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Showing papers in "Journal of Postgraduate Medicine in 1996"


Journal Article
TL;DR: The present study has shown a biological plausability of efficacy of Pk as supported by clinical trial in viral hepatitis, hepatoprotection in animal model and an approach for standardizing extracts based on picroside content.
Abstract: Picrorhiza kurroa (Pk), a known hepatoprotective plant, was studied in experimental and clinical situtations. The standardization of active principles--Picroside 1 and 2 was done with High Performance Liquid Chromatography. Picroside 1 ranged from 2.72 to 2.88 mg/capsule and picroside 2 from 5.50 to 6.00 mg/capsule. In the galactosamine-induced liver injury in rats, Pk at a dose of 200 mg/kg p.o. showed a significant reduction (p < 0.05) in liver lipid content, GOT and GPT. In a randomised, double-blind placebo controlled trial in patients diagnosed to have acute viral hepatitis (HBsAg negative), Pk root powder 375 mg three times a day was given for 2 weeks (n = 15) or a matching placebo (n = 18) was given. Difference in values of bilirubin, SGOT and SGPT was significant between placebo and Pk groups. The time in days required for total serum bilirubin to drop to average value of 2.5 mg% was 75.9 days in placebo as against 27.44 days in Pk group. The present study has shown a biological plausability of efficacy of Pk as supported by clinical trial in viral hepatitis, hepatoprotection in animal model and an approach for standardizing extracts based on picroside content.

82 citations


Journal Article
TL;DR: Of the total 739 cultures of S aureus, 235 were found to be multiply resistant with the individual figures for resistance being 27% (Bombay), 42.5% (Delhi) and 47% (Bangalore).
Abstract: This surveillance study was conducted simultaneously at three centres across India. A total of 13,610 test samples from various sites were obtained. Microbiological methods employed were similar at the three centres. Identification of S aureus was based on the recognition of the production of coagulase with positive isolates being recorded as S aureus. Both tube coagulase tests and slide coagulase test were performed. Antimicrobial susceptibility testing of the isolated strains of staphylococcus aureus and staphylococcus epidermidis to various antimicrobial discs were carried out according to standardized disk diffusion method recommended by NCCLS. Of the total 739 cultures of S aureus, 235 (32%) were found to be multiply resistant with the individual figures for resistance being 27% (Bombay), 42.5% (Delhi) and 47% (Bangalore). MRSA is emerging to be a significant problem pathogen in the surgical setting with vancomycin probably the only reliable choice for these infections.

40 citations



Journal Article
KA Pathak1, RR Khanna1, H. D. Khanna1, S. Khanna1, S. Gupta1, N. N. Khanna1 
TL;DR: Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and provided an average lead time of about 3.9 months before the clinical appearance of metastasis.
Abstract: Serial serum Carcinoembryonic antigen (CEA) levels were measured in 150 individuals (50 patients with breast cancer, 50 benign breast diseases and 50 other controls). These levels were correlated with clinicopathological parameters and follow-up information. Serum CEA levels were independent of the primary tumor status, their histology, lymphoreticular response and the patients' characteristics as well as the age, sex and the menstrual status. However, the nodal status, number of involved nodes and the grade of the tumors had significant influence on the level of serum CEA. Breast cancer patients especially those with metastasis had significantly higher serum CEA levels as compared to the controls and those with localised disease, irrespective of the site of metastasis. These levels were lowered appreciably by the disease regression and were raised or stable during the disease progression. Receiver operating characteristic (ROC) curve showed metastasis to be more frequent in patients with pretreatment serum CEA levels above 25 ng/ml and persistent post treatment CEA levels above 15 ng/ml. Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and serial serum CEA levels provided an average lead time of about 3.9 months before the clinical appearance of metastasis.

25 citations


Journal Article
TL;DR: A rare case of primary fallopian tube carcinoma is reported, which is seldom diagnosed before laparotomy, and the prognosis is described as good.
Abstract: Although Fallopian tubes are frequently involved in benign gynaecological conditions, primary malignant involvement is rare, and because of its rarity, lack of diagnostic accuracy, nonpresenting symptoms and physical findings, primary fallopian tube carcinoma is seldom diagnosed before laparotomy. We are reporting one such rare case.

