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K S Sahni

Publications and source records attributed to K S Sahni.

12 recordsLinked to original sources
PubMed1992

Short segment incremental studies in the evaluation of ulnar neuropathy at the elbow.

Conventional electrodiagnosis may localize an ulnar neuropathy to the general region of the elbow. Separating retroepicondylar compression from compression by the humeroulnar aponeurotic arcade from compression by the deep flexorpronator aponeurosis is more difficult. In 35 patients, we compared localization by conventional inching (stimulating stepwise around the elbow searching for focal conduction block or differential slowing) to localization by a more quantitative short segment incremental stimulation (SSIS) technique assessing latency change over consecutive 1 cm segments. Results of percutaneous studies were compared with findings of intraoperative electroneurography. We conclude that SSIS identifies compression levels more accurately than standard inching, and that SSIS and intraoperative electroneurography correlate highly, but not perfectly. Studies confined to a search for conduction block or differential slowing are limited by the low incidence of conduction block in chronic compression neuropathies.

Adult↗
PubMed1991

Germ cell tumors masquerading as central nervous system sarcoidosis.

The diagnosis of central nervous system sarcoidosis is uncertain without typical multisystem involvement. We describe two patients with isolated central nervous system mass lesions whose biopsy results were consistent with sarcoidosis. After a progressive clinical course, they were found to have diencephalic germinomas. Germ cell tumors, in particular, should be considered in the differential diagnosis of central nervous system sarcoidosis as they are potentially treatable, occur in intracranial locations favored by sarcoidosis mass lesions, and may be surrounded by granulomatous inflammation that can be mistaken for the noncaseating granulomas of sarcoidosis.

Adolescent↗
PubMed1991

Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow.

Two processes account for most instances of ulnar neuropathy at the elbow: compression in the retroepicondylar groove, and compression by the humeroulnar aponeurotic arcade joining the two heads of the flexor carpi ulnaris. While conventional electrodiagnostic criteria may localize an ulnar neuropathy to the elbow, separating retroepicondylar compression from humeroulnar arcade compression is more difficult. In 130 cadaver elbows, we examined the relationships between the medial epicondyle, flexor carpi ulnaris, and ulnar nerve. The humeroulnar arcade lay from 3 to 20 mm distal to the medial epicondyle, the intramuscular course of the nerve through the flexor carpi ulnaris ranged from 18 to 70 mm, and the nerve exited the flexor carpi ulnaris 28 to 69 mm distal to the medial epicondyle. In 6 specimens, dense fibrous bands bridged directly between the medial epicondyle and the olecranon proximal to the cubital tunnel proper; accessory epitrochleoanconeus muscles were present in 14 specimens: both may cause ulnar neuropathy at the elbow. Anatomical variations may contribute to the difficulty in separating causes of ulnar neuropathy at the elbow.

Cadaver↗
PubMed1991

Association of vascular compression in trigeminal neuralgia versus other "facial pain syndromes" by magnetic resonance imaging.

Magnetic resonance imaging was performed in 13 patients with trigeminal neuralgia and 18 control patients with facial pain of other types. Among trigeminal neuralgia patients, eight (62%) had vessels seen abutting, or immediately adjacent to, the trigeminal nerve on the side of their symptoms. Only three control patients (17%) had such vessels. The proportion of patients having a trigeminal region vessel associated with their symptoms was significantly higher in patients with trigeminal neuralgia than in controls (p = 0.0086). These findings provide evidence supporting the theory that trigeminal neuralgia is associated with vascular compression of the fifth cranial nerve.

Constriction, Pathologic↗
PubMed1990

Cerebral botryomycosis: case study.

After oral surgery, a 32-year-old man developed a brain abscess. Actinomycosis was suspected due to history, clinical findings, response to penicillin therapy, and demonstration of "sulfur granules" in the surgical specimen, but anaerobic cultures were negative for Actinomyces. Aerobic cultures yielded Streptococcus sanguis and Pseudomonas cepacia. Coccoid organisms demonstrated histologically reacted positively with periodic acid-Schiff, Gomori's methenamine silver, and Brown and Brenn stains, were Ziehl-Neelsen-negative, and did not include branching filaments. Fluorescent antibody assay for Actinomyces israelii was also negative. Electron microscopy revealed cell wall morphology and pattern of cell division characteristic of gram-positive cocci. These findings led to a final diagnosis of botromycosis due to S. sanguis. This third report of cerebral botryomycosis emphasizes the differential diagnosis with actinomycosis, the association with intermittently treated jaw disease, and identification of the causative agent by histologic, immunologic, and electron microscopic methods.

