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Biomedical subjects

R Saxena

Publications and source records attributed to R Saxena.

At least 19 recordsLinked to original sources

[Autoantibodies as serological markers in the diagnosis of glomerulonephritis].

Autoimmunity is now regarded as the unequivocally predominant pathogenic process underlying most forms of primary and secondary glomerulonephritis in humans, and a number of autoantibodies occurring in conjunction with glomerulonephritis have been discovered. However, apart from the anti-NC1 antibodies occurring in classic Goodpasture's syndrome, the exact pathogenic role of these autoantibodies in human glomerulonephritis remains to be established, though this in no way diminishes the importance of their study. They have been of enormous value in subclassifying glomerulonephritis, previously thought to be a homogeneous entity. Autoantibody analysis has become a vital aid in the early diagnosis of rapidly progressive glomerulonephritis, which in turn has enabled treatment to be started early, thus contributing to a decline in the morbidity and mortality resulting from these disorders. Moreover, investigation of these autoantibodies will be of immense value in future studies focused on the pathogenic mechanisms involved in glomerulonephritis.

Anti-Glomerular Basement Membrane Disease

Isolated right ventricular infarction.

The literature on isolated right ventricular infarction is reviewed and local experience is reported. Chronic lung disease is an important risk factor. Chest pain and breathlessness are common. Syncope and sudden collapse can also occur. Rhythm disorders include sinus bradycardia, atrial fibrillation and ventricular tachycardia or fibrillation. Atrioventricular block is rare. Hypotension and a right-sided fourth heart sound are common. Cautious use of slow-release nitroglycerin is not hazardous in the absence of hypotension. High doses of steroids and anticoagulants can be helpful. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall or massive pulmonary embolism.

Adrenal Cortex Hormones

Autoimmunity and glomerulonephritis.

Autoimmunity is now unequivocally regarded as the predominant pathogenic process underlying most forms of primary and secondary glomerulonephritis in humans. Most of the investigations so far have been focused upon humoral mechanisms. Consequently, the role of cell-mediated immunity in nephritis is still incompletely understood. Nonetheless, as a result of contemporary studies, a number of previously unidentified auto-antibodies in association with glomerulonephritis have been discovered. However, apart from anti-NC1 antibodies in the classical Goodpasture syndrome, the exact role of these auto-antibodies in the pathogenesis of glomerulonephritis yet remains undefined. This fact, however, does not undermine the relevance of exploring these auto-antibodies. They have been of immense help in sub-classifying glomerulonephritis previously thought homogeneous (Figure 3). Besides, analysis of auto-antibodies has assisted tremendously in the early diagnosis of rapidly progressive glomerulonephritis. This, in turn, has aided in early commencement of therapy thus contributing to regression in morbidity and mortality resulting from these disorders. Moreover, investigation of these auto-antibodies is of enormous value for future studies aimed at understanding the pathogenic mechanisms involved in glomerulonephritis.

Autoantigens

Alpha-fetoprotein production by rhabdomyosarcoma of the urinary bladder.

Alpha-fetoprotein has emerged as a useful diagnostic tool for hepatic tumour and tumours of germ cell origin. However, isolated case reports of association of this tumour marker with tumours of the lung and non-germ cell tumours of the ovary are reported. We present a case of a Rhabdomyosarcoma, a generally non-secretory tumour that showed raised levels of AFP in serum and reacted positively for the same in a PAP technique for AFP. Cross striations were visible in many cells on II & E stained sections.

Child

Paget's disease of the breast: a study of 43 cases.

Paget's Disease of the breast is caused by spread of duct carcinoma cells along the mammary ducts to the epidermis of the nipple and areola. This is a study of 43 cases of Paget's Disease of the breast. Though only few patients presented with a lump; a carcinoma, either DCIS or IDC or both were found in all cases. The presence of an underlying breast carcinoma in Paget's Disease of the breast suggests that radical mastectomy is the treatment of choice in this condition.

Adult

Postpartum myocardial infarction treated by balloon coronary angioplasty.

Acute myocardial infarction in pregnancy is a rare event that carries substantial morbidity and mortality. New technologies have been developed in cardiology to open obstructed vessels during the acute evolution of coronary thrombosis. We present a case of acute postpartum myocardial infarction in a woman with class F/R diabetes. She underwent successful balloon angioplasty but developed chest pain suspicious of angina pectoris 6 weeks after the procedure. A thallium scan demonstrated fixed defects in the inferoposterior and posterolateral segments and minimal apical redistribution. This represents the second case of angioplasty performed in pregnancy and the first for an acute myocardial infarction.

Adult

Angiolymphoid hyperplasia with eosinophilia (Kimura's disease): report of a large-sized lesion.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon lesion with a predilection for skin of the head and neck region. It usually presents as one or a few smooth-surfaced nodules which are often asymptomatic. Histologically the nodules reveal two components: abnormal proliferating vessels and a cellular infiltrate consisting of lymphocytes and eosinophils, involving both the dermis and the subcutaneous tissue. A case is presented of an unusually large recurrent lesion on the scalp.

Adult

Circulating anti-entactin antibodies in patients with glomerulonephritis.

