Posterior third ventricular meningioma masquerading a pineal tumour.
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Cerebral Ventricle Neoplasms↗
Biomedical subjects
M Srinivas
Publications and source records attributed to M Srinivas.
Bronchopulmonary foregut malformation in association with diaphragmatic eventration.
Bronchopulmonary foregut malformations are uncommon anomalies, and their association with diaphragmatic eventration is rare. This report presents 2 cases with this association. Embryologically, a simultaneous disturbance in the development of pulmonary vessels and developing esophagotracheal septum may explain the etiopathogenesis of this association. Abnormal budding along the developing foregut tube may lead to foregut cysts. In both cases, the bronchopulmonary foregut malformations were excised, and the diaphragm was repaired. The results of surgery were gratifying in both cases.
Bronchopulmonary Sequestration↗
The clinical value of combining maternal serum screening and uterine artery Doppler in prediction of adverse pregnancy outcome.
Uterine artery Doppler waveform analysis is not offered in routine antenatal care in the UK. The aim of this study is to evaluate a policy of offering uterine artery Doppler ultrasound, in the setting of a District General Hospital, to women who are judged to be at high risk of adverse pregnancy outcome, based on their mid-trimester biochemical serum screening. Data from 73 cases with abnormal serum screening were collected and analysed. Abnormal outcome occurred in 11 cases (16%) including two perinatal deaths. The positive predictive value of adverse outcome was 13% for abnormal serum screening, 26% for human chorionic gonadotropin (hCG) >3 multiples of the median (MOM) and 8% for alfa-fetoprotein (AFP) >2.5 MOM. A total of 56 cases of the study group had uterine artery Doppler at 22 weeks' gestation. Evaluation of the performance of uterine artery Doppler in prediction of adverse pregnancy outcome revealed a sensitivity of 43%, specificity of 70%, a positive predictive value (PPV) of 18% and a negative predictive value (NPV) of 89%. When the presence of diastolic notch was taken to define a positive result the sensitivity remained unchanged, however the specificity, PPV and NPV improved to 91%, 43% and 91%, respectively. In conclusion, the combination of serum markers and abnormal uterine artery Doppler ultrasound improves the identification of women at risk of subsequent pregnancy complications. Raised serum hCG has a better predictive value for adverse pregnancy outcome as opposed to raised serum AFP. In the absence of diastolic notch, the accuracy of abnormal uterine artery Doppler ultrasound is markedly reduced.
Chorionic Gonadotropin↗
Prepubertal unilateral spermatic vessel ligation decreases haploid cell population of ipsilateral testis postpubertally in rats.
DNA flow cytometry is a sensitive and rapid technique to evaluate the germ cell maturation of testis. The haploid cell population of testis specifically denotes testicular maturation. High ligation of spermatic vessels (HLSV) and low ligation of spermatic vessels (LLSV) have been described in the surgical treatment of high undescended testis. Estimation of germ cell population of testis after these maneuvers has not been performed so far by DNA flow cytometry; hence this study was designed. Thirty male rats, aged 30 days, were randomized into three groups. Group I underwent sham surgery; group II underwent unilateral HLSV-ligation and division of main spermatic vessels, similar to the Fowler-Stephens technique; and group III underwent unilateral LLSV-ligation and division of main spermatic vessels close to the testis, similar to the Koff and Sethi technique. Thirty days later, the ipsilateral testes were harvested, and haploid, diploid, and tetraploid cells were counted by DNA flow cytometry. The mean (+/-SD) percentage of the haploid cell population was 68.7+/-4.8, 49.3+/-6.5, and 50.8+/-6.4 in groups I, II, and III, respectively. There was a significant (p<0.05) decrease in haploid cell population between groups I and II and between groups I and III. However, there was no significant difference between groups II and III. In conclusion, prepubertal HLSV as well as LLSV decreases the haploid cell population of ipsilateral testis in rats. LLSV has no advantage over HLSV.
Animals↗
Anorectal malformations and their impact on survival.
