Search

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk

Five cases of xeroderma pigmentosum have been presented, three of the patients belonging to one family. There was no history of consanguineous marriages in this series. All five patients had advanced ocular complications. Three presented with multiple basal cell carcinomata, which were treated by radiotherapy in two cases and surgery in one. One patient presented with a dermatofibroma, which does not seem to have been reported earlier in association with this disease. Reconstructive techniques such as the use of flaps and grafts arc safe, and the healing response is quite satisfactory.

Oral cholecystography is the basic radiodiagnostic procedure required to assess chemical composition of gallstones as well as functional status of gall bladder prior to non-surgical management of gallstones. However, the value of ultrasound in non-surgical management of gallstones is yet to be proved. In this study we attempt to establish sonographic criteria which will predict the composition of gallstones prior to their non-surgical treatment. For this purpose the ultrasonographic characteristics of 233 patients with gallstone disease and functioning gall bladders were studied and an effort was made to correlate cholesterol and calcium content of different types of stones (as estimated by X-Ray powder diffraction study and atomic absorption spectrophotometry) with their ultrasonographic characteristics. Sonographic criteria for the presence of cholesterol stones were those which were floating and gallstones producing acoustic shadowing without internal echoes from within the stone. In detecting findings which would predict the presence of cholesterol stones on ultrasound, ultrasound had a sensitivity of 72.90% and a specificity of 100%. The predictive values of positive findings and negative findings were 100% and 93.4%, respectively. The demonstration of typical features of cholesterol stones on ultrasound obviates the need for oral cholecystography.

Subclavian artery aneurysms are uncommon. Presentation with complication of rupture is extremely rare. We report a patient presenting as hemothorax and shock because of ruptured right subclavian artery aneurysm. This was successfully treated with placement of a covered stent with good clinical outcome.

Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.

Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy were performed in 86 patients with breast lump and the results of these techniques were finally compared with the incisional or excisional biopsy in all the patients. Fine needle aspiration cytology had the sensitivity of 96.8% and specificity of 100%, the imprint cytology had the sensitivity of 98.4% and specificity of 100%. While the tru-cut needle biopsy had the sensitivity and specificity of 100% though in this technique 15 of 86 (17.4%) specimens were rejected as insufficient for any diagnosis.

Fifty-four patients with advanced upper gastrointestinal cancer were assessed for their nutritional status prior to any form of therapy. Anthropometric parameters--weight loss, arm muscle circumference, skin-fold thickness--and biochemical parameters--serum albumin and delayed cutaneous hypersensitivity reactions to purified protein derivative (PPD) and phytohemagglutinin (PHA)--were used for nutritional assessment. Using standard values for comparison, about 80% of all patients were found to be nutritionally depleted. Immunocompetence did not show significant correlation with other nutritional parameters.

The ABH isoantigen was investigated in 80 patients with squamous cell carcinoma of the oral cavity and in their 46 affected lymph nodes. Isoantigen deletion shows a characteristic pattern of benign to malignant transformation of oral cancer. Total loss of isoantigen was found in anaplastic tumours, in metastatic lymph nodes and in the majority of advanced stage tumours. Total loss of isoantigen in metastatic lymph nodes indicates a frequent discharge of isoantigen-negative metastatic cells from the primary tumours to the lymph nodes and the regional organs. It seems that with the recent techniques a prospective observation of ABH isoantigen added to other pathological and clinical findings could be of prognostic significance in patients with squamous cell carcinoma of the oral cavity.

Thirty cases of fungating breast cancer (stages III and IV) were treated preoperatively by combination chemotherapy using cyclophosphamide (Endoxan), methotrexate, 5-fluorouracil, and prednisone. Mastectomy was performed after 2 cycles of preoperative chemotherapy followed by 6 more cycles postoperatively. Of 30 patients, 25 (83.3%) were made operable and had better disease-free survival. Preoperative chemotherapy has an advantage as regards improvement in quality and longevity without much toxicity, and provides a better palliation.

