Bone marrow cyto-morphological changes in multibacillary leprosy

Seventy-two cases of multibacillary leprosy were investigated for cytomorphological changes and presence of lepra bacilli in bone marrow. These patients were divided in two groups. Group A (28) comprised of new cases and group B (44) of those receiving treatment. Myeloid hyperplasia was mostly seen in patients of group B who had erythema nodosum leprosum. Megaloblastic change in erythroblasts was seen frequently in both the groups. While average number of plasma cells and macrophages was on the higher side of normal range, detection of large number of plasma cells underlined enhanced humoral response and created diagnostic problem with multiple myeloma. Morphological changes in the macrophages, their collections and epithelioid cell granulomas were observed in bone marrow. Their nature and significance is discussed.

Serum cholesterol binding reserve and its ratio to serum cholesterol in first degree relatives of patients with ischaemic heart disease

Serum total cholesterol and serum cholesterol binding reserve (SCBR) were estimated in 50 healthy subjects and 25 cases with ischaemic heart disease (IHD) and their seventy asymptomatic first degree relatives. In normal subjects mean values of SCBR tended to expand with increasing levels of serum cholesterol, while this relationship was reversed in cases with IHD. The relatives showed a direct correlation between serum cholesterol and SCBR upto serum cholesterol level of 220 mg/dl, but the correlation was lost beyond this level. The critical levels for predicting risk of IHD were 30 mg/dl for SCBR and 8 for cholesterol: SCBR ratio. The latter was found to be a more sensitive index for predicting the risk of IHD as compared to SCBR alone.

Right precordial mapping. Diagnostic sensitivity and specificity of leads V3R to V6R in different intercostal spaces in cases with right ventricular infarction

Twelve lead conventional electrocardiography and right precordial mapping including precordial leads V2R to V6R in the 2nd to 5th intercostal spaces were obtained in 150 cases with acute myocardial infarction. There were 27 (18%) cases with right ventricular infarction: 24 associated with inferior wall infarction and 3 with anterior wall infarction. In the right precordial mapping, leads V3R to V6R in all intercostal spaces had equal sensitivity of 100%; 3rd intercostal space recording, however, had the maximum specificity of 92.6%.

Exophytic gliomas of the spinal cord

Intradural extramedullary glial tumours of the spinal cord are rare. We report for such tumours arising from the dorsal cord. Myelography and operative findings were almost similar to that of an intradural neurofibroma. Surgical removal had resulted in rewarding neurological recovery. One of them had a recurrence after six years and was re-explored. Anterolateral attachment near the root entry zone suggests its origin probably from the spinal cord with an exophytic growth.

Mesencephalic haematoma, successful surgical evacuation. Case report

A case of mesencephalic haematoma is reported. Emergency surgical evacuation of haematoma was done. The patient improved and has done well for five years. Subtemporal and infratentorial supracerebellar approaches have been used earlier to remove mesencephalic haematoma. It is possible to remove caudal midbrain haematoma via a IVth ventricular approach causing minimal damage.

Ventilatory functions in tropical pulmonary eosinophilia

A study of ventilatory function in tropical pulmonary eosinophilia was carried out. Seventy five cases and 75 healthy controls were studied. Four types of ventilatory patterns were observed-restrictive (52%), mixed (33%), obstructive (4%) and normal (10.6%).

Surgery in spontaneous intra-cerebral haematoma

Twenty-six patients of intracerebral haemorrhage (ICH) were treated by surgical evacuation of clot. Six patients were operated within 24 hour, four on the second day, seven between the third and fifth day and nine after five days. Their therapeutic out-come was compared with an equal number of age, location and severity matched group of patients of ICH who did not undergo surgery. Mortality in surgically treated group (16/26) was comparable to control group (20/26), however, follow up of survivors showed slightly reduced morbidity in operated group. Patients in grade III (level of consciousness) were the only ones who were benefited from surgery. The timing of the surgery did not affect the immediate mortality.

