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Biomedical subjects

A Gupta

Publications and source records attributed to A Gupta.

At least 415 records · Page 23Linked to original sources
PubMed1998

Posterior urethral valves after infancy-urodynamic consequences.

This study describes a subset of patients with posterior urethral valves (PUV) who presented late in childhood. The objective was to identify factors that lead to back-pressure effects on the upper tracts, which persist in spite of adequate valve ablation in some patients, and seek factors that may preserve the upper tracts despite untreated obstruction in other patients. Six children with PUV diagnosed after infancy were evaluated. The pre-operative work-up included renal biochemistry, ultrasonography, voiding cystourethrography, and uroflowmetry. Detailed urodynamic studies, including uroflowmetry and slow-fill cystometry, were performed in all cases 6 months after surgery. Adequacy of valve fulguration was confirmed by urethroscopy. Three of the six patients had normal upper tracts; in these, there was marked improvement in peak urine flow rates after fulguration and bladder pressures were normal. The other three patients had bilateral hydroureteronephrosis, and two had chronic renal failure. This group had markedly decreased functional bladder capacity with loss of compliance at low bladder volumes and significant residual urine volumes in spite of adequate valve fulguration, suggesting myogenic detrusor failure. We conclude that in patients with PUV presenting beyond the age of 5 years, upper-tract deterioration may accompany high storage pressures in the bladder. In some boys with long-standing obstruction the upper tracts may escape damage; in our series this was associated with normal bladder dynamics and appeared unrelated to the severity or duration of outflow obstruction.

Child↗
PubMed1998

Amebic liver abscess with jaundice.

A case of an amebic liver abscess with unusual clinical manifestations is presented. A middle-aged male with an abscess in both lobes of the liver presented with obstructive jaundice due to pressure on the porta hepatis with stasis of the bile in the intrahepatic biliary radicals. The patient did not respond to repeated needle aspirations and thus required open drainage. Subsequently, the patient developed a biliary leak through the drainage sites, and an injection of contrast dye into the cavity revealed a communication between the abscess cavities and the biliary tree. The biliary leak stopped spontaneously, and the large cavities also closed completely during the followup period.

Biliary Tract↗
PubMed1998

Retinal blood flow in nonischemic central retinal vein occlusion.

OBJECTIVE: The authors studied the changes in retinal blood flow (RBF) and oxygen reactivity in a major temporal vein in patients with central retinal vein occlusion (CRVO). PARTICIPANTS: Eleven patients with nonischemic CRVO approximately 7 weeks from onset of disease. INTERVENTION: Laser Doppler velocimetric measurement of RBF and vessel reactivity to inhaling 60% oxygen. Measurements were performed at baseline and 3 months. RESULTS: Flow velocity in the affected eye had increased significantly by 3 months, from 1.6 +/- 0.4 cm/second to 2.0 +/- 0.4 cm/second (P = 0.02). Retinal blood flow, however, remained unchanged (13.7 +/- 5.8 microl/minute versus 15.0 +/- 6.5 microl/minute). The two comparable RBF values, despite differing velocity values, suggest that the relatively normal baseline value was achieved through higher intravascular pressure at baseline (Bernoulli's principle). This is supported by the fact that oxygen reactivity had improved from 2.1% +/- 3.6% at baseline to 3.8% +/- 3.1% (P = 0.001) at 3 months, which suggests an improved ability to respond to hyperoxia from reduced intravascular pressure. CONCLUSION: Intravascular pressure in CRVO appears to continue to decrease during the first 5 months after the onset of CRVO, indicating continuing reduction in the degree of outflow obstruction during this time.

Blood Flow Velocity↗
PubMed1998

The initiation and sequence of digital joint motion. A three-dimensional motion analysis.

