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Biomedical subjects

D Sharma

Publications and source records attributed to D Sharma.

At least 19 recordsLinked to original sources
PubMed2007

Leiomyosarcoma of kidney: a case report with long term result after radiotherapy and chemotherapy.

Leiomyosarcoma of the kidney is a rare entity with poor prognosis. Among renal sarcomas, it is the most common histologic subtype amounting to 50-60% of all cases. The tumors usually arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. We describe a case of renal leiomyosarcoma that presented with history of left flank pain. Physical examination was normal. Abdominal ultrasound showed a solid lesion of 38 x 36 mm arising from the left kidney. Intravenous urography showed cut off of both major and minor calyces of the left kidney from its pelvis with a normal right kidney. Exploratory laparotomy revealed a well-encapsulated mass confined to the renal parenchyma for which radical nephrectomy was performed. Histopathology showed a Grade I leiomyosarcoma arising from the renal capsule. Adjuvant chemotherapy and sandwich radiotherapy was given and he is disease free after six and half years of follow up. The rarity of this disease, its severity and poor prognosis, uncommon form of presentation, resulting delay in diagnosis and difficulty in management is highlighted and reported.

Combined Modality Therapy↗
PubMed2006

Lidocaine infiltration of the scalp does not completely abolish increased intraocular pressure due to skull pin insertion.

Insertion of skull pins results in haemodynamic perturbations, which can be blunted by local anaesthetic infiltration of the pin sites. No study has assessed the effects on intraocular pressure. General anaesthesia was induced in 71 patients undergoing cervical spine surgery with attachment of Gardner Wells tongs to the skull. Skull pins were attached five minutes after induction following either saline (group I, 35 patients) or lidocaine (group II, 36 patients) infiltration of scalp. Intraocular pressure, mean arterial pressure and heart rate were recorded before (baseline), immediately after, and 60 s following pin insertion and analysed statistically. Insertion of pins increased intraocular pressure in both groups (from 8.4+/-2.7 to 14.2+/-3.0 mmHg in group I, and from 8.8+/-2.3 to 12.7+/-2.7 mmHg in group II, P < 0.001), which persisted even at 60 s but the increase was significantly greater in group I. Insertion of pins significantly increased blood pressure in group I only. We conclude that lidocaine infiltration at the skull pin sites for Gardner Wells tong attachment fails to completely abolish increased intraocular pressure.

Adult↗
PubMed2006

Effect of orientation of a standard polyvinyl chloride tracheal tube on success rates during awake flexible fibreoptic intubation.

We conducted a randomised study in 70 patients to assess the effect of orientation of a standard polyvinyl chloride tracheal tube on the ease of railroading the tube during awake fiberoptic orotracheal intubation. Conventional orientation of the tube (with the bevel of the tube directed to the patient's left) was compared with orientation of the tube with the bevel facing posteriorly. The success rate of intubation at the first attempt was higher with the bevel oriented posteriorly (35/35; 100%) than with the conventional orientation (21/35; 60%; p = 0.0001), and the intubating time was shorter (median (range) 7 (5-11) s and 11 (5-60) s, respectively; p = 0.0001). We recommend that the tracheal tube should be aligned in this manner when railroading it over the fibrescope during awake fibreoptic orotracheal intubation.

Adult↗
PubMed2006

Is laparoscopic approach safe for ectopic pelvic kidneys?