Sera from 305 consecutive patients in a renal biopsy series were analyzed for the presence of anti-entactin antibodies by ELISA. Of these patients, 59% had primary glomerulonephritis, 21% had secondary glomerulonephritis, while 20% had other nephropathies (noninflammatory conditions like amyloidosis, diabetic nephropathy, nephrosclerosis, etc.). Forty-one of these patients (13.4%) were positive for IgG/IgM antibodies against entactin: 60% of them had primary glomerulonephritis, 35% had secondary glomerulonephritis, while the remaining 3 patients had other nephropathies. Fifteen (70%) of the 23 patients with primary glomerulonephritis had proliferative glomerulonephritis (PGN), whereas 13 (87%) of the 15 patients with secondary glomerulonephritis were due to systemic connective tissue diseases (SCTD): 7 due to SLE, 4 due to SLE like SCTD and two due to other SCTD. There was a peak of incidence corresponding to the group aged 18 to 30 years. A majority of these patients (12 of the total 17) had primary glomerulonephritis and were associated with nephrotic or subnephrotic grade proteinuria, poorly or nonresponsive to immunosuppressive treatment and associated, in several cases, with progressive deterioration of renal function. In addition, there was a tendency to another peak in the age group 51 to 60 years. Most of these patients (6 of the total 8) had glomerulonephritis secondary, mainly, to SLE or SLE like SCTD with milder degree of proteinuria and better preserved renal functions. Anti-entactin antibodies were not found in certain glomerulonephritides like IgA nephropathy and those secondary to systemic vasculitides and in control subjects (healthy subjects, and patients with a variety of non-renal disorders including inflammatory diseases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Evaluation of four coagulation tests to detect plasma lupus anticoagulants.

Lupus anticoagulant was detected in 205 newly diagnosed, untreated patients with systemic lupus erythematosus by the following tests: kaolin clotting time, activated partial thromboplastin time, plasma prothrombin time, and, in the last 99 patients, by dilute Russell's viper venom time. In 10 patients, lupus anticoagulant was detected by kaolin clotting time prolongation, corrected by inosithin but not by normal plasma; 12 and 6 of them had prolonged activated partial thromboplastin time and partial plasma prothrombin time, respectively. Only 10 patients had a history of recurrent abortions and/or thrombosis, nine of whom had lupus anticoagulant as shown by the kaolin clotting time test. Of the 99 patients studied by all four tests, 9 showed lupus anticoagulant by both kaolin clotting time and dilute Russell's viper venom time; 7 had a history of abortion and/or thrombosis. The dilute Russell's viper venom time test is easy to perform and not affected by inhibitors to factor VIII or IX. It is recommended as a primary screening test for lupus anticoagulant detection in a hospital clinical laboratory.

Adolescent

Circulating autoantibodies in patients with extracapillary glomerulonephritis.

Circulating autoantibodies, namely c-ANCA, MPO-ANCA, anti-Goodpasture (anti-NC1), and anti-entactin antibodies were analysed in sera from 82 consecutive patients with crescentic involvement of more than 50% glomeruli in renal biopsy specimens. Sixty-eight (approximately 83%) patients possessed one or more of these autoantibodies. About two-thirds of all patients had ANCA (c-ANCA, MPO-ANCA or both). Most of the remaining positive patients had anti-NC1 antibodies. Very few patients had anti-entactin antibodies, thereby suggesting a poor association of these antibodies with extracapillary glomerulonephritis (ECGN). Thus two different categories of patients, one possessing ANCA and the other anti-NC1 antibodies, could be recognised. Patients with anti-NC1 antibodies were characterised by linear immune deposits along the glomerular basement membrane and the clinical outcome was invariably grim. On the other hand, despite no significant difference in renal morphology from patients with anti-NC1 antibodies, the disease in patients with ANCA, in general, had a milder course. Among patients with ANCA, those with c-ANCA mainly had systemic small-vessel vasculitis with widespread systemic manifestations, whereas most patients with renal restricted primary ECGN with non-linear immune deposits possessed MPO-ANCA. Furthermore, patients with c-ANCA had a more severe disease than those with MPO-ANCA. These observations indicate that a continuous spectrum of diseases exists between idiopathic small-vessel vasculitides and primary non-linear ECGN. Our study also demonstrates that the presence of auto-antibodies is a dominant feature of severe ECGN and that the type of immunological injury is more important than the extent of crescentic involvement of glomeruli in determining the course of illness in patients with ECGN.

Adolescent

Intraductal hepatocellular carcinoma with normal liver--case report.

Hepatocellular carcinoma commonly invades the portal vein but is rarely seen in the bile duct. When seen, a minor intraductal component usually accompanies a prominent hepatic involvement. We report a case of hepatocellular carcinoma that entirely involved the common bile duct, the hepatic involvement was undiscernible at operation or ultrasonography. The patient had obstructive jaundice both at first presentation and at recurrence. The liver was normal at both explorations. The elevated AFP levels returned to normal after second resection. The diagnosis was confirmed by electron microscopy.

Carcinoma, Hepatocellular

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria.

Clinico-haematological parameters in sixteen patients of paroxysmal nocturnal haemoglobinuria (PNH) are presented. Their modes of presentation included recurrent episodes of cola-coloured urine (6/16), refractory anaemia (9/16) and predominant thrombotic manifestations (1/16). Laboratory investigations revealed the presence of anaemia (16/16), reticulocytosis (14/16), thrombocytopenia (11/16), leucopenia (5/16) and cellular bone marrow (14/16). Two patients had hypoplastic bone marrow initially but subsequently developed PNH. The patients were treated with haematinics, prednisolone (16/16) and oxymethalone (2). Prednisone was effective in suppressing haemolytic episodes. Oxymethalone given to the 2 patients with hypoplastic bone marrow resulted in amelioration of anaemia in one but no effect in the other patient.

Adolescent

Effect of calcium channel blocker (diltiazem) on platelet aggregation.

Platelet aggregation with collagen, ADP and sodium arachidonate was significantly inhibited by 0.48 and 0.24 mg/ml of diltiazem but no significant effect occurred with 0.024 mg/ml of diltiazem. It is suggested that the antiplatelet property of diltiazem may be utilized in clinical setting and diltiazem may be tried synergistically with other antiplatelet drugs.

Diltiazem