Biomedical subjects
Publications and source records attributed to S Goel.
A case of plasmacytoma arising from the hyoid bone is described, this is a distinctly unusual site, as the marrow-containing flat bones are more commonly affected. On a review of the literature this appears to be the first report of plasmacytoma occurring in the hyoid bone. The patient underwent a CT scan and plain radiographs. Histopathology was diagnostic.
Detection of carbamylated haemoglobin, measured as valine hydantoin per g haemoglobin (VH/g Hb), may be useful in differentiating between patients with acute or chronic renal failure. To assess this test, we measured carbamylated haemoglobin prospectively in 42 consecutive patients referred to the regional renal unit with a serum creatinine in excess of 500 mumol/L and a provisional diagnosis of acute renal failure (ARF). Patients were subsequently classed on clinical criteria as having ARF (20) or acute on chronic renal failure (AonCRF, 22). 24 patients with stable chronic renal failure (CRF), matched for degree of renal impairment, were also studied. Standard biochemical tests and haemoglobin were similar among the three groups. Patients with ARF of 10 or less days duration had a lower median (interquartile range [IQR]) carbamylated haemoglobin concentration than those with a longer duration of ARF (29 [27-35] vs 72 [60-83] micrograms VH/g Hb; p < 0.01). Carbamylated haemoglobin concentration was lower in the ARF group than in the AonCRF or CRF groups (42 [31-67], 116 [83-119], and 148 [122-210] micrograms VH/g Hb, respectively; p < 0.001). All patients with a degree of acute and potentially, reversible renal failure (ARF and AonCRF) had a carbamylated haemoglobin concentration below 190 micrograms VH/g Hb (sensitivity 100%, positive predictive value 62% for this cut-off). When the ratio of carbamylated haemoglobin to serum creatinine was calculated, to correct for degree of renal failure, a value of less than 0.2 had a 100% sensitivity and 80% positive predictive value for dividing patients with potentially reversible renal failure from those with CRF. Measurement of carbamylated haemoglobin was useful in identifying patients with acute and potentially reversible forms of renal failure. This test could be of clinical value in deciding which patients require urgent referral for further management and treatment in hospitals without specialist nephrological care.
Pamidronate was given to 10 patients with end stage renal failure who had become symptomatically hypercalcaemic due to the use of calcium based phosphate binders and alphacalcidol. All patients were initially treated with rehydration, increased dialysis and withdrawal of drugs, however despite this they remained symptomatic and the serum calcium remained elevated, mean 3.89 mmol/l (range 3.44-4.74). Pamidronate was given, and the serum calcium had declined to 2.92 mmol/l (2.79-3.84), p < 0.01 by the third day. The reduction in serum calcium observed with pamidronate was more rapid than that in 9 patients who developed asymptomatic hypercalcaemia, mean serum calcium 3.45 mmol/l (3.4-3.56), with an actual median reduction of 0.72 mmol/l (0.37-1.30) in the pamidronate group after 3 days compared to 0.20 mmol/l (0.10-0.52) in the conservatively treated asymptomatic group, p < 0.01, and a median percentage decrease of 19% (10-30) in the pamidronate group and 6% (3-15) in the asymptomatic group, p < 0.01. In this study pamidronate was a safe and effective agent in reducing serum calcium in a group of hypercalcaemic dialysis patients.
Five hundred soil samples were examined for Nocardia species in Patiala area by using paraffin bait technique. Forty (8 per cent) yielded Nocardia species. All the forty isolates identified as Nocardia asteroides were pathogenic to white mice.
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We report two cases of herpes-zoster in which the administration of acyclovir to patients with end-stage renal failure treated by continuous ambulatory peritoneal dialysis (CAPD) resulted in acyclovir neurotoxicity, even though the doses administered were within those recommended by the manufacturer's data sheet for patients with renal failure. Acyclovir removal was negligible with peritoneal dialysis and one patient died. The other patient was successfully treated with hemodialysis, which effectively reduced plasma concentrations, resulting in an improvement in conscious state. Acyclovir neurotoxicity should be considered in patients with renal failure who have been treated for viral infections, in whom the conscious state has deteriorated despite normal brain computed tomography (CT) scan and lumbar puncture investigations. Hemodialysis is the preferred treatment for the rapid removal of acyclovir.
We studied the effect of converting 100 established CAPD patients from aluminium- to calcium-based phosphate binders. After a follow-up of 1 year only 60% of patients remained on calcium carbonate. Hypercalcaemia was the major problem, with more than 40% of patients having a serum calcium in excess of 3.0 mmol/l. Several patients required hospitalization for symptomatic hypercalcaemia. Hypercalcaemia was more common in patients with normal serum parathyroid hormone concentrations (65 versus 25%, P less than 0.01). Serum phosphate control was better prior to commencing calcium carbonate when patients were treated with aluminium phosphate binders mean 1.71 +/- 0.15 mmol/l (SEM) than at the time of maximum serum calcium concentration, 1.81 +/- 0.25, P less than 0.05. This study does not confirm the findings of others, which have suggested that calcium carbonate is a safe and effective phosphate binder for patients with end-stage renal failure.
Holter monitoring is a technique which involves the use of a specialized recorder to record and analyze the ECG of an ambulatory subject for a duration up to 24 h. It is used for persons who have generally normal ECG, but who experience heart disorders under some particular stress conditions. This paper describes the design of an 8086-based Holter monitor using state-of-the-art technology. The old concept of analog signal processing and cassette recording has been replaced by digital signal processing and solid state memories. The main features of the new monitor, as compared with conventional ones, is its intelligence to detect and record arrhythmias which are of clinical importance. Emphasis was placed on miniaturization and minimization of the power consumption while designing the monitor.
Sixteen cases of carcinoma head pancreas and seven cases of periampullary carcinoma are staged together on CT scan because of their morphological similarity and similar parameters. Following parameters are considered for CT staging: tumour mass, involvement of splanchnic vessels, locoregional lymph nodes and presence or absence of hepatic metastases. Findings were confirmed on surgical exploration. A contrast enhanced CT scan was 58.3 percent sensitive and 100 percent specific for the involvement of lymph nodes and 100 percent sensitive and 93.4 percent specific for hepatic metastases. The cases diagnosed as non-resectable on CT staging were found inoperable on exploration. Authors believe that for all practical purposes, pancreatic and periampullary malignancies can be grouped together and a contrast enhanced CT scan can provide reliable information for the staging of the tumor.
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Sodium valproate was used as monotherapy in 90 cases with epilepsy who had at least one fit per week, irrespective of the type of seizures. The effect of the drug was evaluated on the basis of change in seizure frequency. Serum valproic acid levels were estimated by homogenous enzyme immunoassay. All the patients with absence (5/5) and myoclonic (3/3) seizures and 80% (42/53) of cases with generalized tonic-clonic seizures, became seizure free. Six of ten patients with only tonic seizures became seizure free. An average daily dose of 19.6 mg/kg provided a mean valproic acid level of 81.4 micrograms/ml in all seizure free patients. No correlation could be established between valproate dose and serum levels. Mild transient side effects were noted. No haematologic abnormality or hepatotoxicity was observed. Valproate sodium effectively controlled seizures in a majority of patients with partial seizures. Serum level monitoring helps to establish an optimal dose to keep the patient seizure free. No correlation could be established between side effects and serum levels.
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Intentional replantation of mandibular molars was performed in forty patients. Different materials were used for sealing the apex. Healing was assessed by measuring biting force at 2-month intervals for up to 6 months. Gold foil was found to be the best material for apical sealing when improvement in biting force was used as the criterion.