Biomedical subjects
Publications and source records attributed to P Gulati.
A 13-year-old boy presented with acute stroke leading to right-sided hemiparesis. A contrast CT scan of the brain showed a hemorrhagic infarct in the left basal ganglia region with surrounding edema. Echocardiography showed a hydatid cyst in the right atrial chamber extending into the left atrium. A single hepatic hydatid was also seen.
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Gastric yolk sac tumors (YST) are very rare and are mainly reported in elderly people. We present a case of a 36-year-old man with a poorly differentiated gastric cancer showing a mixture of adenocarcinoma and yolk sac tumor that metastasized to Virchow's node. Both biopsies, Virchow's node and gastric tumor, contained areas of adenocarcinoma and yolk sac tumor that stained strongly positive for alpha fetoprotein (AFP) by the immunohistochemistry method. A high level of serum AFP (38,200 ng/mL) was also noted in this case. The response to chemotherapy in this case of mixed gastric yolk sac tumor and adenocarcinoma was not as favorable as would be expected in a pure primary germ cell tumor.
STUDY DESIGN: A retrospective cohort study of tractor-driving farmers (study group) and non-tractor-driving farmers (control group) matched for age, gender, generic/ethnic group, land-holding, and work routines. OBJECTIVES: To determine, using magnetic resonance imaging and clinical investigations, the effect of whole-body vibrations on the back in tractor-driving farmers. SUMMARY OF BACKGROUND DATA: Low back pain and pathologic changes in the lower backs of tractor drivers have been reported. However, no study with a control group matched for work-related risk factors has been reported. METHODS: Fifty tractor-driving farmers were compared with 50 non-tractor-driving farmers matched for age, gender, ethnic group, land-holding, and work routine. Both groups were interviewed for details of work routine, assets held, family profile, and vibration exposure to assess the influence of these parameters on signs and symptoms of backache. Magnetic resonance imaging was done to assess the effect of exposure on whole-body vibration and degenerative changes in the back. Vibration measurements also were done on tractors to observe the actual severity of the vibrations. RESULTS: Regular work-related backache was more common among tractor-driving farmers (40%) than among non-tractor-driving farmers (18%, P = 0.015). Anthropometric evaluation showed abdominal girth and weight to be significantly higher in tractor-driving farmers (P = 0.006 and 0.046, respectively), whereas while height and arm span were similar between the two groups. Clinical examination for evidence of disc or facet degeneration showed no difference between the two groups. Evaluation of magnetic resonance images of tractor-driving farmers and non-tractor-driving farmers by an orthopedic surgeon, radiologist, and neurosurgeon showed degenerative changes to be similar between the two groups (P > 0.050). CONCLUSIONS: Tractor-driving farmers report backache more often than non-tractor-driving farmers, but no significant objective differences on clinical or magnetic resonance imaging evaluation were found between the two groups.
The ultrastructure of the thymus in the chick (Gallus domesticus) was studied after unilateral vagotomy at survival times of 3, 7 and 10 days. Ultrastructural changes in the ipsilateral thymus were observed in axon boutons as well as in myoid and cystic cells in the medulla, especially those situated near the corticomedullary junction. Structural changes in axon boutons ranged from granular degeneration of the axonal cytoskeleton to vacuolation of the axoplasm. Myelin figures of different sizes and configurations and clumping of small agranular vesicles were commonly observed in the axon terminals. Degeneration of myoid cells appeared to peak at 7 days post-vagotomy. Changes ranged from oedematous appearance and intense vacuolation of the peripheral cytoplasm to disorganisation and clumping of myofibrils. In some myoid cells the sarcomeres showed granular degeneration at the I-bands and in others, the myofibrils were completely degenerated such that amorphous material and partially degenerated organelles filled the entire cell. The majority of cystic cells at 3 days post-vagotomy showed a uniform increase in electron density. Numerous electron dense bodies, some displaying concentric lamellation, were observed throughout the expanse of the cytoplasm. At 7 days post-vagotomy, the cytoplasm of some cells gave a "moth-eaten" appearance. Dying cystic cells were encountered at 10 days after vagotomy. Degeneration in the myoid and cystic cells suggests that these cellular components may be the putative targets of the vagal fibres in the chick thymus. The changes in these cells reflect a disturbance in the cell metabolism presumably brought about by the removal of vagal influence.