2-Deoxy-D-glucose induced modification of chromosomal damage in UV-irradiated peripheral human leukocytes

UV-irradiation (0.6 J/m2) of peripheral human leukocytes 27 hr after PHA-stimulation induced a considerable mitotic delay in the cultures. Approximately two thirds of the chromosomal aberrations induced by UV were gaps of the chromatid and isochromatid types. Treatment with glucose antimetabolite 2-deoxy-D-glucose (2-DG) alone did not induce any chromosomal damage. Presence of 2-DG (5 mM, equimolar with glucose) for 2 hr after UV-irradiation resulted in a significant reduction in the frequency of cells with aberrations. Decrease in the total aberrations per cell was also observed. The data are consistent with earlier observations that 2-DG reduces the manifestation of radiation damage in normal proliferating cells.

Cardiac Dysautonomia in Lepromatous Leprosy

Cardio-vascular, autonomic functions were studied in 20 patients with lepromatous leprosy and 20 healthy adult controls Autonomic dysfunction was observed in the form of abnormal response in heart rate on standing 3 (15%) carotid artery pressure 7 (35%). Valsalva manoeuvre 5 (25%) and mental stress 3 (15%) in the leprosy patients. Response of blood pressure to standing and cold pressure test was seen in 2 (10%) and 7 (359o) patients respectively.

Energy linked modifications of the radiation response in a human cerebral glioma cell line

Effects of cellular energy metabolism on the radiation response of a cell derived from a human cerebral glioma have been studied under conditions of energy limitation produced by the presence of inhibitors of respiratory metabolism (KCN) and glycolysis (glucose analogues such as 2-DG, 5-TG, and 3-0-MG). Radiation 60Co induced DNA repair (Unscheduled DNA Synthesis) and micronuclei formation were studied as measures of radiation response. Glycolysis (lactate production) and levels of adenine and related nucleotides (UTP, GTP, ATP etc.) were measured as parameters of energy metabolism. Two 2-DG (5 mM) inhibited DNA repair and increased micronuclei frequency both in the presence and absence of respiration (KCN, 2 mM). Under similar experimental conditions, the presence of 2-DG also significantly reduced the cellular energy status. Five-TG and 3-0-MG on the other hand, neither significantly altered the energy status (sigma XTP) nor influenced the radiation response under respiratory proficient conditions. The results can be explained on the basis of a model postulating differential energy linked modulations of the repair and fixation processes acting on DNA lesions. Implications of the present results for the radiotherapy of brain tumors are discussed.

Clofazimine induced nail changes

Two cases of lepromatous leprosy with erythema nodosum leprosum who were on high doses of clofazimine, showed discoloration of nail plate, subungual hyperkeratosis and onycholysis. These nail changes gradually disappeared when the dose of clofazimine was reduced.

Metal Sensitivity in Children

One hundred children were patch tested with 5% nickel sulphate, 0.5% potassium dichromate, 5% cobalt chloride and pure petrolatum. Seventeen children (11 having eczematous and 6 having non-eczematous dermatoses) showed positive patch test reactions to one or more metals, chromium (13%), nickel (8%) and cobalt (1%). The incidence of metal sensitivity was highger (32.5%) in the older children (8-14 years) as compared to the younger children 7 years of age (2.66%). The female children had a higher incidence of sensitivity as compared to the male children.

Intracranial aneurysmal rupture and ventricular opacification during carotid angiography

A case of intra-angiography rupture of an aneurysm, a rarity, is reported. It was confirmed by CT Scan and autopsy. The aneurysm ruptured despite taking all precautions recommended in the literature. This complication may be reduced by the use of non-ionic contrast media and slow flow rate injections.

Intramedullary cysticercosis

We are reporting two cases of intramedullary cysticercus cysts. Both patients presented with a clinical picture of progressive cord compression. One of them also had bilateral radicular pain. In the female patient the symptoms became exaggerated during her two consecutive pregnancies which is a rare and interesting observation. Excision of cyst resulted in significant improvement in both the patients.

The far cry of a TB brain. Report of a case of tuberculous meningitis, multiple tuberculomas and tuberculous abscess

An unusual case of neurotuberculosis presenting with tuberculous meningitis, tuberculous abscess and multiple tuberculomas is reported. The patient showed a dramatic response and resolution of tuberculomas with antituberculous therapy only after excision of the abscess.

