Endoscopy-assisted ferromagnetic foreign-body removal with a novel magnetic instrument.
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Child↗
Biomedical subjects
D Kumar
Publications and source records attributed to D Kumar.
Older patients' experiences of treatment for colorectal cancer: an analysis of functional status and service use.
Age and ageing are an important part of the context within which the care and treatment of people with cancer is provided. More information is needed about the effects of cancer treatment on the lives of older people following inpatient care. We conducted a 3-year study in which older people with colorectal cancer completed a detailed questionnaire on multidimensional function and service use before and after elective treatment. Here we present an analysis of changes in functional status and service use over the pre- to post-treatment period, and set out a detailed picture of older people's experiences before and after treatment. In total, 337 patients with colorectal adenocarcinoma aged 58-95 years were interviewed before treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), Rotterdam Symptom Checklist (RSCL) and a severity of morbidity score. Study end points were defined as post-treatment functional status, symptom distress, severity of morbidity and frequency of service use. Pre- and post-treatment data were compared using matched analyses. Logistic regression was used to assess associations between age and the main outcome measures, and frequency of service use after treatment was compared between age groups using the chi2 test. Overall, patients experienced both positive and negative outcomes following treatment. It was notable that patients aged > or = 75 years showed improvement in only one of the principal outcome measures. Patterns of service use following treatment suggest that support at home is a key issue for patients. With the exception of nursing care, however, help at home is provided on a majority of occasions by families themselves. This raises important questions about how much preparation patients and families receive or would like before they leave hospital after treatment for cancer. A collaborative, family-centred approach to meeting people's needs is called for in the months following inpatient care.
Adenocarcinoma↗
Complex fracture-dislocation of the proximal interphalangeal joint of the hand. Results of a modified pins and rubbers traction system.
We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85 degrees and that of the distal interphalangeal joint 48 degrees. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply.
Adolescent↗
Successful surgical removal of fibroma from the uterus of a cow: a case report.
A Holstein-Friesian cow aged 6 years aborted twice at 3-4 months of gestation. On rectal palpation a growth was palpable in the apex of one uterine horn. The growth was removed by right flank laparotomy under sedation and paravertebral nerve block. The growth was diagnosed to be a fibroma. The cow conceived and calved normally after the operation.
Abortion, Veterinary↗
Purification and characterization of a small size protease from Bacillus sp. APR-4.
A thermostable extracellular protease of Bacillus sp. APR-4 was purified by size-exclusion and ion-exchange chromatographic methods and its properties were studied. The purified enzyme had a specific activity of 21,000 U/mg of protein and gave single band on SDS/PAGE with a molecular mass of 16.9 KDa. This protease had an optimal pH of 9 and exhibited its highest activity at 60 degrees C. The enzyme activity was inhibited by EDTA, suggesting the presence of metal residue at the active site. Ca2+ (5 mM) had stabilising effect on the activity of protease, but Cu2+ (5 mM) had inhibitory effect. The enzyme exhibited highest specificity towards casein (1%) and had a Km of 26.3 mg/ml and a Vmax of 47.6 U/mg with casein as a substrate. The stability of this enzyme was evaluated in the presence of some organic solvents and the enzyme was stable in methanol, petroleum ether and ethanol. Detergents (Wheel, Farishta) had stimulatory effect on the activity of this enzyme.
Alkanes↗
Factors influencing the results of surgery for hypospadias: experience at NICH.
OBJECTIVE: To evaluate the factors that may influence the results of surgery after hypospadias repair at National Institute of Child Health, Karachi. METHODS: It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analysed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. For most patients who had penile or distal hypospadias TIP (Tubularised Incised Plate) urethroplasty was performed. Patients with severe chordee had Duckett Island flap urethroplasty as a two stage procedure. Patients having moderate chordee were subjected to the Mustardee Procedure. Some underwent MAGPI and Mathieu's repairs. RESULTS: One hundred four patients were operated. Files of only 46 patients with a mean age of 4 years could be retrieved and these were included in the study. Twenty five patients had TIP urethroplasty, 5 had island flap urethroplasty, 2 had Mustardee repair, 6 had MAGPI, 5 had Mathew's repair and 3 had Byers Staged Urethroplasty. Over all incidence of fistula formation was 26%. The frequency of fistula formation was less with TIP urethroplasty (16%) compared to those who received no dartos pedicle flap. Mathieu's repair gave good results with 20% incidence of fistula formation. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee. CONCLUSION: TIP urethroplasty is a safe and reliable method of hypospadias repair. The results of surgery can however be improved by using dartos pedicle flap to protect the repair, meticulous surgical techniques, use of monofilamentous absorbable suture material and soft waterproof dressing.