OBJECTIVE: To evaluate the incidence, types and the effect on outcome of associated anomalies in neonates with anorectal malformations (ARM). METHODS: This retrospective study was carried out on all neonates with ARM admitted to the neonatal surgical intensive care unit (NSICU) from 1998 through 2003. RESULTS: Of the 754 neonates admitted to the NSICU during the study period of 6 years, there were 124 (16.4%) neonates with anorectal malformations. Of these 110 were included in the study. 73 % were male and 27% female. 86% of these were high ARM (HARM) while only 14% were low ARM (LARM). Associated anomalies were seen in 68% of patients. The incidence was 72% for HARM and 50% for LARM. The major associated anomalies consisted of esophageal (13%), gastrointestinal (GIT) (11%), genitourinary (GUT) (32%), skeletal (26%), cardiac (33%) and miscellaneous 26%. The overall survival rate was 84% (82% for HARM and 94% for LARM). The survival among those with associated esophageal anomalies was 43%, GIT 67%, GUT 80%, cardiac 61%, skeletal 76% and miscellaneous 79% respectively. This difference in survival was significant only for those with esophageal (p=0.004) and cardiac anomalies (p=0.0026). The survival rates among those with one, two or more than two organ systems involved with associated anomalies were 88%, 82% and 58% respectively. This difference was significant only for more than two organ systems involvement (p=0.003). CONCLUSION: Associated anomalies are common in neonates with ARM, the incidence being similar for HARM and LARM. The survival depends upon the number and severity of associated anomalies both in patients with LARM and HARM. Neonates with more number of organ systems involved have a poorer survival specially when associated with esophageal and cardiac anomalies. All neonates with ARM merit a meticulous search for associated anomalies so that the management can be tailored for each baby.
Abnormalities, Multiple↗
Apoptosis and cell removal in the cryptorchid rat testis.
In order to determine that apoptosis is responsible for large-scale germ cell elimination, we analyzed cells from cryptorchid testes both in histological sections and among those isolated in vitro. Apoptotic testicular cells during 3 to 7 days were only 8 to 30%, reaching a maximum of 80% by the end of 15 days of cryptorchidism. A similar trend was also observed with the number of dead cells. The process of large-scale germ cell removal in the initial stages was facilitated by the formation of multinucleated giant cells, which stained negative for apoptosis. Increase in oxidative stress and decrease in intratesticular testosterone was also observed. The above findings indicate that large-scale germ cell removal, at least during initial stages of cryptorchidism is not solely as a result of apoptosis. Declined intra testicular testosterone, elevated temperature and high oxidative stress following cryptorchidism probably affect cell viability and trigger a fast pace cell removal through giant cell formation.
Animals↗
Exposure to high fluoride concentration in drinking water will affect spermatogenesis and steroidogenesis in male albino rats.
Sodium fluoride (NaF) administered orally to adult male rats at a dose level of 4.5 ppm and 9.0 ppm for 75 days caused significant decrease in the body weight, brain index and testicular index. A significant decrease in sperm count, sperm motility, sperm viability and sperm function (HOS positive) with increased sperm abnormalities was also observed in NaF-exposed male rats. The activity levels of testicular steroidogenic marker enzymes 3beta-hydroxysteroid dehydrogenase (3beta-HSD) and 17beta-hydroxysteroid dehydrogenase (17beta-HSD) were significantly decreased in NaF-treated rats indicating decreased steroidogenesis and in turn spermatogenesis in rats exposed to NaF.
17-Hydroxysteroid Dehydrogenases↗
Active inflammatory bowel disease and coronary artery dissection.
The case of a young woman with flare-up of Crohn's disease, who had an acute myocardial infarction due to the spontaneous dissection of the left anterior descending coronary artery, is reported. The literature on this rare condition is reviewed and a mechanism postulated for spontaneous coronary artery dissection in inflammatory bowel disease.
Adult↗
Manometric evaluation of the intrathoracic stomach after gastric transposition in children.