Leukemoid reaction in erythema nodosum leprosum in a leprosy patient

A case of lepromatous leprosy with erythema nodosum leprosum (ENL) presenting as a myeloid leukemoid reaction is reported. Very high leucocyte count with immaturity of the cells in myeloid series was present in peripheral blood. High leucocyte alkaline phosphatase score, absence of hepatosplenomegaly and transient nature of leukemoid reaction differentiated it from chronic myeloid leukemia and acute myeloblastic leukemia. The possible mechanisms of leukemoid reaction in ENL are discussed.

Pyrazinamide induced thrombocytopenia

A case of thrombocytopenia caused by pyrazinamide is reported in a patient receiving chemotherapy for pulmonary tuberculosis.

Electroretinograms in early fungal endophthalmitis

To facilitate the early diagnosis of exogenous fungal endophthalmitis, we developed a rabbit model for Aspergillus fumigatus endophthalmitis. Six eyes of six New Zealand white rabbits were inoculated with forty spores of A. fumigatus. A control group of their six contralateral eyes received a similar but sterile inoculum. The rabbit eyes were evaluated with respect to clinical appearance and the electroretinogram. Clinically evident endophthalmitis developed in all six infected eyes at an average of five days after injection (range 3-7 days). Data samples each 48 hours showed transient b-wave amplitude elevations in three infected eyes. These were greater than two standard deviations above the mean pre-injection values (p less than 0.05). These amplitude increases preceded the onset of ophthalmoscopically recognizable infection and were observed at 2 to 5 days after injection (mean = 4 days). B-wave amplitudes in the infected eyes fell below two standard deviations of pre-injection values (p less than 0.05) at an average of 5 days (range 3-7 days) after injection, a corresponding to the onset of clinically obvious infection. At an average of 7 days after injection, all the infected eyes exhibited unmeasurable electroretinogram waveforms and severe infection. Histopathologic study of infected eyes showed extensive fungal infiltration of retina and vitreous tissues. The electroretinogram may be helpful in the early diagnosis of fungal endophthalmitis.

Bilateral giant intracavernous aneurysms. Technique of unilateral operation

We report a case of bilateral intracavernous giant aneurysms of which the right side was clipped by direct surgery. Our case was a 74-year-old woman who developed bilateral abducens palsy. Computed tomography and angiography showed bilateral intracavernous giant aneurysms. This patient was followed up in the outpatient clinic. She developed headache and right trigeminal neuralgia 2 years later. The trigeminal pain was quite severe and very disturbing to her. Repeat angiography showed an increase in the size of the aneurysms. An operation was carried out after a balloon Matus test monitoring electroencephalogram, somatosensory evoked potential, and clinical symptoms. The cavernous sinus was opened and the aneurysm was clipped. There was no postoperative complication except right ophthalmoplegia which resolved after 3 months. Headache and trigeminal neuralgia also disappeared.

Synthesis and antiarrhythmic activity of novel 3-alkyl-1-[omega-[4-[(alkylsulfonyl)amino]phenyl]-omega- hydroxyalkyl]-1H-imidazolium salts and related compounds. 2

Novel analogues of the class III antiarrhythmic agent 1-[2-hydroxy-2-[4-[(methylsulfonyl)amino]phenyl]ethyl]-3-methyl-1H- imidazolium chloride, 1 (CK-1649), were prepared and investigated for their class III electrophysiological activity on isolated canine cardiac Purkinje fibers and ventricular muscle tissue. Structure-activity relationships are discussed for a series of 11 compounds. One compound, N-[4-[1-hydroxy-2-(4,5-dihydro-2-methyl-1H-imidazol-1- yl)ethyl]phenyl]methanesulfonamide hydrochloride, 9, was comparable in activity to 1 in vitro and prolonged the functional refractory period in anesthetized dogs when given intraduodenally. Unlike 1, compound 9 was ineffective at preventing ventricular tachycardia induced by programmed electrical stimulation in anesthetized dogs 24 h after an acute myocardial infarction.

