Biomedical subjects

D K Gupta

Publications and source records attributed to D K Gupta.

At least 55 records · Page 3Linked to original sources

PubMed2002

Etiology, clinical profile, gender identity and long-term follow up of patients with ambiguous genitalia in India.

There is little information on the profile of children with ambiguous genitalia in India. Presented here is an analysis of patients with ambiguous genitalia registered in a general endocrine clinic during the last 2 decades. Seventy-four patients (age 4 months to 36 years) were registered during this period. Fifty-two were more than 5 years old at the time of registration. Thirty-five were reared as females, 29 as males; nine children (4 months to 1 year old) were brought for sex assignment, and one (with epispadias) was brought for correction of urinary incontinence. Investigations revealed 28 patients with congenital adrenal hyperplasia, 14 dysgenetic male pseudohermaphroditism, ten true hermaphroditism, six partial androgen insensitivity, four castration and one epispadias. There were eight patients with perineal hypospadias with normal Leydig cell reserve (normal LH, FSH and testosterone response to LHRH). Sex of rearing and gender identity were concordant in all except the patients with perineal hypospadias with normal Leydig cell response. These observations support the theory that prenatal androgen exposure masculinizes the brain.

Adolescent↗

PubMed2001

A laboratory study of surfactant flushing of DNAPL in the presence of macroemulsion.

Computed tomography (CT) monitored experiments are conducted in a three-dimensional water-saturated sandpack to evaluate the performance of a biodegradable surfactant (Glucopon-425N) in recovering a residually trapped dense nonaqueous phase liquid (DNAPL) tetrachloroethylene (PCE) from two sandpacks. Effects of flow rate, surfactant concentration, and pore size on the remediation process are evaluated. Axial variation in porosity of a sandpack has significant effect on the residual distribution of DNAPL in the sandpack and its subsequent recovery. DNAPL is recovered in two stages in general: mobilization followed by macroemulsion-solubilization. Mobilized DNAPL is recovered as a free-phase for all the experiments in the 30-mesh sandpack and only limited mobilization was observed in the 50-mesh sandpack. The dominant mechanism of recovery is macroemulsion flow (accounts for 46-86% of solubilized-emulsified PCE) in both the sands which leads to much higher PCE effluent concentration than the solubility limit as determined in batch solubilization studies. The effluent PCE concentration in the later stage depends on surfactant concentration but not on surfactant flow rate or pore size.

Biodegradation, Environmental↗

PubMed2001

Adaptogenic activity of a novel, withanolide-free aqueous fraction from the roots of Withania somnifera Dun.

The practitioners of the traditional Indian system of medicine regard Withania somnifera Dun. as the 'Indian ginseng'. A new withanolide-free aqueous fraction was isolated from the roots of this plant and was evaluated for putative antistress activity against a battery of tests such as hypoxia time, antifatigue effect, swimming performance time, swimming induced gastric ulceration and hypothermia, immobilization induced gastric ulceration, autoanalgesia and biochemical changes in the adrenal glands. This bioactive fraction exhibited significant antistress activity in a dose-related manner in all the parameters studied. The extract of Withania somnifera root (a commercial preparation available locally) was used to compare the results. A preliminary acute toxicity study in mice showed a good margin of safety.

Animals↗

PubMed2001

Incarcerated diaphragmatic hernia secondary to plication for eventration of diaphragm.

Diaphragmatic plication is the procedure of choice for congenital diaphragmatic eventration. In the absence of complications, most newborns with eventration do well after plication and have normal long-term respiratory functions. However complications are rare. Recurrence, ipsilateral pneumothorax and rupture of the diaphragm have been reported in literature. We report a case of incarcerated diaphragmatic hernia in a two-year-old child who had undergone plication for eventration of the diaphragm at six months of age.

Diaphragmatic Eventration↗

PubMed2001

Betamethasone in plus phenobarbitone prior to hepatobiliary scintigraphy increases diagnostic accuracy in infants with jaundice.