24 citations


Journal Article
TL;DR: A case of suspected chronic cholecystitis who underwent laparotomy, was found to have agenesis of gall bladder, which should be kept in mind whenever the gall bladder is improperly visualised in routine imaging methods.
Abstract: A case of suspected chronic cholecystitis who underwent laparotomy, was found to have agenesis of gall bladder. Standard investigative modalities which are done for chronic cholecystitis might be fallacious and baffling. Agenesis of gall bladder should be kept in mind whenever the gall bladder is improperly visualised in routine imaging methods.

22 citations


Journal Article
TL;DR: In a series of 207 eyelid tumours and tumour like lesions, pleomorphic adenoma was observed in a male aged 41 years; its incidence being 0.48%.
Abstract: Lid tumours are fairly common. However, pleomorphic adenoma (chondroid syringoma) is quite rare. In a series of 207 eyelid tumours and tumour like lesions, pleomorphic adenoma was observed in a male aged 41 years; its incidence being 0.48%.

19 citations


Journal Article
TL;DR: It is found that surgery (irrespective of whether it was major or minor) significantly depressed PMN and monocyte functions and increased serum cortisol levels and PMN phagocytosis correlated significantly with the rise in serum cortisol.
Abstract: Stress is known to depress the immune system severely. This study was done to evaluate whether surgical stress influenced polymorphonuclear (PMN) and monocyte functions in association with serum cortisol and the anxiety score as measured on the HARS Rating Scale. We found that surgery (irrespective of whether it was major or minor) significantly depressed PMN and monocyte functions and increased serum cortisol levels. PMN phagocytosis correlated significantly (p < 0.05) with the rise in serum cortisol. In spite of these changes, postoperative clinical recovery was uneventful. No major alterations in the HARS scores were noted pre and post operatively. This study demonstrates that surgical stress depresses the immune system with a concomitant rise in cortisol.

17 citations


Journal Article
TL;DR: An eight year old girl presented with acute intestinal obstruction and exploration revealed a structure of proximal jejunum, which demonstrated eosinophilic jejunitis, a rare disease characterised by tissue eOSinophilia.
Abstract: Eosinophilic enteritis or gastroenteritis is a rare disease characterised by tissue eosinophilia which can affect different layers of bowel wall. It can affect any area of gastrointestinal tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently reported. It is important to recognize this disease early and institute the necessary treatment. An eight year old girl presented with acute intestinal obstruction. Exploration revealed a structure of proximal jejunum. Histopathology demonstrated eosinophilic jejunitis. The case is reported owing to this rarity and relevant literature is reviewed.

16 citations


Journal Article
TL;DR: In this study, it was observed that immunoglobulins (i.v.IgG & Rh), and their Fab fragments inhibited the binding of antiplatelet autoantibodies to normal platelets, from 15.8 to 90.8 and 25.7% respectively; whereas, their Fc portion did not show any inhibition.
Abstract: Autoimmune thrombocytopenia (AITP) is caused by autoantibodies to platelet glycoprotein antigens. Intravenous immunoglobulin (i.v.IgG) and Rh immunoglobulin infusions have found great significance in the treatment of AITP patients not responding to corticosteroids and other modes of therapy. In our study, it was observed that immunoglobulins (i.v.IgG & Rh), and their Fab fragments inhibited the binding of antiplatelet autoantibodies to normal platelets, from 15.8 to 90.7% and 25.6 to 90.08% respectively; whereas, their Fc portion did not show any inhibition. The presence of specific anti-idiotypic antibodies to antiplatelet autoantibodies was established by using monoclonal antibodies to Glycoprotein IIb/IIa and Glycoprotein Ib/IX, as the specific idiotype source. The i.v.IgG and Rh immunoglobulin products reacted with the monoclonal antibodies, only through their Fab and not through the Fc portions, thereby confirming its specific anti-idiotype activity.