Eighteen cases of sarcomas of the breast are reported. Cases could be divided into two groups histogenetically. Group A, malignant cystosarcoma phylloides (14 cases); and Group B, pure sarcomas (4 cases). The malignant cystosarcoma phylloides occurred in the fourth decade, had longer duration of illness invariably followed by sudden increase in the size of the tumor, had a striking mucoid and slimy look grossly, and showed discernable epithelial elements histologically. In the event of their recurrence the ductal elements were not seen microscopically. Contrarily, Group B cases presented in the sixth decade were rapidly growing from the beginning, and grossly were fleshy and haemorrhagic. Microscopically these did not reveal any epithelial component. There was poor correlation between cytologic malignancy and the biologic behavior in Group A. Mode of treatment seems more important in determining the subsequent course of the disease. Simple mastectomy with follow-up appears to be adequate in the majority of cases.

Thirty advanced cases of cancer of the oral cavity were treated by intensive combination chemotherapy using bleomycin, methotrexate, 5-fluorouracil, cyclophosphamide, and Oncovin administered over a period of 48 hours. Bleomycin was given as a continuous infusion and Oncovin was administered six hours prior to the administration of other drugs. A clinical response was obtained in 73.3% of the cases, a complete response in 33.3%, and a partial response in 40%. The toxicity was within acceptable limits.

Thirty-eight cases of advanced upper gastrointestinal cancer were assessed for their immune status prior to any form of therapy. Cell-mediated immunity, as tested by absolute lymphocyte count, T-cell count and delayed cutaneous hypersensitivity reactions to purified protein derivative and phytohemagglutinin showed severe depression. Immunoglobulins A and M were elevated, while immunoglobulin G reduced. No correlation could be established between the immune status and the site of cancer or its extent, the performance status of the patients, or their response to chemotherapy.

Serum immunoglobulins (IgG, IgA, and IgM) have been studied in 70 patients with squamous cell carcinoma of oral cavity and in 40 age-matched normal controls. The results were correlated with clinical stage, tumor size, lymph node status, tumor differentiation, and treatment modalities. There was a significant rise in serum IgM and IgA in oral cancer patients as compared to controls. It was further raised in advanced clinical stage, but tumor size and histological differentiation and treatment modalities (surgery and chemotherapy) do not seem to affect serum immunoglobulin levels. The observations implies that the extension and dissemination of tumor mass is the important factor for the change in serum immunoglobulin level in squamous cell carcinoma of the oral cavity.

Two cases of carcinoma and renal tuberculosis occurring in the same kidney, a rare association, are reported. The tuberculous process was apparently overshadowed by the more obvious coexistent tumour, and detected as an incidental finding. A possible explanation for the extremely rare association of carcinoma and renal tuberculosis is discussed.

A case of spontaneous intraperitoneal rupture of a kidney, a rare complication of pyonephrosis, is described. It was mistaken for a burst amoebic liver abscess causing general peritonitis

Reports on comprehensive mandibular tumours are very rare. The present article describes a total of 81 primary tumour and tumour-like lesions of the mandible seen at the University Hospital, Banaras Hindu University, during last 16 years. In the mandible the ratio of odonto-genic to nonodontogenic tumors is 1.6:1. Ameloblastomas constitute 56% of the odontogenic tumors. Among the benign mesenchymal tumours of the jaw 58% are neoplastic and 42% are nonneoplastic in which cementoostoid tissue is laid down secondary to inflammatory process. Over all 40 cases are benign 28 potentially malignant (ameloblastoma) and 13 are malignant lesions. Among the malignant mandibular tumours, bone tumours are more common than the soft tissue sarcomas. Microscopically mandibular osteosarcomas are better differentiated than similar tumours in the long bones. Local, segmental, or radical surgery seems to be the treatment of choice in the mandibular tumours.

Reports on primary tumors of the jaw in children are infrequent. This article reports 24 cases of primary tumors and tumor-like conditions of the jaws in children. All varieties of odontogenic and nonodontogenic tumors are seen in the jaw; fibro-osseous lesions are the most common. A possible explanation for the high incidence of mesenchymal lesions in children may be related to the shedding and eruption of teeth. The differences between childhood and adult types of ameloblastomas are highlighted.