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Biomedical subjects

A Shah

Publications and source records attributed to A Shah.

At least 37 records · Page 2Linked to original sources
PubMed2004

Percutaneous nephrolithotomy in early pregnancy.

Most cases of urolithiasis in pregnancy are managed conservatively either with ureteric stents or percutaneous nephrostomy tubes, which need to be changed at regular intervals. Definitive management of the stone is usually delayed till after delivery. We describe a patient who presented with pyonephrosis in the fifth week of gestation, due to a stone obstructing the right ureteropelvic junction. This was managed by insertion of a nephrostomy tube. She declined nephrostomy tube/stent changes during the rest of her pregnancy and requested termination as an alternative. She successfully underwent percutaneous nephrolithotomy in the 14th week of pregnancy, with radiation exposure strictly localised to the kidney for 6 s. A healthy male baby was delivered at term.

Adult↗
PubMed2004

Right atrial thrombi complicating use of central venous catheters in hemodialysis.

BACKGROUND: There has been an increase in the use of central venous catheters for temporary hemodialysis access. In this report, we describe a case series of 12 patients on hemodialysis who developed intracardiac clots associated with the use of central venous catheters, their outcomes and review the literature on this syndrome. METHODS: Retrospective, single-center case series of 12 patients with right atrial thrombi associated with central venous catheter use for dialysis vascular access. These patients were treated between June 1, 2001 and June 30th 2002 at the three University of Rochester affiliated dialysis clinics. The medical records of these patients were reviewed to obtain information concerning demographics, dialysis history, dates of catheter insertion, catheter complications, identification and dimensions of intracardiac thrombi, echocardiographic data, and outcome of anticoagulant therapy. RESULTS: Right heart thrombi were identified in 12 patients in our hemodialysis population over the study interval. Anticoagulation for 6 months led to clot resolution in more than 50% of our patients. Bacteremia recurred in 6 patients (50%), in spite of catheter replacement. There was zero mortality related to presence of clots in the short term. One patient with non-bacteremic right atrial thrombus suffered sudden cardiac arrest, but was successfully resuscitated. CONCLUSION: Right atrial thrombi may occur in hemodialysis patients who use central venous catheters for dialysis access. These clots are frequently found in the right atrium or right atrial-superior vena caval junction. Ten of 12 patients (83%), had catheter-associated bacteremia, but the precise relationship between bacteremia and intracardiac clots is unclear. Chronic anticoagulation for 6 months lead to resolution of these clots in more than 50% of patients in our series.

Adult↗
PubMed2004

Anemia.

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Anemia↗
PubMed2004

Risk factors for anti tuberculous drugs induced hepatitis: a prospective survey from a chest clinic in a general hospital.

A prospective survey on 14 consecutive cases with tuberculous drug induced hepatitis was done at our chest clinic in a state general hospital over a period of 15 months. There were 30 controls chosen randomly from the chest clinic register. The cases had lower mean body mass index (P<0.008), serum albumin (P<0.005) and higher serum globulin (P<0.04). Serum liver transaminases and total bilirubin rose significantly during the acute episode of drug induced hepatitis. Among the risk factors studied, only chronic hepatitis B carrier status was found to be more prevalent among the cases. There was one death (7.1%) over the whole study period.

Adult↗
PubMed2003

Laparoscopic gastropexy in a neonate for acute gastric volvulus.

A 26-day-old male neonate presented with an acute gastric volvulus which was reduced with a nasogastric catheter. The patient was then subjected to laparoscopic anterior gastropexy. Six months after the procedure, the child is thriving and completely free of symptoms. We present this case as the first wherein a laparoscopic gastropexy has been done for gastric volvulus in a neonate. We have found the procedure acceptable for the treatment of neonates with gastric volvulus.

Acute Disease↗
PubMed2003

Alpha-methyl-L-tryptophan PET detects epileptogenic cortex in children with intractable epilepsy.