Child↗
Radiation-related cytological changes in oral malignant cells.
Carcinoma of the oral cavity constitutes approximately 40% of overall malignant tumours in India, with an incidence of about 56,000 cases per year. Radiation responses in oral cancer cells by cytology have not been extensively studied. 102 patients with squamous cell carcinoma of the oral cavity treated by fractionated radiotherapy were studied. Serial scrape smears were taken from each tumour before and after irradiation. The abnormal nuclear counts per 1000 malignant cells were 1.6 and 14.1(p<0.001) for micronucleation, 0.9 and 5.5 (p<0.001) for nuclear budding, 7.6 and 28.1(p<0.001) for binucleation and 2.4 and 11.7(p<0.001) for multinucleation respectively. The study showed a significant rise in radiation induced cytological responses. In addition, radiation changes observed included abnormal and incomplete divisions of a nucleus, fibroblast like appearance cells, and enlargement of nuclear size as well as cytoplasmic granulation. These changes may have an important role to play in understanding the mechanism of cell killing after radiotherapy.
Adult↗
Choledochal cyst associated with portal hypertension.
Portal hypertension is a known complication of delayed presentation of choledochal cyst. In the literature, choledochal cyst presenting with portal hypertension has not been addressed adequately. The aetiology of portal hypertension in these cases has not been well studied, but it may be related to compression of the cyst over the portal vein, secondary biliary cirrhosis, or even extrahepatic portal venous thrombosis. We present our experience with four cases of choledochal cysts with associated portal hypertension over a 10-year period (1991-2001). Gastrointestinal bleeding, splenomegaly or incidental discovery of oesophageal varices led to the diagnosis of associated portal hypertension. Excision of choledochal cyst and bilioenteric bypass may not be feasible in those patients with massive collaterals in the region of porta with secondary portal hypertension. An initial approach of internal drainage (endoscopic/operative) of the cyst may allow regression of collaterals and subsequent safe excision of the cyst in this difficult group of patients. The liver function and histopathology dictated the final outcome.
Child↗
Preliminary evaluation of an injectable anal sphincter bulking agent (Durasphere) in the management of faecal incontinence.
BACKGROUND: It has been previously shown that 'bulking' of internal anal sphincter defects may provide an effective method to treat patients with faecal incontinence, but the benefit wears off with time. AIM: To assess the efficacy of a larger molecule, bulking agent (Durasphere) over the short- and long-term in patients with an internal anal sphincter defect refractory to conservative management. PATIENTS: Eighteen patients (nine male, nine female) with a mean age of 60 years were recruited. All patients had persistent faecal leakage/soiling. METHODS: Durasphere was injected in the submucosal plane to restore anal canal symmetry. All patients had anorectal physiology, endoanal ultrasound, continence grading, patient satisfaction and quality of life scores assessed at 1, 3, 6 and 12 months. RESULTS: The mean follow-up is 28.5 months. Changes from baseline were not statistically significant up to 6 months. At 12 months there was significant improvement in the continence grading (P=0.003), patient satisfaction (P=0.053) and all quality of life subscales: lifestyle (P=0.004), coping (P=0.011), depression (P=0.024) and embarrassment (P=0.059). Anorectal physiological parameters apart from the maximum tolerable rectal volume at 12 months (P=0.036) showed no significant improvement. CONCLUSIONS: Anal sphincter bulking with Durasphere is safe and effective in the short term as well as the longer term. More importantly, there is no evidence of attenuation of effect over time.
Adult↗
Bile composition in inflammatory bowel disease: ileal disease and colectomy, but not colitis, induce lithogenic bile.
BACKGROUND: Inflammatory bowel disease is a risk factor for gall-bladder stones, but there is controversy about the composition of these stones and whether such patients develop lithogenic bile. METHODS: In 54 gallstone-free inflammatory bowel disease patients and 13 non-inflammatory bowel disease patients with cholesterol-rich gallstones, we measured the biliary cholesterol saturation indices, nucleation times and bilirubin concentrations, and determined the bile acid composition and molecular species of phosphatidylcholine, in gall-bladder bile. RESULTS: Patients with Crohn's colitis or ulcerative colitis had less saturated bile (mean cholesterol saturation index, 0.9) and longer nucleation times (median, 21 days) than those with ileal Crohn's disease (1.5; 14 days) or those who had undergone colectomy (1.6; 5 days). In patients with ileal Crohn's disease, the mean biliary bilirubin concentration was two- to three-fold higher than that in the other groups, and was associated with a decrease in the percentage of biliary deoxycholate and an increase in the percentage of ursodeoxycholate, compared with disease controls, but phosphatidylcholine species were similar. CONCLUSIONS: Patients with small bowel Crohn's disease, or who have undergone colonic resection, have supersaturated bile and an increased risk of cholesterol gallstone formation. In patients with ileal disease, the presence of high biliary bilirubin concentrations and low percentage of deoxycholic acid may also favour the formation of mixed, pigment-rich, gallstones.