OBJECTIVE: In the diagnostic work up of the child with neonatal obstructive cholangiopathy (NOC), hepatobiliary scintigraphy (HBS) determines the need for peroperative cholangiography (POC). Traditionally, phenobarbitone is recommended to prime the liver to HBS. This retrospective study was designed to evaluate whether addition of the betamethasone (BM) alters the diagnostic accuracy of the HBS in distinguishing neonatal hepatitis (NH) from extra hepatic biliary atresia (EHBA). METHODS: Between 1993-1999, 202 patients presented with NOC and this study was not designed as a prospective randomized clinical trial. Of these, 126 patients had received Phenobarbitone (Group I) and the remaining 76 (Group II) had received BM in addition to the PB in a dose of 5 mg/k/d and 2.2 mg/k/d respectively for 7 days prior to HBS. RESULTS: Retrospective analysis revealed that, in the Group I, 41 showed excretion and 85 did not show any excretion of the radiopharmaceutical and the latter underwent POC which revealed that 31 patients (36%) of them showed patent biliary tract. In group II, 32 patients revealed excretion and 44 did not show any excretion of the radiopharmaceutical and the latter had undergone POC, which revealed that only 8 patients (18%) showed patent biliary tract. The percentages of false positives (36% vs 18%) was statistically significant (p < 0.03). CONCLUSION: Addition of BM increases the diagnostic accuracy of the HBS and this would lead to decreased need for POC to distinguish NH from EHBA.

Betamethasone↗

PubMed2001

Advanced biliary atresia: is portoenterostomy justified in all infants?

During 1989-98, of the 127 patients with biliary atresia, 23 were seen with advanced biliary atresia (ABA) presenting with (i) at more than 120 days of age (ii) established cirrhosis and (iii) features of portal hypertension. Sixteen of these underwent exploratory laparotomy, dissection at the porta hepatis and hepatico-portoenterostomy (HPE) (group I). The remaining 7 infants underwent portal dissection and sump drainage only (instead of HPE). The drainage if any was evaluated for any change in colour, volume and concentration in the post-operative period (group II). Age and presentation were the same in both the groups. In group-II, HPE was considered only if the bile flow was noted after portal dissection. Bile flow was seen in 3/16 in group I and 0/7 in group II. The fall in serum bilirubin during the first seven post operative days was noted in 2/16 in group I and 0/7 in group II. No drain output was recorded in any of the group II infants. The incidence of complications and the duration of hospital stay was significantly higher in group I patients. The sump drainage as an alternative procedure to HPE not only served the purpose of evaluating the patients with ABA for the possible bile flow in the post operative period but also avoided the need for a major operative procedure like HPE.

Biliary Atresia↗

PubMed2001

Association between lower hair zinc levels and neural tube defects.

Though folic acid supplementation has reduced the incidence of Neural Tube Defects (NTD), NTD still constitutes one of the important congenital malformations having wide medical, social and ethical implications. Zinc deficiency has been reported to produce NTD in animals. This study was designed to evaluate zinc status of the newborn babies with NTD and their mothers. Eighty newborn babies with NTD and their mothers served as cases. Eighty apparently normal newborn babies and their mothers served as controls. Serum and scalp hair zinc levels were analyzed by atomic absorption spectrophotometry. The mean (+/- SD) serum and hair levels in normal mothers were 74.1 +/- 4.1 micrograms/dl and 142.3 +/- 8.0 micrograms/g respectively. The mean (+/- SD) serum and hair levels of the mothers who delivered NTD babies were 75.7 +/- 5.6 micrograms/dl and 129.9 +/- 5.3 micrograms/g respectively. The mean (+/- SD) serum and hair levels in normal newborn babies were 77.8 +/- 5.3 micrograms/dl and 188.8 +/- 6.2 micrograms/g respectively. The mean (+/- SD) serum and hair levels in NTD babies were 80.1 +/- 12.9 micrograms/dl and 174.2 +/- 10.7 micrograms/g respectively. The hair zinc levels of the affected babies and their mothers were significantly lower (P < 0.001) than the controls. This study has found association between NTD and decreased hair zinc levels and large population based studies are recommended to confirm the association between zinc and NTD and to investigate whether zinc supplementation would reduce the overall incidence of NTD.

Developing Countries↗

PubMed2001

AIIMS clinical score: a reliable aid to distinguish neonatal hepatitis from extra hepatic biliary atresia.

It is important to distinguish neonatal hepatitis (NH) from extra hepatic biliary atresia (EHBA) in a neonate presented with jaundice as the former is purely medical management and the latter requires surgical procedure at the earliest. The observations on the critical evaluation of the neonatal jaundice cases led us to propose AIIMS clinical score (ACS) and this retrospective study was designed to evaluate the reliability of the ACS in all the 120 babies with jaundice referred to the pediatric surgery department during the past 10 year period. The ACS described here is based on 5 clinical parameters--Age, Jaundice, Colour of urine and stool and Clinical examination of liver. The accuracy of the hepatobiliary scan (HBS) with respect to the diagnosis of EHBA in this series, as compared to per operative cholangiography (POC) which is considered as the gold standard to distinguish these conditions was only 68%. However, ACS showed a sensitivity of 91.5%, a specificity of 76.3%, positive predictive value of 89.2%, negative predictive value of 80.5% and an overall diagnostic accuracy of 86.6%. ACS is reliable to distinguish NH from EHBA at bedside.

