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Biomedical subjects

A Gupta

Publications and source records attributed to A Gupta.

At least 631 records · Page 35Linked to original sources
PubMed1994

Spinal anaesthesia for caesarean section following epidural analgesia in labour: a relative contraindication.

Three cases are described in which epidural analgesia was performed during labour using an infusion of bupivacaine 0.125-0.25%. When, in all 3 cases, caesarean section was required for failure to progress, hyperbaric bupivacaine was given in doses of 10 mg, 12.5 mg and 15 mg respectively. Within 2-4 min all 3 patients had a high block, complained of difficulty in breathing and subsequently developed apnoea. The trachea was intubated after administration of thiopentone and succinylcholine and the operation continued. Cardiovascular support was provided by the administration of ephedrine injected intermittently intravenously. The spinal block receded and the patients were able to return to the ward without any further complications. All three mothers remain in good health and do not regret having had spinal anaesthesia for caesarean section. In contrast to previously reported cases of high spinal anaesthesia following unsuccessful epidural anaesthesia for caesarean section, this report describes 3 cases of high spinal following the administration of spinal anaesthesia upon an ongoing epidural infusion of local anaesthetic during labour. As no guidelines are available as to the recommended dose of spinal anaesthetic under such circumstances and, in view of the several case reports describing a similar complication under different circumstances, we suggest that spinal anaesthesia is contraindicated upon ongoing epidural analgesia or following a failed epidural.

Journal Article↗
PubMed1994

Carotid brachial bypass for treating proximal upper-extremity arterial occlusive disease.

Symptomatic occlusive disease of the subclavian arteries, not associated with thoracic outlet syndrome, is an uncommon problem with a paucity of literature related to the appropriateness of bypass graft selection and long-term patency for revascularization. Between 1985 and 1993, 9 patients (3 men and 6 women) underwent 13 carotid brachial bypasses for chronic severe upper-extremity ischemia. Ages ranged from 47 to 75 years (mean 65). Three patients had documented collagen vascular disease, 1 had radiation arteritis, and 4 had bilateral disease requiring staged arterial reconstruction. Indications for operation included severe exercise-induced ischemia in two limbs (15%), rest pain in eight (62%), and gangrene or infection, or both, in three (23%). Two bypasses were performed for failed prior reconstructions. Inflow originated from the carotid artery (4 proximal and 9 bifurcation), and distal anastomoses were made to a disease-free section of brachial artery. Reinforced 6 mm thin-wall polytetrafluoroethylene (PTFE) grafts were used in all operations. No operative mortality or major upper-extremity amputation was associated with the procedure, although digital amputations were performed in four instances. Follow-up ranged from 4 to 83 months with a mean of 38 months. The 5-year primary patency rate, by life-table analysis, was 92%. Our results showed excellent long-term patency when prosthetic grafts were used for carotid brachial bypass, because of excellent runoff and the relatively short graft length required.

Aged↗
PubMed1994

Effect of betaxolol on the retinal circulation in eyes with ocular hypertension: a pilot study.

This study investigated the effect of betaxolol, a beta 1 selective blocker, on the retinal circulation in 10 patients with ocular hypertension. In a masked randomised fashion, one eye of each subject received betaxolol and the fellow eye received placebo (hypromellose). Retinal blood flow (RBF) was determined in a major temporal vein of each eye just prior to instillation of drops and 2 h later, using laser Doppler velocimetry and monochromatic fundus photography. There was an increase of 15.0% in RBF (p = 0.03) in the betaxolol-treated eyes. No significant change was observed in the placebo-treated eyes. Intraocular pressure was reduced by 27.7% in the treated eyes, resulting in an increase of 16.9% in perfusion pressure (p = 0.02) compared with an 8.4% increase in placebo-treated eyes (p = 0.15). This study demonstrated that betaxolol increases RBF in eyes with ocular hypertension; this increase is probably related to the increase in perfusion pressure.

Administration, Topical↗
PubMed1994

Nasal continuous positive airway pressure in the treatment of respiratory distress syndrome: an experience from a developing country.