BACKGROUND: In children with tuberous sclerosis, the PET tracer alpha[11C]methyl-L-tryptophan (AMT) has been shown to be selectively taken up by epileptogenic tubers, thus allowing differentiation from nonepileptogenic tubers in the interictal state. OBJECTIVE: To determine whether cortical areas showing increased AMT uptake in children without tuberous sclerosis complex with intractable neocortical epilepsy indicate the epileptogenic zone, and to assess the relative contributions of AMT and 2-deoxy-2[18F]fluoro-D-glucose (FDG) PET abnormalities to the localization of epileptogenic cortical regions. METHODS: Areas of increased AMT and decreased FDG uptake were marked objectively as regions with abnormal asymmetry using an in-house written software in 27 children who underwent comprehensive evaluation for resective epilepsy surgery. The marked PET abnormalities were compared to the locations of scalp and subdural EEG epileptiform abnormalities, as well as histology and surgical outcome. RESULTS: Focal cortical increases of AMT uptake were found in 15 patients. The lobar sensitivity (39.0%) of AMT PET for seizure onset was lower, but its specificity (100%) was higher (p < 0.0001) than that of hypometabolism on FDG PET (sensitivity 73.2%, specificity 62.7%). AMT PET abnormalities were smaller than corresponding FDG PET hypometabolic regions (p = 0.002), and increased AMT uptake occurred in two patients with nonlocalizing FDG PET. Histologically verified cortical developmental malformations were associated with increased AMT uptake (p = 0.044). Subdural electrodes adjacent to the area of increased AMT uptake were most often involved in seizure onset. CONCLUSIONS: Focal increase of cortical AMT uptake in children is less sensitive but more specific for the lobe of seizure onset than corresponding FDG PET hypometabolism, and it is often associated with epileptogenic cortical developmental malformations. AMT PET can assist placement of subdural electrodes even when MRI and FDG PET fail to provide adequate localizing information. Cortical areas adjacent to increased AMT uptake should be carefully addressed by intracranial EEG because these regions often show a high degree of epileptogenicity.

Adolescent↗
PubMed2003

Leiomyosarcoma of the broad ligament: a case report and literature review.

Primary leiomyosarcoma of the broad ligament is a very rare, rapidly progressive and highly malignant gynaecological tumor. There are only 11 cases reported so far in the literature. An 87-year-old Caucasian lady with leiomyosarcoma of the broad ligament is presented. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oopphorectomy. Unusually, she developed large recurrent pelvic disease in the absence of disseminated metastasis following surgery. She died within 8 weeks of primary surgery. This highlights the unknown behavior of this tumor and the need for more research into management.

Aged↗
PubMed2003

Synthesis and biological evaluation of N-substituted alpha-amino acids from 4-hydroxy coumarins.

The synthesis of a series of N-(methylene-4-oxo coumarinyl) carbamates by the condensation of various carbamates with 4-hydroxy coumarins in the presence of triethylorthoformate was undertaken to obtain the the title compounds in 50-55% yields. Preliminary data shows that only few molecules are active against B. subtilis, S. aureus, E. coli and P. aeruginosa at minium inhibitory concentrations (MIC) of 100, 300, 500 micrograms/ml compared to streptomycin (CAS 57-92-1) and kanamycin (CAS 59-01-8). The alkyl groups present in the benzenoid part and the higher amino acid residues like 3a, 3c, 5a and 5b were found to be more active in the title compounds (i.e. 2d and 2e).

4-Hydroxycoumarins↗
PubMed2003

Phase I population pharmacokinetics of irofulven.

Our aim was to develop a population pharmacokinetic model for irofulven and to assess covariates that might affect irofulven pharmacokinetics. Irofulven was administered by 5- or 30-min i.v. infusion to cancer patients during a phase I study. Blood samples were collected over 4 h. Plasma samples were analyzed to quantitate irofulven by high-performance liquid chromatography. Population pharmacokinetic analysis was performed using a non-linear mixed effects modeling program, MP2. Fifty-nine patients were available for pharmacokinetic analysis. Irofulven plasma concentration-time profiles were best described by a two-compartment pharmacokinetic model. Clearance and central volume of distribution were not significantly influenced by individual characteristics, i.e. body weight (BW), body surface area (BSA), age and gender. Final parameter estimates of clearance and central volume of distribution were 616 l/h and 37 l, respectively, resulting in a very short terminal half-life of less than 10 min. A relatively high level of variability was observed in irofulven pharmacokinetics, which was mainly due to a significant residual variability, 39%. For a 30-min irofulven infusion, the optimal sampling schedule for clearance estimation using the Bayesian method was the three time points 0.35-0.45, 0.80 and 1-1.2 h from the beginning of a 30-min infusion. We conclude that after i.v. infusion of irofulven, plasma clearance was high and not dependent upon patient age, gender, BSA or BW.

Adult↗
PubMed2003

Chronic Klebsiella pneumonia in an immunocompetent host.

