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Biomedical subjects

A M Khan

Publications and source records attributed to A M Khan.

At least 37 records · Page 2Linked to original sources
PubMed2003

Assessment of secondary haemorrhage rates following adult tonsillectomy--a telephone survey and literature review.

Many previous studies have considered patient re-admission rates alone as the true rate of secondary haemorrhage following adult tonsillectomy. We aimed to determine the true rate of secondary haemorrhage following tonsillectomy in adults by performing a telephone interview with 60 consecutive patients. Whilst 40% (n = 24) of our patients reported a significant episode of bleeding (blood actively flowing from their mouth for more than 1 min) following discharge, only 8% (n = 5) were re-admitted and only 3% (n = 2) required return to theatre. Review of the current literature suggests that return-to-theatre rates are more consistent than hospital re-admission rates in large studies. We would suggest that although secondary haemorrhage can occasionally be very serious, the majority is minor, and it would therefore be more useful when comparing different techniques for tonsillectomy to consider numbers of patients returning to theatre rather than re-admission rates.

Adolescent↗
PubMed2003

A chapter in emergency: a surgical trainee's experience.

OBJECTIVES: To assess (1) the exposure a senior house officer (SHO) gains while training in accident and emergency (A&E) and (2) how much this experience benefits a surgical trainee. METHODS: An SHO trained in A&E for a period of six months as part of his surgical rotation. Besides regular daily duties, he prospectively collected details of patients in a logbook. For each patient records of name, age, sex, address, presenting symptoms, specialty, and treatment outcome were noted. Also recorded were courses attended, certificates achieved, and audits performed during this period. RESULTS: A total of 1249 patients were seen during this period. This included 423 (33%) medical, 374 (30%) orthopaedic/trauma, and 268 (21%) paediatric cases. Some 153 (12%) were surgical, 55 urology, 41 patients presented with "pain" symptoms in different body regions (excluding abdominal pains), and 120 patients included all other specialties (psychiatry, ENT, ophthalmology, dental, gynaecology). Twenty (1.6%) practical procedures were performed. The SHO attended two courses (ATLS, ALS), achieved two certificates, and was involved in two audits. CONCLUSIONS: Wide exposure in all specialties and branches of medicine including internal medicine, orthopaedics and trauma, paediatrics, and surgery was gained. As a surgical trainee, training in A&E did not provide hands on practical experience, but was useful in contributing towards general clinical skills.

Adolescent↗
PubMed2003

Trash feet after coronary angiography.

Cholesterol crystal embolisation is a frequently underdiagnosed condition. While coronary catheterisation is safe and commonly performed, the reported patient developed very painful trash feet after undergoing this routine procedure. Ulceration and gangrene occurred after catheter manipulation during cardiac angiography, which caused occlusion of the small arteries in his feet. The triad of pain, livedo reticularis, and intact peripheral pulses is pathognomonic for cholesterol embolisation. The prognosis depends on the extent of the systemic disease and a high rate of mortality (75-80%) is observed. Prognosis is poor and the treatment is only supportive. It is suggested that while cardiac catheterisation is largely safe and a very commonly performed procedure, it can still lead to complications with serious side effects and can even prove fatal.

Aged↗
PubMed2003

Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty.

Out of a total of 623 patients who, over a ten-year period, underwent primary total knee replacement (TKR) without patellar resurfacing, 20 underwent secondary resurfacing for chronic anterior knee pain. They were evaluated pre- and postoperatively using the clinical and radiological American Knee Society score. The mean follow-up was 36.1 months (12 to 104). The mean knee score improved from 46.7 to 62.2 points and the mean functional score from 44.7 to 52.2 points. Only 44.4% of the patients, however, reported some improvement; the remainder reported no change or deterioration. The radiographic alignment of the TKR did not influence the outcome of secondary resurfacing of the patella. Complications were noted in six of the 20 patients including fracture and instability of the patella and loss of movement. Anterior knee pain after TKR remains difficult to manage. Secondary resurfacing of the patella is not advocated in all patients since it may increase patient dissatisfaction and hasten revision.

Aged↗
PubMed2002

Congenital hearing impairment associated with rubella: lessons from Bangladesh.

