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Biomedical subjects

M Akhtar

Publications and source records attributed to M Akhtar.

At least 451 records · Page 25Linked to original sources
PubMed1977

Gastrointestinal adaptation following small bowel bypass for obesity.

Small intestinal morphologic and biochemical changes were studied following jejuno-ileal bypass for obesity after body weight stabilization had occurred. Four patients underwent biopsy of in-continuity and bypassed jejunal and ileal segments of the small intestine 11 to 22 months after the bypass operation. Microscopically, marked mucosal villus hypertrophy of the in-continuity bowel was observed, especially in the ileum. Bypassed jejunal mucosa underwent atrophy compared with pre-bypass jejunum, whereas bypassed ileum appeared similar microscopically to pre-bypass ileum. The specific activities of mucosal disaccharidase enzymes (maltase, sucrase, lactase and trehalase) in units per mg protein remained similar to pre-bypass levels in segments of the in-continuity jejunum and the bypassed jejunum and ileum. On the other hand, elevated mucosal disaccharidase levels were measured in biopsy specimens of the in-continuity ileum. Total enzyme activity per unit length of intestine, however, was estimated to be elevated in both in-continuity jejunum and ileum secondary to mucosal villus hypertrophy. These data indicate that following small bowel bypass: (1) the in-continuity ileum undergoes greater biochemical and morphologic adaptation than the jejunum; and (2) intraluminal nutrients and chyme appear to be essential to maximal intestinal adaptation.

Adaptation, Physiological↗
PubMed1977

Fluoroscope-generated electromagnetic interference in an external demand pacemaker: report of a case.

Electromagnetic interference presented as inhibition and resetting of the demand circuitry of a ventricular-inhibited temporary external pacemaker in a 70-year-old man undergoing surgical implantation of a permanent bipolar pacemaker generator and lead. The arrhythmia was found to be due to oversensing of waveforms modulated to simulate myocardial potentials emitted by a faulty fluoroscopy unit used in the vicinity of external temporary transvenous pacing equipment. The documentation of this disruption of pacemaker rhythm reinforces the need for continuous monitoring of patients treated with external demand pacemakers and for the careful maintenance of all electrical equipment.

Aged↗
PubMed1977

Induction of iatrogenic electrocardiographic patterns during electrophysiologic studies.

Indwelling cardiac catheters by producing local mechanical stimulation or trauma can induce electrocardiographic (ECG) patterns which simulate known electrophysiologic phenomena. Catheter-induced ECG patterns were analyzed in 447 consecutive patients undergoing electrophysiologic studies. Iatrogenic nature of these patterns was suggested by 1) absence prior to placement of catheter; 2) sudden appearance with catheter placement and disappearance with catheter repositioning; 3) reoccurrence with remanipulation of catheters; and 4) simulation (in some cases) by programmed electrical stimulation from the catheter. Common catheter-induced patterns were 1) right bundle branch block (RBBB) lasting less than 24 hours occurred in 19 patients; 2) transient third degree atrioventricular block in His-Purkinje system developed in 3/13 patients with pre-existing left BBB; 3) catheter-induced ventricular pre-excitation which simulated ECG patterns of type B Wolff-Parkinson-White syndrome; 4) fortuitous synchronization of right ventricular excitation from the catheter, and left ventricular excitation from sinus beat resulted in normalization of the QRS complexes in 5/68 patients with pre-existing RBBB; 5) premature beats from the atria, right ventricle, and His bundle, which were common, resulted in complex ECG patterns. These iatrogenic ECG patterns must be identified in order to avoid errors in interpretation.

Arrhythmias, Cardiac↗
PubMed1977

Modification and abolition of re-entry within the His-Purkinje system in man by diphenylhydantoin.

The phenomenon of macrore-entry (Re) within the His-Purkinje system (HPS) was consistently observed in 10 of 19 patients during retrograde refractory period studies. Effects of intravenous infusion of diphenylhydantoin (DPH) on Re were studied in these 10 patients 10 minutes after completion of infusion (mean plasma level equal to 17.0 microgram/ml). Diphenylhydantoin modified determinants of Re in seven patients (group I) and abolished Re in the remaining three patients (group II). In group I, DPH shortened the critical V1 V2 from 310.0 +/- 30.5 to 292.9 +/- 25.6 msec (P less than 0.025) and critical V2 H2 intervals for Re from 201.4 +/- 18.4 to 185.0 +/- 13.8 msec (P greater than 0.05). In group II, DPH abolished Re in two of three patients by precluding attainment of critical V2 H2 intervals whereas Re was abolished in the remaining one patient despite attainment of critical V2 H2 intervals (vs control). For both groups, DPH significantly shortened functional and effective refractory periods of the HPS (P less than 0.001 and less than 0.01, respectively) without significantly affecting the effective refractory period of the ventricular muscle. Diphenylhydantoin either completely abolished or significantly shortened the retrograde gap zones in the HPS. It is concluded that diphenylhydantoin significantly shortens His-Purkinje system refractoriness, abolishing Re in the patients with higher degree of improvement in refractoriness.

