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Biomedical subjects

F Patel

Publications and source records attributed to F Patel.

At least 55 records · Page 3Linked to original sources
PubMed1992

Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.

Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.

Brachytherapy↗
PubMed1992

A matter of large body passing through a small hole: the holeproof out the window.

A baffling case of fall-from-height is described focusing on aspects of a human body passing through a small hole, within a holeproof window. It is a classic example of an unsatisfactory outcome when a scene of death is modified adversely due to delay in the commencement of scene management. The operative factors may be entirely outside the control of scene investigators. The primary medical attendant is reminded of the forensic obligations at a scene of unnatural death. Reporting this case might encourage forensic practitioners having experience of a similar case to respond through this journal.

Adult↗
PubMed1992

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement: a forensic presentation.

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement (CVR) are apparently unreported in the recent literature. An uncommon example of delayed non-valvular lethal complication of CVR occurring in the early out-patient period is reported here. The forensic aspects of wound dehiscence in cardiovascular surgery for cardiac valve replacement are discussed, and complemented by a study of the fracture ends of suture material in wound breakdown associated with the suture failure.

Adult↗
PubMed1992

The fatal paracetamol dosage--how low can you go?

Popular texts and forensic literature pertaining to paracetamol toxicology advocate an acceptable minimal dose or lower limit of the blood level 'normally' associated with a fatal single overdose. A case of fatal, acute paracetamol poisoning from a minimal single dose, within the recommended therapeutic daily total and associated with a zero blood paracetamol level, is reported. It also emphasizes the common knowledge that the toxicological tabulated reference data available on fatal levels of most drugs is merely a guide. The proper interpretation of the analytical results thus requires the full consideration of the circumstances surrounding the death in each case. The clinico-pathophysiology and toxicology of paracetamol poisoning is briefly reviewed in an attempt to establish how low a fatal paracetamol dosage can go. The phenomenon of fatal dose and blood level is in a paracetamol limbo.

Acetaminophen↗
PubMed1992

Fatal self-induced hyperinsulinaemia: a delayed post-mortem analytical detection.

The inconspicuous number of cases of self-induced hyperinsulinaemia reported in the literature may suggest that many are obscure enough to escape their detection. A case of fatal suicidal hyperinsulinaemia in a non-diabetic is reported here, and in whom only a retrospective biochemical analysis provided an explanatory cause of death. A quantitative radioimmuno assay (RIA) estimation of the refrigerated postmortem blood sample stored at 4 degrees C for three weeks gave a positive insulin yield. It reiterates the need, in forensic cases, for a very low threshold of suspicion and a good back-up for the appropriate body fluid analysis or tissue microexamination, especially when full details of the circumstances surrounding the death are not available at the autopsy. A brief résumé on insulin is presented as a background to the current forensic interest in the apparent increase in sudden deaths in young diabetics amidst the controversy about the bio-designed 'human' insulin and subjective unawareness of severe hypoglycaemia.

Adult↗
PubMed1992

Yeasts at different mucosal sites in patients with carcinoma cervix before and following radiotherapy.

The yeasts isolated from four superficial sites and blood were studied before and during radiotherapy in patients with carcinoma of the cervix. Significant yeast growth increased markedly in all four superficial sites during the 1st and 2nd week following radiotherapy. By the 4th week the count had decreased in all samples except in stool of 4 patients. Candida albicans was the most frequent isolate (54.3%) followed by C. tropicalis (28.3%).

Candida↗
PubMed1992

Acallosal brain in sudden infant death syndrome (SIDS).

A definitive explanation of "crib" or "cot" death remains unknown. An unusual incidental autopsy finding of agenesis of the corpus callosum in a case presenting as "near miss" sudden infant death syndrome (SIDS) is discussed. Hitherto, only a single case associated with SIDS has been reported in the literature. The condition may be easily missed outside the interest in neuropathology.

Agenesis of Corpus Callosum↗
PubMed1991

Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate.

In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.

Administration, Oral↗
PubMed1990

Sucralfate enema in ulcerative rectosigmoid lesions.

To assess the efficacy of sucralfate enemas in distal colonic ulcerative lesions, 22 patients with radiation proctitis (n = 8), idiopathic ulcerative proctitis (n = 5), and solitary rectal ulcer (n = 5) unresponsive to conventional medical therapy, and those with ulcerated and bleeding rectal polyps awaiting polypectomy (n = 4) were studied. Enemas of sucralfate suspension (2 gm in 20 ml water) were administered twice daily for a period of three weeks. Clinical and sigmoidoscopic improvements were observed in 19 and 18 of the 22 patients, respectively (86 and 82 percent, respectively). No side effects were seen. The authors conclude that sucralfate enemas are useful in the treatment of ulcerative lesions of the rectosigmoid.

Administration, Topical↗
PubMedDate not supplied

Fetal mild hydronephrosis and chromosomal defects: relation to maternal age and gestation.

The presence of multiple ultrasonographic abnormalities is associated with a significantly increased risk of chromosomal defects, while for isolated abnormalities, the association is less clear. In a study of 1,177 fetuses with mild hydronephrosis at 16-26 weeks of gestation, the fetal karyotype was abnormal in 86 (7.3%) of the cases and the most common chromosomal defects were trisomies 21, 18 and 13. The frequency of chromosomal defects increased with the number of additional abnormalities and for each chromosomal defect there was a characteristic pattern of associated abnormalities. However, in the 805 fetuses with apparently isolated hydronephrosis there were 5 (0.62%) with trisomy 21. On the basis of the maternal age and gestational age distribution of the population the expected frequency of trisomy 21 was 0.40%, which was not significantly different from the observed (0.62%). To demonstrate that such a difference is significant, it would be necessary to investigate at least 1 million pregnancies. In the meantime, parents could be counselled that the presence of mild hydronephrosis does not increase significantly the risk that the fetus has trisomy 21. Alternatively, the risk is 1.6 times higher than the maternal age and gestational age-related risk.

Adolescent↗