We studied the initiation and sequence of digital joint motion during unrestricted flexion and extension using a 3-D motion analysis of all fingers moving simultaneously. Our results showed that motion started in a single joint in 83%, of flexion and 80%, of extension cycles. The DIP joint initiated flexion and extension in the index, middle, and ring fingers, but in the little finger, flexion started in the PIP joint, and extension in the MP joint. The two most frequent sequences of joint movement during flexion of the three radial fingers were DIP-PIP-MP and PIP-DIP-MP. The two most frequent sequences during extension of the three radial fingers were DIP-MP-PIP followed by DIP-MP/PIP. In the little finger, however, the most frequent sequences during flexion were PIP-DIP-MP followed by DIP-PIP-MP and during extension, DIP-MP/PIP followed by PIP/DIP-MP.

Adult↗
PubMed1998

Frontal lobe proton magnetic-resonance spectroscopy in Graves' disease: a pilot study.

Patients with hyperthyroidism may show impaired performance on several neuropsychological tests that require complex visual discrimination, conceptualization, mental flexibility or organization. These neurocognitive impairments appear to be consistent with prefrontal lobe dysfunction. This pilot study was undertaken to characterize the metabolite profile in the right prefrontal cortex in six patients with untreated Graves' disease by using in vivo proton magnetic-resonance spectroscopy (1H-MRS). For comparison, 1H-MRS was also carried out in seven healthy controls. The choline/creatine (Cho/Cr) and N-acetyl aspartate/creatine (Naa/Cr) ratios were determined. Cho/Cr ratios of the hyperthyroid patients were significantly lower than that of controls (means +/- SD = 0.61 +/- 0.09 vs. 0.90 +/- 0.18, p = .05). The two groups did not differ in their Naa/Cr ratios. Follow-up data after antithyroid treatment were available in three patients: Cho/Cr ratios were higher after treatment (euthyroidism) than before treatment (1.06 vs. 0.55; 0.82 vs. 0.54; 1.15 vs. 0.76). Tentatively, these preliminary data are most consistent with reversible reductions in the concentrations of choline-containing compounds (especially glycerophosphocholine and phosphocholine) in the prefrontal area during hyperthyroidism. However, these findings await confirmation by a definitive study with a larger sample size. A possible explanation of the findings is an altered brain cholinergic-adrenergic balance in hyperthyroidism.

Adolescent↗
PubMed1998

The motion path of the digits.

This study investigates whether the path taken by the fingertips of the human hand during unrestricted flexion and extension follows a precise mathematical pattern: an equiangular spiral. Eight normal subjects participated in the study. Subjects performed numerous flexion and extension trials at a random speed. Motion was recorded by a 6-camera, 3-dimensional motion analysis system with 24 retroreflective markers affixed to the dominant hand at predetermined locations. Four hundred eighty flexion-extension arcs were analyzed. We used the coefficient of multiple determination to compare the flexion and extension motion arc of each finger to an equiangular spiral curve derived mathematically. Our results indicate that the path of the hand during flexion and extension closely follows the path of an equiangular spiral with the coefficient of multiple determination values consistently above 0.95.

Adult↗
PubMed1998

Cataract surgery in patients with dry eyes.

PURPOSE: To evaluate the potential causes of postoperative complications and the visual outcome after surgery for age-related cataract in dry eyes. SETTING: Tertiary-care multidisciplinary referral medical institution. METHODS: The records of 15 patients (21 eyes) with age-related cataract, a Schirmer value of 5.0 mm or less in 5 minutes, and a tear-film breakup time of 5 seconds or less having complications after cataract surgery were reviewed. Patients were assigned to 1 of 2 groups: dry eye with probable secondary Sjögren's syndrome (Group 1); dry eye without connective tissue disorders (Group 2). The surgical procedure, preoperative and postoperative medications, postoperative complications, and final visual outcome were analyzed. RESULTS: Ten eyes (8 patients) in Group 1 and 11 (7 patients) in Group 2 had cataract surgery. In Group 1, postoperative endophthalmitis developed in 3 eyes and peripheral keratolysis in 4; 5 eyes attained a visual acuity between 6/60 and 6/18 2 years after surgery. In Group 2, filamentary keratitis developed in 6 eyes and peripheral keratolysis in 2 eyes; 6 eyes achieved a visual acuity of 6/12 or better 2 year after surgery. A significant decrease in visual acuity occurred between 3 months and 2 years postoperatively in both Group 1 (P = .010) and Group 2 (P = .0005). CONCLUSION: Cataract surgery in dry eyes had fewer complications and better visual outcome in patients who did not have connective tissue disease than in those who did.