Adult↗
PubMed1977

Mutilated nose.

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Adult↗
PubMed1976

The role of the pseudo-disaccharide neamine as an intermediate in the biosynthesis of neomycin.

By using wild-type and deoxystreptamine-negative mutants of Streptomyces fradiae grown in media containing [6(-3)H]glucose or [U-14C]glucose, and by subsequent hydrolysis of the labelled neomycin produced, neamines labelled with 3H in both rings I and II, but with 14C in ring I only, were prepared. A mixture of these two forms of neamine was converted by deoxystreptamine-negative Streptomyces rimosus forma paromomycinus into neomycin (not paromomycin) with a 30% yield. The3H: 14C ratio in this neomycin was the same as the measured in neamine produced by hydrolysis of the neomycin, and in unused neamine reisolated from the incubation medium. The 3H:14C ratio in the neomycin was not affected by the presence of unlabelled deoxystreptamine during the incubation. The radioactivity in the neomycin was associated with rings I and II only. It is concluded that the added neamine is incorporated into antibiotic intact, without initial hydrolysis, and that the probable first step in the subunit assembly of neomycin is the formation of neamine.

Disaccharides↗
PubMed1976

The asymmetric distribution of enzymic activity between the six subunits of bovine liver glutamate dehydrogenase. Use of D- and L-glutamyl alpha-chloromethyl ketones (4-amino-6-chloro-5-oxohexanoic acid.

A method for the preparation of D- and L-glutamyl alpha-chloromethyl ketones (4-amino-6-chloro-5-oxohexanoic acid) is described. These chloromethyl ketones irreversibly inactivated bovine glutamate dehydrogenase, whereas several other related compounds had no adverse effect on the activity of the enzyme. The inactivation process was shown to be due to the modification of lysine-126. The time-courses for the inactivation and the incorporation of radioactivity from tritiated L-glutamyl alpha-chloromethyl ketone into the glutamate dehydrogenase were biphasic. The results were interpreted to suggest the involvement of 'negative co-operative' interactions in the reactivity of lysine-126. From the cumulative evidence it is argued that the first subunit of the enzyme, which takes part in catalysis, makes the largest, and the last the smallest, contribution to the overall catalysis. It is emphasized that three of the six subunits of the enzyme may possess as much as 80% of the total activity of bovine glutamate dehydrogenase.

Amino Acid Chloromethyl Ketones↗
PubMed1976

Abnormal Q waves in Wolff-Parkinson-White syndrome. Incidence and clinical significance.

Between January 1970 and January 1975 the diagnosis of Wolff-Parkinson-White syndrome was entertained in 44 patients. Thirty-one (70%) of these patients had negative sigma-deflections (Q waves) on one or more electrocardiographic leads, thereby simulating a pattern of myocardial infarction (Mi). Fifteen patients (34%) were initially referred with an erroneous diagnosis of Mi based on the presence of Q waves. In nine of these 15 patients, the referring diagnosis was Mi plus ventricular preexcitation; in six, the diagnosis of ventricular preexcitation was overlooked entirely. The incidence of misdiagnosis (34%) was exactly the same as that reportly by Wolff and White approximately 30 years ago. Erroneous diagnosis of Mi can be virtually eliminated by normalizing the QRS complex by premature stimulation of the atrium during the effective refractory period of the accessory pathway.

Adult↗
PubMed1976

Mechanism and stereochemistry of enzymic reactions involved in porphyrin biosynthesis.

5-Aminolaevulinate synthetase cataylses the condensation of glycine and succinyl-CoA to give 5-aminolaevulinic acid. At least two broad pathways may be considered for the initial C--C bond forming step in the reaction. In pathway A the Schiff base of glycine and enzyme bound pyridoxal phosphate (a) undergoes decarboxylation to give the carbanion (b) which then condenses with succinyl-CoA with the retention of both the original C2 hydrogen atoms of glycine. In pathway B, loss of a C2 hydrogen atom gives another type of carbanion (c) that reacts with succinyl-CoA. Evidence has been presented to show that the initial C--C bond forming event occurs via pathway B which involves the removal of the pro R hydrogen atom of glycine. Subsequent mechanistic and stereochemical events occurring at the carbon atom destined to become C5 of 5-aminolaevulinate have also been delineated.(Carticle) Several mechanistic alternatices for the formation of the two vinyl groups of haem from the propionate residues of the precursor, coproporphyrinogen III, have been examined. (see article). It is shown that during the biosynthesis both the hydrogen atoms resident at the alpha positions of the propionate side chains remain undisturbed thus eliminating mechanisms which predict the involvement of acrylic acid intermediates. Biosynthetic experiments performed with precursors containing stereospecific labels have shown that the two vinyl groups of haem are formed through the loss of pro S hydrogen atoms from the beta-positions of the propionate side chains. In the light of these results, three related mechanisms for the conversion, propionate leads to vinyl, have been considered. In order to study the mechanism of porphyrinogen carboxy-lyase reaction, stereo-specifically deuterated, tritiated-succinate was incorporated into the acetate residues of uroporphyrinogen III which on decarboxylation generated asymmetric methyl groups in coproporphyrinogen III and then in haem. Degradation of the latter yielded chiral acetate deriving from C and D rings of haem. Configurational analysis of this derivate acetate shows that the carboxy-lyase reaction proceeds with a retention of configuration.

