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Biomedical subjects

K Moorthy

Publications and source records attributed to K Moorthy.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2004

Robot-assisted laparoscopic adrenalectomy: preliminary UK results.

OBJECTIVE: To describe the results of our first two cases of laparoscopic adrenalectomy using the da Vinci surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS: Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS: Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25-37) min and mean procedure time 118.5 (107-130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up. CONCLUSIONS: Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system.

Adenoma↗
PubMed2004

The simulated operating theatre: comprehensive training for surgical teams.

Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.

Clinical Competence↗
PubMed2004

Evaluation of the benefit of VR simulation in a multi-media web-based educational tool.

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality multimedia learning materials with VR simulation. The aim of this study was to evaluate the benefit of the VR simulation on the learning of procedure based psychomotor skills. Subjects were divided into three groups. The group that used the entire package including the VR simulation were superior to the group that used only the multimedia component in terms of the their procedural skills in the post-training assessment. Both groups performed better than the controls.

Computer-Assisted Instruction↗
PubMed2003

Validity and reliability of a virtual reality upper gastrointestinal simulator and cross validation using structured assessment of individual performance with video playback.

BACKGROUND: This study aims to evaluate the ability of an upper gastrointestinal virtual reality simulator to assess skills in endoscopy, and to validate its metrics using a video-endoscopic (VES) technique. METHODS: The 32 participants in this study were requested to undertake two cases on the simulator (Simbionix, Israel). Each module was repeated twice. The simulator's metrics of performance were used for analysis. two blinded observers rated performance watching the simulator's playback feature. RESULTS: There were 11 novices (group 1), 11 trainees with intermediate experience (10-50 procedures, group 2), and 10 experienced endoscopists (>200 procedures, group 3). There was a significant difference in the total time required to perform the procedure (p < 0.001), percentage of mucosa visualized (p < 0.001), percentage of pathologies visualized (p < 0.001), and number of inappropriate retroflexions (p = 0.015) across the three groups. The reliability of assessment on the simulator was greater than 0.80 for all parameters. The VES assessment also was able to discriminate performance across the groups (p < 0.001). There was a significant correlation between the VES score and the percentage of mucosa visualized (rho = 0.60; p < 0.001). CONCLUSIONS: The upper gastrointestinal simulator may be a useful tool for determining whether a trainee has achieved a desired level of competence in endoscopy. The next step will be to validate the VES score in real procedures.

Endoscopy, Gastrointestinal↗
PubMed2003

The effect of stress-inducing conditions on the performance of a laparoscopic task.

BACKGROUND: The availability of objective means for assessment of surgical skills has made it possible to evaluate the effect of adverse environmental conditions on surgical performance. METHODS: Participants performed a laparoscopic transfer task under five conditions: a simple verbal mathematical task (M), operating theatre background noise at 80 to 85 dB (N), performance as quickly as possible (T), all three stressors combined (A), and quiet conditions (Q). The effect of these conditions on performance was evaluated by using a motion analysis system and an error score. RESULTS: The study included 13 right-handed surgeons with varying levels of laparoscopic experience. There was a significant increase in the path length per movement of the right hand (p = 0.001) under T and a significant increase in the path length per movement of the left hand under M (p = 0.002), T (p = 0.01), and A (p = 0.02). A significantly higher number of errors occurred under all four stress-inducing conditions. The effect was more pronounced when all the stressors were applied in combination ( p = 0.001) followed by performance under M (p = 0.005), then T (p = 0.01) and N (p = 0.03). CONCLUSIONS: All three stressors led to impaired dexterity and an increase in the incidence of errors.

Adult↗
PubMed2003

Learning the skills of flexible sigmoidoscopy - the wider perspective.

BACKGROUND: Nurse-led gastrointestinal endoscopy is a priority clinical area in the UK. Endoscopic procedures are challenging to learn, requiring a combination of technical competence (manipulating a flexible endoscope and interpreting the findings) and interpersonal skills (engaging effectively with a conscious patient who is frequently apprehensive). This paper explores the potential of an innovative, scenario-based approach which links a simulated patient with a computer-driven virtual reality (VR) training device for flexible sigmoidoscopy. Within this safe yet realistic quasi-clinical environment, learners carry out the procedure while interacting with the 'patient'. Communication skills are assessed by simulated patients, while quantitative performance data relating to the procedure is generated automatically by the VR simulator. METHODS: This pilot study took place within a nurse practitioner endoscopy course. A mixed methodology combined qualitative and quantitative data (observation and interview studies, communication rating scales and a range of computer-generated output measures from the VR simulator) in a multifaceted evaluation. RESULTS: Seven nurses took part in the study. Participants found the scenarios to be a convincing and powerful learning experience. All experienced high levels of anxiety. Simulated patients identified strengths in participants' communication skills, together with areas for development. Simulator-based practice led to an improvement in objective performance measures. DISCUSSION: Scenario-based training provides a powerful learning experience, allowing participants to build their technical expertise and apply it within a holistic clinical context without the risk of causing harm. We used this pilot study as a springboard for discussions over wider implications of procedure-based skills training, locating it within the literature on expertise and situated learning.

