Biomedical subjects
Publications and source records attributed to M Khalilullah.
Hemobilia in children is rare and has so far been described only as a complication of blunt abdominal trauma. A case of hemobilia secondary to liver abscess treated successfully by selective arterial embolization is described. Hemobilia should be considered in any case of gastrointestinal hemorrhage before any operative intervention is undertaken.
Congenital intrapericardial aneurysm of the left atrial wall is a rare anomaly with protean manifestations. Subtle electrocardiographic and chest radiographic abnormalities often give a clue to this disease. This study describes clinical characteristics, cross-sectional and Doppler echocardiographic features of this anomaly in 4 young male patients.
Twenty patients with dilated cardiomyopathy (11 males and 9 females) aged from 14 to 54 (37.3 +/- 10.5) years were treated orally with metoprolol (dose 37.5 mg-100 mg/day, mean 91 +/- 18.6 mg/day) after a baseline hemodynamic study. On follow-up, all patients showed improvement in symptomatic status by at least one NYHA class within 2 to 4 weeks of the initiation of therapy. Repeat right heart study and left ventricular angiography (venous digital subtraction angiography) afer 3 to 6 months of treatment in 10 patients showed a fall in the mean pulmonary arterial wedge pressure from 24.4 +/- 9.6 to 12.8 +/- 7.7 mm Hg (P = 0.025), right ventricular end-diastolic pressure from 8.8 +/- 4.7 mm Hg to 4.5 +/- 1.9 mm Hg (P = 0.025) and mean pulmonary arterial pressure from 34.2 +/- 12.4 mm Hg to 25.9 +/- 10.9 mm Hg (P less than 0.01). There was no significant change in the left ventricular ejection fraction (18.7 +/- 1.6% vs. 22 +/- 0.48%, P = NS) or cardiac index (2.2 +/- 0.48 l/m/m2 to 2.12 +/- 0.68 l/m/m2, P = NS). These hemodynamic results indicate that the improvement in symptoms and congestive cardiac failure produced by treatment with metoprolol in patients having dilated cardiomyopathy is related to improvement in diastolic function of the myocardium.
Short term hypolipidemic effects of oral L. sporogenes therapy (360 million spores/day in tablet form) were studied in 17 patients with type II hyperlipidemia in an open label fixed dose trial. Total serum cholesterol (330 +/- 55 mg/dl vs 226 +/- 46 mg/dl, P less than 0.001), LDL-cholesterol (267 +/- 58 mg/dl vs 173 +/- 54 mg/dl, P less than 0.001) and total cholesterol to HDL cholesterol and LDL-cholesterol to HDL-cholesterol ratios (P less than 0.001) were reduced significantly over a period of three months. HDL-cholesterol was marginally increased (43.6 +/- 7 mg/dl vs 46.8 +/- 8.9 mg/dl, P less than 0.05); however there was no change in serum triglyceride levels.
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Twenty-eight patients with mitral stenosis, 17 females and 11 males, underwent percutaneous balloon mitral valvuloplasty (BMV). The age range was 10 to 30 (mean 17.8 +/- 6.7) years and all were symptomatic (New York Heart Association [NYHA] class III, 12 patients; class IV, 16 patients). BMV was done with a single balloon in 10 patients and double balloon in 16 patients. Following BMV, there was a significant reduction in transmitral end-diastolic pressure gradient from 23.1 +/- 5.8 to 7.6 +/- 4.2 mm Hg (p less than 0.001) and a significant increase in mitral valve area from 1.06 +/- 0.29 to 2.64 +/- 1.35 cm2 (p less than 0.001), along with an increase in cardiac index from 3.40 +/- 1.18 to 4.26 +/- 1.46 L/min/m2 (p less than 0.01). Improvement in symptomatic status by at least one NYHA class was seen in all patients. Mild mitral regurgitation developed in four and moderate mitral regurgitation developed in one patient. Angiographic evidence of atrial septal defect was present in one patient. Follow-up at 8 to 12 weeks in 12 patients has shown sustained hemodynamic improvement. These short-term results indicate that BMV is an effective nonsurgical procedure for the management of patients with rheumatic mitral stenosis.
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The converting enzyme inhibitor, captopril, in dose of 75-100 mg/day with or without diuretic was given to 40 patients (18 males, 22 females), mean age 47.5 years with moderate to severe essential hypertension. Sustained control of blood pressure was achieved in all except three patients on follow up of 12 weeks. Adverse side effects included temporary taste disturbance, rash, tachycardia, leucopaenia, nausea and transient albuminuria. No effect on electrolyte mileu was observed. First dose hypotensive or triphasic response was not noted in any patient. Our results suggest that captopril in moderate doses is very safe, acceptable and effective drug with minimal side effects for treatment of moderate to severe essential hypertension on out patient basis.
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Four patients with aortitis and stenotic lesions of the aorta were successfully treated by percutaneous transluminal balloon angioplasty. The peak systolic gradient across the constrictions decreased from 82.5 +/- 35.7 to 37.5 +/- 18.5 mm Hg immediately after dilatation. Repeat angiography in the first three patients performed 2 months later showed a further decrease in the gradient to 13.8 +/- 9.5 mm Hg. There were no complications during or after the procedure, and all the patients have shown remarkable symptomatic relief during the follow-up.
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We attempted percutaneous transcatheter-balloon mitral commissurotomy in eight children and young adults (9 to 23 years of age) with rheumatic mitral stenosis. The atrial septum was traversed by needle puncture, and an 8-mm angioplasty balloon was advanced over a guide wire. The atrial septal perforation was then dilated to allow passage of the valvuloplasty balloon catheter (18 to 25 mm) across the mitral annulus. Inflation of the transmitral balloon decreased the end-diastolic transmitral gradient temporarily in all patients (from 21.2 +/- 4.0 mm Hg [mean +/- S.D.] to 10.1 +/- 5.5 mm Hg; P less than 0.001). The immediate decrease in the gradient was associated with increases in cardiac output (from 3.8 +/- 1.0 to 4.9 +/- 1.3 liters per minute per square meter of body-surface area; P less than 0.01) and in the calculated mitral-valve-area index (from 0.73 +/- 0.29 to 1.34 +/- 0.32 cm2 per square meter; P less than 0.001). Murmur intensity diminished immediately after commissurotomy in all patients. The greatest reduction in pressure gradient (76 to 95 per cent) occurred when the largest balloon (inflated diameter, 25 mm) was used in the smallest patients (0.9 to 1.2 m2). The balloon commissurotomy produced minimal mitral regurgitation in only one child. Follow-up catheterization (at two to eight weeks) demonstrated persistence of hemodynamic improvement with evidence of partial restenosis in one patient. These early results indicate that balloon mitral commissurotomy can be a safe and effective treatment for children and young adults with rheumatic mitral stenosis.
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