OBJECTIVE: To assess the feasibility and safety of a laparoscopic approach to pelvic kidneys for ablative and reconstructive surgery. METHODS: Between January 2002 and February 2005, 6 patients with a left pelvic kidney; 2 with ureteropelvic junction obstruction, 2 with nonfunctioning kidney and 2 with pelvic stones were selected. These patients underwent dismembered pyeloplasty, simple nephrectomy and pyelolithotomy by laparoscopic approach. For pyeloplasty, omitting the prior retrograde stent facilitated dissection around the pelvis, which was identified first and then the ureter was traced downwards. Dismembered pyeloplasty was done by continuous sutures using 4-0 vicryl over a double-J stent placed antegradely. During nephrectomy, the ureter was identified over the iliac vessels and divided first. Subsequent dissection was carried out after lifting the kidney to identify ectopic renal vessels. Pyelolithotomy was performed for a large single pelvic stone after placing the ureteric catheter and confirming the stone's position by fluoroscopy. RESULTS: One patient with pyelolithotomy was converted to open surgery while the others were completed laparoscopically. Mean hospital stay was 4.16 (range 3-5) days, blood loss 115 (range 30-300) ml and mean operative time was 170 (range 140-220) min. There were no post-operative complications. After pyeloplasty there was significant improvement in renal function and drainage pattern on diuretic scan at 11 and 12 months. CONCLUSION: The laparoscopic approach provides all the benefits of a minimally invasive procedure to the patients. Due to the different locations of renal vessels, it is safe to approach the ureter first when performing nephrectomy. When performing pyeloplasty, omitting the prior stent placement helps in the identification and dissection of the renal pelvis.

Adult↗
PubMed2006

Asystole during percutaneous ethanol injection of symptomatic vertebral haemangioma.

Computed tomography guided percutaneous ethanol injection is frequently employed for treatment of symptomatic vertebral haemangiomas. The procedure is performed under monitored anaesthesia care in the prone position. It has several advantages over open surgery and other therapeutic modalities and is generally considered safe. There is no previous report of any significant haemodynamic disturbance attributable to alcohol ablation of vertebral haemangiomas. We report a case in which a patient of ASA physical status I developed asystole following injection of 100% alcohol into a vertebral haemangioma, and became apnoeic and unresponsive. He recovered following intravenous administration of atropine. All staff involved in this procedure should be aware of and prepared for, this rare but potentially life-threatening complication.

Adult↗
PubMed2006

Leptin promotes the proliferative response and invasiveness in human endometrial cancer cells by activating multiple signal-transduction pathways.

An increase in the risk of cancer is one of the consequences of obesity. The predominant cancers associated with obesity have a hormonal basis and include breast, prostate, endometrium, colon and gall-bladder cancers. Leptin, the key player in the regulation of energy balance and body weight control also acts as a growth factor on certain organs in both normal and disease states. Therefore, it is plausible that leptin acts to promote cancer growth by acting as a mitogenic agent. However, a direct role for leptin in endometrial cancer has not been demonstrated. In this study, we analyzed the proliferative role of leptin and the mechanism(s) underlying this action in endometrial cancers which express both short and long isoforms of leptin receptors. Treatment with leptin resulted in increased proliferation of ECC1 and Ishikawa cells. The promotion of endometrial cancer cell proliferation by leptin involves activation of STAT3 and ERK2 signaling pathways. Moreover, leptin-induced phosphorylation of ERK2 and AKT was dependent on JAK/STAT activation. Therefore blocking its action at the JAK/STAT level could be a rational therapeutic strategy for endometrial carcinoma in obese patients. We also found that leptin potently induces invasion of endometrial cancer cells in a Matrigel invasion assay. Leptin-stimulated invasion was effectively blocked by pharmacological inhibitors of JAK/STAT (AG490) and phosphatidylinositol 3-kinase (LY294002). Taken together these data indicate that leptin promotes endometrial cancer growth and invasiveness and implicate the JAK/STAT and AKT pathways as critical mediators of leptin action. Our findings have potential clinical implications for endometrial cancer progression in obese patients.

Cell Proliferation↗
PubMed2005

Effect of hormone replacement therapy in normalizing age related neuronal markers in different age groups of naturally menopausal rats.