Clinical Competence↗
PubMed2003

Validation of a web-based training tool for lumbar puncture.

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality courseware, self-assessment exercises, video clips and VR simulation. This pilot study was carried out to validate the lumbar puncture (LP) module in training. Subjects who had never performed an LP participated in the study. The subjects were randomized into 2 groups: 1) underwent training and 2) control group. Both groups performed a pre-test and post-test LP on a synthetic mannequin. There was a significant improvement in the training group in terms of performance assessment as compared to the control group. This study showed that there was a significant improvement in the performance of the procedure and in procedural knowledge after training with WebSET.

Computer Simulation↗
PubMed2001

The management of simple hepatic cysts: sclerotherapy or laparoscopic fenestration.

BACKGROUND: Prior to the era of laparoscopic surgery, open surgical deroofing was considered to be the most appropriate therapy for uncomplicated simple hepatic cysts. Recently, there have been a number of reports of successful laparoscopic fenestration of simple hepatic cysts. Simple aspiration of these cysts is associated with a high recurrence rate. Cyst sclerosis with alcohol and, more recently, minocycline hydrochloride have been found to be effective in their management. So far there have been no trials comparing laparoscopic deroofing with sclerotherapy. A lack of consensus in their management results in considerable confusion and difficulty in deciding the optimum form of therapy. METHODS: A systematic review of articles on the subject appearing in journals in the English language was conducted using the Medline database and by cross-referencing. RESULTS AND CONCLUSIONS: Both laparoscopic deroofing and cyst sclerosis have been found to be effective in partial or complete obliteration of the cyst and in the relief of symptoms produced by the cyst. It is essential to rule out cystadenoma, malignancy, biliary communication and infection prior to treating these cysts. Alcohol/minocycline based sclerotherapy has the advantage of being associated with a lower incidence of complications. Surgery is indicated if it is difficult to rule out the above mentioned conditions, in the presence of biliary communication, in those cysts where sclerosis has been ineffective and in cases of recurrence. The choice between open and laparoscopic surgery depends on the location of the cysts within the liver parenchyma.

Cysts↗
PubMed2000

Necrotising perineal infection: a fatal outcome of ischiorectal fossa abscesses.

INTRODUCTION: Necrotizing perineal infection or Fournier's gangrene is an uncommon but lethal complication of ischiorectal fossa abscesses. It is associated with a high mortality, especially in diabetics and immunocompromised individuals. Attempts have been made to study factors which could serve as prognostic indicators. The role of faecal diversion has not been clearly determined. MATERIALS AND METHODS: The medical records of 8 patients who presented with necrotizing perineal infection as a complication of ischiorectal fossa abscesses were reviewed. Various parameters were studied to see if any of them could serve as predictors of outcome. Mean surface area of involvement was calculated using modified burns assessment criteria. To study the effect of colostomy on the general condition of the patient the physiological and biochemical parameters before and after the procedure were compared. Statistical analysis was done using the unpaired and paired 't' tests. RESULTS: The mean age of the patients was 50.6 +/- 10.3 years. Five patients were diabetic, of whom four died; all the non-diabetics survived. The mean surface area of involvement was 5.1 +/- 0.75%, among the survivors, and 9.6 +/- 3.4% among the non-survivors. Colostomy was performed in four patients one of whom died. While in one patient the colostomy was created along with the initial radical debridement, in three other patients it was formed on days three, five and five, respectively. There was a significant improvement in their general status and biological parameters. All patients with testicular involvement died. CONCLUSION: Evidence of systemic sepsis at presentation, extent of tissue and testicular involvement, a low haematocrit, a high blood urea and creatinine and a low serum albumin, were associated with a higher mortality. Prompt recognition of the condition, urgent radical surgical debridement and the use of appropriate antibiotics are the mainstays of management. Formation of a diverting colostomy appears to favour survival.

Abscess↗
PubMed2000

Gastric stromal tumours: a practical approach.

Recent findings on the pathological diversity of gastric stromal tumours and their unpredictable behaviour prompted us to review our series of 16 patients who had undergone surgery for these tumours from 1991 to 1998. There were 13 benign and 3 malignant lesions. The majority of patients presented with either upper gastrointestinal bleeding or anaemia alone (12 of 16). Endoscopy was an extremely useful diagnostic tool, revealing the lesion as an intraluminal protuberant tumour with or without ulcer in 10 cases and as an ulcer alone in 4 cases, and in 1 case features suggesting an extrinsic mass. All the patients in the series underwent surgery. We used staplers (AutosutureR TA 55) to excise the tumours in 7 cases, all of which on histological examination were benign with clear resection margins. Gastric resections were performed in 5 cases for either large tumours or those situated at the fundus or antrum and local excision of the remaining 4. The mean follow-up of these patients was 24 months. Two patients with malignant lesions died of irresectable recurrences, one 2 months and one 18 months after surgery. There have been no recurrences in the tumours diagnosed as benign on histology. Tumour size, position and the ability to apply the stapler leaving adequate margin below the tumour should be the determinants of extent and type of excision. Reliable determinants of behaviour are tumour size, grade and mitotic index.

Adult↗