16 citations


Journal Article
TL;DR: It is felt that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual.
Abstract: Forty cases of Austin Moore Replacement done for transcervical fractures of the femur in patients were reviewed after a period of 12 to 48 months postoperatively (mean 26 mth). 30 cases (75%) had mild to severe pain of non-infective origin, starting as early as 6 months postoperatively. This was irrespective of the make, size or position (varus/valgus) of the prosthesis. Though the Aufranc and Sweet clinical scoring was satisfactory in 65% cases, radiological evidence of complications like sinking, protrusion, etc. were seen in majority of the cases. Calcar resorption was seen in 34 cases (85%) as early as 4 months postoperatively. Results of THR and bipolar replacement done for transcervical fractures in recent literature show 85% pain-free cases at 5 years. We feel that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual. This is corroborated by unsatisfactory results in patients less than 65 years of age (p < 0.05).

Journal Article
TL;DR: A lumbar hernia which had developed following blunt abdominopelvic trauma is described here and the successful surgical correction is reported.
Abstract: A lumbar hernia which had developed following blunt abdominopelvic trauma is described here. The successful surgical correction is reported.

Journal Article
TL;DR: The onset of sensory and motor blockade with lignocaine was faster than pethidine, however the sensory andMotor blockade lasted longer with pETH, while need for additional analgesia were studied.
Abstract: 100 patients with ASA risk I & II and undergoing perianal surgery were studied for anaesthetic effects and postoperative analgesia following either intrathecal pethidine or lignocaine. Saddle block was performed either with intrathecal pethidine 5% (50 mg/ml) 0.5 mg/kg or 1 ml of 5% lignocaine. Sensory and motor block postoperative analgesia, need for additional analgesia were studied. The onset of sensory and motor blockade with lignocaine was faster than pethidine. However the sensory and motor blockade lasted longer with pethidine. The duration of postoperative analgesia was 15.39 +/- 5.14 hours as against duration of postoperative analgesia with lignocaine which was 1.3 +/- 0.53 hours. Only 10% of patients in the pethidine group required intramuscular analgesic supplementation whereas 30% of patients in the lignocaine group required intramuscular analgesic supplementation.

Journal Article
TL;DR: The measurement of preoperative Stg/thyroid mass has been utilised to find out Tg synthesizing capacity of the tumour, and the value of this ratio was significantly higher in the patients with follicular variety than in papillary thyroid carcinoma.
Abstract: Although serum thyroglobulin (STg) is a useful tumour marker to detect the recurrence of tumour in well differentiated thyroid carcinoma, it has as yet not been reported to be of value in predicting the behaviour of thyroid cancer. In the present study of 20 patients, the measurement of preoperative Stg/thyroid mass has been utilised to find out Tg synthesizing capacity of the tumour. This ratio was significantly higher in the patients with follicular variety than in papillary thyroid carcinoma. It was significantly higher in the metastasis group than in the group of patients without metastasis. The patients with functioning metastasis had a higher than average value of this 'ratio' than those with non functioning metastasis, though the difference was not statistically significant. Despite the limitation of a small number of patients included in this study, it is possible to highlight the possible utility of preoperative Stg estimation as a tumour marker in categorization of the patients of carcinoma of the thyroid gland.

Journal Article
TL;DR: This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay with good results with good hypertrophy of bone after union, and one case had poor result with fracture going into delayed union with nohypertrophy.
Abstract: Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.

Journal Article
TL;DR: Positive relationships between a falling sperm count, a decrease in motility and total motile counts were seen and increasingly, abnormal forms were found with lower sperm counts.
Abstract: Variations in semen analyses of 177 males over a 1 year period were assessed. The average means of total counts, motility, morphology, total motile count and non-motile % were determined for 5 classes of patients ranging from azoospermic to normospermic. Positive relationships between a falling sperm count, a decrease in motility and total motile counts were seen. Also, increasingly, abnormal forms were found with lower sperm counts.