Infection with rubella virus during pregnancy may cause fetal death or the multiple congenital fetal abnormalities that are known as congenital rubella syndrome (CRS). Studies have demonstrated that congenital hearing impairment is the most frequent abnormality associated with intrauterine rubella infection. In the present study, the first of its kind in Bangladesh, we investigated the presence of rubella antibody in hearing-impaired children in order to understand the possible role of rubella infection in the development of hearing impairment. A total of 198 hearing-impaired children and 200 children without hearing problems were studied. After taking a detailed history from the parents, blood samples were collected from both mothers and children; sera were subjected to enzyme-linked immunosorbent assay (ELISA) for anti-rubella IgG. Rubella antibody was detected in 74% of the hearing-impaired children and in 18% of those with normal hearing: this finding correlated with the presence of rubella antibody in the mothers (67%) of rubella seropositive hearing-impaired children. In contrast, we observed rubella antibody in only 14% of the mothers of the children without hearing problems. Consistent with the presence of antibody, 41% of the seropositive mothers who had hearing-impaired children gave a history of fever and rash during early pregnancy. Our study indicates a strong association between rubella infection and hearing impairment in Bangladeshi children. In addition, it also indicates that infection by rubella virus is common in Bangladesh: this suggests that priority should be given to implementing appropriate measures for the control of rubella.

Antibodies, Viral↗
PubMed2001

Treatment of severe theophylline toxicity with hemodialysis in a preterm neonate.

Theophylline, a drug frequently used to treat apnea of prematurity, has a prolonged half-life of 30 h in neonates. Severe overdoses of theophylline have an associated 10% mortality and significant morbidity. We describe a 1,220-g neonate who developed status epilepticus due to a theophylline overdose. Hemodialysis was instituted to increase elimination of theophylline. The patient tolerated the procedure without complication. The half-life of theophylline was 0.7 h during dialysis. No reported therapies used in neonates have achieved this magnitude of clearance. In fact, the clearance of theophylline in this neonate approached that obtained with hemoperfusion, the standard therapy for theophylline overdose in adult patients. This case demonstrates that hemodialysis is a safe and effective means of enhancing theophylline elimination for neonatal theophylline overdose.

Bronchodilator Agents↗
PubMed2001

Monopolar radiofrequency energy for arthroscopic treatment of shoulder instability in the athlete.

Monopolar radiofrequency energy is increasingly being used in the treatment of shoulder instability. Basic science studies and early clinical results have shown that application of thermal energy can result in successful shrinkage of the shoulder capsule. This procedure is useful in treating certain traumatic and recurrent instability conditions of the shoulder especially in the athlete where range of motion is preserved, recovery is faster than with open procedures, and there, is little disruption or alteration of inherent anatomy. The procedure is technically easy to perform, and the complication rate is low. Success, however, depends on proper patient selection, attention to the rehabilitation program, and patient compliance. Long-term follow-up will be necessary to determine if results for this procedure will deteriorate over time, especially in patients with multidirectional instability.

Arthroscopy↗
PubMed2001

Four new flavones and a new isoflavone from Iris bungei.

Four new irisflavones A-D (1-4) and irilin D (5) have been isolated from the underground parts of Iris bungei along with known isoflavones, irilins A-B (6-7) and tlatancuayin (8). The structures of the new compounds were determined using NMR and mass spectroscopic methods and were found to be 2',5,7-trihydroxy-3,6-dimethoxyflavone (1), 2',5-dihydroxy-3,6,7-trimethoxyflavone (2), 2',5,6'-trihydroxy-3,6,7-trimethoxyflavone (3), 3,3',5-trihydroxy-2',7-dimethoxyflavone (4), and 3',4',5,7-tetrahydroxy-6-methoxyisoflavone (5). The structures of irisflavones 1, 3, and 4 were confirmed by single-crystal X-ray diffraction studies.

Chromatography, Thin Layer↗
PubMed2001

Reduced osmolarity oral rehydration solution for persistent diarrhea in infants: a randomized controlled clinical trial.

