Biomedical subjects
Publications and source records attributed to S M Chandi.
We have confirmed the usefulness of nifedipine in the treatment of pain present in lesions of multiple skin leiomyomata. Our patient, a 28-year-old woman, had hundreds of skin lesions, proven histologically to be leiomyomata. Nifedipine (10 mg) three or four times daily was remarkably effective in diminishing pain that was more marked in the winter season.
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Measurements of the maximum width and depth of the intertubercular sulcus (ITS), angles of the medial and lateral walls with the floor of the ITS, as well as the length of the humerus in 100 right and 100 left matched, unpaired dry humeri of 100 adults were statistically analyzed. Since 90-95% of the general population is right handed, on the basis of altered size of the dimensions of the right ITS relative to the left, it is proposed that greater width and smaller angles of the medial and lateral walls of the ITS of one side are indicative of handedness on that side. Handedness can further be deduced by the presence of a < 50 degrees angle of the medial wall and of a supratubercular ridge of Meyer on that side. The length of the humerus correlated with the width and depth of the ITS (P < 0.001). Regression equations of the length of the humerus on width, depth, as well as width and depth of the ITS have been derived.
A 7-year-old girl presented with focal seizures without symptoms of raised intracranial tension. Routine histological, immunocytochemical and ultrastructural methods revealed a desmoplastic low grade cerebral astrocytoma. Follow up for 2 years after biopsy did not show recruitment of neurological symptoms or signs. Biphasic tumours containing glial and mesenchymal elements have been described in the literature under various diagnostic headings. As the histologically benign variants of mixed glial and mesenchymal tumours appear to have a good prognosis, identification of these as separate entities seems imperative. With a review of literature we propose a pathological classification of mixed glial and mesenchymal tumours.
Neuro-axial melanotic schwannoma is a rare entity. We report the clinical, CT and pathological features of a solitary, cellular intracerebellar melanocytic schwannoma in a 65-year-old woman. The probable origin of this type of tumour is discussed.
A study of the clinical, radiological, and pathological correlations in 43 patients with solitary cysticercus granuloma and epilepsy focused on factors that might help in predicting the presence of the parasite in the granuloma and those that might influence the formation of oedema around the granuloma. The duration of symptoms (< six months and > or = six months) and CT morphology of the granuloma (ring and disc, type A; nodular lesion, type B) were studied as factors that could possibly predict the presence of the parasite in the granuloma. The influence of sex of the patient and the presence of a neutrophilic response in the granuloma on the intensity of oedema around the lesion as seen on CT was also studied. The pathological features were studied in the excised granulomas. The intact or degenerated form of the cysticercus was evident in 22 of 43 specimens. Neither the duration of seizures (P = 0.17) nor the type of lesion on CT (P = 0.16) was predictive of the presence of the parasite in the granuloma. The sex of the patient (P = 0.51) and the neutrophilic response in the specimen (P = 0.73) did not correlate with the degree of oedema on CT indicating that neither of these host factors was a major determinant of oedema production. The findings point to the varied and unpredictable natural history of solitary cysticercus granulomas and the complex nature of host-parasite interactions in individual patients. The inability to predict the presence of the parasite in the granuloma on the basis of the clinical or radiological features precludes a selection of patients with such lesions for cysticidal drug treatment.
A 52-year-old man presented with symptoms of progressive cervical radiculomyelopathy. A myelogram showed an intradural block at the C-6 level. Magnetic resonance T1-weighted imaging revealed a hypointense, sausage-shaped mass extending from C-3 to C-6, located posterolaterally on the right side and pushing the spinal cord to the left and anteriorly. At surgery, a mass was found attached solely to the pia mater, with a normal arachnoid and dura mater overlying it. The mass was excised completely and microscopic examination identified a mesenchymal chondrosarcoma. The patient was symptom-free 6 months after surgery.
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Melanotic neuroectodermal tumors occur very rarely in the epididymis, only eleven cases having been reported to date in the world literature. An additional case is reported which we believe is the first from India.
