Biomedical subjects
Publications and source records attributed to S Singhal.
An extremely rare case of asymptomatic squamous cell carcinoma of the esophagus metastatic to the spine leading to paraplegia is reported. The rarity of such an event signifies the relationship between hypercalcaemia and carcinoma of the esophagus. Its occurrence as a second silent primary neoplasm and its association with a negative esophagogram is highlighted.
Occurrence of skeletal metastases in carcinoma of uterine cervix is infrequent. There are only a few cases who present wits osseous involvement at the time of initial diagnosis. Appearance of skeletal metastases in carcinoma uterine cervix is an ominous sign of progression of disease. Screening studies for detection of occult skeletal metastases in asymptomatic patients are not recommended.
A modified high frequency resonant oscillations (HFRO) technique was developed to improve the nasal muco-ciliary transport in patients with impaired ciliary functions due to various chronic diseases of the upper respiratory tract. Twelve healthy males (group I) and ten patients suffering from malignancy of the upper respiratory tract (group II) were exposed to HFRO in order of 200, 250, 300, 400, 500 Hz respectively. The muco-ciliary transport (MCT) was assessed by using saccharine clearance time technique. A significant improvement in MCT was observed in both the groups at all the frequency levels, more so in the range of 400 and 500 Hz. An overall relative improvement of 174 per cent (P less than 0.01) in group I and 145 per cent (P less than 0.001) in group II was observed. No significant side effects were noted.
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Cyclosporine administration can result in graft-vs-host disease (GVHD) after syngeneic or autologous bone marrow transplantation (BMT). However, data on its anti-tumor effects are limited. We have tried to produce cyclosporine-induced GVHD or graft-vs-leukemia (GVL) against two Ia-bearing murine leukemias. BALB/c mice undergoing syngeneic BMT after total-body irradiation received 1 mg/kg or 10 mg/kg cyclosporine or dextrose intraperitoneally for 30 days post-transplant, followed by 5 x 10(3) BCL1 murine leukemia cells 1 or 3 weeks after stopping cyclosporine. Similarly, SJL/J mice undergoing syngeneic BMT received 10 mg/kg cyclosporine or dextrose intraperitoneally for 30 days post-transplant, and were inoculated with 5 x 10(3) or 10(5) murine acute myeloid leukemia (mAML) cells 3 weeks after stopping cyclosporine. No clinical or histological evidence of GVHD was seen, and leukemia-free and overall survival was similar with cyclosporine and dextrose. We conclude that under the experimental conditions used, it is not possible to induce syngeneic GVHD with cyclosporine in BALB/c or SJL/J mice. In the absence of GVHD, this approach is also not associated with any GVL effect against murine leukemias BCL1 and mAML.
India is a land of varied foods and food habits. This makes the task of collecting dietary and nutrient intake data difficult. Methods need to be devised to improve the accuracy in reporting intakes by various population subgroups. There is an urgent need to develop a questionnaire that is simple enough to be administered on a large sample and whose validity and reproducibility has been quantified. Regional differences in food habits and availability will have to be taken into account in the questionnaire design. Packaging of food items with definite portion sizes is not a common practice in Indian markets and labels on food products are neither very informative nor descriptive. Epidemiologists addressing the effects of diet have generally used questionnaires that inquire about the frequency of specified foods consumed and sometimes also attempt to quantify usual portion sizes. A number of investigators have conveyed, apparently independently, that the food frequency questionnaire (FFQ) as a method of dietary assessment is best suited for most epidemiological applications. A food frequency list can form the basis for nutrition education and allows the dietician and the patient to relate individual eating patterns to specific foods. Other advantages of the FFQ are that it is independent of the ability or inclination of an individual to maintain a diary and also provides immediate feedback to patients, physicians and counsellors.
BACKGROUND: We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls. METHODS AND RESULTS: A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05). CONCLUSIONS: An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).
Peak expiratory flow rate (PEFR) of 106 children working in different units of lock factory was measured and compared with age and sex matched control group of same socio-economic status children. All the children worked for about ten hours per day. It was observed that there was a significant decrease in PEFR of children working in the different units of lock factories i.e. Hand press, Polishing, Lock fitting, Lock packing units as compared to control group (P>0.001). The reduction percentage of PEFR was maximum in children working in polishing unit (25.48%).
A rare case of primary plasmacytoma of the stomach is reported. The diagnostic value of gastroscopy leading to non-surgical management is highlighted. Radiation therapy is an effective alternative mode of treatment and should be employed as the primary modality of therapy.