Gastric transposition (GT) is one of the options for the esophageal replacement in children with esophageal atresia with or without tracheoesophageal fistula (EATEF). To date, no manometric studies have been conducted on the intrathoracic stomach after GT in EATEF patients; hence, this study was designed. Babies ( n=18) of EATEF who underwent esophageal replacement by GT were studied and manometry was correlated with the clinical outcome, age at surgery, and route of GT. The mean age at evaluation was 30.5 months (range 4-84 months). These cases were sub-stratified into group I (GT during neonatal period) and group II (GT during post-neonatal period). Mean age at surgery was 6 days and 7.8 months in groups I and II, respectively. There was no propulsive antegrade propagated peristaltic waves in any of the patients. Mean resting pressure and mean peak pressures were 19.5 and 50.4 mm Hg in groups I and II, respectively. Mass contractions to liquid swallow was noted in 77 and 55% of patients in groups I and II, respectively. There was no significant difference in the pressure parameters or appearance of mass contractions between group-I and group-II patients. Similarly, there was no significant difference in pressure parameters or appearance of mass contractions between the children who had transhiatal vs retrosternal GT. It needs to be determined whether the mass contractions noted in GT ever progress to a coordinated propulsive rhythmic contractions and whether this has a final bearing on the long-term functional outcome of GT patients.
Age Factors↗
Changes in nitrergic innervation of defunctionalized rat colon after diversion colostomy.
After 45 days of complete diversion colostomy in male Wistar rats, morphometry of soma and nuclei of NADPH diaphorase positive cells of the myenteric plexus was evaluated. There was a significant (P < 0.0001) diminution in the area, perimeter and volume-weighted mean volume of soma and nuclei of nitrergic myenteric neurones in the defunctionalized colon. In addition, there was a significant reduction in the neuronal density of the myenteric neurones, and increased distance between the ganglia. In addition, there was myenteric glial atrophy. Atrophy of colonic myenteric neurones was accompanied by significant reduction (P < 0.001) in the volume fraction of the muscularis externa, the prime targets of these neurones. The disturbances in the microecology of the colon may jeopardize the finely orchestrated functioning of the components of the Enteric nervous system (ENS) leading to colonic dysfunction. Our observations, by extrapolation, may explain the bowel dysmotility in humans after restoration of colonic continuity after colostomy.
Animals↗
Protective role of cyclosporine in experimental unilateral blunt testicular trauma: evaluation by 31P MR spectroscopy.
Magnetic resonance (MR) imaging is a useful tool to study the anatomy of the testis while 31P magnetic resonance spectroscopy (MRS) provides a non-invasive alternative method to demonstrate the metabolic status of testes. This study was designed to test whether the protective role of cyclosporine in experimental unilateral blunt testicular trauma (UBTT) could be assessed by 31P MRS. Male Wistar rats (n = 30) aged 20 days were randomised into group I (sham surgery), group II (UBTT) and group III (UBTT and cyclosporine for 7 days). Contralateral testicles of 5 rats from each group was evaluated by 31P MRS at 30 and 60 days of age and phosphomonoesters (PM), phosphodiesters (PD), and adenosine triphosphate (ATP) levels were measured. At 60 days of age the PM/ATP ratio was 0.32+/-0.08 in group I whereas it was 0.68+/-0.31 in the group II (p<0.05). Group III rats showed PM, PD and PM/ATP ratios similar to the controls. In conclusion, it is observed that UBTT causes contralateral testicular damage which could be prevented by short-term cyclosporine treatment and 31P MRS is an excellent modality for such an evaluation.
Animals↗
Unilateral spermatic vessel ligation in prepubertal rats decreases microvascular blood flow to ipsilateral testis postpubertally.
