Biomedical subjects
Publications and source records attributed to K Kumar.
A case of Salmonella typhimurium endocarditis of a Blalock-Taussig shunt in an infant is described for its rarity. Wider appreciation of such infections is warranted.
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The fixation of skin grafts often poses a problem, particularly in patients who have undergone tangential excision and grafting for burns. Sutures, staples, fibrin glue and other adhesives have been used for graft fixation. We present the use of Opsite spray as a simple method for graft fixation and stabilization. Opsite markedly reduced pain and discomfort at the time of first graft dressing and obviated the necessity for an anaesthetic which is often required for the removal of staples.
A convenient synthesis of 4-nitrobenzyl-substituted macrocyclic tetraamines and their conversion to bifunctional poly(amino carboxylate) chelating agents is described. Cyclization of (4-nitrobenzyl)-ethylenediamine with appropriate BOC-protected amino disuccinimido esters in dioxane at 90 degrees C resulted in the formation of 12- and 14-membered ring diamides in 40% and 44% yield, respectively. A 12-membered macrocyclic triamide was also prepared in 44% yield by cyclization of N-(2-aminoethyl)-4-nitrophenylalaninamide with disuccinimidyl N-(tert-butoxycarbonyl)iminodiacetate. Deprotection (HCl/dioxane) and reduction with borane gave the substituted macrocyclic amines which were then alkylated with either bromoacetic acid or tert-butyl bromoacetate. Preparation of the isothiocyanate derivatives and 14C labeled chelating agents are described. Attempts to prepare a 9-membered macrocyclic diamide using this cyclization technique resulted instead in a 20% yield of a 10:1 mixture of isomeric fused 5,6 ring acylamidines. Deprotection (HCl/dioxane) and reduction with borane gave a substituted piperazine derivative in 55% yield.
This article examines the headaches that can develop with deep brain stimulation. We identified 15 (23.4%) of 64 patients who developed chronic headaches following implantation of deep brain stimulation electrodes for relief of chronic pain syndromes. Electrodes were implanted in the periaqueductal gray, sensory thalamus, and internal capsule. None of these 15 patients reported similar headaches prior to the implantation. Although 5 patients were intermittent headache sufferers prior to implantation, they reported post-implantation headaches to be completely different in nature. Our experience suggests that headache syndromes may arise due to disturbance of serotonergic neurotransmission within deep brain structures.
OBJECTIVE: To assess the efficacy and safety of Insuflow (Georgia BioMedical, Inc.) filter heater hydrator device in reducing the incidence, severity and extent of hypothermia, length of recovery room stay and postoperative pain at the time of laparoscopy. DESIGN: Prospective, randomized, blinded, controlled multi-center study. Patients underwent gynecologic procedures via laparoscopy; surgeons, anesthesiologists and recovery room personnel assessed the results. SETTING: Seven North American institutions. PATIENTS: Seventy-two women for safety evaluation and efficacy studies. INTERVENTIONS: Intraoperative pre-conditioning of laparoscopic gas with the Insuflow device (treatment) or standard raw gas (control) during laparoscopic surgery and postoperatively. MAIN OUTCOME MEASURES: Incidence, severity and extent of hypothermia, postoperative pain perception and length of recovery room stay. RESULTS: The Insuflow group had significantly less intraoperative hypothermia, reduced length of recovery room stay and reduced postoperative pain. Pre-conditioning of laparoscopic gas by filtering heating and hydrating was well tolerated with no adverse effects. The safety profile of the Insuflow pre-conditioned gas showed significant benefits compared to currently used raw gas. CONCLUSIONS: Pre-conditioning laparoscopic gas by filtering heating and hydrating with the Insuflow device was significantly more effective than the currently used standard raw gas and was safe in reducing or eliminating laparoscopic-induced hypothermia, shortening recovery room length of stay and reducing postoperative pain.
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"The present endeavour has an emphasis on analysing distributional patterns of some...population characteristics [in India] as a case perceived at the physiographic-regional level, that is to say, the variability of population characteristics over different natural environments as well as within a similar physical entity. Specifically it aims at analysing the pattern of population density, growth, urbanisation level and literacy varying from one physiographic region to [another] and the relationship of these four variables with each other at the same level of regional structure."
BACKGROUND: Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome. METHODS: A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid. RESULTS: Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. CONCLUSION: Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.
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Two hundred and eighty four industrial workers were screened to determine their visual acuity. Significant visual impairment was observed in 21.8% individuals and moderate impairment in 34.5% of cases. Convergence insufficiency was a problem in 9.86% of the workers. Since uncorrected refractive errors are a prelude to disastrous workplace related eye injuries, it is recommended that prior to job placement all workers undergo visual acuity screening and get their refractive errors rectified.
This study is aimed at presenting the profile of ocular lesions observed in the inmates of a leprosy rehabilitation centre. Corneal involvement was found to be the highest (52.7%), followed by lesions of the eyebrows (47.3%) and eyelids (30.9%), uveal tract involvement (18.1%) and chronic conjunctivitis (1.8%).
School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.
Intra carpal, cubital and tarsal tunnel pressures were measured with open bore needle technique in 170 normal subjects. The pressure in carpal tunnel with wrist in neutral position was between 2.75 to 4.46 mm Hg which increased to 20-30 mm Hg. during flexion and extension of wrist. Pressures recorded in cubital tunnel were 2-5 mm Hg with full extended elbow and rose to 10-15 mm Hg and 20-28 mm Hg during 90 degrees flexion and full flexion of elbow respectively, pressures in tarsal tunnel were between 4-7 mm Hg in neutral position of ankle joint and with dorsi and plantar flexion of ankle it rose to 15-20 and 10-15 mm Hg respectively. There was no significant pressure difference between either sides and sexes; ages and proximally situated tunnel with distaly situated tunnel in same limb (Carpal tunnel Vs. Cubital tunnel). There was significant pressure difference between Carpal tunnel and Tarsal tunnel with wrist and ankle in their anatomical positions respectively.
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Management of 111 trophic plantar ulcers existing in 100 patients of leprosy have been reviewed. Male preponderance with 4th and 5th decade of life predilection was observed. Most of the patients were of lepromatous type. Ulcers were grouped into superficial and deep. They were treated by various methods viz. plaster cast alone and in combination with curettage, posterior tibial neurovascular decompression and metatarsectomy. It was observed that ulcers heal faster if conservative plaster cast treatment is clubbed with surgical treatment of the ulcer. Indications of various surgical methods is defined. Role of proper footwear in the management of plantar ulcers has been emphasized.