Forty-four premature infants with respiratory distress syndrome (RDS) were admitted and initially treated with binasal continuous positive airway pressure (CPAP) using Beneveniste's valve and silastic nasal prongs. Twenty-seven cases (61 per cent) were successfully treated compared to 17 cases (39 per cent) who failed to respond to CPAP. Neither gestational age nor birth weight had a detremental effect on the success of nasal CPAP. There was significant improvement of RDS with a mild to moderate degree of severity on CPAP. No pneumothorax was reported in any of our cases. The success group had a significantly lower incidence of infection, apnea, intraventricular haemorrhage and retinopathy of prematurity.

Developing Countries↗
PubMed1994

Intrathoracic use of tubed latissimus dorsi musculocutaneous flap for reconstruction of the cervical and thoracic esophagus in a child.

A case report of an intrathoracic application of tubed latissimus dorsi musculocutaneous flap as an island flap for one-stage reconstruction of an extensive and impassable stricture, following corrosive burns of the oropharynx and the cervical and upper half of the thoracic esophagus in a 1-year-old child, with follow-up results of 9 years is presented. Esophagoscopic and cineradiographic studies were carried out at regular intervals to monitor the growth and the patency of the neoesophagus. This was probably the youngest patient for whom the latissimus dorsi musculocutaneous flap has been used for an intrathoracic application. Also this may be the first reported case of the use of the latissimus dorsi flap for reconstruction of the thoracic esophagus.

Burns, Chemical↗
PubMed1994

High prevalence of rotavirus infection among neonates born at hospitals in Delhi, India: predisposition of newborns for infection with unusual rotavirus.

Although rotavirus is the most common cause of diarrhea in children older than 3 months of age, neonatal infections, which are asymptomatic, have rarely been surveyed and have been identified in only a few discrete nosocomial outbreaks. After such a nosocomial outbreak of rotavirus infection among newborns at a hospital in Delhi, we screened infants born at five other nurseries in the immediate area to assess the prevalence of neonatal infections and to determine whether the unique neonatal rotavirus strain, 116E, previously identified in Delhi, was present in other settings. Infection was documented in 43 to 78% of hospitalized infants between 4 and 6 days of life born at five of the six hospitals. Infection with strains related to 116E were the most common, but other unusual strains and no strains common in the community were detected. In addition a shift in genotype was observed among specimens collected from two of these hospitals during a 2-year period. Our observation that neonatal rotavirus infections are more common than recognized previously would encourage the administration of rotavirus vaccines during the newborn period and suggests that the low efficacy of vaccines observed during trials in developing countries may be caused by early natural exposure of infants before immunization. The extraordinary predisposition of neonates for unusual rotavirus strains not commonly found in the community should encourage others to screen neonates for this infection, characterize the strains more fully and attempt to understand at a molecular level the unique relationship between the infecting strain type and the age of the host.

Feces↗
PubMed1994

Alfentanil or fentanyl during isoflurane-based anaesthesia for day-care knee arthroscopy?

Forty patients agreed to participate in a study to compare whether fentanyl or alfentanil used as analgesic is associated with quicker recovery following anaesthesia for outpatient arthroscopy procedure. Psychomotor tests including choice reaction time (CRT), perceptive accuracy test (PAT) and finger tapping test (FTT) were done prior to induction of anaesthesia with propofol (2-3 mg.kg-1). Patients were then divided into two groups: Group F (fentanyl) received 0.1 mg fentanyl prior to start of surgery and thereafter 0.05 mg every 30 min during the procedure. Group A (alfentanil) received 0.5 mg alfentanil prior to the onset of surgery and 0.25 mg every 15 min thereafter. Anaesthesia was then maintained using isoflurane (0.5-2%) in oxygen and air (FiO2 0.33) during spontaneous respiration with a face mask in a Bain's system. Psychomotor tests were repeated every 45 min postoperatively. Clinical recovery, visual analogue pain intensity score (VAS) and time to discharge home were also assessed by a nurse blind to the method used. Patients in Group A returned to baseline values on the FTT after 90 min while those in Group F did not return to baseline values until 135 min after the end of the operation. Clinical recovery and time to discharge home ("home ready") were also significantly longer in Group F. There was no difference in recovery as seen in the PAT and CRT between the groups. Also, there was no difference in the incidence of side effects and the pain intensity (VAS) scores were similar in the two groups at all time periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Out-patient surgery--a survey of anaesthesia care in a university hospital.