Journal Article
TL;DR: There was no recurrence of a Giant Cell Tumour affecting the proximal end of femur, the function was good and the hip was reconstructed using Charnley type of low friction total hip arthroplasty.
Abstract: A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

Journal Article
TL;DR: This article reviews and examines the therapeutic alternatives available to treat multi-drug resistant typhoid (MDRTF) in children with a focus on India.
Abstract: Thyroid fever continues to be a major health problem due to poor hygienic and sanitary conditions prevalent in developing countries. India reported more than 354000 cases of enteric fever in 1991 resulting in 1448 deaths. The emergence of Salmonella typhi strains resistant to multiple antibiotics have been causing enormous childhood morbidity and increasing the cost of therapy. This article reviews and examines the therapeutic alternatives available to treat multi-drug resistant typhoid (MDRTF) in children. (excerpt)

Journal Article
TL;DR: The unusual occurrence of plastic deformation in an adult is described.
Abstract: The unusual occurrence of plastic deformation in an adult is described.

Journal Article
TL;DR: An unusual case of clival chordoma seen in a 7 month 16 day old infant is presented and the literature on this subject, clinical course of such tumours and the management strategy in paediatric age group is reviewed.
Abstract: An unusual case of clival chordoma seen in a 7 month 16 day old infant is presented. The literature on this subject, clinical course of such tumours and the management strategy in paediatric age group is reviewed.

Journal Article
BV Mohan, SS Kishan, PP Munshi, RH Pathak, HH Pandit 
TL;DR: This rare injury requires surgical intervention with anatomic repositioning of the structures responsible for the irreducibility viz. the long Flexor tendon and the volar plate.
Abstract: Two cases of posttraumatic irreducible compound dislocation of the interphalangeal joint of the thumb are presented. This rare injury requires surgical intervention with anatomic repositioning of the structures responsible for the irreducibility viz. the long Flexor tendon and the volar plate.

Journal Article
TL;DR: An eleven year old boy presented with sudden onset right-sided hemiplegia and ipsilateral lower facial weakness and two-dimensional echo revealed the diagnosis of idiopathic dilated cardiomyopathy with multiple intracardiac clots, and died 2.5 months later due to resistant cardiac failure.
Abstract: An eleven year old boy presented with sudden onset right-sided hemiplegia and ipsilateral lower facial weakness Two-dimensional echo revealed the diagnosis of idiopathic dilated cardiomyopathy with multiple intracardiac clots MRI scan of head showed infarctions in the area of caudate nuclei, putamen, brain stem and cerebellum On anticoagulation therapy, all thrombi, except one, disappeared The child died 25 months later due to resistant cardiac failure

Journal Article
TL;DR: Three sibs with mild autosomal recessive variety of osteopetrosis had a typical facial appearance, and the only atypical features were microcephaly, a normal upper segment to lower segment ratio and a normal arm span.
Abstract: We report three sibs with mild autosomal recessive variety of osteopetrosis. The prominent clinical features were short stature, malocclusion of teeth, hepatosplenomegaly and a typical facial appearance. The only atypical features were microcephaly, a normal upper segment to lower segment ratio and a normal arm span.

Journal Article
TL;DR: Antenatal detection of Meckel-Gruber Syndrome associated with short-limbed devarfism is described and this association has not been previously reported.
Abstract: Antenatal detection of Meckel-Gruber Syndrome associated with short-limbed devarfism is described here. This association has not been previously reported.

Journal Article
TL;DR: Doppler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise.
Abstract: Blood flow velocity waveforms were recorded by color Doppler ultrasound from intraplacental villous and umbilical arteries in 20 normal and 23 severe preeclamptic pregnancies. The results of the resistance index measurements in intraplacental villous arteries were 0.51 +/- 0.037 and 0.55 +/- 0.052 in healthy controls and preeclamptics respectively, which was not significantly different. Resistance indices showed a decrease through the umbilical cord from fetus to placenta in both groups. We also noted that Doppler examination of the umbilical cord might be an early indicator of fetal compromise. Detectable intraplacental villous flows were in normal limits even in patients with abnormally high umbilical resistance indices and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise. We conclude that Doppler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia.

