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Biomedical subjects

A Saxena

Publications and source records attributed to A Saxena.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Value of antenatal echocardiography in high risk patients to diagnose congenital cardiac defects in fetus.

Results of fetal echocardiography in 1062 high risk pregnant patients are described. It was performed before 28 weeks of gestation in 770 cases. These were 38 abnormal scans (3.6%). A fetal arrhythmia was diagnosed in 14 cases and structural abnormality of the heart in 24. Complete atrioventricular block was commonest (n = 12), structural heart disease associated in two of these cases. Other lesions identified were atrioventricular septal defect (n = 5), hypoplastic left heart syndrome (n = 4), ventricular septal defect (n = 4), Ebstein's anomaly (n = 3), coarctation of aorta (n = 2) and others (n = 9). Postnatal confirmatory echocardiography is available in a total of 993 babies including 36 of 38 abnormal cases. There were eleven neonatal deaths amongst babies with abnormal scans. Errors in interpretation were observed in six instances. An anomaly was missed in five cases; in two of these, the main cardiac malformation was picked up but secondary lesions were missed. In one case, a false positive diagnosis of atrial septal defect was made. These errors did not influence the management of the pregnancy. Fetal echocardiography is a very sensitive (91.6%) and specific (99.9%) tool for antenatal diagnosis of congenital heart disease in high risk pregnancies. The information so obtained helps in guiding the optimal obstetric and neonatal management of these cases.

Echocardiography↗
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Optimal timing of surgery in common left to right shunts.

Left to right shunts like atrial septal defect, ventricular septal defect and patent ducts arteriosus are commonly encountered congenital malformations of the heart. With advances in diagnostic and therapeutic technology over the last three decades the recognition and management of these lesions has markedly improved. Currently, the surgical procedures are being performed in infants and neonates with the hope that long term results would be better. Children with atrial septal defects are usually asymptomatic or mildly symptomatic and closure of the defect is best performed at 3-4 years of age. Large ventricular septal defects, on the other hand, may produce symptoms like congestive heart failure in early infancy and early closure is recommended for these babies. These defects are also known to close spontaneously and therefore in mildly symptomatic cases without pulmonary arterial hypertension, one may wait for a natural reduction in size. Surgical ligation of a patent ductus arteriosus is a safe and simple procedure and all these cases must undergo closure of the duct.

Child↗
PubMedDate not supplied

Pulmonary artery calcification in recipient twins of twin to twin transfusion syndrome: a report of three cases.

Twin to twin transfusion syndrome may rarely complicate monochorionic twin gestation, resulting in discordant size of the twins. Cardiac dysfunction and various types of cardiac defects have been described in the recipient twin of this syndrome. Pulmonary artery calcification has been described earlier in one case only. We report three recipients of twin to twin transfusion syndrome with pulmonary artery calcification resulting in obstruction of pulmonary trunk in two of these. One case with progressive severe narrowing was successfully operated at four months of age with patch repair of pulmonary artery. He is doing well three years later. The obstruction is moderate in the other case. Calcification in the wall of pulmonary artery may be secondary to vascular injury sustained as a result of volume overloading of the circulation of the recipient twin.

Adult↗
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Atrioventricular septal defect with cor triatriatum: case report and review of the literature.

Atrioventricular septal defect with cor triatriatum is a rare combination, with only nine cases reported so far. Cor triatriatum, a potentially correctable cause of pulmonary arterial hypertension in atrioventricular septal defect patients, was missed in a few earlier case reports, leading to death and subsequent diagnosis at autopsy. We report the case of 3-year-old female child with this combination (partial atrioventricular septal defect with cor triatriatum) wherein the final diagnosis was made at cardiac catheterization. Successful surgical correction was performed.

Abnormalities, Multiple↗
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Obstructed infracardiac total anomalous pulmonary venous connection in an adult.

Adult survival in patients with uncorrected obstructed infracardiac total anomalous pulmonary venous drainage has not been reported. A 17-year-old man who presented to us with features of severe pulmonary arterial hypertension was diagnosed to have obstructed pulmonary venous drainage to the hepatic vein. Presence of a large ventricular septal defect in this patient may have contributed favorably to survival.

Adolescent↗
PubMedDate not supplied

The product of the imprinted gene IPL marks human villous cytotrophoblast and is lost in complete hydatidiform mole.