This study was done at the Linköping University Hospital, Sweden, to assess the quality of care given to patients undergoing outpatient anaesthesia. A questionnaire was given to all adult patients (> 15 years old) immediately on admission to the outpatients' surgical ward and the patients were asked to answer all the questions, if necessary with the help of an attending nurse. Another questionnaire was given to the patients in the post-operative ward immediately prior to their being discharged home. Analyses of results indicate that although most patients were satisfied with the care offered at the outpatient surgical unit, 50% requested, but were not given, anxiolytic premedication before the operation. A majority of these were women undergoing gynaecological operations. Twenty per cent of the patients complained of post-operative pain that was poorly managed. Drowsiness (12%), headache (10%), and sore throat (8%) were common complications following general anaesthesia. In contrast, patients who had regional or local anaesthesia had an extremely low incidence of complications. Almost one-third of the patients were discharged without a responsible person accompanying them home and 25% were alone at home during the first 24 hours. Of the patients who went home alone, most either walked, cycled or took the bus, but 4% actually drove home after the operation. In our opinion more stress should be laid on patient information before the operation and better methods to relieve preoperative anxiety should be used whenever indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Steroid response pattern in Indian children with nephrotic syndrome.

The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeutic and prognostic value for the treating physician in managing children with nephrotic syndrome. None of the studies from our country has analysed the clinical, biochemical and histopathological profile in different steroid response categories. To address this problem we conducted a study comprising 127 children with nephrotic syndrome referred to our institute. They were treated with oral prednisolone according to the APN protocol. Based on the subsequent response these children were classified into different steroid response categories on follow-up. Of the 116 children with follow-up of more than six months, infrequent relapsers constituted the majority (37.9%). The frequency of other steroid response categories was as follows: frequent relapsers (21.6%), steroid-dependent (18.1%), initial non-responders (17.3%) and subsequent non-responders (5.1%). The factors predicting a poor response to standard prednisolone therapy in our study were age of onset more than eight years, male sex, hypertension, microscopic haematuria and presence of non-minimal change nephrotic syndrome lesions on histopathology.

Child↗
PubMed1994

Pure anteropositioning of inferior oblique. A selective weakening procedure.

Anteropositioning of inferior oblique is of late becoming popular but it inadvertently also entails a compulsory recession which may be undesirable at times. We have evaluated the effect of a 'pure' anteropositioning procedure (11 eyes), with Elliot & Nankin's anteropositioning (10 eyes) and Parks' recession (17 eyes). The mean change of vertical deviation in elevation in adduction (surso adduction) was 15.09 +/- 8.3 prism dioptres (p.d.) in pure anteropositioning; 23.50 +/- 5.6 p.d. in E & N's anteropositioning and 14.82 +/- 5.9 p.d. in Parks' recession, showing this procedure to be as effective as a conventional recession procedure. However, while the latter two methods produced an intorsion, 'pure' anteropositioning produced no significant change in torsion. It is a much simpler procedure to weaken the elevation without affecting the torsion.

Eye Movements↗
PubMed1994

Characterization of rotavirus strains from newborns in New Delhi, India.

Between 1986 and 1993, 72% of rotavirus strains isolated from newborns at five hospitals in New Delhi, India, had long electropherotypes, subgroup II VP6 antigens, and G and P genotypes (G9P11) identical to those of prototype strain 116E. A novel strain with a G9P6 genotype, representing 13% of the isolates, was identified. These results demonstrate that G9P11 and G9P6 rotavirus strains are common in nurseries in New Delhi.

Base Sequence↗
PubMed1994

Effects of CGRP, forskolin, PMA, and ionomycin on pHi dependence of Na-H exchange in UMR-106 cells.