Aging of the normal brain is accompanied by changes in its structure, function, and metabolism. There are significant gender differences in aging brain. Most of these changes increase during menopausal condition in females when the level of estradiol and progesterone are decreased. The objective of this study was to determine the effect of estradiol and progesterone (separate as well as combined) hormones in neuronal tissues from naturally menopausal rats of different age groups. Results show decreased activity of Acetylcholine esterase (AChE) whereas the level of lipid peroxidation increased with age, and after the hormone treatments both AChE activity and level of lipid peroxidation returned to control values. The deposition of lipofuscin, a pigment that accumulated intraneuronally in brain and other tissues and is considered a marker of aging, was increased with aging and the hormone treatment decreased this deposition. The present study clearly shows reduction in risk factors associated with aging in the murine model system by hormone treatments, namely estrogen and progesterone by increasing the activity of acetylcholine esterase and decreasing the levels of lipid peroxidation and lipofuscin deposition in different parts of aging brain. This study suggests that hormone replacement therapy may either reduce or delay the onset of age related diseases like Alzheimer's, Parkinson's and other neurological disorders.

Acetylcholinesterase↗
PubMed2005

Administration of estradiol and progesterone modulate the activities of antioxidant enzyme and aminotransferases in naturally menopausal rats.

In aging tissues the oxidative stress increases due to decreased activity of antioxidant enzymes and proteolysis increases due to decreased activity of aminotransferases, which can be modified by hormonal replacement therapy (HRT). The aim of the present study was to determine the effect of HRT on the activities of an antioxidant enzyme superoxide dismutase (SOD) and aminotransferases like alanine aminotransferase (Ala-AT) and aspartate aminotransferase in different age groups (12, 18 and 24 months) of naturally menopausal rats. The rats were given the subcutaneous injection of 17beta-estradiol, progesterone and combination of estradiol and progesterone for 1 month. The activity of SOD, Ala-AT and Asp-AT was measured in the brain (cerebral hemisphere, CH), heart, liver, kidney and uterus. The activity of SOD decreased with age in all the tissues taken particularly in liver. After HRT the enzyme activities were increased as compared to age-matched controls in all the tissues of aging rats. The activities of transaminases (Ala-AT and Asp-AT) showed a decrease with age in all the tissues and administration of estradiol and combination of estradiol and progesterone further decreased both the aminotransferases. Our study elucidates that increased activity of SOD contributes in protection of cells from oxygen toxicity by catalyzing the dismutation of free radicals in tissues. Furthermore, the HRT probably decreases gluconeogenesis and proteolysis by decreasing the activities of Ala-AT and Asp-AT in aging rat tissues.

Aging↗
PubMed2005

Anaesthetic management of Osler-Weber-Rendu syndrome with coexisting congenital methaemoglobinaemia.

A 9-year-old cyanosed child suffering from Osler-Weber-Rendu syndrome with bilateral pulmonary arteriovenous malformations (PAVMs) was posted for cerebral angiography under general anaesthesia. Careful preanaesthetic evaluation led to the diagnosis of coexisting congenital methaemoglobinaemia. There is no previous report of Osler-Weber-Rendu syndrome coexisting with congenital methaemoglobinaemia. This report emphasizes that a second contributory cause of cyanosis must be suspected and meticulously looked for if the symptomatology in a patient cannot be explained by a single established diagnosis. Positive-pressure ventilation was associated with reduction in arterial oxygenation despite an increasing inspired oxygen concentration, which returned to preanaesthetic levels only after extubation and resumption of spontaneous respiration.

Anesthesia↗
PubMed2005

Autodestruction of penis due to carcinoma.

Four unusual cases of autodestruction of the penis are described with their aetiology, diagnosis and management. Causes for delay in diagnosis and therapy, prevention and early recognition of this condition are emphasized.

Carcinoma, Squamous Cell↗
PubMed2005

Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers.