Actinomycosis↗
PubMed1990

Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia.

The effects of percutaneous retrogasserian glycerol rhizolysis were observed in a population of 58 cases of classical trigeminal neuralgia. The follow-up period ranged from 7 to 52 months postoperatively. It was noted that 84% of the patients had immediate relief of pain. The overall recurrence rate was 29%. Based on Kaplan-Meier survival curves, the overall half-life (T1/2) of this procedure was 16 months. Although none of the patients developed anesthesia dolorosa or corneal ulceration, one group of patients developed either a clinical or subclinical persistent "minimal hypesthesia." In these there was a statistically significant difference in the T1/2 associated with this procedure (p = 0.01). This finding suggests that, contrary to the general belief, persistent hypesthesia after glycerol rhizolysis is a negative indicator of long-term success.

Adult↗
PubMed1989

Cushing's disease in two sisters.

Hereditary Cushing's syndrome is an uncommon clinical entity, and most reported cases have been described in families with nodular adrenocortical dysplasia. Isolated cases of Cushing's disease (pituitary-dependent bilateral adrenal hyperplasia) have been reported in association with the multiple endocrine neoplasia syndrome, Type I (MEN I), but there are no published reports of pedigrees with more than one affected family member. Within a period of 8 months, two sisters presented with clinical findings suggestive of hypercortisolism, and Cushing's disease was confirmed by appropriate diagnostic studies. There was no evidence of any other endocrine excess syndrome in either patient. Transsphenoidal pituitary surgery confirmed the presence of an ACTH-immunostaining pituitary adenoma in each woman. The authors think this is the first report in the English literature of Cushing's disease in first-degree relatives.

Adenoma↗
PubMed1988

Thyrotropin-induced hyperthyroidism: evidence for a common progenitor stem cell.

A 36-year-old woman with hyperthyroidism, elevated blood thyroid-stimulating hormone (TSH) and alpha-subunit levels, amenorrhea, hyperprolactinemia and no evidence of acromegaly, was found to have a pituitary adenoma containing TSH, alpha-subunit and growth hormone by immunohistochemistry. Preoperative testing revealed elevated TSH and alpha-subunit with no response to thyrotropin-releasing hormone (TRH) but a normal response in prolactin to TRH. Culture of the pituitary cells showed release of TSH, alpha-subunit and prolactin. In vitro, TRH failed to cause TSH discharge; however, it increased prolactin concentrations in the culture medium. Triiodothyronine, added to the pituitary cell culture, resulted in no inhibition of TSH and prolactin discharge. By electron microscopy, the adenoma cells showed features of thyrotrophs. However, some adenoma cells contained fibrous bodies characteristic of some growth hormone cell tumors and acidophil stem cell adenomas, suggesting that the adenoma originated in a common progenitor cell.

Adenoma↗
PubMed1987

CT-guided stereotactic biopsies of lesions in the medulla and a case of Leigh's disease.

CT-guided stereotactic biopsy of lower brain stem lesions in 7 consecutive cases is discussed. A frontal transincisural approach was used. Five patients had astrocytomas histologically. The single patient who had undergone empirical radiation therapy prior to tissue diagnosis revealed only necrosis. One patient was found to have pathology suggestive of Leigh's disease. This patient was not radiated and is the first alive adult to have this diagnosis confirmed. Although controversy still exists in the management of brain stem lesions, we intend to demonstrate the value of tissue diagnosis in the management of such lesions.

Adult↗
PubMed1986

High thoracic disc herniation.

A case of T-1, T-2 disc herniation is reported. The patient presented with diminished hand strength, medial arm and shoulder pain, and medial arm, forearm, and hand paresthesias. After surgical decompression and removal of a disc fragment, the patient made a complete recovery. Routine cervical myelography was considered inadequate in view of this patient's symptoms. High thoracic myelography followed by computed tomographic scanning should be considered for patients with this presentation. Improved diagnosis with myelography and computed tomography is discussed.

Humans↗