Biomedical subjects
Publications and source records attributed to M Panja.
A nine year old girl presented with chest pain and dyspnoea of sudden onset. She had no marfanoid features, with a normal slit lamp examination and a normal aortic valve on echocardiography. The diagnosis of dissecting aneurysm of the ascending aorta involving the aortic valve cusps, the right coronary artery and the pericardium was later established with the help of ECG, pericardiocentesis, echocardiography and aortography.
Explore the source record for details and available documents.
A case of pericardial metastasis from adenocarcinoma of lung was having a separate paratracheal bulge at left border of aorta mimicking a tumour. This was a very uncommon extension of pericardial effusion. Interestingly this mediastinal bulge on left border of aorta disappeared completely immediately after pericardio-centesis. The rarity of chest roentgenographic findings prompted us to report this case.
Lung biopsy specimens were taken from 15 adolescents (aged 11-21 years), at the time a mitral valvotomy was performed. In addition to quantitative light microscopic studies three specimens were also examined by scanning and transmission electron microscopy. In all cases, the pulmonary vascular abnormalities were most marked in the capillary bed and in the vessels immediately proximal and distal to it. The capillaries showed a marked increase in basement membrane material at the blood/gas barrier, and were embedded in dense connective tissue within the alveolar walls. Intra-acinar and, to a lesser extent, pre- and post-acinar vessels showed an increase in muscularity, severe circumferential intimal fibrosis, and abnormally thick and dense adventitial connective tissue. The peripheral airways were encased in dense connective tissue, which appeared to compress them. Bronchial smooth muscle was increased. Six months after the mitral valvotomy was performed, the mean pulmonary arterial pressure had fallen from 42 mm Hg to 23 mm Hg. Despite this satisfactory haemodynamic result, the long-term effects of small airway compression on the growing lung indicate the need for early relief of mitral valve obstruction, possibly made easier by the new technique of balloon angioplasty.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Out of 195 cases of Takayasu's arteritis who presented in our institute between January 1988 and December 1997, 12 (5.58%) had dilated cardiomyopathy. Age of these patients ranged from 10 to 30 years (17.25 +/- 5.30 years) and male-female ratio was 1:11. All the cases had cardiovascular system features (dyspnoea, oedema, palpitation, angina, etc. but without hypertension), three had central nervous system features (headache, vomiting, convulsion etc.) and all had general systemic features like weight loss, malaise, fever, arthralgia etc. Electrocardiography, chest X-ray and echocardiographic findings were consistent with dilated cardiomyopathy. Haemodynamic findings showed raised left ventricular end-diastolic pressure and pulmonary capillary wedge pressure in all; raised pulmonary artery pressure, pulmonary vascular resistance, right ventricular pressure and right atrial pressure in 6, 6, 4 and 2 cases, respectively; reduced left ventricular peak systolic pressure in 10 cases but central aortic pressure and systemic vascular resistance in all the cases were within normal limits. Angiography showed type I, II and III involvement in 7 (majority), 3 and 2 cases, respectively. Coronary and pulmonary angiography were normal and left ventricular angiography showed poor left ventricular systolic function in all the cases. Histopathological study (on 3 autopsy cases) showed non-specific inflammation of myocardium with lymphocyte/mononuclear cell infiltration and normal coronary vessels. So, dilated cardiomyopathy in Takayasu's arteritis is not rare, though not much reported, and can influence the prognosis of aortoarteritis cases.
Fifty patients with drug resistant tachyarrhythmias were treated with amiodarone for 6-22 months; 16 for recurrent ventricular tachycardia (VT), 2 for VT followed by ventricular fibrillation (VF), 14 for complex ventricular ectopics, and 18 for supraventricular tachyarrhythmias (SVT). Amiodarone was administered in a dose much lower than that used in western trials. The actual incidence of successful amiodarone therapy was 81.2% at 22 months for patients with VT. Among the patients with SVT, 88.6% patients were successfully treated for 22 months (range 3-22 months). Amiodarone toxicity appeared in 22 of 50 patients (44%) treated for more than 12 weeks. Withdrawal of therapy was required in 4 patients. Despite the lower dose, clinical efficacy and onset of action were comparable to the western experience.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sixty patients aged 5-16 years underwent implantation of permanent pacemaker and were followed up for 3-11 years. All these patients presented with syncope or symptomatic bradyarrhythmias; two also had congestive cardiac failure in addition, which was ameliorated by pacemaker implantation. A majority of the patients (48) had congenital complete heart block. 8 patients presented with sick sinus syndrome; 4 patients presented with post operative chronic complete heart block. Transvenous endocardial electrode was used in 54 cases and epicardial pacing was done in 6 cases. A majority (55) of the patients received VVI pacemakers; AV sequential pacemakers were implanted in 5 cases. On follow up, the children returned to normal activity and their psychological well being was striking. Reoperation had to be done in 35 cases, a majority being due to over stretching of electrodes (15) and battery exhaustion (12). Two patients died, one due to bacterial endocarditis and the other succumbed to sudden death during vigorous physical activity. Major problems of pacing in children are that veins are often too thin and delicate for electrode insertion, and of the child's growth that stretches the lead system. The problems of pulse generator size and longevity have been partly overcome by introduction of newer models that are small and programmable.
Explore the source record for details and available documents.
We studied 38 patients with cardiac tumours. Of these, 30 had primary cardiac tumours while the rest had secondary tumours. The commonest manifestations in patients with primary tumours were exertional breathlessness (23), fever (9), mitral diastolic murmur (15), loud pulmonary component of the second heart sound (16), and mitral systolic murmur (21). Left atrial myxoma was the commonest diagnosis (24) followed by left ventricular leiomyoma (2), right atrial myxoma (2, one with RA and RV both), RV myxoma (1), and left ventricular haemangioma (1). The commonest modes of presentation of secondary cardiac tumours were atrial extrasystoles (5) and pericardial friction rub (4). Histopathological reports revealed bronchogenic carcinoma (4), breast carcinoma (2), seminoma of the testis (1) and lymphoma (1). The unexpectedly low number of secondary cardiac tumours in this series is attributed to the lack of routine autopsy studies in our institute.