Biomedical subjects
Publications and source records attributed to R Kamal.
A case of cerebellar medulloblastoma in a 65 year old male is reported. Cerebellar medulloblastoma is classically seen during childhood, and less than 25% of these tumours are found in adults below 40 years of age. Rarely, cases are reported above the age of 40 years. So far only three cases have been reported in patients aged above 64 years and none of these case reports are from India.
Craniopharyngioma fluid spillage during surgery is reported to cause aseptic meningitis, but effects of the spillage on vessels have not yet been studied. Therefore we experimentally studied the effect of external contact on femoral vessels of the rat to assess its possible role in the cerebral vascular complications. The major direct effect of the craniopharyngioma fluid on the femoral vessels was vasospasm, appearing on the fourth day after instillation. The vasospasm was observed in 83% of femoral vessels studied between 4-15 days and one of the vessels showed intra-luminal thrombus. The difference in the vessel diameter after instillation (4-15 days) was compared with the controls and was statistically significant (p < 0.01). These findings correspond well with the observed deterioration on post-operative days 5-7, due to vascular complications. No histopathologic (light-microscopic) changes of inflammation or necrosis were found in the femoral vessels. Our study shows that contact of craniopharyngioma fluid to arteries leads to vasospasm, and spillage during surgical excision may contribute to vascular complications encountered in the post-operative period. Prevention of spillage of this fluid and the routine use of cerebral vasodilators to prevent ischemic complications after craniopharyngioma surgery needs further evaluation.
A case of lumbar split cord malformation (SCM) with a bony spur situated dorsally is presented. This was associated with a hypertrophied posterior arch. The ventral dura was totally intact, and there was no fibrous septum connecting the bony arch to the dura. To our knowledge, such a case has not been reported earlier. In view of this unique finding, we propose a slight modification in Pang's unified theory of embryogenesis in the development of SCM.
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Dot-ELISA, a technique that shares the same principles as the enzyme immunoassay, is useful for detection of anti-Schistosoma mansoni antibodies in the sera of patients with Schistosoma mansoni infections. The antigens were fixed to the nitrocellulose strips, blocked with 1% bovine serum albumin in 0.05% Tween 20. Patient sera (40) and normal laboratory personnel sera (9) were applied to the sheet directly, without cutting the strips into small discs. The nitrocellulose sheets are kept in a humid chamber for 30 min and then washed. After incubation with peroxidase-conjugated goat anti-human antibody, washing, and addition of substrate, positive reactions appear as brown dots against the white background. The room temperature assay takes about 2 hr. The optimum antigen concentration is 20-80 ng per dot and the optimum serum dilution is 1:100-1:400. The sensitivity and specificity of the assay are 90-95% and 90%, respectively. The level of positivity of the dot-ELISA by an arbitrary scale compares with standard micro-ELISA. The single positive reaction in a normal serum sample in dot-ELISA is also positive in micro-ELISA. Cross-reactivity between the S. mansoni antigen and human fascioliasis sera was noticed in 2 out of 8 patient sera. Good correlation between the arbitrary level of dot-ELISA and the absorbance of standardized micro-ELISA shows that the dot-ELISA is useful both for laboratory and field studies.
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Latex agglutination was used for the development of a simple and fast immunochemical faecal occult blood test which is ultrasensitive and specific for human haemoglobin. "In vitro" detection limits of 0.0002 and 0.003 ml blood/100 g stool homogenate were obtained for the tube and filter versions of the latex-agglutination test. The quantification of the blood content in stool homogenates is possible by diluting the haemoglobin containing faecal extract until no more agglutination occurs. Considering the nonuniform distribution of blood in faeces "in vivo" sensitivities of greater than 0.002 and greater than 0.03 ml blood loss/day respectively can be expected for the tube and filter versions of the latex agglutination test. This test is about 10,000 times more sensitive than the unspecific chemical guaiac type occult blood tests and at least 1,000 times more sensitive than other immunochemical occult blood tests which use immunofluorescence, radial immunodiffusion or an enzyme immunoassay. Nuclear medical reference methods like 51Cr faecal excretion or 59Fe whole body retention cannot be used for the calibration of the ultrasensitive latex agglutination test since they are not specific for blood losses below 3 (51Cr) and 5 (59Fe) ml/day.
Spinal dysraphism (SD) is characterized by maldevelopment of neural tube, notochord, mesoderm and cutaneous ectoderm. Incidence of SD is 2-4/1000 live births. One hundred and nineteen patients operated from January 1991-June 1996 at Department of Neurosurgery, All India Institute of Medical Sciences, were studied. Only 21 patients (17.6%) presented when they were less than one year old and 17 patients came in adult age group (> 16 years). Lumbar and lumbosacral region was the commonly involved site in 81 patients (74.7%). Weakness of lower limbs (74%), difficulty in walking (54%), muscle atrophy (41.2%) were the commonest indicators of motor system involvement. Loss of sensation, trophic ulcer, backache were seen in 45, 14, 10 patients respectively. Cutaneous lipoma (26%), hypertrichiosis (20%), dermal sinus (13.4%), midline dimples (7%) were the important cutaneous markers. Foot and limb deformity was seen in 25% cases. Tethering of cord, syringomyelia & split cord malformation were the most common radiological findings. Only 10% of our patients had hydrocephalus that required shunt. Out on 119 cases operated, 43 improved, Twenty had sensory improvement and 18 showed motor improvement. Fifteen patients regained continence. Twelve patients were lost to follow-up. Sixty-seven patients had no change in neurological status, post-operatively. Six cases deteriorated in terms of motor or sensory deficit and one patient lost continence. CSF leak (8%) and wound infection (6%) were the common complications. Six patients required second surgery as T.P. Shunt (4), rotation flap (1), reexploration and duraplasty (1).