination of the malignancy and hence a poor prognosis even though there is no significant impairment of renal function.

Adenocarcinoma↗
PubMed1999

Acute pneumonitis with pulmonary hemorrhage an uncommon and potentially fatal complication of systemic lupus erythematosus: a case report.

Acute pneumonitis with diffuse alveolar haemorrhage is potentially fatal. When it occurs in a patient of systemic lupus erythematosus, the primary disease itself may be responsible for it; rather than any complicating infection or metabolic/physiological derangement. Diagnosis of primary pulmonary involvement by systemic lupus erythematosus can only be made on open lung biopsy coupled with immunofluorescent and/or ultrastructural studies. Early diagnosis of acute pulmonary complications in systemic lupus erythematosus patients is essential as specific management is reported to improve the chances of recovery.

Adolescent↗
PubMed1998

Isolated bilateral renal aspergillosis: an unusual presentation in an immunocompetent host.

A 35 year old apparently immunocompetent farmer developed isolated bilateral renal aspergillosis. He presented with acute renal failure due to granulomatous interstitial nephritis and had bilateral renal abscesses on CT scan. Diagnosis came from renal histology and was confirmed on serology. The patient responded quite satisfactorily to single agent antifungal chemotherapy with IV amphotericin B.

Acute Kidney Injury↗
PubMed1998

Secondary membranoproliferative glomerulonephritis due to hemolytic uremic syndrome: an unusual presentation.

Secondary membranoproliferative glomerulonephritis is an uncommon disorder. A six year old girl presented to us with microangiopathic hemolytic anemia and nephrotic syndrome and the renal biopsy showed membranoproliferative glomerulonephritis. Demonstration of fibrin thrombus in one glomerulus pointed to hemolytic uremic syndrome as the cause of membranoproliferative glomerulonephritis. Institution of plasma exchange quickly reversed both the microangiopathic hemolytic anemia and the nephrotic syndrome. The relationship between HUS and glomerular disease is discussed.

Child↗
PubMed1998

External clues to inner malformations.

A malformation is a morphological defect of an organ, or a larger region of the body resulting from an intrinsically abnormal developmental process. In this analysis of 1421 neonatal autopsies performed between 1984 and 1993, 243 (17.1%) cases showed malformations. The data was analysed to find external cues to internal malformations. Twenty three (85%) of the 27 neonates with various facial abnormalities had associated internal malformations in the form of cardiac (n = 11; 40%), renal (n = 7; 25%), or gastrointestinal (n = 3; 11%) abnormalities and diaphragmatic hernia (n = 2). Sixty seven neonates had neural abnormalities. These were associated with cardiac (n = 7; 10%), renal (n = 12; 18%) or gastrointestinal (n = 7; 10%) abnormalities; 43 cases, however, did not have any associated malformations. Renal malformations (n = 66) had highest association with skeletal abnormalities (n = 9; 22%). As many as 45(76%) of the 59 cases with cardiac abnormalities had no external anomalies. Five cases of hypoplastic lungs were seen, all associated with external malformations.

Abnormalities, Multiple↗
PubMed1997

Role of iron and iron chelation therapy in oxygen free radical mediated tissue injury in an ascending mouse model of chronic pyelonephritis.

The contribution of iron towards the free radical generation leading to renal tissue damage was assessed using a non-obstructive ascending mouse model for chronic pyelonephritis. The parameters studied include luminol dependent chemiluminescence (LDCL), histopathology and some biochemical investigations. We found that iron enhanced the renal tissue damage and led to renal scarring, and end point in chronic renal inflammation, irrespective of the bacterial strain studied. In addition a role of iron chelation therapy as a treatment for chronic renal inflammation is also suggested.

Animals↗
PubMed1997

Laryngeal malakoplakia.

We report a case of malakoplakia of the epiglottis in a 45-year-old female patient. Only three cases of laryngeal malakoplakia have been reported in the world literature, one of which was associated with tracheal malakoplakia. To our knowledge this is the first reported case of isolated malakoplakia of the epiglottis. Malakoplakia, a rare granulomatous lesion, has been seen more frequently in the urinary tract. Other organs like the genito-urinary tract, testis, epididymis, lymph nodes, middle ear, nasopharynx, tonsil and retroperitoneal tissue have been also involved though less frequently.

