Search PubMed⌕ Search

Biomedical subjects

N H Patel

Publications and source records attributed to N H Patel.

At least 55 records · Page 3Linked to original sources
PubMed1998

Imaging of acute thoracic aortic injury due to blunt trauma: a review.

Much recent work on the use of computed tomography (CT) and transesophageal echocardiography in screening for and facilitating the diagnosis of acute thoracic aortic injury in the patient with blunt chest trauma has shown favorable results. This has led some physicians to question whether conventional thoracic aortography is still the reference standard. The purpose of this review article is to summarize the epidemiology and pathophysiology of acute thoracic aortic injury, the current status of the individual imaging modalities in use, and the surgeon's perspective. Despite a burgeoning literature and a confounding array of clinical and imaging advances, timely diagnosis of acute thoracic aortic injury remains a challenge. To overcome this problem, some trauma centers have used CT, transesophageal echocardiography, or both, in their diagnostic algorithm for acute thoracic aortic injury. These diagnostic algorithms are individually tailored by each institution and are still under investigation; therefore, no definite conclusions can be reached.

Acute Disease↗
PubMed1998

Functional analysis of eve stripe 2 enhancer evolution in Drosophila: rules governing conservation and change.

Experimental investigations of eukaryotic enhancers suggest that multiple binding sites and trans-acting regulatory factors are often required for wild-type enhancer function. Genetic analysis of the stripe 2 enhancer of even-skipped (eve), an important developmental gene in Drosophila, provides support for this view. Given the importance of even-skipped expression in early Drosophila development, it might be predicted that many structural features of the stripe 2 enhancer will be evolutionarily conserved, including the DNA sequences of protein binding sites and the spacing between them. To test this hypothesis, we compared sequences of the stripe 2 enhancer between four species of Drosophila: D. melanogaster, D. yakuba, D. erecta and D. pseudoobscura. Our analysis revealed a large number of nucleotide substitutions in regulatory protein binding sites for bicoid, hunchback, Kruppel and giant, as well as a systematic change in the size of the enhancer. Some of the binding sites in D. melanogaster are either absent or modified in other species. One functionally important bicoid-binding site in D. melanogaster appears to be recently evolved. We, therefore, investigated possible functional consequences of sequence differences among these stripe 2 enhancers by P-element-mediated transformation. This analysis revealed that the eve stripe 2 enhancer from each of the four species drove reporter gene expression at the identical time and location in D. melanogaster embryos. Double staining of native eve protein and transgene mRNA in early embryos showed that the reporter gene mimicked native eve expression and, in every case, produced sharply defined stripes at the blastoderm stage that were coincident with eve stripe 2 protein. We argue that stripe 2 eve expression in Drosophila evolution can be viewed as being under constant stabilizing selection with respect to the location of the anterior and posterior borders of the stripe. We further hypothesize that the stripe 2 enhancer is functionally robust, so that its evolution may be governed by the fixation of both slightly deleterious and adaptive mutations in regulatory protein binding sites as well as in the spacing between binding sites. This view allows for a slow but continual turnover of functionally important changes in the stripe 2 enhancer.

Animals↗
PubMed1998

Gadolinium-enhanced three-dimensional MR angiography of the aorta and peripheral arteries: evaluation of a multistation examination using two gadopentetate dimeglumine infusions.