We examined the effects of calcitonin gene-related peptide (CGRP), forskolin, phorbol 12-myristate 13-acetate (PMA), and ionomycin on the intracellular pH (pHi) dependence of Na-H exchange in UMR-106 cells. In the nominal absence of CO2-HCO3-, each agent increased pHi, measured with 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF). From the rate of pHi recovery (dpHi/dt) from an acid load, and intracellular buffering power, we computed the pHi dependence of the total acid-extruding flux (JTotal). All four agents increased JTotal. From dpHi/dt data obtained in the presence of ethylisopropyl amiloride (EIPA, a blocker of Na-H exchange), we determined the EIPA-resistant component of JTotal (JEIPA/R). We estimated the Na-H exchange flux (JNa-H) as the difference JTotal-JEIPA/R-CGRP, forskolin, and PMA produced similar increases in the slope of the JNa-H vs. pHi-relationship. The net effect of these agents, as well as ionomycin, was to increase JNa-H over a broad pHi range. Ionomycin alkaline shifted the JEIPA/R vs. pHi relationship; the other agents had no effect. Our results indicate that CGRP increased JTotal by stimulating Na-H exchange, with little effect on EIPA-resistant processes. A signaling pathway involving only adenosine 3',5'-cyclic monophosphate, only protein kinase C, or only Ca2+ cannot account for the effects of CGRP on both pHi and pHi dependence of JNa-H. Thus, CGRP probably affects UMR-106 pHi physiology via more than one pathway.

Animals↗
PubMed1994

Neurotensin binding to human embryonic lung fibroblasts.

Several neuropeptides have been shown to regulate the function of cells involved in immune response and inflammation. Neurotensin is a 13 amino acid neuropeptide localized primarily to the nervous system and gut. Neurotensin also stimulates mast cell degranulation and enhances phagocytic and cytolytic capability of macrophages, suggesting that this peptide regulates inflammatory and immune responses. Fibroblasts play an important role in inflammation and tissue healing, and these processes may be regulated by several neuropeptides that have been shown to bind to fibroblasts. However neurotensin receptors have not been identified on fibroblasts. Human embryonic lung fibroblasts (HELF) were examined for binding and biological effects of neurotensin. 125I-neurotensin binding to adherent and confluent human embryonic lung fibroblasts (HELF), plated in 12mm diameter wells was specific and saturable. Computer-assisted resolution of the binding data demonstrated two classes of binding sites: a high affinity, low capacity site (Kd = 1.6 x 10(-11) M, 19.5 x 10(7) sites/well), and a low- affinity, high-capacity site (Kd = 10(-8) M, 4 x 10(9) sites/well). Neurotensin stimulated immediate, transient, dose-dependent increases of cytosolic calcium in HELF (threshold dose: 10(-11) M), suggesting release of calcium from intracellular stores. The novel finding of neurotensin receptors on fibroblasts provides further support for this neuropeptide's role as a regulator of inflammatory and immune responses.

Calcium↗
PubMed1994

Angiotensin II binding to human embryonic lung fibroblasts causes transient changes in cytosolic calcium and promotes fibrin gel contraction.

Contraction of granulation tissue is promoted by the peptide vasoconstrictor angiotensin II (AII), which presumably acts on the fibroblasts present in granulation tissue. Direct effects of AII on fibroblast contraction were examined using an in vitro fibrin gel contraction model. Fibrin gels were formed by mixing cultured human embryonic lung fibroblasts with fibrinogen, in the presence of thrombin and measurement of gel volume was used to determine the extent of fibrin gel contraction by fibroblasts. AII stimulated an additional 28.5 +/- 3% decrease in gel size after 24 hr, AII is also shown to specifically bind to human embryonic lung fibroblasts and stimulate rapid transient increases in cytosolic calcium. AII stimulates contraction of human embryonic lung fibroblasts as reflected by acceleration of fibrin gel contraction. Fibrin clot contraction contributes to extra cellular matrix reorganization during initial stages of wound repair and AII-stimulated fibroblast contraction may accelerate this process.

Angiotensin II↗