Biomedical subjects
Publications and source records attributed to N Varma.
It is important to differentiate non-dyplastic aplastic anaemia from hypocellular myelodysplastic syndrome (MDS). Four patients presenting with hypocellular bone marrow and different evolution patterns are being described. Certain morphological features and variable hypocellularity were found to be useful indices for this purpose.
Twenty spleens of steroid resistant cases of idiopathic thrombocytopenic purpuras were studied by light and electron microscopy. Weights of the spleen were within normal range and were unremarkable grossly. On light microscopy reactive lymphoid follicles were seen in the five of the cases. Prominent and dirty looking sinusal histiocytes contain phagocytosed materials. Prominence of plasma cells were seen in the red pulp and also in the marginal zone. The three cases which failed to respond to splenectomy did not show any morphological variation from the others who had responded.
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The relative efficacy of trephine sections, trephine imprints and aspiration smears in yielding diagnostic and additional information was compared in 767 sets of bone marrow samples. Trephine sections were diagnostic in significantly more cases as compared to trephine imprints and aspiration smears (P < 0.001). Additional information was obtained in 326 trephine sections which was not available from trephine imprints and aspiration smears. Significantly more number of trephine sections provided diagnosis in case of dry tap/scanty material, for assessment of lymphoma-tumour infiltration, cellularity, Perl's reaction, megakaryocyte density and proliferating cell lines in myeloproliferative disorders. Fibrosis of bone marrow, pattern of bone marrow involvement and topographical alterations were appreciable only on trephine sections. The differential counts done on trephine imprints and aspiration smears correlated well and cytomorphological characterisation of immature cells (blasts and promyelocytes) could be done on these two preparations. Although trephine sections provide maximum information, all three preparations were found complementing each other and should be evaluated simultaneously for complete bone marrow interpretation.
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Despite the dramatic success of inhaled steroids in controlling asthma symptoms there remains a small number of patients in whom asthma can only be treated with continuous oral steroids. Eighteen such patients, aged 19-62 years (seven males, 11 females) were followed in an open trial of nebulized budesonide over 12-18 months. All had required at least 7.5 mg or more daily prednisolone to control their symptoms over the preceeding 2 or more years and were taking 1200 micrograms beclomethasone dipropionate or 1600 micrograms budesonide daily. With a daily dose ranging between 4 and 8 mg nebulized budesonide, 14 patients successfully stopped oral steroids while in three the dose was reduced; only one patient failed to benefit. There was an increase in the mean FEV1 from 1.9 (+/- 0.9) to 2.2 (+/- 0.9) l, and in the mean morning PEFR, from 238 (+/- 119) to 286 (+/- 130) l min-1. There was also a significant decrease in the mean number of hospital admissions for acute severe asthma, from 1.5 (+/- 1.8) to 0.9 (+/- 1.1) per year. These findings should encourage a careful and controlled evaluation of nebulized steroids as a substitute for oral steroids in this difficult group of asthmatics.
An analysis of the underlying pathology and different clinico-haematological features of 202 adult pancytopenic patients is presented. Aplastic anaemia (40.6%), megaloblastic anaemia (23.26%) and acute myeloblastic leukaemia (12.8%) together accounted for most of the cases. Our aplastic anaemia cases showed several different features compared to the cases reported in western literature. Aplastic anaemia and megaloblastic anaemia patients revealed significant differences in the incidence of hepatosplenomegaly, anisocytosis, circulating erythroblasts, relative lymphocytosis (P < 0.001 for all) and reticulocytosis (P < 0.01). The present study stresses the importance of physical and peripheral blood findings in the management of pancytopenic patients.
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Gelatinous transformation of bone marrow is usually encountered in patients of anorexia nervosa. We report two cases of gelatinous transformation of the marrow, one without any detectable cause and the other associated with visceral leishmaniasis.
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Castleman's disease is an uncommon clinical entity. We report two cases of this disease with a brief review of literature. Both of them had extrathoracic disease which is relatively infrequent. One of them presented with localized hyaline vascular type of the disease and the other with the multicentric plasmacytic variety. The patient with the latter form of Castleman's disease had sclerodactyly, which has not been reported earlier in association with this disease.
We describe the clinical course of a patient with pregnancy-related, acquired, pure red cell aplasia (PRCA). The course of PRCA was prolonged and ultimately responded only to corticosteroids. It did not recurr over 4 years of observation despite another gestation, and no other cause for PRCA could be detected during this long period.
We present a case of tracheobronchomegaly seen in association with ankylosing spondylitis. To the authors' knowledge this combination has not been previously described. A review of the chest radiographs of 30 other patients with ankylosing spondylitis revealed no evidence of tracheal dilatation.
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Clinicopathological findings of six cases of Hairy cell leukaemia are presented. All the patients were males, the age ranged between 32-57 years. Complications of anaemia and neutropenia were common modes of presentation. Hepatomegaly and splenomegaly were present in all the cases whereas only 2 patients had lymphadenopathy. Severe pancytopenia was detected in 3 cases and circulating hairy cells were present in all the cases. Trephine biopsy done in all six patients was found to be diagnostic. Tartrate resistant acid phosphatase was detected in the hairy cells of 2 cases.
To the best of our knowledge, gelatinous transformation of the marrow has not been described in association with Leishmania donovani infection. Here we report one such case.