Computed tomography (CT) has been suggested as an alternative to surgery for predicting the stage and resectability of primary gastric lymphoma. It is our policy to perform CT scan on all patients and the decision to explore is based upon CT findings. We reviewed our experience to see if any changes were warranted. 12 patients with primary gastric lymphoma underwent CT scanning. The CT findings were compared with the pathological findings available for 10 patients. CT correctly staged 90 per cent of the patients and it obviated unnecessary exploratory surgery in 42 per cent of the patients. It permitted the planning of non-excisional therapy in 75 per cent of the patients and was useful as an indicator of response to therapy and as a follow up measure.
A 14 year old boy with well differentiated squamous cell carcinoma of the upper oesophagus is being presented because of its rarity. The patient presented with dysphagia for 8 months. Barium swallow and endoscopy revealed a narrowing in the upper oesophagus with a proximal dilatation diverticulum. No definite aetiologic factor could be demonstrated. The case was treated with definitive irradiation with excellent immediate response.
Pedicled omentum, after lengthening, was transferred to the ischemic lower limbs of 12 patients with Buerger's disease to assess its capacity to improve the blood supply to these compromised extremities. The immediate (after one month) and long-term (9-12 months) results were encouraging. After one month, rest pain had diminished in 83% of cases, claudication was relieved in 75% of cases, temperature became normal in all cases (100%) and ischemic ulcers either healed or showed signs of healing in 83% of cases. During long-term follow up (after 9-12 months), the results deteriorated slightly, but they remained promising. Rest pain had disappeared in 80% of cases. Claudication was still relieved in 70% of cases, temperature was still improved in 60% and ulcers had healed completely in 67% of cases.
Adenoid cystic carcinoma constitute around 0.4 to 1.7% of all carcinomas of cervix. It generally presents in elderly age group, however few cases in younger age have also been reported. Majority of cases present in early stage. Though concluding statement regarding the results cannot be made from the cases accumulated from the various reported series, nonetheless this review shows that radiotherapy too is effective in early stage and even in stage I results with radiotherapy appear better than surgery. In advanced stage outcome is invariably poor. In early stage main pattern of failure is distant metastasis. Both local and distant failure are observed in stage III and IV. Though lung is the commonest site of metastases (51%), abdominal cavity and brain are also found to be involved in some cases. Limited experience shows effectiveness of high doses of cisplatin and multiagent chemotherapy. Cases of early stage disease having risk for metastases and local failure should be identified and managed with multimodality treatment using surgery for bulky disease with post-operative radiotherapy and chemotherapy. In advanced stages combination of chemotherapy and radiotherapy is required. Exenterative surgery for central failure has been used effectively. Overall no evidence of disease rate is found to be about 48%, with mean follow-up of 39 months.
A diagnosis of leiomyosarcoma of ovary was made in a 60 year old female presenting with generalised weakness and abdominal lump. On clinical examination, a hard, big mass with some cystic areas was found occupying the pelvic cavity. Chest X-ray revealed presence of metastases. Deranged renal function and structure due to extrinsic pressure were evident on pyelography and USG. USG also suggested the ovarian origin of the mass. Fine needle aspiration biopsy was suggestive of leiomyosarcoma. Laparotomy was carried out for excision of tumor along with bilateral salpingo-oophorectomy and hysterectomy. Post-operatively renal functions normalized. A course of radiotherapy was given. At 6 months' follow-up, abdomino-pelvic sonography was normal but lung metastases were found to be enlarged. The patient was asked to follow up for chemotherapy but did not come. She died 18 months after treatment, as revealed through correspondence.
In order to predict possibility of local control in carcinoma of the oesophagus by radiotherapy, the relationship between the x-ray findings before and after radiotherapy were analyzed in 55 irradiated cases. In the superficial or proliferative type on x-ray before treatment, local control was observed in 87% cases with dose of 40 Gy, whereas in the ulcerative or infiltrative type it was observed in 20% cases. Radiation response is remarkably good in proliferative and superficial lesions seen in oesophagogram.
Adenoid cystic carcinoma of the cervix is a rare disease. It usually occurs in an elderly age group. A case who presented at a younger age (30 years) is being reported. The chief complaint was excessive vaginal bleeding for 2 months. Per vaginum examination revealed a growth. She was staged FIGO IIIb. She was treated with radical radiotherapy. Disease regressed slowly and complete local response appeared after six months of treatment. Presentation of adenoid cystic carcinoma in younger age group and effect of radiotherapy in advanced stage is reviewed.