Adult↗
PubMed1998

Balloon mitral valvotomy in pregnancy: maternal and fetal outcomes.

BACKGROUND: Rheumatic mitral valve stenosis contributes to significant morbidity in pregnancy. Surgical commissurotomy has been performed during pregnancy in patients with severe mitral stenosis for several decades, but the efficacy and safety of percutaneous balloon mitral valvotomy (BMV) in this subset has not been clearly defined. STUDY DESIGN: In 1996 and 1997, 40 pregnant women aged 24+/-5 years underwent BMV at 21+/-11 weeks of pregnancy. Special shielding was used during BMV to limit radiation to the fetus, except in those who were to undergo medical termination of pregnancy subsequently. A detailed echocardiographic evaluation was performed before and after BMV. After the BMV, the 29 patients in whom pregnancy was continued were assessed every 2 weeks for symptoms and fetal growth. RESULTS: The BMV procedure was successful in 39 patients with an increase in mitral valve area from 0.8+/-0.2 cm2 to 1.7+/-0.2 cm2 (p < 0.001) and marked symptomatic relief. Fluoroscopy time was 7.8+/-1.9 minutes. Eleven patients whose BMV was performed before 20 weeks of pregnancy, subsequently underwent medical termination of pregnancy uneventfully. Eighteen patients had a normal delivery, three underwent cesarean section for fetal distress, one had a preterm delivery, and there was one stillbirth. Four patients are continuing pregnancy and two are lost to followup. Fullterm delivery data were available in 23 babies, whose birth weights were 2.32+/-0.5 kg. None of these babies needed any special care and were healthy at discharge. CONCLUSIONS: During pregnancy, BMV by the Inoue technique is feasible, safe, and effective. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

Adult↗
PubMed1998

Primary lingual tuberculosis: a case report.

Tuberculosis is very common in India and Southeast Asia, where the prevalence rate is about four per 1000 population and the incidence rate of the disease is two per cent. Fifteen per cent of the tuberculous population of the world reside in India. Both secondary and primary tuberculous lesions of the tongue and oral cavity are rare. We report a 60-year-old male with the seventh case of primary lingual tuberculosis.

Humans↗
PubMed1998

Xanthogranulomatous cholecystitis.

Xanthogranulomatous cholecystitis exists in a small but significant proportion of routine cholecystectomy specimens. A few recent reports have shown a possible association of this disease with carcinoma of the gallbladder. All cholecystectomized specimens were prospectively evaluated over a period of two and half years in a single surgical unit to examine the incidence of xanthogranulomatous cholecystitis and its association, if any, with carcinoma of the gallbladder in an area that is prone to gallbladder diseases. A total of 460 cholecystectomies were performed for various gallbladder diseases. Histological confirmation revealed chronic cholecystitis in 311 (67.6%) cases, carcinoma of the gallbladder in 62 (13.5%), acute cholecystitis in 29 (6.3%), xanthogranulomatous cholecystitis in 41 (8.9%), and xanthogranuloma and carcinoma of the gallbladder in one case (0.2%) only. Almost all cases were suspected to have chronic cholecystitis on clinical and ultrasonographic features. Two specimens on gross examination showed mass lesions, and hence were suspected to be carcinoma of the gallbladder. Subsequent frozen section and histopathology demonstrated xanthogranulomatous cholecystitis. Only one case of xanthogranuloma was found to be associated with carcinoma of the gallbladder but no firm association could be established between xanthogranulomatous cholecystitis and carcinoma of the gallbladder.

Acute Disease↗