High ligation of spermatic vessels (HLSV) and low ligation of spermatic vessels (LLSV) have been described in the surgical treatment of high undescended testis. Testicular capillary blood flow utilizing laser Doppler flowmetry after these maneuvers has not been studied thus far; hence, this study was designed. Thirty male rats, aged 30 days, were randomized into three groups: group I, sham surgery; group II, unilateral HLSV ligation and division of main spermatic vessels high in the left retroperitoneal space; and group III, unilateral LLSV ligation and division of main spermatic vessels close to the left testis. Thirty days later, both testes were explored through scrotal incision and capillary blood flow was measured by laser Doppler flowmeter continuously and simultaneously from both testes. The right testis, the vessels of which were not disturbed in any group, served as the control. The mean decrease in the testicular blood flow between the right testis and left testis was 4.8, 92.9, and 74.2 PFU in groups I, II, and III respectively. There was a significant ( p<0.05) decrease in ipsilateral blood flow in group-II and group-III rats; however, upon comparing group II with group III, there was no significant difference between them. Both HLSV and LLSV in rats significantly decrease the capillary blood flow of ipsilateral testis. Although LLSV group had less reduction in capillary blood flow to the ipsilateral testis than HLSV group, the difference was not statistically significant.
Animals↗
Neonatal gastric pull up: reality or myth?
Between 1991 and 1998, 28 out of 356 neonates with esophageal atresia and tracheoesophageal fistula (EATEF) required esophageal substitution. As only 8 returned (28%) for the esophageal replacement after initial esophagostomy and gastrostomy at our center, we were prompted to offer single-stage esophageal replacement when the primary repair had either failed or was not found feasible. Twelve full-term neonates (mean birth weight 2.32 kg) with EATEF who underwent esophageal replacement by gastric pull-up between 1998 and 2000 were reviewed. The indications were: major leak after primary repair (n=9); pure EA (n=2); and EATEF with a very wide gap (n=1). The average ages at presentation and gastric pull-up were 6.0 and 8.5 days, respectively. The patients were evaluated for gastric transit by a colloid radiopharmaceutical, for duodenogastric reflux (DGR) by hepatic immunodiacetic acid (HIDA) scan, and for gastric clearance and transit by contrast studies. Three patients had minimal leaks from the neck site, all of which healed well. Follow-up with nuclear scans and contrast studies to evaluate gastric emptying revealed obstruction in 1 case and DGR in 25% of cases. There were 2 deaths (16%), 1 due to complex congenital cardiac disease and the other due to septicemia. In view of the acceptable morbidity, mortality, and functional outcome following gastric pull-up, we recommend this procedure if it becomes inevitable in the neonatal period.
Esophageal Atresia↗
Prepubertal human chorionic gonadotropin injection affects postpubertal germ cell maturation and androgen production in rat testis.
OBJECTIVES: To examine the effects of varying doses of prepubertal human chorionic gonadotropin (hCG) administration on postpubertal germ cell status and androgen status in rats. The long-term effects of prepubertal hCG administration on postpubertal testicular function are still debated. METHODS: Forty male prepubertal Wistar rats, aged 20 days, were divided into four equal groups. Group 1 served as the controls. Each rat in groups 2, 3, and 4 received subcutaneous hCG injections of 5 IU, 10 IU, and 50 IU, respectively, on days 20 and 30 of life. Serum testosterone levels were estimated on days 33 and 70. On day 70, the left testis of each rat was harvested for DNA flow cytometric analysis. RESULTS: The testosterone levels on day 33 progressively increased from groups 1 through 4, and the difference between any two groups was statistically significant. In contrast, the testosterone levels on day 70 were greatest in group 1 and progressively decreased in groups 2 through 4, with the lowest value in group 4. On day 70, only group 4 rats had a significantly reduced haploid cell population compared with all other groups. CONCLUSIONS: Prepubertal hCG administration adversely affects testosterone levels, and a high dose of hCG has adverse effects on the germ cell haploid cell population. A critical reevaluation of the use of hCG is required in prepubertal boys, especially with respect to the dosage.
Androgens↗
Evaluation of cerebral vascular reserve by single photon emission tomography in children with congenital hydrocephalus.
