An unusual neurological complication in a CAPD patient.
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Aged↗
Biomedical subjects
D Kumar
Publications and source records attributed to D Kumar.
Endoscopic band ligation for non variceal bleed.
Endoscopic band ligation (EBL) is an infrequently used modality for treatment of non-variceal hemorrhage. We report the successful use of this technique for the management of bleed from blue rubber bleb nevus syndrome lesions and post polypectomy bleeding stalk.
Adolescent↗
Use of complementary and alternative medicine by patients with diabetes mellitus.
BACKGROUND: A wide variety of alternative medicines have been traditionally used for the treatment of diabetes in India. We did a cross-sectional study to assess the use of complementary and alternative medicine by patients with diabetes attending our outpatient department. METHODS: Four hundred and ninety-three patients attending the outpatient endocrine clinic for allopathic treatment were included. They were interviewed to assess their knowledge, awareness and methods of practice of non-allopathic forms of therapy. Information on the patients' background characteristics, family history of disease, existing knowledge of their disease and therapy was obtained. RESULTS: The user rate of complementary and alternative medicine was 67.8% and this was not significantly associated with the educational or socioeconomic status of the patients. Desire for early and maximum benefit was the most common reason (86.8%) for using these remedies. The patients felt that acupressure followed by naturopathy were the most beneficial alternative therapies, while homeopathy was felt to have the least benefit in the control of diabetes. CONCLUSION: There was widespread use of complementary and alternative systems of medicine by our patients. It is therefore necessary to obtain objective data to assess the improvement in blood sugar level with, and side-effects of, these methods of treatment.
Adult↗
Achalasia cardia: A study of 113 patients managed with indigenous dilator.
BACKGROUND: Endoscopic dilatation of achalasia cardia is an effective nonsurgical management option. It requires costly pneumatic dilators which are used under fluoroscopic guidance. This study assesses the efficacy and safety of an indigenous pneumatic dilator used without fluoroscopic guidance. METHODS: Over a period of eleven years, 113 patients (69M, 44F) ofachalasia cardia underwent dilatation with indigenous pneumatic dilators without fluoroscopic guidance. The dilatation was performed under endoscopic vision. RESULTS: The procedure was successful in all patients. After six weeks following dilatation, there was significant improvement in the mean dysphagia score 3.63 + 0.61 to 0.53 + 0.93 (P<0.01). The response was still significant (0.78 + 1.03, P <0.05) at the end of one year. Excellent response with single dilatation was seen in 70.7% patients. After two dilatation sessions 92% of patients showed an excellent response. One patient had perforation. There was no mortality. CONCLUSION: Pneumatic dilatation under endoscopic vision without fluoroscopic assistance with the indigenous dilator is very effective and safe for short term treatment of achalasia carida.
Adolescent↗
Ocular manifestations of leukaemia.
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Adult↗
Use of a premixed insulin regimen (Novolin 70/30) to replace self-mixed insulin regimens.
The efficacy and safety of transferring 76 patients with poorly controlled type II diabetes mellitus from various self-mixed human insulin regimens to a premixed insulin regimen (Novolin 70/30, 70% NPH and 30% Regular insulin, semisynthetic) were evaluated in a 24-week, multicenter, open-label study. During the initial 12-week run-in period, the patients received twice-daily doses of NPH and Regular human insulin mixed in ratios of 60/40, 80/20, 90/10, or NPH alone, as recommended by their physicians. Subsequently, these patients were transferred to a regimen of Novolin 70/30 twice daily for an additional 12 weeks. In most cases, the transfer was made on a dose-for-dose basis. Following the transfer from self-mixed to premixed insulin, the mean glycated hemoglobin fell from 9.3% to 8.7% at 6 weeks (P < 0.001) and to 8.5% at 12 weeks (P < 0.001). This improved glycemic control was not accompanied by an increase in the frequency or severity of hypoglycemic episodes. It is concluded that patients with type II diabetes mellitus who are poorly controlled on a wide range of self-mixed insulin ratios can be safely transferred, often in a dose-for-dose fashion, to a more convenient 70/30 premixed regimen.
Adult↗
Route-specific cardiorespiratory and neuromuscular changes following organophosphorous poisoning in rats.
Organophosphorous compounds cause a variety of physiological effects. The effect of various routes of administration of these compounds on the pathophysiology is still an open question. The present study addresses the effect of two organophosphorous compounds, namely diisopropyl fluorophosphate and methylisopropyl phosphonofluoridate, given by two different routes (i.v. and s.c.), on physiological parameters in anaesthetized and artificially ventilated rats. Both organophosphorous compounds produced a dose-dependent rise in blood pressure, bradycardia and twitch potentiation after i.v. administration. These effects are mediated by muscarinic as well as alpha-adrenoreceptors and are not affected by adrenalectomy. However, after s.c. administration, both organophosphorous compounds produced a dose-dependent transient hypotension and bradycardia, mediated by muscarinic receptors, without affecting other physiological parameters. The results indicate the route-specific effects of these compounds on the cholinergic-catecholaminergic interactions in rats.
Adrenalectomy↗
Perianal and anorectal conditions.
Day-case surgery applies equally to colorectal surgery as any other discipline in surgery. Careful patient selection is the key to a successful outcome. All patients must be examined before the procedure as a change in symptoms and signs is likely to modify the choice of procedure. This review examines day-case management of common perianal and anorectal conditions.
Ambulatory Surgical Procedures↗
Growth hormone-producing pituitary tumours: clinical profile and results of surgery.
BACKGROUND: Growth hormone-producing pituitary tumours present with a wide variety of manifestations. The optimum diagnostic work up, management and follow up of such patients is complex and involves a multidisciplinary approach. There is paucity of data from India with regard to the clinical presentation and results of surgery for growth hormone-producing tumours. METHODS: We studied the first 50 patients presenting during 1989-94 with growth hormone-producing pituitary tumours to our centre. The work up included detailed endocrine and radiological assessment. The surgical outcome was analysed for 35 patients who were operated (trans-sphenoidal 29, transcranial 6) at our centre. RESULTS: All the patients had macroadenomas [mean (SD) diameter 3.12 (0.87) cm]. Seventy-five per cent of the patients had supra- and/or parasellar extension and 57% had visual field defects. Tumour size correlated with the preoperative basal (r = 0.57) and glucose-suppressed (r = 0.54) growth hormone levels. Thirty-three of the 35 patients operated at our centre (trans-sphenoidal 28, transcranial 5) were available for follow up (median duration 34 months). After trans-sphenoidal surgery alone, 12 of the 28 (43%) patients had normalization of growth hormone levels (post-glucose growth hormone < 5 ng/ml), and 9 of 11 (82%) showed improvement in visual fields. CONCLUSION: In India, growth hormone-producing pituitary tumours are usually large in size. The growth hormone levels correlate with the size of the tumour. These tumours can be effectively treated by trans-sphenoidal or transcranial surgery.
Adolescent↗
Notification of tuberculosis: an updated code of practice for England and Wales.
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Child↗
Benign cystic peritoneal mesothelioma in a man.
Benign cystic mesothelioma of the peritoneum is uncommon and usually occurs in women. We report this condition in a man, who was treated successfully by surgical excision of the tumor.
Diagnosis, Differential↗