Biomedical subjects
Publications and source records attributed to L K Sharma.
Mesenchymal hamartoma of the liver is a rare benign tumor of infancy and childhood. A case of mesenchymal hamartoma of liver seen in a 37 day old child is reported and the available literature on the subject is briefly reviewed.
A case of segmental renal dysplasia presenting with loin pain, a renal mass and hypertension in a young girl of 16 years is being reported. Clinical and histological features of this rare renal anomaly are discussed.
The classical Hadfield's operation for duct ectasia/periductal mastitis results in nipple anaesthesia in most women and nipple/areola necrosis in some patients. To obviate these two complications we have modified the technique of major duct excision. The incision is given over only one-third of areolar circumference and no areolar flap is raised. In the 17 women treated by this technique the cosmetic results were good in all of them with no nipple/areola necrosis. The nipple sensation was preserved in all cases. There was only one case of recurrence of nipple discharge. The technique offers a safer alternative to the classical Hadfield's operation.
A 14 year old girl with bilateral genu valgum of 6 years duration was brought for evaluation of primary hyperparathyroidism. She had clinical features of rickets such as frontal bossing, rachitic rosary, lumbar lordosis and fixed adduction deformity of the left leg. She had undergone osteotomy earlier for correction of these deformities without benefit. Laboratory investigations showed hypercalcaemia and hypophosphataemia, with elevated alkaline phosphatase and parathyroid hormone levels. A skeletal survey showed generalized decreased density of bone and brown tumours and, coincidentally, a right renal calculus. A computerized tomography scan of the neck and thallium-technetium subtraction scan delineated an adenoma of the left superior parathyroid gland, which was surgically removed. Parathyroid adenoma manifesting with bone deformities, especially genu valgum, is very rare in children. Early diagnosis and prompt treatment is essential to prevent such deformities.
A non-lip-splitting approach to the oral cavity is described, using a curved incision through the angle of the mouth along the inferior buccolabial sulcus. The incision provides good access to the entire oral cavity and heals efficiently with good cosmetic results. It is suited to patients who require excision of the oral commissure.
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Twenty eight patients of sporadic primary hyperparathyroidism seen over a period of 10 years were studied. There were 18 females and 10 males with a mean age of 35.9 years. Bone involvement was the commonest clinical presentation (90%) followed by renal involvement (65%) and more than half the patients (54%) had involvement of both the skeletal and renal systems. The tumor was clinically palapable in six patients. Thalliumtechnetium subtraction scan had a sensitivity of 87% followed by computerised tomography (70%), and ultrasound (65%) in diagnosing parathyroid pathology. All the patients underwent surgical excision of the abnormal gland (S). Adenomas constituted the single largest group (90%). Histologically, only 32% of the patients had chief cell morphology. Clear cell (32%) mixed cell, and oxyphil cell (7.2%) types accounted for the remaining adenomas. Majority of the patients (82%) had symptomatic postoperative hypocalcemia requiring intravenous calcium with or without vitamin D supplementation. In contrast to western reports most of our patients were young, presented late with florid bone and renal disease and had large palpable tumors.
To assess the feasibility and advantages of short-stay surgery in India, a policy of early discharge was adopted for 386 patients undergoing various major and minor operations. The mean postoperative and total hospital stays of patients admitted for minor surgery were 1.9 and 3.7 days respectively; the corresponding figures for age- and sex-matched historical controls were 7.4 and 11.3 days. The mean postoperative and total stays of patients who had undergone major surgery were 4.1 and 8.0 days respectively; the corresponding control values were 8.9 and 12.5 days. The use of absorbable subcuticular skin sutures helped to shorten postoperative hospital stay and avoided an extra follow-up visit. The overall complication rate in the study group was 9.6 per cent and in historical controls 13.4 per cent (P > 0.05). A total of 2357 hospital bed-days were saved during the study and 95.6 per cent of patients approved of short-stay surgery.