BACKGROUND/AIMS: Single photon emission tomography scan (SPECT) is used to measure cerebral blood flow (CBF) and also cerebral vascular reserve (CVR) after intravenous acetazolamide (ACZ) challenge. This prospective study was designed to test the utility of CVR in congenital hydrocephalus (CHC). METHODS: Patients (n = 21, mean age 6.2 m) with CHC underwent a baseline ultrasonography (US), retinal fundus examination (RF), neurological score (NS), and SPECT to evaluate CVR after intravenous ACZ. Monthly US, RF, NS, CBF, and CVR were evaluated. RESULTS: Ten patients showed good CVR and also had stable NS and RF despite mild to moderate ventriculomegaly and were followed up on conservative treatment. None of these patients in a mean follow-up period of 9.8 months showed deterioration. Eleven patients, who had poor CVR initially, were also treated conservatively. Over a period of 4 months, 8 patients showed a fall in CVR to < 30 % of baseline and a fall in NS despite RF and US remaining the same and hence were operated. Five of these operated cases showed an improvement in CVR and NS over a mean follow-up period of 4 months and the remaining 3 patients failed to show improvement in CVR and NS. CONCLUSIONS: In CHC, CVR measured by ACZ challenge test is a sensitive parameter as alterations in CVR occur prior to changes in other conventional parameters such as ventriculomegaly and RF. Patients with normal CVR at presentation are unlikely to deteriorate and can safely be managed conservatively. Patients who show a deterioration in CVR should be considered for prompt surgery.
Brain↗
Exstrophy variants: should they be considered malformation complexes separate from classic exstrophy?
PURPOSE: Exstrophy variants are very rare and have a better prognosis than classical exstrophy. The authors came across a case of superior vesical fissure (SVF) together with esophageal atresia and tracheoesophageal fistula (EATEF) and a case of SVF with gross limb anomalies. These associated malformations have not been reported so far in the literature and hence we reviewed all the cases of exstrophy variants presented to us with particular emphasis on the associated malformations. METHODS: Records (n=9) of patients who were diagnosed as exstrophy variants at our institution between 1989 and 2000 were evaluated retrospectively. RESULTS: Out of 9 cases, 7 cases had associated malformations: EATEF, urethral atresia, absent radius, large umbilical hernia, low anorectal malformation, true diphallus with bifid scrotum, or high anorectal malformation. CONCLUSION: The high incidence of associated congenital malformations, noted in our exstrophy variant series, raises doubts about the clubbing together of the exstrophy variants with classical exstrophy. Further investigation of such cases may elucidate shared or unique causes of the dysembryogenic mechanisms in the etiologies of variants of bladder exstrophy.
Abnormalities, Multiple↗
Asperaldin, a new aldose reductase inhibitor from Aspergilus niger CFR-1046. I. Fermentation, isolation and characterization.
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Aldehyde Reductase↗
Pediatric surgery in India - a specialty come of age?
The quality of neonatal surgical care and scientific publications are reliable yardsticks that were used to assess the status of pediatric surgery in India. A specific questionnaire to assess neonatal care and surgical outcome was mailed to all institutes imparting pediatric surgery training. Data were obtained regarding the outcome of important neonatal surgical conditions for the year 1998 and a PubMed literature search was performed to identify scientific articles between 1995 and 2000. Though a literature search was done to compile a complete list of publications of all the consultants in all the institutes, of the 24 questionnaires mailed, only 11 (45.8%) institutes provided data. The mean (range) annual neonatal admissions in neonatal surgical units was 137 (42-263). The mean newborn admissions requiring surgical intervention per surgeon per year was 36 (17-80). The overall survival was 57.2% (30%-75%), 70.8% (40%-100%), 90.4% (75%-100%), 74.7% (30%-100%), and 59.1% (0%-100%) for esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), congenital diaphragmatic hernia, anorectal malformations, intestinal atresia, and abdominal-wall defects, respectively. The center that had the lowest survival in EA/TEF and CDH had the highest workload per consultant. Between 1995 and 2000, the mean number of scientific articles published in indexed journals compiled from all the institutes (n = 24) was 10.7 (0-84). In conclusion, this is a preliminary study toward setting up national databases of neonatal surgery in different parts of the world to set goals for improvement.
General Surgery↗