Chemical shift imaging in diagnosis of adrenal adenoma.
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Adrenal Gland Neoplasms↗
Biomedical subjects
M Kulkarni
Publications and source records attributed to M Kulkarni.
Paget's disease from Western India.
AIM AND OBJECTIVE: To prospectively study prevalence of Paget's disease from Western India. METHODS AND MATERIALS: Seventeen consecutive cases from Western India from 1998 to 2005 are analysed for the clinical, biochemical, skeletal profile. Seventeen cases (15 males & 2 females) with mean age of 62 were diagnosed RESULTS: The Western Indian cohort of Paget's disease has male preponderance with a mean age of 62 years at onset. Its clinical features are pain, fracture and typical skeletal involvement. It is a non-familial, polyostotic disease with pelvis, skull, spine and femur being the commonly affected bone sites. Elevated alkaline phosphatase is typical which responds well to bisphosphonate therapy in 6 months. Most cases do well with low dose alendronate (10-20mg/day). CONCLUSIONS: Paget's disease in western India is rare with classical clinical, radiological and biochemical features and responds well to low dose alendronate therapy. In eight years, seventeen cases of Paget's disease were seen from Western India indicating though still rare is present in this population of Western India.
Aged↗
The significance of extensor tendon tethering and dorsal joint capsule tightening after injury to the hand.
This paper examines the clinical problem of extensor tendon tethering and/or dorsal joint capsule tightening secondary to hand injury. One hundred and forty-one patients were examined 13 to 51 months after hand injuries of varying severity. Fifty-six patients (40%) had suffered simple and eighty-five patients (60%) complex injuries. Seventy-four (52%) of the 141 patients had no extensor tendon tethering and/or dorsal joint capsule tightening. In 30 (21%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be "obvious" in that it was easily seen on examination using various commonly used clinical tests of finger flexion and extension. In 37 (26%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be of "lesser degree" because it was only evident on application of specific tests which are described in this paper. Of the 37, 21 (56%) described themselves as being unable to make a "proper" fist with the injured hand, 33 (89%) had pain or discomfort on the dorsum of the injured hand and/or fingers on gripping (P < 0.01) and 25 (70%) had weakness of power of gripping (P < 0.01). Thirty-two (87%) complained of functional problems at work, with activities of daily living or with the pursuit of their hobbies.
Activities of Daily Living↗
Dupuytren's disease of the big toe.
This short paper present four cases of Dupuytren's disease of the big toe.
Adult↗
Comparison of cognition abilities between groups of children with specific learning disability having average, bright normal and superior nonverbal intelligence.
BACKGROUND: Specific learning disabilities (SpLD) viz. dyslexia, dysgraphia and dyscalculia are an important cause of academic underachievement. AIMS: To assess whether cognition abilities vary in children with SpLD having different grades of nonverbal intelligence. SETTING: Government recognized clinic in a medical college. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: Ninety-five children with SpLD (aged 9-14 years) were assessed. An academic achievement of two years below the actual grade placement on educational assessment with a Curriculum-Based test was considered diagnostic of SpLD. On basis of their nonverbal Intelligence Quotient (IQ) scores obtained on the Wechsler Intelligence Scale for Children test, the study children were divided into three groups: (i) average-nonverbal intelligence group (IQ 90-109), (ii) bright normal-nonverbal intelligence group (IQ 110-119), and (iii) superior-nonverbal intelligence group (IQ 120-129). A battery of 13 Cognition Function tests (CFTs) devised by Jnana Prabodhini's Institute of Psychology, Pune based on Guilford's Structure of Intellect Model was administered individually on each child in the four areas of information viz. figural, symbolic, semantic and behavioral. STATISTICAL ANALYSIS USED: The mean CFTs scores obtained in the four areas of information were calculated for each of the three groups and compared using one-way analysis of variance test. A P value < 0.05 was to be considered statistically significant. RESULTS: There were no statistically significant differences between their mean CFTs scores in any of the four areas of information. CONCLUSIONS: Cognition abilities are similar in children with SpLD having average, bright-normal and superior nonverbal intelligence.