Journal Article
TL;DR: Methyl thiazol tetrazolium (MTT) assay can be used as a reliable, simple, rapid and economic method for assessing the viability status based on mitochondrial respiration even for homograft valves.
Abstract: Viability status before and after treatment with antibiotics was investigated in a total of 104 homograft valves using MTT (3-[4, 5-dimethyl thiazol-2-y1]-2, 5-diphenyl tetrazolium bromide). The valves with warm ischaemic time above 11 hours, were found to be non-viable. Increase in storage time directly decreases cell viability. Methyl thiazol tetrazolium (MTT) assay can be used as a reliable, simple, rapid and economic method for assessing the viability status based on mitochondrial respiration even for homograft valves. Basal media with and without nutrients i.e., DMEM and Hanks BSS showed no difference in viability of the cells.

Journal Article
TL;DR: A single injection of Epsilon Aminocaproic Acid instilled into the cavity under aseptic precautions achieved lasting hemostasis with resultant wound healing.
Abstract: An 82 year old man developed antibodies against coagulation factor VIII:C without any apparent cause. Bleeding from the soft tissue cavity could not be controlled by factor VIII:C concentrates, immunosuppression with steroids and intravenous immunoglobulin therapy in the standard dosages. However, a single injection of Epsilon Aminocaproic Acid (EACA) instilled into the cavity under aseptic precautions achieved lasting hemostasis with resultant wound healing.

Journal Article
TL;DR: The diagnosis and management of a thirty year old male with a hemangiopericytoma of the kidney is reported.
Abstract: The diagnosis and management of a thirty year old male with a hemangiopericytoma of the kidney is reported.

Journal Article
TL;DR: Three cases of cri du chat syndrome with varying ages of presentation are compared and contrasted to highlight the clinical features and evolution of the phenotype with time.
Abstract: Three cases of cri du chat syndrome with varying ages of presentation are compared and contrasted to highlight the clinical features and evolution of the phenotype with time.

Journal Article
HH Kulkarni, AA Srinivas, A Vora, P Kerkar, B Dalvi 
TL;DR: Acute hemodynamic studies are useful before prescribing vasodilators in patients with PPH since more of the commonly used drugs like ISDN, AMN, NIF could have detrimental hemodynamic responses in some patients but great caution should be exercised before performing hemodynamic study as the procedure has definite mortality and morbidity.
Abstract: Acute hemodynamic effects of high flow oxygen (O2) inhalation, sublingual isosorbide dinitrate (ISDN), intravenous aminophylline (AMN) and sublingual nifedipine (NIF) were studied in 32 patients with primary pulmonary hypertension (PPH). In 30 out of 32 patients the basal ratio of pulmonary to systemic vascular resistance (Rp/Rs) was > 0.5 (mean = 0.77 +/- 0.20). Oxygen caused significant decrease in the mean resistance ratio to 0.68 +/- 0.20 (p = 0.005). ISDN, AMN and NIF caused increase in the resistance ratio to 0.79 +/- 0.26; 0.78 +/- 0.26; and 0.80 +/- 0.23 respectively. O2, ISDN, AMN and NIF caused a fall of Rp/Rs in 21 (65.6%), 10 (31.2%), 10(31.2%) and 9(28.1%) patients respectively. Thus, of the four drugs tested high flow O2 inhalation resulted in fall of Rp/Rs in two thirds of patients whereas ISDN, AMN and NIF caused a mean rise in Rp/Rs. One third of patients did respond acutely to the latter three drugs. Acute hemodynamic studies are useful before prescribing vasodilators in patients with PPH since more of the commonly used drugs like ISDN, AMN, NIF could have detrimental hemodynamic responses in some patients. However, great caution should be exercised before performing hemodynamic study as the procedure has definite mortality and morbidity.