Epiglottis↗
PubMed1997

Effect of sorbinil and ascorbic acid on myo-inositol transport in cultured rat Schwann cells exposed to elevated extracellular glucose.

The effect of long-term (2 weeks) exposure to 0-50 mM glucose and 0-1 mM sorbitol on myo-inositol metabolism was studied in cultured rat Schwann cells. Experiments were carried out to determine the effect of sorbinil and ascorbic acid on myo-inositol uptake in rat Schwann cells cultured in the presence of increased extracellular glucose or sorbitol. myo-Inositol uptake and its incorporation into phospholipids decreased significantly when cells were grown in > or = 30 mM glucose for a period of 2 weeks. This inhibitory effect was partly blocked by sorbinil, an aldose reductase inhibitor, in a dose-dependent fashion. Significant prevention was achieved with 0.5 and 1 mM sorbinil. Ascorbic acid also prevented the reduction in myo-inositol uptake due to excess extracellular glucose, at 3 and 30 microM concentrations, but not at 300 microM. Neither sorbinil nor ascorbic acid could prevent the alterations in myo-inositol transport in cells exposed to high sorbitol levels for the same period of time. These data suggest that glucose-induced alteration of myo-inositol transport in Schwann cells is mediated, at least in part, via sorbitol accumulation. This myo-inositol transport impairment is prevented by sorbinil and also by ascorbic acid. Ascorbic acid may hold a fresh promise for the treatment/prevention of diabetic neuropathy/complications, at least as an adjunct therapy along with known aldose reductase inhibitors.

Aldehyde Reductase↗
PubMed1997

Therapeutic efficacies of isoniazid and rifampin encapsulated in lung-specific stealth liposomes against Mycobacterium tuberculosis infection induced in mice.

One recent promising development in the modification of drug formulations to improve chemotherapy is the use of a liposome-mediated drug delivery system. The efficacies of isoniazid and rifampin encapsulated in lung-specific stealth liposomes were evaluated by injecting liposomal drugs and free drugs into tuberculous mice twice a week for 6 weeks. Liposome-encapsulated drugs at and below therapeutic concentrations were more effective than free drugs against tuberculosis, as evaluated on the basis of CFUs detected, organomegaly, and histopathology. Furthermore, liposomal drugs had marginal hepatotoxicities as determined from the levels of total bilirubin and hepatic enzymes in serum. The elimination of mycobacteria from the liver and spleen was also higher with liposomal drugs than with free drugs. The encapsulation of antitubercular drugs in lung-specific stealth liposomes seems to be a promising therapeutic approach for the chemotherapy of tuberculosis.

Animals↗
PubMed1997

Correlation of the growth fraction, nucleolar organizer region counts and epidermal growth factor receptor with histomorphological prognostic criteria in breast cancer.

A total of 60 cases of breast cancer were studied to find the correlation between newer parameters of prognosis viz growth fraction (GF), nucleolar organizer region (AgNOR) counts and epidermal growth factor receptor (EGFR) positivity with the various histomorphological factors such as tumour size, nuclear grade, histological grade and mitoses. Growth fraction measured by Ki67 monoclonal antibody varied from 3.6 to 73.7 percent. AgNOR counts ranged from 1.2 to 16.9 dots per tumour cell nucleus with a mean of 6.26 dots. EGFR positivity was seen in 66.7% of cases. Ki67 score correlated with all prognostic variables studied except the presence of axillary metastases. AgNOR counts correlated with size of tumour, axillary lymph-node metastases and Ki67 score but no correlation was seen with histologic or nuclear grade. EGFR positivity correlated strongly with size of the tumour and weakly with Ki67 score, AgNOR counts and mitoses.

Breast Neoplasms↗
PubMed1997

Pulmonary sarcoidosis: spirometric correlation with transbronchial biopsy.

We studied the relationship between the histopathology obtained by trans-bronchial lung biopsy (TBLB), and spirometric indices in 28 patients of pulmonary sarcoidosis in whom the diagnosis was confirmed. There was a rough correlation between FVC and the histologic granuloma load, interstitial inflammation and the overall histopathological score. Radiological features did not correlate with either spirometry or histopathology.

Adult↗
PubMed1997

Immunohistochemical analysis of human embryos and fetuses: an insight into the mechanism of subversion of antigenic differentiation in neoplasia.