The IPL/TSSC3 gene is expressed nearly exclusively from the maternal allele, and its protein product acts to limit placental growth in mice. This protein specifically marks Type II trophoblast in the labyrinthine layer of the mouse placenta. To investigate mouse-human homologies, we carried out immunohistochemistry with antibodies against human IPL. There was strong expression of IPL in villous cytotrophoblast of the human placenta, contrasting with complete lack of expression in syncytiotrophoblast. Staining for IPL was weak in cells of the villous mesenchyme and extravillous trophoblast, including the cytotrophoblast columns in the basal plate and the intervillous trophoblast islands. The IPL and p57(KIP2)/CDKN1C genes are closely linked and coordinately imprinted, and immunostaining showed that their protein products are co-expressed in villous cytotrophoblast. However, other cell types, including extravillous cytotrophoblast and cells in various non-placental tissues, expressed p57(KIP2), but not IPL. IPL protein was absent in both of two cases of androgenetic complete hydatidiform mole examined by immunostaining, and IPL mRNA was absent in an additional three cases of this neoplasm examined by northern blotting. In the mouse, Ipl-expressing cells disappear at mid- to late-gestation when placental growth ceases, but persistent IPL mRNA and protein expression was observed throughout human gestation, correlating with the continuous growth of the human placenta. These findings highlight dosage regulation of human IPL by imprinting and, more generally, suggest homology between Type II labyrinthine trophoblast in the mouse and villous cytotrophoblast in humans, both of which are proliferative stem cell-like compartments.

Amino Acid Sequence↗
PubMedDate not supplied

Results of renal angioplasty in nonspecific aortoarteritis (Takayasu disease).

PURPOSE: To evaluate the long-term results of percutaneous transluminal renal angioplasty (PTRA) in the management of renovascular hypertension caused by nonspecific aortoarteritis (Takayasu disease). MATERIALS AND METHODS: The results of 96 stenoses in 66 patients were retrospectively studied. The indications for PTRA included hypertension uncontrolled by single-drug therapy, evidence of greater than 70% diameter stenosis in the renal artery with a peak systolic gradient of greater than 20 mm Hg, and clinically inactive disease. RESULTS: Technical success was obtained in 91 (95%) stenoses in 62 patients. Clinical success was seen in 59 (89%) and included "cure" in 14 and "improvement" in 45 patients. The stenosis decreased from 88% +/- 6% (range, 70%-100%) to 11% +/- 12% (range, 0%-40%), systolic pressure gradient decreased from 95 mm Hg +/- 22 (range, 30-140 mm Hg) to 9 mm Hg +/- 8 (range, 0-30 mm Hg), blood pressure improved from 181 +/- 16 (range, 150-220)/115 +/- 10 (range, 90-146) to 136 +/- 25 (range, 130-210)/86 +/- 16 (range, 80-130) mm Hg, and the drug requirement decreased from 3.9 +/- .6 (range, 2-5) to 1.1 +/- .9 (range, 0-3) (P value for all < .001). Complications included transient intrarenal arterial spasm in three patients, groin hematoma in two patients, and ipsilateral renal vein injury in one patient. At 22 months +/- 17 (range, 4-84 months) follow-up, the restenosis rate, as determined by recurrence of hypertension and angiographic demonstration of restenosis, was 16%. CONCLUSION: Despite some technical problems, PTRA is safe and effective in treating renovascular hypertension caused by nonspecific aortoarteritis. The complication rate is low.

Adolescent↗
PubMedDate not supplied

Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system.

Twenty-two navicular stress fractures sustained during athletic activity were retrospectively reviewed for return to activity time and the appearance of fracture pattern on computerized tomography. There were 10 females and nine males, with the average patient age being 27.2 years. Three patients sustained bilateral injuries at separate times. Average follow-up was 36.5 months. Nine patients underwent open reduction, internal fixation (some with bone grafting); this group's average return to activity (RTA) was 3.1 +/- 1.2 months (range, 1.5-5 months). Thirteen patients treated conservatively had an average return to activity of 4.3 +/- 2.8 months (range, 2-13 months). The difference between the two groups' RTA was significant (p = .02). Eleven patients utilized pulsed electromagnetic fields (PEMF) and had an average RTA of 4.2 +/- 3.4 months, 27.3% of those patients with PEMF also had surgery. Two conservatively treated fractures that took 5 and 8 months to RTA, respectively, re-fractured during the treatment process. Retrospective review showed CT fracture patterns in the frontal plane that were classified as: dorsal cortical break (type I), fracture propagation into the navicular body (type II), and fracture propagation into another cortex (type III). This is a proposed classification system. It includes modifiers "A" (avascular necrosis of a portion of the navicular); "C" (cystic changes of the fracture), and "S" (sclerosis of the margins of the fracture), the latter of which was most common in our series, particularly in continually symptomatic patients. Type I fractures were more likely to receive conservative treatment (p = .02) and type III fractures took significantly longer to heal than types I and II (p values .001 and .01, respectively). Type I and II injuries had an average RTA of 3.0 and 3.6 months, respectively. Type III injuries had an average RTA of 6.8 months. Based on our findings, we recommend surgery for patients with these modifiers, particularly with type II and III injuries. Conservative treatment may be prolonged, and requires at least 6 weeks of nonweightbearing in a below-knee cast/boot to be successful.