Adolescent↗
Right myocardial bridge on CT coronary angiography.
Myocardial bridging is a condition where the coronary artery traverses through the myocardium. Although it is not an uncommon finding in left anterior descending coronary artery (LAD), recently we came across a very rare case of right coronary artery (RCA) traversing through the right myocardium on CT coronary angiography.
Adult↗
Local anaesthetic infusion for postoperative pain.
The role of continuous bupivacaine infusion either into the wound or as a local nerve block, following hand surgery was investigated in 100 patients. After excluding six patients with complex pain problems in whom neither the bupivacaine infusion nor any other conventional analgesic techniques provided adequate analgesia post-operatively, 86 of 94 (91%) patients were adequately treated for post-operative pain by this system during the first night after surgery when pain is presumed to be greatest. This system also provided adequate on-going analgesia for up to 1 week after surgery, controlling nerve pain and allowing mobilization of tendons after tenolysis. Continuous bupivacaine infusion is of particular use in these two groups of patients and after major hand injuries, when considerable pain can be anticipated. Pain during the first night was not controlled adequately by the bupivacaine infusion system in eight of the 94 patients (8%). All eight had a technical failure of the system, which was rectified in six cases to restore adequate analgesia by the infusion system. Two patients developed infection at the infusion cannula insertion site, which occurred only after 1 week and was successfully treated by removal of the cannula and oral antibiotics.
Adult↗
Screening for gestational diabetes: a retrospective audit.
There are various indications for screening pregnant women for gestational diabetes. Screening is then often carried out by performing a timed random blood sugar (t-RBS). In this unit a raised t-RBS is an indication to perform a glucose tolerance test (GTT), and if this is abnormal, the patient is managed with dietary modification or insulin therapy. A t-RBS is considered abnormal if the fasting value (> 2 hours since last meal) is > 5.7 mmol/l, or the non-fasting value (<2 hours since last metal) is > 6.3 mmol/l. However, higher t-RBS values have been recommended by the Diabetic Pregnancy Study Group. This group considers a t-RBS abnormal if the fasting value is > 6.1 mmol/l, or the non-fasting value is > 7.0 mmol/l. A retrospective audit was carried out to determine if cases of gestational diabetes would have been missed if the new guidelines were adopted. There were 112 patients with a fasting t-RBS of 5.8 to 6.1 mmol/l, inclusive, and 196 patients with a non-fasting t-RBS of 6.4 to 7.0 mmol/l, inclusive; 45 patients did not have a GTT result. Therefore 263 patients were included in the study. The number of patients with a normal GTT result was 257 (97.7%), and 6 (2.30%) patients had an abnormal GTT result. Only 4 (1.52%) were labelled as gestational diabetics, and all these cases were managed with diet alone with no adverse obstetric outcome. A large number of GTTs are performed unnecessarily in our unit, and the values recommended by the Diabetic Pregnancy Study Group should be adopted.
Diabetes, Gestational↗
An observational study to detect leptospirosis in Mumbai, India, 2000.
BACKGROUND: Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai. AIMS: To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness. METHODS: From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (>39 degrees C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed. RESULTS: Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis. CONCLUSION: Leptospirosis should be suspected in febrile children with contact with flood water.
Age Distribution↗
Intramedullary nailing of pathological forearm fractures.
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Aged↗
The potential for improvement in outcome of children with intussusception in the South Island.
AIMS: To review the experience in the South Island to predict the extent to which the outcome in intussusception might be expected to improve by the introduction of management guidelines and access to a regional specialist paediatric surgical service. METHODS: Children with intussusception treated in the South Island during an eleven year period until 1998 were identified from hospital coding systems, the Southern RegionalHealth Authority and from departmental audit programmes. Details of management and outcome were analysed. RESULTS: Data proved difficult to obtain. There were 83 children identified with intussusception confirmed on enema or at surgery; 76 had an enema that was successful in 44. Delayed repeat enema and gas enema techniques were not used as frequently as might be expected. The operative rate was higher than that reported by other centres. CONCLUSIONS: Current data, coding and audit systems have significant short comings, which limit availability of reliable outcome data. Increased awareness of the expanded indications for enema reduction, use of air (rather than barium) and delayed repeat enemas, and access to specialist paediatric surgical involvement appears to increase the nonoperative rate. Implementation of guidelines for the management of intussusception might be expected to reduce by more than half the number of children undergoing surgery for this condition in the South Island.