OBJECTIVE: We evaluated and compared the efficacy of the World Health Organization (WHO) oral rehydration solution (ORS) and 2 different formulations of reduced osmolarity ORSs in infants with persistent diarrhea. STUDY DESIGN: Infants with persistent diarrhea (n = 95) were randomized to 1 of the 3 ORSs: WHO-ORS (control, n = 32), a glucose-based reduced osmolarity ORS (RORS-G, n = 30), or a rice-based reduced osmolarity ORS (RORS-R, n = 31) for replacement of ongoing stool losses for up to 7 days. Major outcome measures were stool volume and frequency, ORS intake, and resolution of diarrhea. RESULTS: Although there were variations from one study day to another, the stool volume was approximately 40% less in the reduced osmolarity ORS groups; consequently, these children required less ORS (22% for RORS-G and 27% for RORS-R groups). A higher proportion of children in the RORS-R groups also had resolution of diarrhea during the study period. No children in any of the treatment groups had hyponatremia. CONCLUSION: Reduced osmolarity ORS is clinically more effective than WHO-ORS and may thus be advantageous for use in the treatment of children with persistent diarrhea.

Bicarbonates↗
PubMed2001

Management of symptomatic ureteric stumps laparoscopically.

AIM: To study the advantage of excision of the distal symptomatic ureteric stumps with the retroperitoneal laparoscopic approach. METHODS: Four patients who had failed to settle their symptoms with the initial conservative management were included in the study. All underwent excision of the distal symptomatic ureteric stumps with the retroperitoneal laparoscopic approach and then received prophylactic antibiotics. RESULTS: We have achieved better results than those reported in the literature in terms of operating time (mean 1 h 45 min), blood loss (< 10 mL), postoperative recovery (within 12 h) and hospital stay (< 48 h). CONCLUSION: Retroperitoneal laparoscopic excision is a safe, simple and effective method in the management of symptomatic ureteric stumps.

Adult↗
PubMed2000

N-methyl-D-aspartate receptor subunit NR2B is widely expressed throughout the rat diencephalon: an immunohistochemical study.

Glutamate (Glu), a major excitatory neurotransmitter within the hypothalamus and thalamus, acts upon many receptors, including the N-methyl-D-aspartate (NMDA) subtype. Abundant evidence suggests that variations in the subunit composition of NMDA receptors (NMDA-Rs) contribute to differences in Glu's immediate electrophysiological effects as well as to the patterns of signal transduction cascades it triggers to mediate long-term changes in neuronal function. We have previously shown that hypothalamic NMDA-Rs containing the NR2B subunit may be involved in the control of eating as well as in the mediation of physiological responses to osmotic stimuli. To broaden our understanding of diencephalic NMDA-R participation in other functions, we localized the NR2B subunit in the diencephalon of the adult male rat using immunoperoxidase, immunogold, and immunofluorescence techniques and an affinity-purified polyclonal antibody specific for the NR2B subunit of the NMDA-R. In addition, we used a monoclonal NR2B antibody with immunoperoxidase detection to confirm the NR2B distribution seen with the polyclonal antibody. In the hypothalamus, the highest levels of NR2B immunoreactivity (-ir) were found in the magnocellular neurosecretory system, including the paraventricular and supraoptic nuclei. A new finding was that intense NR2B-ir was present within perivascular "accessory" magnocellular groups of this system, including the nucleus circularis, anterior fornical nucleus, and scattered clusters of lateral hypothalamic cells apposed to blood vessels. Robust NR2B-ir was also present within the arcuate nucleus, the median eminence, and the tuberal nucleus, and light immunostaining was found in all other hypothalamic nuclei examined. In the thalamus, the highest NR2B-ir was observed in the medial habenula and the anterodorsal, paraventricular, rhomboid, reticular, and dorsal lateral geniculate nuclei. As in the hypothalamus, all thalamic nuclei examined displayed at least light immunostaining for this subunit. Control sections, including those incubated with the polyclonal NR2B antibody preadsorbed with its fusion protein, were virtually devoid of immunostaining. This demonstration that the NR2B subunit of the NMDA-R is widely distributed in the diencephalon, implicates it in a wide variety of functions, and provides a useful anatomical framework for establishing a comprehensive map of Glu receptor populations within this major subdivision of the brain.

Animals↗
PubMed2000

Screening colonoscopy in asymptomatic average-risk African Americans.

