Bilateral traumatic patellar tendon rupture.
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Biomedical subjects
Publications and source records attributed to M V Perera.
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The clinico-pathological features of cardiac and pulmonary involvement were studied in seven cases of fatal leptospirosis. Petechial haemorrhages occurred in the heart and pericardium in all cases with blood-stained pericardial effusions in five. Interstitial myocarditis was noted in five patients and probably caused the changing electrocardiographic abnormalities and clinical cardiovascular effects during the illness. Sub-pleural and intrapulmonary haemorrhages occurred in all seven cases with pleural effusions in four. Pulmonary oedema was a striking feature during the early stages of the illness, while in patients surviving the first week of the disease infiltrative and proliferative lesions were common. The latter type of pulmonary changes occurred at a stage when acute renal failure was improving and were not related to the presence and severity of jaundice. The clinico-pathological profile of pulmonary involvement in leptospirosis appears to fall into an adult respiratory distress syndrome and, when present, carries a serious prognosis and would then be a prime factor in mortality. As clinical manifestations of pulmonary involvement appear late during the clinical illness and may be of abrupt onset, auscultatory and radiological surveillance becomes mandatory in severe leptospiral infections.
Amoebic liver pus has an acidic pH. Hence the pleural aspirate from an amoebic empyema due to rupture of an amoebic liver abscess has an acidic pH. In contrast, the pH of pleural aspirates from effusions and empyema of non-amoebic aetiology were noted to have an alkaline pH. The clinical significance of these observations is discussed.
The hepatic manifestations were studied in 65 patients having uncomplicated primary attacks of vivax and falciparum malaria. Hepatomegaly due to a "non-specific reactive hepatitis" occurred in 57% of cases. Jaundice occurred in 15% of patients and was invariably associated with hepatomegaly. The clinical syndromes of jaundice and hepatomegaly in uncomplicated primary attacks of malaria have to be distinguished from those related to disorders like viral hepatitis, hepatic amoebiasis, typhoid hepatitis, infectious mononucleosis and Q fever. The causes for the jaundice and the pathogenesis for the hepatic lesions have been discussed.
The renal profile was studied in 61 patients having leptospirosis. Leptospira-induced acute renal failure conformed to one of two distinct clinical patterns, either oliguric on non-oliguric renal failure. The prognosis was excellent in the latter variety of renal failure and mortality was confined to patients with oliguric renal failure, where severe glomerular and widespread tubulo-interstitial lesions were invariably present. These patients had unfavourable prognostic features during life, such as prolonged oliguria and anuria, absence of a diruetic phase, persistent elevations in BUN and persistently low urea excretion. The prognostic significance of the age of the patients, hypotension and jaundice in relation to the occurrence and type of acute renal failure have been discussed. Retrospective observations indicate that both a vasculotoxic or haemorrhagic state and oliguric acute renal failure are important causes for mortality in human leptospiral infections.
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A fatal case of bile peritonitis due to ruptured amoebic liver abscess is reported. Exudation of bile from a solitary abscess within the liver was the cause of the biliary peritonitis. Secondary bacterial peritontis and Gram negative septicaemia were complications and their clinical significance has been discussed.