OBJECTIVES: Immunohistochemical identification of intermediate filaments and other cell identity markers is of immense value in diagnostic tumor pathology. However, the literature contains many examples of inappropriate expression of markers by various tumors or coexpression of two or more markers supposedly specific for different cell types. The present study investigated this subversion of antigen differentiation in tumors by using developing tissues as a model. MATERIALS AND METHODS: Twenty-five human embryos and fetuses of 4 to 24 weeks' gestation were studied. An indirect immunoperoxidase method was applied to formalin-fixed, paraffin-embedded sections using a panel of 13 commonly used cell identity markers including intermediate filaments. RESULTS: During early development, vimentin was found to be coexpressed with cytokeratin in surface ectoderm, developing notochord, renal tubule epithelium, and intestinal mucosa. It coexpressed with glial fibrillary acidic protein in developing neuroglial tissue, with S100 in cartilage, and with skeletal muscle markers in myotubules. Hence, vimentin represents immaturity of tissues and is coexpressed with specific cell markers to be eventually replaced by the latter. Transbarrier expression of cytokeratin in smooth muscle was also noted. CONCLUSION: The aberrant expression of antigens in neoplastic tissues, as reported in the literature, simulates the varying expression of antigens in immature tissues during development. Hence, it is proposed that the phenomenon of antigenic subversion in neoplasia is related to the process of maturation and differentiation.

Antibodies, Monoclonal↗
PubMed1997

Mucinous adenocarcinoma of the renal pelvis--a case report.

A case of mucinous adenocarcinoma of the renal pelvis is added to those so far reported. Association with long standing chronic infection and large renal calculi is emphasized. The occult gross appearance of most of these tumours may lead the pathologist to overlook their presence. Hence, any kidney with the proper setting must be carefully looked for this entity.

Adenocarcinoma, Mucinous↗
PubMed1997

Nipple involvement in peripheral breast carcinoma: a prospective study.

Twenty six females patients of carcinoma of the breast were studied prospectively to find out the incidence of microscopic involvement of the Nipple Areolar Complex (NAC). The tumours were situated at minimum of 2.5 cms away from areola and the nipple was grossly normal. Majority of the patients (69.3%) had T.N.M. stage II disease. Tumours were situated within 4 cms of areola in 88.5% of the cases. Axillary lymph node metastasis was present in 38.4% of the cases. Irrespective of the size & stage of the tumour and tumour areola distance, the incidence of the microscopic involvement of NAC was 0%.

Adult↗
PubMed1996

The high incidence of tuberculosis among renal transplant recipients in India.

Tuberculosis is an important infection encountered after renal transplantation in third-world countries. Over an 8-year period, 36 cases of tuberculosis were encountered in 305 renal transplant recipients (11.8%) with grafts functioning for more than 3 months followed up at our center. The infection was limited to the thoracic cavity in 41.7% and a single extrapulmonary site in 11.1%, and it was disseminated in 27.8% cases. In 19.4% of cases, the disease appeared as pyrexia of unknown etiology and the diagnosis was confirmed by a good therapeutic response to antitubercular therapy. Tuberculosis was diagnosed within 1 year of transplantation in 58.3% of cases. There was no significant difference in the incidence of tuberculosis in patients on different immunosuppressive regimens. The Mantoux test was positive in 33.3% patients. A total of 23 patients were treated with isoniazid and rifampicin, with the addition of a third drug for the first 2 months. Treatment was continued for 9 months in 11 cases with isolated pleuropulmonary disease and for 12-15 months in the other 12 patients. The other 13 were on cyclosporine and were given isoniazid, pyrazinamide, and ethambutol for 18 months. Two patients died of fulminant disease and five more died from unrelated causes. No recurrence of disease has been noted in any of the patients after a mean follow-up of 14.6 months. We conclude that the incidence of tuberculosis in renal allograft recipients in third world countries is much higher than that seen in the western world. Most of the cases are encountered in the first posttransplant year. Tuberculosis must be considered seriously in all patients who have prolonged fever of undetermined etiology. Treatment with isoniazid and rifampicin for 9 months is adequate for patients with localized pleuropulmonary disease. In patients on cyclosporine to whom rifampicin cannot be given because of economic considerations, treatment with isoniazid, pyrazinamide, and ethambutol should be given for 18 months.

Adult↗