Adult↗
Symptoms and anal sphincter morphology following primary repair of third-degree tears.
BACKGROUND: Approximately 0.6-9 per cent of vaginal deliveries are complicated by third-degree tears. The precise impact of such injuries on future pelvic floor function remains unknown. The aim of this study was to define the extent of structural and physiological damage to the anal sphincter and to investigate anorectal function in women who sustained third-degree tears during vaginal delivery. METHODS: Fifty-six women who sustained a third-degree tear were investigated prospectively. All patients had a primary repair of the anal sphincter complex, and were assessed by anorectal physiology and endoanal ultrasonography at a mean of 3.6 months. Symptoms were assessed by direct personal interview and also by a self-completed questionnaire. RESULTS: Forty-four patients had a persistent anal sphincter defect on ultrasonography. The mean resting and squeeze anal canal pressures were significantly lower in patients with a combined defect than in those in whom the repair was intact (P = 0.036 and P = 0.005 respectively). At direct interview three patients volunteered current symptoms of faecal and/or urinary incontinence whereas 32 reported bothersome symptoms on the questionnaire (P < 0.001). CONCLUSION: The anatomical and physiological damage sustained during third-degree tears appears to be much greater than is generally appreciated. Primary repair does not provide lasting integrity. A self-administered questionnaire appears to be more accurate in defining the symptomatology.
Adolescent↗
Antinociceptive and antipyretic activities of Pongamia pinnata leaves.
In the present study, the antinociceptive activity of a 70% ethanol extract of Pongamia pinnata leaves (PLE) was investigated in different models of pain in mice and rats. Further, PLE was also evaluated for its antipyretic activity in Brewer's yeast-induced pyrexia in rats. Per os (p.o.) administration of the PLE (100-1000 mg/kg) produced significant antinociceptive activity in the hotplate and tail flick (central) as well as in acetic acid writhing and Randall-Selitto (peripheral) nociceptive tests suggesting the involvement of both central and peripheral mechanisms in alleviating the pain response. In addition, PLE also exhibited a significant antipyretic response in Brewer's yeast-induced pyrexia in rats. These results demonstrated that PLE possesses marked antinociceptive as well as antipyretic activities and thus scientifically validated its use in the treatment of pain and pyretic disorders.
Acetic Acid↗
Laser reflectance imaging of human forearms and their tissue-equivalent phantoms.
Laser back-scattered radiation from a human forearm is affected by the compositional variation in tissues and was imaged by a reflectance imaging system. The measurement probe consisted of one input fibre and one output fibre, separated by a distance of 0.3 cm. The diffuse reflectance data were collected by placing the probe on the forearm. By interpolation and median filtering of these data, the colour-coded reflectance images of the forearms of ten subjects were reconstructed. For comparative analysis of the mean reflectance, the forearm area was divided into ten regions. The mean normalised back-scattered intensity (NBI) near the ulnar region of the wrist was 4.76 +/- 0.24% and was significantly higher (p < 0.0005) compared with that at other regions, which varied from 3.49 +/- 0.17% to 4.43 +/- 0.14%. Tissue-equivalent phantoms of these, required for the clinical assessment of optical techniques, were constructed using various combinations of paraffin wax and dyes. The matching of the NBI images of these stable and inexpensive phantoms with those of the forearms of the respective subjects showed the similarity of their optical parameters.
Adult↗
Non-invasive imaging of optical parameters of biological tissues.
The normalised back-scattered intensity (NBI) profiles at various locations on the forearms of ten human subjects were obtained by moving the multi-probe of a laser reflectometer. The statistical analysis of the NBI data showed that the variation in the NBI was significantly higher at the ulnar region compared with that at other regions. For determination of the scattering (mus) and absorption (mus) coefficients and the anisotropy parameter g at each location on the forearm, these profiles were matched with the NBI profiles simulated by a Monte Carlo procedure (chi(2)0.99). For the reconstruction of images of variation of these parameters, the averaged values of mua, mus, and g at all locations on the forearms of the subjects were determined. The absorption coefficient had a minimum (1.92 cm(-1)) and maximum (2.21cm(-1)) at the wrist and the lateral region of the forearm, respectively. The scattering coefficient had a maximum (194 cm(-1)) at the medial side and near the elbow, and a minimum (186 cm(-1)) at the lateral side of the forearm. Similar changes in the anisotropy parameter were also observed. By interpolation of the data of each parameter on a 100 x 100 image matrix and after median filtering, colour-coded images of the variation in the optical parameters were constructed. These images could be useful for diagnostic and therapeutic applications of lasers.