[A personal point of view to EC-IC bypass surgery in completed stroke after the co-operative study]

The role of EC-IC bypass surgery has become a very controversial issue recently. EC-IC anastomosis was performed in 132 patients of stroke in our institute. Thirty six of them which could be followed up completely had a completed stroke and ten of these showed a significant clinical improvement by the next day of surgery. We studied the angiograms, CT scans and dynamic CT studies of all 36 patients to determine the common factors responsible for a significant clinical improvement in these ten patients. It was found that patients with occlusion of middle cerebral arteries and with good collateral circulation fared better than those with other lesions and good cross circulation. Site of low density on CT revealed patient with watershed low density did well. Characteristic of low density area was found to be a significant factors. If the low density area was homogeneous and well defined in an arterial territory, it was invariably associated with no improvement after surgery. Patients showing an improvement had scattered or irregular low density areas. Dynamic CT studies were not found to be significant.

Benign subarachnoid haemorrhage (subarachnoid haemorrhage of unknown aetiology)

Forty three patients of subarachnoid haemorrhage of unknown aetiology have been studied for their clinical presentation, rebleed rate, morbidity and mortality. The results have been compared with other similar studies. The present study and those of others indicate a very good prognosis in acute stage. The rebleed rate ranged between 0 and 7% over a period of two to three years. The mortality rate ranged between 0 and 5% during the same period of follow-up. Majority of the patients returned to their full working capacity. The benign nature of this subgroup as compared to the poor outcome of subarachnoid haemorrhage as a whole prompted us to call it "Benign subarachnoid haemorrhage".

An experimental model of communicating hydrocephalus in C57 black mouse

The authors report a new experimental model for the study of hydrocephalus. Hydrocephalus was produced in C57 black mouse by transplanting human glioma cultured cells. 20% of the animals developed hydrocephalus while the incidence of spontaneous hydrocephalus is only 1%. The transplanted cells disappeared within 72 hours. The mouse developed progressive hydrocephalus. There was no evidence of blockage of CSF pathways. The only abnormal microscopic finding was a scattered collection of lymphoid cells in some of the animals, which may be a hypersensitivity reaction to the cells. A similarly hypersensitive reaction to the foreign maternal protein which may enter the foetal circulation is suggested as the cause of hydrocephalus in some of the cases of congenital hydrocephalus.

Nail Patella Syndrome

A 14-year-old male having nail-patella syndrome, manifested as deficient nails on the ubw aspect of thumbs, V-shaped half- moons, rudimentry patella on right side and absence on left side. X-ray of pelvis showed iliac horns.. Family history was suggestive of autosomal dominant of inheritance.

Modification of the radiation induced damage by 2-deoxy-D-glucose in organ cultures of human cerebral gliomas

Effects of a glucose antimetabolite, 2-deoxy-D-glucose (2-DG), on the gamma ray induced radiation damage have been studied in organ cultures of human cerebral gliomas. Percentage of cells with micronuclei (M-fraction) was used to assay the radiation damage. Experimental data indicate the following results. Untreated cerebral gliomas show considerable spatial heterogeneity in M-fraction; In spite of this heterogeneity, increases in M-fraction induced by gamma rays can be clearly observed, if multiple and randomly selected explants are analyzed for each group; The radiation induced M-fraction in different gliomas varies over a wide range; Presence of 2-DG (5 mM) for 4 h after irradiation leads to an increase in the radiation induced M-fraction in the majority of tumors, while in a smaller number (congruent to 25%) a decrease is observed under similar conditions. These results can be explained on the basis of a model postulating differential effects of 2-DG on the energy linked modulations of the processes of repair and fixation of DNA damage, which competitively influence the formation of micronuclei.

Hemiatrophy and glioblastoma

There are very few recorded instances of brain tumors with ipsilateral secondary brain atrophy. All 10 cases in the literature are from Japan. We report a case of primary cerebral hemiatrophy with ipsilateral glioblastoma. As far as we are aware, no such case has been described in the literature.