5-Aminolevulinate Synthetase↗
PubMed1976

Mechanism and stereochemistry of vinyl-group formation in haem biosynthesis.

5-Aminolaevulinate containing tritium at C-3 and C-5 was converted into haem using a preparation of anaemic chicken blood. The biosynthetic haem was degraded to ethylmethyl maleimide and haematinic acid which had relative tritium radioactivity of 0.58 and 1.0 respectively. These results indicated that in the formation of the vinyl group of haem only one of the hydrogen atoms from the beta-positions of two propionate side chains of coproporphyrinogne III was removed. Haem was also biosynthesised from [(3R)-3H1]2-oxoglutarate. The determination of relative radioactivity in ethylmethyl maleimide and haematinic acid endorsed the above conclusion and further indicated that the pro-R hydrogen atoms located at the beta-positions of the propionate side chains are retained in haem biosynthesis. In order to explore the status of hydrogen atoms located at the alpha-positions of propionate side chains haem was biosynthesised using [2RS)-3H2]succinate, [(2R)-3H1]succinate and [(2S)-3H1]succinate. Degradation of the three samples of haem into ethylmethyl maleimide and haematinic acid showed that both the vinyl groups of haem are formed through the loss of pro-S hydrogen atoms located at the beta-positions of the propionic acid side chains of coproporphyrinogen III. The results further showed that the hydrogen atoms located at the alpha-positions of the side chains are not involved in the biosynthesis of haem. Various mechanisms for the formation of vinyl groups in the biosynthesis are discussed.

Aminolevulinic Acid↗
PubMed1976

Elastogenesis in adenomatoid tumor: histochemical and ultrastructural observations.

An adenomatoid tumor from the round ligament of a 50-year-old woman was studied by light and electron microscopy. Ultrastructurally the tumor was remarkably similar to normal as well as neoplastic mesothelium, thus lending further support to the concept of a mesothelial origin of adenomatoid tumors. Comparative histochemical and ultrastructural studies revealed presence of acid mucopolysaccharides mainly along the luminal borders of the tumor cells, thus indicating likely production of this material by the tumor cells as opposed to the stromal cells. The stroma was rich in elastic fibers and there was evidence of active elastogenesis. This paper represents the first unequivocal demonstration of elastogenesis in an adenomatoid tumor.

Adenoma↗
PubMed1976

Congenitally corrected transposition of the great vessels: localization of the site of complete atrioventricular block using his bundle electrograms.

Complete atrioventricular block proximal to the bundle of His in a patient with congenitally corrected transposition of the great vessels was documented using His bundle electrograms. The spontaneous rhythnm probably originated from the bundle of His and was responsive to carotid sinus massage, atropine and isometric and treadmill exercise. These electrophysiologic observations are consistent with recent anatomic studies of congenitally corrected transposition of the great vessels.

Adult↗
PubMed1976

Electrophysiologic effects of procainamide in subtherapeutic to therapeutic doses on human atrioventricular conduction system.

The effects of single intravenous infusions of 50 to 400 mg of procainamide on the functional properties of the atrioventricular (A-V) conduction system were studied in 36 patients and correlated with plasma concentrations. A 50 mg dose of procainamide resulted in a plasma concentration of less than 1.0 mug/ml and produced no electrophysiologic changes. Doses of 100, 200, 300 and 400 mg resulted in progresively increasing plasma concentrations (1.2, 1.8, 3.5 and 4.2 mug/ml, respectively). The effects of procainamide on the sinus rate were variable and not dose-related. The effects of doses of up to 300 mg on A-V nodal conduction were variable and not dose-related. Only in a dose of 400 mg did procainamide prolong A-V nodal conduction in six of seven patients. Whereas 100 mg had no effect on His-Purkinje system conduction, doses of 200, 300 and 400 mg prolonged His-Purkinje system conduction time by 6, 8 and 9 msec, respectively. Dose-related increases in atrial refractoriness started with a dose of 200 mg and became statistically significant with doses of 300 and 400 mg. The effects of procainamide on A-V nodal functional refractoriness were variable and not dose-related, but in doses of 100 to 400 mg, procainamide produced significant and progressively dose-related increases in His-Purkinje system refractoriness. Suppression of some types of ventricular arrhythmia by small doses of this drug may be explained by changes in refractoriness of the His-Purkinje system produced by doses of procainamide as small as 100 mg.

Atrioventricular Node↗