Biliary Atresia↗

PubMed2001

Epigastric heteropagus twins--a report of four cases.

Asymmetrical conjoined twinning is an extremely rare congenital anomaly constituting only 1%-2% of all conjoined twins. In epigastric heteropagus twins (EHT), the dependent portion (parasite) is smaller than the host (autosite). The embryopathy is related to incomplete cleavage of the embryo at 2 weeks of gestation. However, some form of ischaemic insult in early gestation leads to selective atrophy of the cranial part of one of the monozygous twins. We report our experience with four cases of EHT and a review of the literature with a discussion of possible embryopathy.

Abnormalities, Multiple↗

PubMed2001

Azygos vein anomaly: the best predictor of a long gap in esophageal atresia and tracheoesophageal fistula.

The gap between the pouches has a direct bearing on the tension at the anastomosis that ultimately determines the anastomotic leak in esophageal atresia with or without tracheoesophageal fistula (EA-TEF). Long-gap EA has been reported to be associated with aortic-arch anomalies and 13 pairs of ribs. Our observation that EA-TEF with an azygos-vein anomaly (AVA) invariably had a long gap led us to retrospectively analyze our data. The mean gaps (+/- SD) in the groups with 13 pairs of ribs (n = 6), right-sided aortic arch (n = 16), and AVA (n = 9) were 1.25 +/- 0.27, 2.18 +/- 0.98, and 3.16 +/- 0.16 cm, respectively. There was no statistically significant difference in the gap in patients who had 13 pairs of ribs compared with controls who had 12 pairs of ribs. The gap was highest in the AVA group and was statistically significant (P < 0.001) compared with patients with a normal azygos vein. In addition, the AVA group had a significant increase in mortality (P < 0.05) compared to the groups with a normal azygos vein; although there was no statistically significant difference in other factors: birth weight, time between delivery and surgery, cardiac anomalies, anorectal malformations, renal malformations, and chest infection in the AVA group and controls. An extra pair of ribs is not associated with a long gap, and an AVA per se is an independent predictor of a long gap and mortality in EA-TEF.

Abnormalities, Multiple↗

PubMed2001

Factors affecting outcome in the management of posterior urethral valves.

Children with posterior urethral valves (PUV) are at high risk for renal failure (RF). The outcome of renal function is significantly influenced by early diagnosis and the choice of primary therapy. We reviewed the outcome of renal function in 58 children with PUV. The choice of therapy in each case primary valve fulguration, vesicostomy, or high ureterostomy--was individually decided on the basis of the response to initial catheter drainage of the bladder. Patient age at diagnosis varied from newborn to 5.5 years, and follow-up ranged from 1.6 to 6 years (mean 3.9 years). The most common procedure was primary endoscopic valve ablation, which was carried out in 56.8% of cases. The other procedures were vesicostomy in 32.75% and high ureterostomy in 10.45%. Most neonates (66.6%) had RF at presentation, but one-half of them had achieved normal serum creatinine values at last follow-up. The recovery of renal function was lowest (33%) in older children where the diagnosis was delayed. A comparison between two groups of neonates and infants who differed on the basis of creatinine concentrations at 1 year of age suggested a statistically significant trend: children with normal or near-normal serum creatinine (0.8 mg/dl or less) by 12 months of age maintained good renal function at the time of final evaluation (1.0 mg/dl or less). Children with higher creatinine values at 1 year of age continued to have progressive RF. Seventy-five percent of the patients who had undergone early high ureterostomy after failure to respond to initial catheter drainage had regained normal renal function. We conclude that: serum creatinine at presentation is not predictive of subsequent renal function, but the values after a period of urinary-tract decompression are prognostically more useful; delay in diagnosis results in a poor outcome of renal function; and for optimal recovery of renal function, the choice of the primary procedure varies from case to case and can be determined by a systematic, stepwise approach (stepladder protocol).

Child, Preschool↗

PubMed2001

Telemedicine in pediatric surgery.