The treatment of dural AVM by embolization with aron alpha (ethyl-2-cyanoacrylate)

The authors report four cases of dural arteriovenous malformation (AVM) treated by a modified technique of embolization. Three cases had posterior fossa dural AVM and one had bilateral supratentorial dural AVM. The authors think that the best way to treat dural AVM is to close its nidus completely. This could be achieved by a safe and easy technique of embolization. The material used for embolization should intimately adhere to the vascular network and should not become fragmented. We used aron alpha (Ethyl-2-cyanoacrylate). This is a biological glue and it sets in a solid membranous form instantaneously on coming into the contact with an ionic medium. It does not get fragmented. Aron alpha was injected into the nidus of the AVM through a cannula inserted only into the main feeding artery in four cases of dural AVM reported here. Postoperative angiography showed complete obliteration of the AVM's, they did not fill either from the treated artery or from the untreated feeding arteries. The technique is easy and safe. There was no operative or postoperative complication. All the patients have remained asymptomatic to date, i.e. 2, 2, 6 and 7 1/2 years after the procedure.

Pancreaticoduodenectomy for duodenal bleeding due to hereditary hemorrhagic telangiectasia

A variant of hereditary hemorrhagic telangiectasia may be gastrointestinal bleeding with no other classical symptoms. This case demonstrates the effectiveness of surgical resection as treatment of duodenal bleeding from telangiectatic lesions.

Neurostimulation for patients in vegetative status

Dorsal column stimulation has been used in four patients who were in a persistent vegetative state. There was improvement of the EEG in four patients and clinical improvement in three patients. Stimulation was for 12 hours per day at 100 Hz, 5 to 8 volts, and with a pulse width of 0.12 msec. The mechanism of improvement may involve changes in cerebral blood flow.

[Evaluation of hypertensive intracerebral hematomas based on the study of long-term outcome--part IV: Prognostic importance of the age of the patient and the laterality of the lesion in putaminal hematoma]

The age of the patient and the laterality of the lesion are said to play an important role in determining surgical indications and prognosis of any neurosurgical disease. These two factors have been evaluated in 355 cases of putaminal haematoma, which were seen during the last 10 years after the introduction of the CT scan. Patients have been divided in three age groups; less than 59 years, 60-69 years and greater than 70 years, consisting of 235, 80 and 40 cases in each group respectively. Long-term outcome of three groups has been compared in both surgically and conservatively treated patients. The hematoma was situated on left side in 182 and on right side in 173 cases. 56.6% of left sided and 48.7% of right sided hematoma cases were operated. The long-term outcome of the two sides has also been compared in both surgically and conservatively treated patients. One has to be careful while considering patients of greater than 70 years of age as there is always some natural selection among these patients before they are referred to the hospital or are operated upon thereafter. One tends to be less aggressive for so old patients. Only in moderate type and operated cases the younger patients (less than 59 years) showed a better long-term outcome (ADL) than other surgically treated patients. Otherwise age did not effect the long-term outcome (ADL) in any type of putaminal haematoma. No effect of laterality was found in mild and very severe types of hematoma for the long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the hypertensive intracerebral hematoma based on the study of long-term outcome--Part III. Evaluation of neurological grading and CT classification]

It is very important to have a standard neurological grading system and CT classification for "putaminal hemorrhage" to compare, contrast and discuss the results and the surgical indications of various workers. We evaluated 355 cases of putaminal hemorrhage for their long-term outcome by using neurological grading and CT classification of Kanaya et al and compared it with our new classification based on the mode of hematoma extension. The long-term outcome (ADL) showed a better correlation with our new classification. While by using the earlier method (Kanaya et al), there was no significant statistical difference in the ADL between the patients of neurological grade IVb & grade V and also between the patients of CT class II and IIIa. In this classification, the definition of CT class V is not clear as the putaminal hemorrhage does not penetrate into the thalamus. It also ignores the upward or downward extension of the hematoma. Therefore, we emphasize the need for the modification of the presently existing neurological grading system and the CT classification for a better correlation with the long-term outcome.