Adult↗
Observations on the musculature and isolated muscle fibres of the liver fluke, Fasciola hepatica.
The liver fluke, Fasciola hepatica relies on a well-developed muscular system, not only for attachment, but for many aspects of its biology. Despite this, little is known about the system beyond the gross organization of the main somatic muscle layers. In the present study, a range of techniques have been applied to F. hepatica in order to understand more about various aspects of muscle organization, biochemistry (in terms of muscle proteins) and identity of isolated muscle fibres. Scanning electron microscopy has provided a direct visualization in situ of the somatic muscle layers and the organization of the muscle fibres within the ventral sucker. The muscle bundles contributing to the main somatic muscle layers are made up of up to 10 individual muscle fibres. Phalloidin staining for actin, in conjunction with confocal microscopy, confirmed the presence of 2 main somatic muscle layers (outer circular, inner longitudinal), beneath which lies a third layer of oblique muscle fibres. The use of propidium iodide in combination with phalloidin staining for actin demonstrated that the cell bodies associated with the 2 main somatic muscle layers are situated beneath the longitudinal muscle layer and are connected to their respective muscle fibres by short cytoplasmic processes. Myosin immunoreactivity was demonstrated in the somatic muscle layers and in the muscle layers surrounding various organ systems within the fluke. Double labelling for actin and myosin confirmed the co-localization of the 2 muscle proteins in the muscle fibres of the ventral sucker. Muscle fibres from the somatic muscle layers and the ventral sucker have been isolated and images obtained with phase-contrast microscopy and scanning electron microscopy. The muscle fibres contain actin and myosin, but lack a nucleus, the connection with the cell body having been broken during the isolation procedure.
Actins↗
Treatment decisions in older patients with colorectal cancer: the role of age and multidimensional function.
The aim of the study was to investigate the role of age and multidimensional functional status in treatment decisions in older patients with colorectal cancer. Three hundred and thirty-seven patients aged 58-95 years with adenocarcinoma of the colon or rectum were interviewed before and after treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), a self-reported severity of morbidity scale, and the Rotterdam Symptom Checklist (RSCL). The OMFAQ rates five dimensions of function: social resources, economic resources, mental and physical health and self-care capacity. The likelihood of patients with Duke's C colorectal cancer receiving adjuvant chemotherapy decreased significantly with age (P = 0.001, trend). Differences in treatment received were not explained by differences in morbidity, economic, mental or physical function, self-care capacity, or any of the RSCL measures. After controlling for age, Duke's C patients who received adjuvant chemotherapy were less impaired in social resources than Duke's C patients who did not (P = 0.06). No other significant pre-treatment differences in functional status were found. Differences in age and social resources exist between patients who do and do not receive adjuvant chemotherapy. Care should be taken to ensure that patients are not excluded from treatment with known survival benefits because of their age, and the question of providing appropriate social support during adjuvant chemotherapy should be re-examined.
Adenocarcinoma↗
Colonic motor activity in slow-transit idiopathic constipation as identified by 24-h pancolonic ambulatory manometry.
Colorectal motor activity in slow-transit idiopathic constipation has not been fully evaluated under physiological conditions. The aim of this study was to evaluate colorectal motor activity in chronic idiopathic constipation using 24-h ambulant pancolonic manometry. Ten healthy volunteers (six females) 19-31 years of age, and eight females 25-46 years of age with slow-transit idiopathic constipation were studied. Motor activity was measured using two custom-made silicone-coated catheters, each with five solid-state pressure transducers. Bowel preparation or sedation was not used. Frequency of high-amplitude propagated contractions was reduced in chronic idiopathic constipation, median 1.9/24 h vs 6/24 h (P = 0.01). Contractile frequency of low-amplitude complexes was reduced throughout the colon in slow-transit idiopathic constipation (P < 0.0001). The interval between contractile complexes was reduced in the transverse colon and splenic flexure (P < 0.0001). This study demonstrates that colonic motor activity is abnormal in slow-transit idiopathic constipation; decreased motor activity leads to a reduction in propulsion of intraluminal contents.
Adult↗
Anorectal malformation with malrotation of gut.
Infants with anorectal anomaly have a high risk of having other congenital anomalies, but associated gastrointestinal tract anomalies are quite rare. Malrotation of gut is rarely associated with anorectal anomaly. We report two such cases of anorectal malformation with malrotation of gut. The high index of suspicion, diagnostic difficulty and surgical management with avoidance of appendicectomy in these neonates is discussed.
Abnormalities, Multiple↗