OBJECTIVE: Three-dimensional gadolinium-enhanced MR angiography is a rapid and accurate method that can at times image only a limited amount of anatomy during an examination. We evaluated a technique that doubled the anatomy imaged by obtaining two separate gadolinium-enhanced MR angiograms during a single examination. MATERIALS AND METHODS: Twenty-three patients referred for MR evaluation of aortic or peripheral vascular disease underwent two successive gadolinium-enhanced three-dimensional MR angiographic examinations during a single MR examination. An injection of 15 ml of gadopentetate dimeglumine was used for the first MR angiogram, and 25 ml was used for the second MR angiogram. The angiograms were quantitatively and qualitatively evaluated to determine the effect of residual gadolinium from the initial MR angiogram on the second angiogram. RESULTS: The two studies depicted either the entire aorta to the femoral arteries (n = 10) or the distal aorta to the popliteal arteries (n = 13). The total mean gadolinium dose was 0.245 mmol/kg per patient. An average of 15 min elapsed between injections. The value of arterial signal-to-noise ratio (mean, 48.8 versus 56.4) and artery-to-vein contrast-to-noise ratio (mean, 45.5 versus 49.0) increased between the first and second angiograms, respectively. Residual gadolinium elevated the values for venous signal-to-noise ratio (mean, 2.3 versus 7.2) and background-to-muscle signal-to-noise ratio (mean, 5.5 versus 10.1) on the second MR angiogram. Qualitative evaluation by three observers showed no significant differences in diagnostic usefulness or overall image quality between the first and second MR angiograms. CONCLUSION: The use of two low-dose gadolinium-enhanced three-dimensional MR angiograms during a single examination is a feasible approach to increase anatomic coverage when performing gadolinium-enhanced three-dimensional MR angiography of the aorta and peripheral vessels. Although background enhancement is slightly elevated on the second angiogram, such enhancement does not significantly change diagnostic usefulness or overall image quality.

Aged↗
PubMed1998

Carbon dioxide angiography of the transplanted kidney: technical considerations and imaging findings.

OBJECTIVE: We evaluated the usefulness of carbon dioxide as the primary contrast material for renal transplant arteriography. CONCLUSION: Carbon dioxide accurately showed artery pathology including anastomotic and intrarenal stenoses, arteriovenous shunting, and diffuse arterial disease from chronic transplant rejection. Using carbon dioxide as a contrast agent reduced the volume of iodinated contrast material that needed to be used. There was no procedure-associated nephrotoxicity.

Adult↗
PubMed1997

Crustacean appendage evolution associated with changes in Hox gene expression.

Homeotic (Hox) genes specify the differential identity of segments along the body axis of insects. Changes in the segmental organization of arthropod bodies may therefore be driven by changes in the function of Hox genes, but so far this has been difficult to demonstrate. We show here that changes in the expression pattern of the Hox genes Ubx and AbdA in different crustaceans correlate well with the modification of their anterior thoracic limbs into feeding appendages (maxillipeds). Our observations provide direct evidence that major morphological changes in arthropod body plans are associated with changes in Hox gene regulation. They suggest that homeotic changes may play a role in the normal process of adaptive evolutionary change.

Animals↗
PubMed1997

Renal artery origins: best angiographic projection angles.

PURPOSE: To determine the best projection angles for imaging the renal artery origins in profile. MATERIALS AND METHODS: A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed. RESULTS: In patients with an abdominal aortic diameter no larger than 3.0 cm, approximately 0.5 mm of the proximal part of the renal artery and origin may be hidden from view if there is a projection error of +/-10 degrees from the ideal image. A combination of anteroposterior and 20 degrees and 40 degrees left anterior oblique projections resulted in a 92% yield of images that adequately profiled the renal artery origins. Right anterior oblique projections resulted in the least useful images. CONCLUSION: An error in projection angle of +/-10 degrees is acceptable for angiographic imaging of the renal artery origins. Patients sex, site of interest (left or right artery), and local diameter of the abdominal aorta are important factors to consider.

Angiography↗
PubMed1997

Genetic separation of the neural and cuticular patterning functions of gooseberry.