The efficacy and tolerability profile of nimesulide was assessed in a double-blind, piroxicam-controlled trial in 49 patients with osteoarthritis of the knee joint. Nimesulide was administered orally as 100 mg twice daily, and piroxicam was administered as 20 mg orally in the morning and placebo in the evening. These patients were stratified into two groups: clinical assessment and magnetic resonance imaging evaluation of the knee. All patients were followed for 8 weeks with clinical assessment every 2 weeks; of these, 11 patients were selected for magnetic resonance imaging evaluation, and they were treated for 24 weeks. The principal efficacy parameters were improvement in osteoarthritis severity index, joint tenderness, swelling, and functional capacity of the patients. The final judgment of efficacy was made by the physician. Nimesulide improved all primary and secondary efficacy parameters with an activity comparable to piroxicam. Significant reduction in joint swelling and tenderness was observed as early as 2 weeks in the two treatment groups; however, a greater number of patients were relieved in nimesulide group. At 8 and 24 weeks, the number of patients with no joint swelling were 66.7% versus 50% and 80% versus 66.7% in the nimesulide and piroxicam groups (P <.05). Functional capacity at 8 weeks improved in 72.2% of nimesulide and 44.4% of piroxicam recipients. Mild adverse effects, mainly gastrointestinal, considered possibly related to treatment were recorded in 4 patients treated with nimesulide and in 12 patients treated with piroxicam. No significant change in the articulating cartilage of the tibiofemoral joint was observed over a 24-week period with either treatment. Nimesulide was as efficacious as piroxicam in reducing the inflammatory indices, and both drugs were equally well tolerated.
The aim of the study was to assess the efficacy, tolerability and chondroprotection afforded by nimesulide, a selective cyclooxygenase-2 inhibitor and piroxicam in a randomised, double blind, controlled clinical trial in 90 patients suffering from osteoarthritis of the knee joint. A significant improvement in the osteoarthritis severity index at 2 weeks (p < 0.01) and an improvement in physicians assessment of global arthritic condition at 4 weeks (p < 0.01) was seen with both the treatments. A significant decrease in articular index of joint tenderness (p < 0.05) at 8 weeks and in self assessment of handicap at 4 weeks (p < 0.05), in comparison to baseline, was observed only in patients receiving nimesulide. Rescue therapy was required by a greater percentage of patients being administered piroxicam. Functional capacity improved in 64% of the patients on nimesulide and 74.5% of the patients receiving piroxicam. Adverse effects were observed in 6 patients on nimesulide and 9 patients receiving piroxicam. No significant difference was found in any of the efficacy and tolerability parameters between the two treatment groups. Magnetic resonance imaging evaluation of the knee joint of 10 patients showed no significant change in the articular cartilage and associated joint structures after 6 months of therapy with both the treatments. The results show that nimesulide and piroxicam are comparable in efficacy and tolerability in patients suffering from osteoarthritis.
Nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry was used to demonstrate the presence of nitric oxide in the developing chicken thymus. NADPH-d was first expressed in the epithelial cells located at the corticomedullary junction of the thymic rudiment on day 13 of incubation. The number of labelled cells gradually increased from day 13 to day 21. Ultrastructural evidence showed that the labelling was localized in a heterogeneous population of cells in the medulla near the corticomedullary junction, comprising the cystic, undifferentiated, myoid, lymphoid and epithelial reticular cells. At this age, the vascular endothelium was NADPH-d positive. Labelling was also detected in some macrophages. The reaction product primarily labelled profiles of rough endoplasmic reticulum and to a lesser extent the outer membranes of mitochondria, portions of the nuclear envelope and the Golgi apparatus. By day 18/19, NADPH-d-labelled nerve fibres were occasionally observed in the interlobular connective tissue. By day 21, these fibres formed perivascular plexuses. Labelled nerve fibres were occasionally observed in the medullary parenchyma. Possible functions of nitric oxide in the embryonic thymus are discussed.
To our knowledge, five cases of Castleman's disease involving only the central nervous system have been reported previously. We report a sixth case, which occurred in a 47-year-old woman with a 3-month history of headaches and a large superior frontal lobe mass on neuroimaging. Excisional biopsy revealed confluent lymphoid nodular areas with multiple well-developed germinal centers surrounded by concentrically layered proliferations of small B lymphocytes typical of Castleman's disease. Ultrastructural study found 100-nm virallike particles within follicular dendritic cells as well as intercellular spaces. These particles were suggestive of a D-type retrovirus. The patient underwent postoperative radiotherapy and was neurologically normal 3 months after surgery.
In order to study the tolerability, toxicity and therapeutic efficacy of interferon-alpha2b (Intron-A), 20 patients with superficial transitional cell carcinoma (TCC) of the urinary bladder (Ta, T1) were given intravesically a low dose (9 million IU) of the drug mixed with 30 ml physiological saline for 8 weeks, starting 1 week after transurethral resection (TUR). Follow-up included urine cytology, ultrasonography of the abdomen and cystourethroscopy. Eleven patients (55%) had no signs of recurrence during a follow-up of 6-32 months (mean duration 24 months). Four patients (20%) had superficial tumor recurrence and 5 patients (25%) showed recurrence with progression to invasive tumors. Tolerability was very good, while toxicity in the form of mild flu-like symptoms was observed in only 3 patients. This pilot study showed that, at a low dose, intravesical interferon therapy can significantly lower the recurrence rate in superficial TCC of the urinary bladder with good tolerance and practically no side effects.