A case with an unusual presentation of sepsis after Ivalon sponge rectopexy is reported. A strong index of suspicion is important for correct diagnosis. Early removal of infected sponge allows quick resolution of the sepsis without recurrent prolapse.
Ketoconazole, an imidazole derivative is known to decrease adrenal steroid biosynthesis by inhibiting cytochrome P450 dependent adrenal enzymes. Three patients of adrenal carcinoma treated with ketoconazole, 600-1200 mg daily showed significant fall in plasma and urinary cortisol levels, but no reduction in tumor size, one patient developed liver dysfunction which reverted back to normal on discontinuing the drug.
Levamisole administered by oral, subcutaneous or transdermal routes following vaccination against Pasteurella multocida enhanced the humoral response in cross-bred calves. The group that received levamisole subcutaneously elicited highly significant (P less than 0.01) antibody titres during the primary humoral response in comparison with groups that received levamisole orally or transdermally. During the secondary response in the same experiment, levamisole administered subcutaneously and transdermally showed highly significant (P less than 0.01) haemagglutination titres relative to oral administration of the drug. In a second experiment, the group that received levamisole subcutaneously showed highly significant (P less than 0.01) antibody titres during the anamnestic humoral response over other treated groups.
Angiosarcoma of the breast is a rare and aggressively malignant tumour. A case of a young lady presenting with bilateral mammary angiosarcoma and associated pregnancy is reported. Only one such case is documented in the literature. Existing literature is also reviewed. The often deceptively benign histological appearances which are extremely variable demand serious suspicion of angiosarcoma when confronted with an angiomatous lesion of the breast. Early and complete surgical excision is the treatment of choice, and adjuvant chemotherapy may have a role in the treatment. Histological grading is the most important prognostic factor with poor grades having an unfavourable outlook.
The presence of two types of fast myoelectrical activities, medium fast activity and fast activity, has been demonstrated previously in the electromyogram of colon in normal children and in the rat by the authors. An absence of medium fast activity in Hirschsprung's disease and in experimental aganglionosis of colon in the rat has also been described. In the present study the fast components of colonic myoelectrical activity were analysed during the procedures affecting ganglionic transmission. It was observed that ganglionic stimulants, such as balloon inflation, and intra-arterial injections of acetylcholine and small amounts of nicotine, increased the spike activity and the frequency of medium fast activity without affecting fast activity. The intra-arterial injections of ganglionic blocking agents, such as nicotine in large amounts and pentolinium tartrate, completely abolished the medium fast activity. These observations suggest that the ganglionic activity is responsible for the genesis of medium fast activity and that the absence of cholinergic ganglionic transmission is the most important single factor for the reported altered electromyogram pattern in aganglionosis.
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By radioisotope technique, we studied the emptying function of the vagotomized intrathoracic stomach after esophagectomy for carcinoma of the esophagus in 24 patients, and compared it with the preoperative emptying function. The patients were randomized into a control group (no pyloroplasty) and a study group (pyloroplasty). Gastric emptying was delayed in both groups, postoperatively; however, the delay was greater in the control group than in the study group. Therefore, vagotomy delays the emptying of the thoracic stomach, and this delay is not completely corrected by pyloroplasty.
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A retrospective review of 143 cases of carcinoma of the gall bladder is presented. The disease was more common in females in the 5th and 6th decades. Pain, anorexia, weight loss and jaundice were the common presenting symptoms, and hepatomegaly and palpable gall bladder the common signs. Laboratory and radiological investigations were merely confirmatory as the diagnosis in a majority of the cases was clinically obvious. Aspiration cytology and laparoscopic biopsy were of help in obtaining histological diagnosis. Only 47 patients were considered fit enough to undergo laparotomy. In a majority of these patients biopsy alone was possible while palliative procedures were performed in the others. The operative mortality was 18% even in this selected group of patients, due to the poor general condition and the advanced stage of the disease at the time of diagnosis. Curative resection may be possible and long term survival is expected in incidentally found carcinoma at cholecystectomy. The only hope lies in prevention by prompt treatment of patients with benign biliary disease.