Adolescent↗
PubMedDate not supplied

Return to athletic activity after foot and ankle surgery: a preliminary report on select procedures.

One hundred thirty-eight "athletic" patients from the author's practice underwent retrospective review of their foot and ankle surgery that was performed from 1990 to 1997 to evaluate the time to return to activity. Athletes were defined as follows: professional, varsity college and high school, runners amassing more than 25 miles per week, or those involved in regular competition. No recreational athletes were included. Average follow-up for the group as a whole was 49.4 months, (range, 12-108 months). One hundred seventeen of the 138 patients were able to be contacted and/or had been evaluated by September 1998. One hundred thirteen patients considered their surgery a success. All but two patients were able to return to the desired level of performance. Twenty-three of the patients increased their activity level after surgery. Twenty-eight athletes underwent Achilles tendon-related surgery (average follow-up was 44.5 months). Runners undergoing peritenolyses had an average return to activity of 4.0 weeks (range, 3-6 weeks). Patients undergoing Achilles procedure involving bone resection had an average return to activity of 13.8 weeks (range, 10-20 weeks). Forty-four bunionectomy procedures were performed, including 31 first metatarsal osteotomies. The group's average follow-up was 52.9 months (range, 13-100 months), and average return to activity for the first metatarsal osteotomies was 8.9 weeks. There were 48 rearfoot procedures. Lateral ankle stabilization procedures returned to activity on an average of 10 weeks (range, 7-16 weeks), while excised ossicles (os tibiale externum, os trigonum) had an average return to activity of 9.1 weeks (range, 8-14 weeks). Seven neuroma patients (via dorsal approach) had a return to activity of 4.0 weeks (range, 2.5-6 weeks), sesamoidectomy 7.5 weeks (range, 4-10 weeks), and Valenti arthroplasty of 6.5 weeks (range, 4-12 weeks), respectively. There were minimal complications. Two patients in the Achilles surgery group required revision surgery. One patient with a bunionectomy had postoperative hallux limitus. Eight patients had symptomatic screws removed.

Achilles Tendon↗
PubMedDate not supplied

Hypophosphatemic rickets presenting as recurring pedal stress fractures in a middle-aged woman.

Stress fractures frequently occur from overtraining. When stress fractures recur, underlying metabolic abnormalities should be ruled out. We report a middle-aged woman in whom such an evaluation demonstrated previously undiagnosed hypophosphatemic rickets after she presented with recurring stress fractures in her feet. Treatment with phosphate and calcitriol was associated with clinical improvement that would likely not have occurred without this intervention. Any patient with recurring stress fractures should be evaluated with several screening laboratory tests, metabolic bone x-rays, and a measurement of bone mineral density.

Calcitriol↗
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Magnetic resonance and cadaveric findings of the "watershed band" of the achilles tendon.

A review of 63 magnetic resonance images of 86 ankles was performed. (There were 23 bilateral studies.) A contiguous fascial band from the deep posterior compartment to the Achilles tendon watershed region was noted in 83 ankles. This fascial band enveloped the watershed region, coursing from the flexor (lacinate) ligament medially, to the peroneal retinaculum laterally. This band was absent in three patients who were scanned, two of whom sustained a complete Achilles tendon rupture, while the third had previously undergone peritenolysis. Forty cadaveric specimens with no known Achilles tendon pathology were evaluated for presence of this structure. An organized fascial band existed in all of these specimens. This previously undescribed structure is termed the "watershed band" and may have surgical significance.

Achilles Tendon↗
PubMedDate not supplied

The Valenti procedure for hallux limitus/rigidus.

The results of 12 Valenti procedures on 11 patients are presented. Preoperative hallux dorsiflexion was 12.9 degrees; postoperatively, patients achieved 40.4 degrees of dorsiflexion. The Valenti procedure is a useful arthroplasty for grades II and III hallux limitus/rigidus.

Adult↗
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Surgery for chronic Achilles tendon problems.

The author introduces a new procedure for surgical treatment of Achilles tendocalcinosis and other techniques for treatment of various chronic Achilles pathologies. Results of 21 procedures on 19 patients are presented.

Achilles Tendon↗
PubMedDate not supplied

Valenti arthroplasty.

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Arthrodesis↗