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BACKGROUND: Due to lack of reliable biochemical/radiological markers, the diagnosis of acute appendicitis is based only on clinical features. METHODS: We estimated plasma serotonin levels in 48 patients with acute appendicitis (histologically proven), 27 patients with abdominal pain of other etiologies, and 20 healthy controls. RESULTS: The plasma serotonin levels were (mean +/- SD) 36.6 +/- 12.5 nmol/L, 12.5 +/- 3.6 nmol/L and 10.4 +/- 3.5 nmol/L in the three groups, respectively. The levels in patients with acute appendicitis were significantly higher (p < 0.001) than in the other groups, giving 93.8% sensitivity and 95.7% specificity to the test. CONCLUSION: Plasma serotonin level is a reliable marker of acute appendicitis, especially in the first 48 hours.
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Infertility has a fair degree of male factor contribution in its aetiology, hence needs complete evaluation of male partner especially the status of spermatogenesis. In the present study comparative evaluation of fine needle aspiration cytology (FNAC) and biopsy of testis showed 90% accuracy of FNAC in respect of histopathological diagnosis of spermatogenesis. FNAC is a safe, fairly accurate, outdoor investigation in infertile man and it is devoid of the complications of haematoma formation, suppression of spermatogenesis and antigenic stimulation as seen with testicular biopsy.
Nitrergic and peptidergic innervation of the chick thymus was studied using histochemical and immunohistochemical methods. Nicotinamide adenine dinucleotide hydrogen phosphate-diaphorase (NADPH-d) histochemistry and anti-nitric oxide synthase (NOS) antibodies stained both nerve fibres and 'neuron-like' cells located in the septal connective tissue. NADPH-d and NOS were partially colocalised. Staining of NADPH-d positive neuron-like cells with the neuronal marker, neuron specific enolase, confirmed the neuronal nature of these cells. Antibodies against vasoactive intestinal peptide (VIP), neuropeptide tyrosine (NPY), substance P (SP) and calcitonin gene related peptide (CGRP) were used to map the peptidergic innervation of the chick thymus. The distribution of nerve fibres staining for the various neuroactive chemicals in specific thymic compartments was non-uniform. Out of all the peptides, VIP-containing nerves appeared to be the most abundant. In addition, double-labeling of the thymic sections revealed that VIP and NADPH-d were colocalised in the neuronal structures. Immunostaining of the chick embryos demonstrated that VIP, NPY, SP and CGRP were first expressed in the chick thymus during late ontogeny. The significance of these novel findings was discussed.
Nicotinamide-adenine-dinucleotide phosphate-diaphorase positive cells in the chick thymus were studied at the electron-microscopic level. The formazan, a marker for the enzyme nitric oxide synthase, labelled cystic, undifferentiated, endocrine-like and myoid cells in the medulla. Some lymphoid and reticulo-epithelial cells were also lightly labelled. The reaction product was predominantly bound to the membranes of the endoplasmic reticulum in all the cells labelled and also to the nuclear envelope and outer membrane of mitochondria. The Golgi apparatus and the plasma membrane were free of the reaction product.
Developmental expression of the Myxococcus xanthus gene 4521 requires extracellular A-signal. This signal is generated in response to nutrient limitation and functions in cell density sensing. To identify the upstream limit of the minimum region required in vivo for A-signal-dependent 4521 expression, a 5' deletion analysis of the 4521 regulatory region was performed. A new vector, pHBK280, was designed to facilitate this analysis. This vector creates tandem copies of the 4521 gene in the M. xanthus chromosome, such that the regulatory region to be tested is upstream of a single copy of the lacZ reporter gene. The 5' deletion analysis revealed that at most, 146 bp of DNA upstream of the transcription start site (TSS) was required for full developmental expression of 4521. Basal expression levels were observed with constructions containing 90 bp of DNA upstream of the TSS. In vitro gel retardation assays revealed that DNA fragments with 5' ends of 146 and 125 bp upstream of the TSS and a common 3' end of +24 bp were retarded in their mobility after incubation with all of the M. xanthus developmental crude cell extracts tested. In contrast, a fragment starting at 90 bp upstream of the TSS and ending at +24 bp was not retarded in its mobility after incubation with the same cell extracts. These in vivo and in vitro data suggest that cis-acting elements located between 146 and 90 bp upstream of the TSS serve as binding sites for one or more trans-acting regulatory factors required for 4521 developmental expression.
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