Superoinferior ventricles: report of six cases.
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Biomedical subjects
Publications and source records attributed to S G Kinare.
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In our study of 1326 autopsied cases of congenital heart disease, we have encountered 3 cases of atresia of the common pulmonary vein. This is a rare condition of which, to the best part of our knowledge, only 19 cases have been reported so far. Interestingly, two of our cases were associated with isomerism of the right atrial appendages, and one also had a common arterial trunk. The association with isomerism of the right appendages, and with absence of the spleen, has been observed previously but no previous case of which we are aware has had a common arterial trunk. Atresia of the common pulmonary vein is part of the spectrum related to totally anomalous pulmonary venous connexion, a lesion known to be frequently associated with isomerism of the right atrial appendages. Atresia of the common pulmonary vein, however, has not commonly been found with isomerism of the right appendages.
The etiology of acute rheumatic fever (ARF) is believed to involve an immunological response to group A streptococcal antigens. Antibodies to group A carbohydrate (A-CHO) have been reported in ARF and rheumatic heart disease patients. As N-acetylglucosamine (GlcNAc) units form the major immunodominant regions in A-CHO antigens, we investigated levels of antibodies to GlcNAc and heparin (with repeated sequences of GlcNAC) in rheumatic fever (RF) patients. Serum samples from 26 acute cases (ARF), 18 remission cases and 17 normal healthy subjects were analyzed for IgG and IgM levels of antibodies to GlcNAc and heparin. High titres of IgG antibodies to heparin and GlcNAc were observed in the ARF group in comparison with controls (p less than 0.0025 and 0.0125 respectively). There was no difference in the levels of IgM antibodies. Remission group demonstrated low titres of IgG to heparin and GlcNAc (p less than 0.01 and 0.0125 respectively) in comparison with ARF group. Heparin antibodies of IgM class was comparatively lower in remission group (p less than 0.005). While the role of these antibodies in different phases of RF needs to be investigated, we conclude that GlcNAc antibodies do not play any role in the pathogenesis of RF or rheumatic heart disease.
Congenital Bicuspid Aortic Valve is a common congenital anomaly. We studied 48 cases of bicuspid aortic valve seen over a period of 20 years. 18 cases were associated with other congenital anomalies, patent ductus arteriosus being the most frequent. 30 were isolated lesions. The morphology of the cusps and position of raphe were noted. Calcification and infective endocarditis were frequently noted in the isolated forms of Bicuspid Aortic Valve. Coronary arteries were dissected in 32 cases to determine the dominance.
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Two hundred and twenty one consecutive cases of bronchogenic carcinomas were studied histologically for evidence of associated lesions. Seventy eight lesions were seen in 55 patients (24.8%). The most frequent was tuberculosis, seen in 29 patients. The next in frequency were scars, in 22, emphysema in 12 and thickened pleura in 7. Interstitial fibrosis, chronic bronchitis, lobar pneumonia and bronchiectasis, were other lesions, seen in very few cases. The types of carcinoma, in which associated lesions seen were, undifferentiated carcinoma (76%), adeno-carcinoma (56%), mixed tumor (37%), large cell anaplastic (25%), small cell anaplastic (23.7%) and epidermoid carcinoma in (5.44%). The incidence of tuberculous lesions in autopsies unassociated with tumor is 7%, as compared to 24.8% incidence of association with carcinoma; which is significant. There were seven scar cancers; with origin in tuberculous scars in two. The study indicates necessity of prospective study in this field.
Nine cases of acute and 8 cases of chronic tuberculous pericarditis were studied for involvement of epicardial structures such as the S-A node, A-V node and large coronary arteries. Extensive caseation was seen in the region of the S-A node in 2 cases of chronic and one case of acute pericarditis. No nodal tissue was identifiable in these cases. In one more case of chronic pericarditis, granuloma with fibrosis was seen in the S-A node. Minor mononuclear infiltration of the S-A node was seen in 2 cases. In the rest of the cases, the S-A node was normal though inflammation was very close to it in 4 cases of acute and all the cases of chronic pericarditis. The A-V node, bundle of His and coronary arteries were normal in these cases.
One hundred and eighty five consecutive prostate specimens were studied. The predominant lesion noted was benign prostatic hyperplasia (B.P.H.) (92.97%). The incidence of carcinoma was low, (7.02%). Conditions which can mimic and should be considered in the differential diagnosis of carcinoma, like basal cell hyperplasia, atypical hyperplasia and atrophy associated hyperplasia were noted in 10, 4 and 3 cases of B.P.H. respectively. None of these cases showed evidence of carcinoma. Corpora amylacea were noted in 38.91% of the cases of B.P.H. and were conspicuously absent in cases of carcinoma. Chronic prostatitis was frequently encountered (58%) and metaplastic changes were seen in 11% of the cases.
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A quantitative study of the mitral valve and its tension apparatus was carried out in 54 cases of pure mitral stenosis, 13 cases of mitral stenosis with incompetence, both diseased groups due to rheumatism, and 25 normals. In the group with pure mitral stenosis, the annular size was unaltered but the annular attachment of the mural leaflet was decreased. The average circumference of the orifice was 27 mm. The leaflet length increased by 24%. In the group with mitral stenosis with incompetence, the annular size was increased by 18%. The average circumference of the orifice was 39 mm, but no significant increase in the length of the leaflets was found. The rough zone of the aortic leaflet in pure mitral stenosis is disproportionately increased, indicating greater apposition during closure. In pure mitral stenosis, the cords were severely affected as compared to combined lesion. They were totally absent in 18.5% of cases while this lesion was restricted to the aortic leaflet in 37%. The commissural, paracommissural and paramedial cords were not seen in 75, 60, and 72%. The main cords were not seen in 50% of cases. In the combined lesion, cords attached to the aortic leaflet only were absent in 7.69%. The commissural, paracommissural and paramedial cords were absent in 33, 39, and 23%, respectively. The main cords were absent in only 19%. The reduction in lengths of the cords is more marked in cases with pure stenosis. We conclude that the mitral valve is better preserved in the group having stenosis with incompetence, the incompetence being the result of a larger annulus and orifice with normal leaflets and shorter tendinous cords. In pure mitral stenosis, the incompetence through a small orifice is prevented by the longer leaflets, particularly the aortic.
Polymorphonuclear (PMN) cell function was assessed in 30 children with active rheumatic fever (ARF) (Group I), 30 cases with active rheumatic heart disease (RHD) (Group II), 28 cases of ARF and RHD in remission (Group III) and 34 adults with quiescent RHD along with their age matched controls. All the groups showed normal spontaneous and chemotactic movement. Phagocytosis of yeast particles was significantly reduced in groups II (P less than 0.0005), III (P less than 0.025) and IV (P less than 0.005). The opsonic activity of disease sera was low in all 4 groups (P less than 0.0005). The intracellular metabolic activity was moderately elevated in Group III. Phagocytosis and opsonic activity were thus persistently low in all the groups including the remission and quiescent group.
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