Barium Sulfate↗
Approach to learning disability.
Learning disabilities (LD) is one of the important causes of poor academic performance in school going children. Learning disabilities are developmental disorders that usually manifest during the period of normal education. These disabilities create a significant gap between the true potential and day to day performance of an individual. Dyslexia, dysgraphia and dyscalculia denote the problem related to reading, writing and mathematics. Perinatal problems are certain neurological conditions, known to be associated with LD; however, genetic predisposition seems to be the most probable etiological factors. Evaluation of a child suspected to be having LD consists of medical examination, vision and hearing test analysis of school performance. The psycho-behaviour assessment and education testing are essential in the process of diagnosis. The experienced persons in the field of LD should interpret the results of such tests. With Individualized Remedial Education Plan (IEP) most children learn to cope up with disability and may get integrated in a regular steam.
Adolescent↗
Superoxide generation links nociceptin/orphanin FQ (NOC/oFQ) release to impaired N-methyl-D-aspartate cerebrovasodilation after brain injury.
BACKGROUND AND PURPOSE: Although activation of the N-methyl-D-aspartate (NMDA) receptor is thought to contribute to altered cerebrovascular regulation after traumatic brain injury, the effects of such injury on the vascular response to NMDA itself has been less well appreciated. The newly described opioid nociceptin/orphanin FQ (NOC/oFQ) elicits pial artery dilation, at least in part, in a prostaglandin-dependent manner and is released into cerebrospinal fluid after fluid percussion brain injury (FPI). Generation of superoxide anion (O(2)(-)) occurs after FPI, and a byproduct of cyclooxygenase metabolism is the generation of O(2)(-). This study was designed to determine whether NOC/oFQ generates O(2)(-), which in turn could link NOC/oFQ release to impaired NMDA-induced pial artery dilation after FPI. METHODS: Injury of moderate severity (1.9 to 2.1 atm) was produced by the lateral FPI technique in anesthetized newborn pigs equipped with a closed cranial window. Superoxide dismutase-inhibitable nitroblue tetrazolium (NBT) reduction was determined as an index of O(2)(-) generation. RESULTS: Under non-brain injury conditions, topical NOC/oFQ (10(-)(10) mol/L, the concentration present in cerebrospinal fluid after FPI) increased superoxide dismutase-inhibitable NBT reduction from 1+/-1 to 20+/-3 pmol/mm(2) but had no effect itself on pial artery diameter. Indomethacin (5 mg/kg IV) blunted such NBT reduction (1+/-1 to 6+/-2 pmol/mm(2)), whereas the NOC/oFQ receptor antagonist [F/G] NOC/oFQ (1-13) NH(2) (10(-)(6) mol/L) blocked NBT reduction. [F/G] NOC/oFQ (1-13) NH(2) and indomethacin also blunted the NBT reduction observed after FPI (1+/-1 to 15+/-1 versus 1+/-1 to 4+/-1 versus 1+/-1 to 4+/-1 pmol/mm(2) for sham, NOC/oFQ antagonist, and indomethacin-treated animals, respectively). NMDA (10(-)(8) and 10(-)(6) mol/L)-induced pial artery dilation was reversed to vasoconstriction after FPI, and [F/G] NOC/oFQ (1-13) NH(2) attenuated such vasoconstriction (sham 9+/-1% and 16+/-1% versus FPI -7+/-1% and -12+/-1% versus FPI-[F/G] NOC/oFQ (1-13) NH(2)-pretreated animals -2+/-1% and -3+/-1%). Indomethacin and the free radical scavengers polyethylene glycol superoxide dismutase and catalase also partially restored NMDA-induced vasodilation. CONCLUSIONS: These data show that NOC/oFQ, in concentrations present in cerebrospinal fluid after FPI, increased O(2)(-) production in a cyclooxygenase-dependent manner and contributes to such production after FPI. These data show that NOC/oFQ contributes to impaired NMDA-induced pial artery dilation after FPI. Therefore, these data suggest that cyclooxygenase-dependent O(2)(-) generation links NOC/oFQ release to impaired NMDA-induced cerebrovasodilation after brain injury.