Diabetic and ischaemic non-healing pedal ulcers have a tendency for chronicity and increased chances of infection, which may threaten the viability of the foot. Systemic administration of therapeutic agents may be insufficient in these cases. We have assessed the role of retrograde venous perfusion (RVP) for the treatment of nine diabetic and 10 ischaemic non-healing pedal ulcers. Agents used were soda bicarbonate, heparin, lignocaine, gentamicin and pentoxiphylline. Five of nine diabetic non-healing ulcers showed complete healing and the remaining four improved. The complete recovery in the cases of diabetic ulcer occurred in 10-24 days (mean 16 days), while ischaemic ulcers took 10-14 days for complete recovery (mean 13.6 days). There was a reduction of rest pain in all 10 patients with ischaemic disease; five patients showed complete healing of ulcers, and the other five improved significantly. In two patients, pre-gangrene changes were reversed. RVP is a useful adjunct to conservative or surgical treatment of non-healing pedal ulcers. Its main impact was in improving ischaemia and promoting healing.

Adult↗
PubMed2004

Estradiol and progesterone treatments change the lipid profile in naturally menopausal rats from different age groups.

The effect of estradiol and progesterone therapy in serum and liver on the lipid profile of naturally menopausal albino rats of the Wistar strain of different age groups (12,18 and 24 months) have been measured and compared with the age matched groups. Three months old rats were used as young controls. The aged rats were administered subcutaneous injection of 17-beta-estradiol (0.1 microg/g body weight), progesterone (2.5 microg/g body weight) and similar concentrations of both in combined treatment for 1 month and the level of triglycerides (TG), total lipids (TL), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were measured in serum and liver of 3, 12, 18 and 24 months old control as well as treated groups. The results show that TG, HDL, VLDL levels were increased significantly by 71%, 155%, 54%, respectively in liver of 24 months old rats by combination treatment when compared with age matched control animals. The levels of TL, TC and LDL were decreased by 20%, 31%, and 30%, respectively in serum of 12 months old rats in combination treatment group. The effect was more significant in 12 and 24 months old female rats with administration of estrogen and combined (EP) treatments. The results indirectly suggest that hormone replacement therapy (HRT) can reduce the risk of cardiovascular disease (CVD) thereby playing a cardio-protective role by restoring lipid and hormone levels to the similar levels as found in young female animals.

Aging↗
PubMed2004

Effect of estradiol and progesterone treatment on carbohydrate metabolizing enzymes in tissues of aging female rats.

The aim of this study was to determine the effect of administration of estradiol (E2), progesterone (P4), and combination of estradiol and progesterone (EP) in aging female rats. The changes in the activities of hexokinase (HK), glucose-6-phosphatase (G6P'tase) and glucose-6-phosphate dehydrogenase (G6PDH) enzymes, and in protein levels in tissues of rats namely brain (cerebral hemisphere), heart, liver, kidney and uterus have been measured in different age groups. The random blood sugar level was measured in serum and liver. The different age groups of rats were given 0.1 microg/g body weight estradiol, 2.5 microg/g body weight progesterone and a similar concentration of both in a combined treatment for 1 month. This dose was selected after determining estrogen and progesterone levels in 3 month adult female animals so that the aging female animals had circulating hormone levels nearly the same as those of young female animals. The random sugar level was determined in serum and liver cytosolic fractions, and it was increased by combination treatment. The protein content in tissues showed significant changes only with combined hormone administration when compared with age-matched controls. The activity of HK decreased in aged animals and significantly increased by hormone treatments in all the tissues of the aged rats studied. The activity of G6P'tase increased with age up to 1.5 years and decreased in 2 years. Treatment with E2 and EP further decreased the activity significantly in all the tissues. G6PDH showed a similar pattern as was observed in HK in all the age groups. Therefore, the E2 and EP treatments caused an entire series of growth-related responses, including an increased uptake of glucose, increased the protein level in the tissues of aging rats, thereby reducing the risk factors associated with aging by normalizing hormone levels which decreased with aging and resulted in diseases such as Alzheimer's diseases and diabetes.

Age Factors↗