Selective flexion deformity of the middle and ring fingers resembling a mild type of Volkmann's contracture resulted from Cysticercus cellulosa infection within the deep flexor muscle of the forearm in a middle-aged woman. Excision of the fibrotic segment of the muscle and tenodesis of all the flexor profundus tendons restored normal range of motion to these fingers. Vascular compromise in addition to the inflammatory response to the infection were considered causes for the deformity. There is no previous report of this kind in the literature.
Cranial nerves, being of fine caliber and having a poorly defined epineurium, pose problems in intracranial sutural anastomosis. The CO2 laser is a comparatively new prospect that is being evaluated for sutureless neural anastomosis. Because there are no reports on the laser anastomosis of a peripheral spinal nerve to a cranial nerve, we designed this study to explore the possibility of performing a laser anastomosis of the facial nerve, using an autologous sural nerve graft in a primate model. Six monkeys underwent resection of the right facial nerve in the parotid fossa. In five of them, the CO2 laser was used to anastomose sural nerve interposition grafts by the use of microsurgical techniques. In one control animal, the sural nerve graft was interposed between the cut ends of the facial nerve and no anastomosis was performed. Compound muscle action potentials were recorded preoperatively and 2, 4, and 6 weeks postoperatively. At the end of 6 weeks, the wound was again explored and the grafts were examined. The neurophysiological results showed that in the five laser-welded nerves, at 4 weeks and 6 weeks postoperatively, the proximal latencies showed an improving trend with each successive recording. It was concluded that the CO2 laser can be used for the anastomosis of interposition grafts to the facial nerve.
We report two cases of primary Ewing's sarcoma of the skull. The literature contains previous reports of only four such cases.
Nondiagnostic biopsies were analyzed in a consecutive series of 407 patients undergoing computerized tomography (CT)-guided stereotactic biopsies. These were categorized as either negative biopsies, when normal tissue or nonspecific pathology was found, or inconclusive, when a definitive diagnosis could not be made although representative tissue was obtained. Nineteen biopsies (4.7%) were negative and 10 (2.4%) were inconclusive, giving an overall nondiagnostic biopsy rate of 7.1% (29 of the 407 cases). Suspected neoplastic masses (390 cases) were classified on the basis of their CT morphology into four groups: Group 1 included purely hypodense nonenhancing masses; Group 2 included isodense nonenhancing masses; Group 3 included ring-enhancing masses; and Group 4 included mixed-density enhancing masses. Although a higher proportion of hypodense nonenhancing masses (six of 56, or 10.7%) yielded a negative result, there was no statistically significant difference in the negative biopsy rates for the different CT categories (p = 0.06). The negative biopsy rates for the 6 years of the study, 1987 to 1992 (1987 being an incomplete year) were as follows: 13.3%, 6%, 3.2%, 3%, 5.8%, and 2.7%. There was no significant decrease in the negative biopsy rate as experience with this procedure increased (p = 0.20). A total of eight surgeons independently performed the biopsies. There was no significant difference (p = 0.24) in the negative biopsy rate of the surgeon with the most experience (124 biopsies, 2.4% negative biopsy rate) compared with that of the seven other surgeons combined (283 biopsies; 5.7% negative biopsy rate). These findings suggest that the yield in a stereotactic biopsy is independent of the CT appearance of the mass. Adherence to certain basic principles in patient and target selection will ensure a reasonable percentage of positive yield with stereotactic biopsy procedures even if the surgeon is relatively inexperienced. There does not appear to be a learning curve in the performance of CT-guided stereotactic biopsies. The management of patients with nondiagnostic biopsies is discussed.
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At caesarean section the right ovary of a patient was found to be absent. There was an omental cyst that was excised and this was found to be an ectopic ovary. This case is reported because of its rarity. The nomenclature and embryological aspects of the condition are discussed.
Cystic cerebellar schwannoma is a rare tumour which may not be considered when a low attenuation computed tomographic (CT) lesion is seen in the cerebellar parenchyma. Since the origin of the Schwann cell in the cerebellar parenchyma is conjectural, immunohistochemical techniques are necessary for a diagnosis.
The pathological findings in a multinodular malignant oncocytoma of the parotid gland in a male 62 years of age, with tumour infiltration into the adjacent skin and skeletal muscle and with regional lymph node metastasis is presented.