Animals↗
Anomalies of the flexor digitorum superficialis muscle.
Three anomalies of the human flexor digitorum superficialis are presented. The normal development of this muscle from the amphibian to the human is discussed and the described anomalies of the muscle in humans classified.
Adult↗
Double clostridial mycotic aneurysms of the aorta.
Mycotic aortic aneurysm continues to present challenging and difficult management issues with a significant morbidity and mortality. The offending organism in the etiology of this aneurysm can be variable and unusual. The first report of two mycotic aortic aneurysms caused by Clostridium septicum in the same patient is described here. Presentation and management as well as conditions commonly associated with Clostridium septicum infection and a review of all clostridial mycotic aortic aneurysms in the English literature are discussed.
Aged↗
Klebsiella pneumoniae osteomyelitis in sickle cell anemia.
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Amikacin↗
Heparinized saline versus normal saline in maintaining patency of the radial artery catheter.
OBJECTIVE: To compare the ability of normal versus heparinized saline infusion to maintain patency of the radial artery catheter used for monitoring or multiple blood sampling. DESIGN: Randomized double-blind trial. SETTING: A university-affiliated hospital. PATIENTS: All 108 patients admitted to the surgical intensive care unit who required radial arterial line catheters. Excluded were patients who required emergency admission, those who refused to give consent, those who needed anticoagulants, thrombolytic or platelet therapy, those whose cannulation site was other than the radial artery, inadvertent discontinuation of the arterial line or incomplete data collection. This resulted in a sample of 78 adults, randomized according to date of admission. INTERVENTIONS: Forty patients admitted on odd-numbered dates received heparinized normal saline (2 units/mL), and 38 patients admitted on even dates received normal saline, both as continuous flush solutions. MAIN OUTCOME MEASURES: Measurement of radial artery flow and pressure before and after cannulation, and catheter patency during cannulation. RESULTS: The type of flush solution did not adversely affect the radial artery or the hand in any measurable way. Catheter blockage occurred in three patients receiving heparinized saline and seven patients receiving normal saline as the flush solution (p = 0.06). At 96 hours of cannulation, 92% of the catheters in the heparinized saline group were patent compared with 74% in the normal saline group. Intra-arterial blood pressure was inaccurate compared with the brachial cuff pressure in 6 patients in the heparinized saline group compared with 14 patients in the normal saline group (p < 0.03). CONCLUSIONS: There is no significant difference between flushing with normal saline and heparinized saline in the maintenance of radial arterial line patency. However, the use of a continuous heparinized flush solution in pressurized arterial lines is beneficial in that it results in greater accuracy of blood pressure monitoring than normal saline infusion.
Adult↗
Coomassie brilliant blue R-250 as a highly sensitive pre-stain for immediate visualization of human serum proteins on polyacrylamide gel disc electrophoresis and raising monospecific antibodies.
We hereby describe electrophoretic analysis of normal human serum pre-stained with Coomassie Brilliant Blue R-250 (CBB). The proposed method was optimized by studying as many as 450 disc electrophoretic separations and 30 variables. The method when compared with the post-electrophoretic staining by Amido Black (AB) revealed that the pre-stained discs were intensely well defined and resolved within 2 hours with a transparent gel. Gels stained with AB, despite a prolonged destaining, showed a residual dye retention making identification of the faint components difficult. Protein eluted from the CBB pre-stained gels retained its purity and immunoreactivity and conjugates of the two prototype proteins namely the albumin and the transferrin produced high-titre monospecific antisera in immunized rabbits.
Amido Black↗