In addition to their role in the specification of the epidermal pattern in each segment, several segment polarity genes, including gooseberry (gsb), specify cell fate in the Drosophila central nervous system (CNS). Analyses of the gsb CNS phenotype have been complicated by the fact that the previously available gsb mutants, all caused by cytologically visible deficiencies, have severe segmentation defects and also lack a number of additional genes. We have characterized two novel gsb mutants which, due to their hypomorphic nature, have CNS defects, but have only weak or no segmentation defects. These gsb alleles, as well as gsb rescue experiments, have allowed us to determine which aspects of the deficiency mutant phenotypes can be attributed to loss of gsb. gsb mutants lack U and CQ neurons, have duplicated RP2 neurons, and display posterior commissure defects. gsb neural defects, as well as the gsb cuticle defect, are differentially sensitive to the level of functional Gsb. We have used one of the novel gsb alleles in order to understand the genetic interactions between gsb, wingless (wg), and patched (ptc) during the patterning of the ventral neuroectoderm. In contrast to epidermal patterning, where Gsb is required to maintain wg transcription, we find that Gsb antagonizes the Wg signal that confers neuroblast (NB) 4-2 fate.

Animals↗
PubMed1996

Krüppel, a Drosophila segmentation gene, participates in the specification of neurons and glial cells.

We report that the Drosophila segmentation gene Krüppel (Kr) is expressed in neural precursor cells, neurons and glial cells at different stages of neurogenesis and that Kr mutants develop aberrant peripheral (PNS) and central (CNS) nervous systems. Expression derived from a Kr minigene rescues the segmentation defects but these embryos continue to lack most of the neural Kr activity. Phenotypic analysis of the rescued embryos indicates that, in addition to overall effects on the PNS and CNS structure via its segmentation role, Kr expression in the nervous system is functionally required for establishing particular neural and glial fates.

Animals↗
PubMed1996

Neo-Darwinian developmental evolution: can we bridge the gap between pattern and process?

In the past decade, there has been a surge of renewed interest in the study of developmental evolution. One approach that has been taken is to examine the expression patterns of a candidate gene in divergent taxa and to use these results to infer which aspects of a particular genetic pathway are either conserved or altered. Here we consider this approach from the perspective of the neo-Darwinian paradigm for evolutionary change. If adaptations are typically composed of large numbers of gene substitutions that are of small effect individually, then the candidate gene approach is unlikely to bridge the gap between developmental pattern and evolutionary process: changes in gene expression patterns may identify the steps in developmental pathways that have been altered during evolution but fail to identify the actual genetic changes that have occurred. On the other hand, there is growing support for the view that adaptations often involve large-effect genes; fortunately, the candidate gene approach is well suited to this type of genetic architecture.

Animals↗
PubMed1996

Posttraumatic Budd-Chiari syndrome treated with thrombolytic therapy and angioplasty.

Injury of the hepatic veins or suprahepatic inferior vena cava is a rare cause of Budd-Chiari syndrome. Treatment of this syndrome has primarily involved hepatic venous decompression with a variety of portosystemic shunts. We report a case of thrombosis of the inferior vena cava after blunt injury managed with interventional radiologic techniques.

Abdominal Injuries↗
PubMed1996

Imaging of complications in liver transplantation.

Hepatic transplantations are being performed with increasing frequency, leading to greater demand for accurate evaluation of related complications. Ultrasonography (US) is the primary screening technique for detection of vascular complications of hepatic transplantation: angiography is used to confirm the US findings or when the US study is suboptimal. Hepatic artery thrombosis, the most common (as high as 42% of pediatric cases; 4%-12% of adult cases) and important vascular complication, may be associated with bilomas, infarcts, or abscesses at gray-scale US and absence of proper hepatic and intrahepatic arterial flow at Doppler analysis. Hepatic artery stenosis (seen in 11% of cases) is suspected if a focal accelerated velocity of greater than 2-3 m/sec with turbulence is seen at or distal to the stenosis or if a tardus parvus pattern of intrahepatic arterial flow is seen. In cases of inferior vena cava thrombosis and stenosis, US may show echogenic thrombus or obvious narrowing, with a substantially increased flow velocity through the stenosis or reversal of flow in the hepatic veins. Biliary complications occur relatively often (13%-25% of cases) after liver transplantation; bile leakage and biliary stricture, the most common biliary complications, are seen as a fluid collection and a stricture, respectively. Although acute rejection is one of the most serious complications affecting graft survival, it cannot be reliably detected with available diagnostic tests or radiologic methods.

Anastomosis, Surgical↗