BACKGROUND: Recent data indicate that colorectal cancer incidence and mortality in white Americans have been declining since 1985 at a rate of 2% to 3% per year. In African Americans, however, mortality from colorectal cancer appears to be increasing. We sought to evaluate the prevalence of colonic neoplasia in asymptomatic African Americans. METHODS: We performed a cross-sectional colonoscopy screening study to determine the prevalence of colonic neoplasia in asymptomatic African Americans older than 50 years of age. RESULTS: One hundred sixty-six subjects were evaluated for the study of whom 121 (69 women) were deemed to be asymptomatic average-risk persons and completed colonoscopy. Forty-two individuals (35%) had a total of 72 adenomas (67 tubular and 5 tubulovillous); 47 (65.3%) of these were proximal to the splenic flexure. Three subjects had an adenoma 1 cm or greater in diameter and none had severe dysplasia. CONCLUSIONS: The overall prevalence of adenomas in asymptomatic average-risk African Americans was comparable to that of previously described populations. The predominance of right-sided adenomas in this study confirms previous findings and is an area requiring further study. Until this issue is resolved, we suggest the use of colonoscopy rather than sigmoidoscopy for screening for colorectal neoplasia in asymptomatic, average-risk African Americans.

Adenomatous Polyps↗
PubMed2000

Dose-intense paclitaxel, etoposide and cyclophosphamide: a safe and active regimen for tumor cytoreduction and stem cell mobilization in metastatic breast cancer.

Patients with metastatic breast cancer in complete remission are the ones most likely to have an improved outcome with subsequent high-dose chemotherapy and autologous peripheral blood stem cell transplantation (HDC-PBSCT). Peripheral blood stem cells are usually procured following mobilization with single agent chemotherapy and colony-stimulating factor support. We utilized a dose-intense regimen of paclitaxel 200 mg/m2 i.v., etoposide 60 mg/kg i.v., and cyclophosphamide 3 g/m2 i.v. (TEC) followed by daily administration of granulocyte colony-stimulating factor. The aim was not only to mobilize stem cells but also to achieve optimal tumor cytoreduction prior to HDC/PBSCT. One hundred consecutive patients with metastatic breast cancer received 257 cycles of TEC between March 1994 and June 1997, with the aim of collecting 5 x 106 CD34-positive cells/kg usually following the second cycle of chemotherapy. Patient characteristics included a median age of 45 years, a median of two organ systems involved by disease, a median of two prior chemotherapy regimens and eight prior chemotherapy cycles, and a median interval of 8 months from diagnosis of metastases to first cycle of TEC. There were 61 febrile episodes during neutropenia and 13 of these were associated with bacteremia or fungemia. Mortality rate was 1%. An adequate number of stem cells was collected in 90% of patients. The overall response rate of the tumor was 58.8% with 23.7% complete responders among 97 evaluable patients. Multivariate analysis demonstrated chemosensitivity to the most recent standard chemotherapy regimen administered for metastatic disease, an ECOG performance score of 0 as opposed to 1, 2 or 3, and involvement by disease of only one organ system as significant variables for achieving a complete remission with TEC. This novel dose-intense regimen was safe and well tolerated, highly active against metastatic breast cancer, and capable of excellent stem cell mobilization. Bone Marrow Transplantation (2000) 25, 123-130.

Antineoplastic Agents, Hormonal↗
PubMed2000

Percutaneous nephropexy.

OBJECTIVE: The authors present a 12-year (1986-98) study of a new procedure called percutaneous nephropexy (PCNP). This procedure was performed on 51 renal ptosis patients at two urological departments (in Pakistan and Hungary) with satisfactory results. The idea for PCNP was adapted from the observation that after drain insertion following nephrostomy a scar is quite sufficient to hold the kidney in place. That idea was used to fix the kidney at the required level. MATERIAL AND METHODS: Thirteen patients complained of a palpable mobile mass in the abdomen while others suffered from pain in their affected flank with recurrent attacks of urinary tract infection. On ultrasonic examination the kidney was found to be lower than the normal position. This observation was confirmed by a standing intravenous urography (IVU) examination that also showed a tortuous ureter. Nine patients also had a stone in the affected kidney. The operation involved puncture and dilatation of a channel through the lower calyx. RESULTS: Control IVU examination was performed after wound healing and was repeated 2 months after the operation, followed by consecutive ultrasonic examinations. Standing X-ray films obtained after contrast material injection showed the kidney to be at a higher level with a straight ureter. Forty-five patients (88.2%) recovered completely. CONCLUSION: In the authors' opinion PCNP is a good alternative to open nephropexy operations in renal ptosis cases, particularly when laparoscopic surgery facilities are not available. Although PCNP was developed in circumstances in which the availability of equipment was restricted, in terms of benefits it is comparable with laparoscopic nephropexy.

Adolescent↗