Telemedicine is a new academic specialty at the crossroads of medical informatics whose potential is still largely untapped by pediatric surgeons. Telemedicine aims to alleviate travel concerns associated with the delivery of health care, to bring expert pediatric surgeons to areas where currently none exist, and to improve coordination between pediatric surgeons, transcending all barriers. Today, it is possible to transmit all digitized data--roentgenograms, echocardiograms, radiologic images, intraoperative photographs, histologic images, etc., and to consult specific experts in the subspecialties of childcare. It is possible to train and guide surgical trainees by experts without their physical presence. In the future, telemedicine will constitute an integral part of the health care of children and the training of pediatric surgeons.

Child↗

PubMed2001

Evaluation of developing rat testis by phosporus 31P magnetic resonance spectroscopy and DNA flowcytometry.

For the assessment of germ-cell maturation of the seminiferous tubules, DNA flowcytometry is a rapid and sensitive method. Phosporus 31P magnetic resonance spectroscopy (MRS) is a non-invasive alternative that demonstrates the metabolic status of the testis, reflecting the type and relative proportion of germ cells in the testis. This study was designed to evaluate the utility of 31P MRS in reflecting the haploid-cell population of the testis as measured by DNA flowcytometry. A single testicle was evaluated in male Wistar pre-pubertal rats at 30, 40, 50, and 60 days of age. In order to minimize the contamination of signals from the contralateral testis, scrotum, and tail, the technique was modified and the testis was evaluated ex-vivo with an intact blood supply. At 30 days of age the percentage of haploid cells was 43.6 +/- 1.8, and this increased to 72.7 +/- 1.4 at 60 days of age. During this period, the testicular phosphomonoester/adenosine triphosphate (PM/ATP) ratio changed from 1.70 +/- 0.21 to 0.32 +/- 0.08. There was a significant (P < 0.001) linear correlation between the proportion of haploid cells evaluated by DNA flowcytometry and the PM/ATP ratio evaluated by 31P MRS. 31P MRS is thus a reliable, noninvasive technique for accurately assessing the status of the seminiferous epithelium.

Animals↗

PubMed2001

Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function.

OBJECTIVES: To evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with kidneys with ureteropelvic junction obstruction (UPJO) and split renal function (SRF) of less than 10%, because the management of such cases is still under debate. If SRF improves, we perform pyeloplasty, otherwise nephrectomy is done. METHODS: The records of all patients with UPJO (n = 20; 17 unilateral and 3 solitary kidney) with poor function who underwent PCN were analyzed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose oral trimethoprim prophylaxis. Repeated renography was obtained after 4 weeks. If no improvement in the SRF had occurred, nephrectomy was performed, otherwise pyeloplasty was performed. The patients were followed up with renograms at 3 months, 1 year, 2 years, and 5 years. RESULTS: Twelve of 17 kidneys with unilateral UPJO improved after PCN drainage and underwent pyeloplasty. The 5 kidneys that did not show improvement in the SRF underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF increased to 29.2% +/- 12.6% and pyeloplasty was performed. At a mean follow-up of 2.3 years, none of these patients had developed hypertension, and the most recent SRF value was 31.4% +/- 12.8%. CONCLUSIONS: Most of the poorly functioning UPJO kidneys show improvement in function and not all such kidneys should be removed without a trial of PCN.

Child↗

PubMed2001

Expression of prostaglandin H synthase-1 and -2 in murine intrauterine and gestational tissues from mid pregnancy until term.

These studies were undertaken to evaluate the changes in mRNA expression of prostaglandin H synthase (PGHS)-1 and -2 in murine gestational tissues during the latter half of pregnancy. Gestational tissues (decidual caps, membranes surrounding the fetus, and placentae), uterus, and cervix were collected from pregnant mice at days 12, 14, 16, 18, and 19 (am and pm) of gestation (n = 4), and total RNA was isolated and evaluated for PGHS-1 and PGHS-2 expression by northern blot analysis. Expression was normalized to GAPDH. There were no significant increases in PGHS-2 mRNA expression in any of the tissues studied through gestation. In contrast, expression of PGHS-1 mRNA increased significantly at term in the uterus and fetal membranes. In the placenta, mRNA for PGHS-1 was elevated at day 18 and remained elevated over the remainder of the study. These findings suggest that, in the mouse, increased production of PGs by uterine and intrauterine tissues during pregnancy is associated with up-regulation of PGHS-1 and not PGHS-2.

Animals↗

PubMed2001

Inoue balloon mitral valvotomy in patients with atrial septal aneurysm.