A 55 years immunocompetent male was evaluated for chronic pulmonary disease of over 12-month duration for which he had twice been prescribed anti-tubercular therapy. Investigations led to the diagnosis of chronic Klebsiella pneumonia, which is rarely encountered in immunocompetent hosts in the antibiotic era.

Chronic Disease↗
PubMed2003

Testis-sparing surgery for benign and malignant testicular tumours.

We report the technique of testis-sparing surgery in three young men with testicular tumours, two of which were found to be benign (Leydig cell tumour and benign teratoma) and one malignant (seminoma) on frozen section and final pathological evaluation. The principles of clamping the spermatic cord with a soft bowel clamp, testicular cooling with ice slush, tumour enucleation with clear margins, meticulous haemostasis and frozen section analysis were followed. Testicular preservation was successful in the patients with benign disease. The patient with seminoma was found to have a separate nodule of invasive, poorly differentiated seminoma in the residual testis, which had not been detected on preoperative ultrasound scanning. As a result he was converted to radical orchidectomy.

Adult↗
PubMed2002

A survey of the views of geriatric psychiatrists in the United Kingdom on the use of electroconvulsive therapy to treat physically ill people.

BACKGROUND: One of the main concerns about ECT is its use for people with concurrent medical illnesses. Geriatric psychiatrists are more often likely to encounter this situation in working with older age groups. Drawing on the collective experience of all UK geriatric psychiatrists may allow a better understanding of the use of ECT for people with major medical illness. METHODS: A postal questionnaire was used to seek the views of all consultant geriatric psychiatrists in the UK on the use of ECT in the presence of major illness. The questionnaire was developed from previous literature on the subject, a previous pilot study, published guidelines and clinical experience of the authors. RESULTS: Geriatric psychiatrists most often favour bilateral ECT. They are likely to carry out physical examination, chest X-ray, ECG, haemoglobin estimation, urea and electrolytes, thyroid and liver function tests in medically ill people before considering ECT. They are more likely to change their ECT assessment procedures when dealing with medical illness, rather than any other aspect of treatment, and are unlikely to change any aspect of ECT treatment in someone of advanced age. CONCLUSIONS: Geriatric psychiatrists see their roles in relation to ECT as primarily that of assessment, and rely on others to advise on anaesthetic drug use, treatment technique, concurrent drug treatment and post-ECT management. It is important that the ECT consultant and ECT anaesthetist are aware of their role and prepared to offer appropriate advice. The role of the ECT consultant in relation to the responsible medical officer requires clarification.

Aged↗
PubMed2002

Natural and anthropogenic processes that concentrate Mn in rural and urban environments of the lower Mississippi River delta.

This study evaluated natural processes and projected methylcyclopentadienyl manganese tricarbonyl fuel additives as sources of Mn accumulation in the environment. Data sets include fresh alluvium and sediments from the lower Mississippi River Delta and a soil metal survey of metropolitan New Orleans. The (1) railroad Mn, (2) industrial Mn, and (3) dynamic aquifer-stream transfer of Mn hypotheses were tested with the Mississippi River Delta data. Friction between Mn-rich steel wheels and rails contributes Mn (P = 0.017) to the environment, supporting (1). Sediment loads of Mn were similar (P = 0.77) upstream and downstream from the Louisiana industrial corridor, not supporting (2). The median Mn on the alluvium surface (59 mg/kg), in the aquifer (159 mg/kg), and in the riverbank aquifer discharge zone (513 mg/kg) support (3) as a mechanism for Mn enrichment of clay. The New Orleans soil metal survey data set shows a rural to urban increase of fourfold for Mn and three orders of magnitude for Pb. At 1999 U.S. highway fuel use, 8.3 mg of Mn per L would yield 5000 metric tons of Mn annually. If 13% of Mn were emitted, 650 tons of Mn would become aerosols annually, while 87% or 4350 tons would remain in engines. The 1999 toxic release inventory for Mn shows 370 tons as total emissions compared to the potential of 390 and 260 tons from vehicles, respectively, in urban and rural areas. A precautionary lesson from the use of Pb as a fuel additive is that the use of Mn as a fuel additive would be associated with an increased risk for neonates exceeding the estimated total tolerable daily intake of 2.1-16.5 micrograms Mn (especially in urban inner city environments) because neonates lack fully functional hepatic clearance for Mn.

Fresh Water↗
PubMed2002

Sezary syndrome.

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Anesthesia, Epidural↗