Atrial septal aneurysms (ASA) are not uncommonly detected in patients with rheumatic mitral stenosis and pose problems during transeptal puncture in patients undergoing balloon mitral valvotomy. From a period of August 1995 to May 1998, we performed a total of 680 Inoue Balloon Mitral Valvotomy (IBMV) procedures with ASA noted in 30 patients, 13 of diffuse and 17 localized type. Transesophageal echocardiography (TOE) was used in all patients with suspected aneurysm on transthoracic echo (TTE) for exact three-dimensional delineation of the location and extent of the aneurysm. The localized type of aneurysms were further subcategorized into five types viz. antero-superior and leftwards (6), postero-superior and rightwards (2), antero-inferior and leftwards (2), postero-inferior and rightwards (5), and central (2), depending on their location in the atrial septum. The site for transeptal puncture was decided after this localization and the remainder of the IBMV procedure was as usual. In the set of thirteen patients with diffuse type of atrial septal aneurysms all but one case had a successful transeptal puncture using standard technique except for a somewhat inferior puncture site so as to be perpendicular to the plane of atrial septum and a successful mitral valve dilatation was possible at first attempt. In the set of 17 patients with localized type of aneurysms, all had a successful transeptal puncture except one. In patients with aneurysms localized antero-superiorly and leftwards the septal puncture was done in a slightly inferior location with transeptal needle pointing some what more posterior, i.e. 5 or 6 o'clock position and in patients with aneurysms localized postero-inferiorly the puncture was done more cephalic with needle directed somewhat anterior, i.e. 3-2 o'clock position. In the two patients with Atrial septal aneurysms located postero-superiorly and to the right the puncture was done slightly inferior but with transeptal needle pointing to about 3 or 2 o'clock position and in the single patient with antero-inferior location the puncture was done in slightly higher but with a more posterior directed needle, i.e. 5-6 o'clock position. The two patients with centrally located localized type of aneurysms had successful transeptal puncture with standard needle direction (4 o'clock) but at a slightly inferior location. We conclude that a good localization of atrial septal aneurysms using transesophageal echocardiography and our technique of transeptal puncture leads to a successful outcome in majority of cases undergoing Inoue balloon mitral valvotomy with associated atrial septal aneurysms.

Adult↗

PubMed2001

Expression of interleukin-1beta mRNA in murine uterine and gestational tissues: relationship with gestational age.

PROBLEM: The pro-inflammatory cytokine interleukin (IL)-1beta has been shown to stimulate the production of prostaglandins (PG) in gestational tissues. Increased PG synthesis is considered a key step in the initiation of labor both at term and preterm. In this study. IL-1beta mRNA in the uterus and gestational tissues of mice during mid to late pregnancy was studied to characterize its tissue specific as well as gestational age expression. METHOD OF STUDY: Gestational tissues (placenta. decidual cap and fetal membranes). uterus, and cervix were collected from pregnant mice during gestation. Total RNA was isolated and probed for the expression of IL-1beta mRNA. RESULTS: There was a significantly increased expression of IL-1beta mRNA in the uterus on day 18 of pregnancy. In the decidual caps, there was increased expression of IL-1beta mRNA on day 14 of pregnancy and a decrease in expression with the onset of labor. In the fetal membranes and placenta, IL-1beta mRNA expression significantly increased on days 14 and 18 of pregnancy. respectively, and then remained elevated for the duration of pregnancy. In the cervix, there was a decrease in expression with labor onset. CONCLUSIONS: The increases in IL-1beta mRNA in the fetal membranes and placenta late in pregnancy are consistent with a localized, tissue specific inflammatory activation involved in the initiation of parturition.

Animals↗

PubMed2001

Gestational age-dependent effects of lipopolysaccharide on prostaglandin production by murine decidual caps.

We sought to determine whether the gestational age of the pregnant mouse had any relationship with its lipopolysaccharide (LPS) responsiveness. Murine decidual caps from days 13, 15 and 17 of gestation (term is day 20) were dissected out, placed in inserts and equilibrated in media overnight. The following day, media were removed, replaced with fresh media (+/-LPS at 10 microg/mL). After LPS stimulation (24 h), prostaglandin (PG)E2 production by decidual caps from days 13 and 15 increased by 80-fold and 5-fold, respectively. PGF2alpha, 6-keto-PGF1a and TxB2 production also increased. Day 17 decidual caps were unaffected by LPS, pregnant mice inoculated i.p. with LPS (50 microg) at day 13 of gestation induced 100% delivery within 24 h. However, mice treated at days 15 and 17 had an equal occurrence of premature delivery or fetal resorption. This change in LPS responsiveness may indicate changes in the fetal-maternal immune system in late pregnancy.

6-Ketoprostaglandin F1 alpha↗