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Biomedical subjects

N Prasad

Publications and source records attributed to N Prasad.

136 records · Page 8Linked to original sources
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Transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt--a comparative study.

BACKGROUND/AIMS: No general consensus exists regarding the proper surgical management of recurrent variceal bleeding due to hepatic cirrhosis. Transjugular intrahepatic portosystemic shunt and distal splenorenal shunt are increasingly being performed in the management of these patients. The present study was undertaken to compare the efficacy, complications and survival rate of these two procedures. METHODOLOGY: Sixty-seven patients with alcoholic liver cirrhosis of Child-Pugh's class A (n = 22) and class B (n = 45) with recurrent variceal bleeding not controlled by conservative means underwent either transjugular intrahepatic portosystemic shunt placement (n = 35) or a distal splenorenal shunt operation (n = 32). These patients were followed for a mean of 887 +/- 189 days. Both groups were compared with respect to the rates of survival, recurrence of gastrointestinal bleeding, encephalopathy, ascitis, shunt blockade and other relevant biochemical parameters. RESULTS: Patients who underwent a distal splenorenal shunt operation had lower rates of recurrence of gastrointestinal bleeding (6.25% vs. 25.71%), encephalopathy (18.75% vs. 42.86%) shunt blockade (6.25% vs. 68.57%) and lower mean fasting blood ammonia levels (56.70 +/- 7.10 mumol/L vs. 61.70 +/- 5.70 mumol/L). However the rate of ascitis was higher amongst these patients (40.63% vs. 11.43%). There was no significant difference in the midterm survival rates between these groups (81.25% vs. 80.00%). Both procedures were effective in controlling functional renal failure, splenomegaly and features of hypersplenism. CONCLUSIONS: Distal splenorenal shunt operation is a better therapeutic option than transjugular intrahepatic portosystemic shunt placement for control of recurrent variceal bleeding due to hepatic cirrhosis.

Adult↗
PubMedDate not supplied

Current issues in hypertension research and therapy.

Essential hypertension is one of the most common cardiovascular diseases and treatment is based on reducing overall cardiovascular risk. This article reviews current growth areas in hypertension research and practice.

Angiotensin II↗
PubMedDate not supplied

Evaluating the use of a semiautomated cuff-oscillometric sphygmomanometer in the hypertension clinic.

Measuring blood pressure in the clinic setting is confounded by 'white coat' hypertension, observer bias and digit preference. In this study a semiautomatic blood pressure measuring device (the UA-751) was tested for its use as a reliable assessment of blood pressure and improved patient management in the hypertension clinic. Blood pressures were recorded in 156 patients and compared with physicians' readings measured using a standard mercury sphygmomanometer. The mean blood pressure differences between the two methods showed that the device gave consistently higher readings for both systolic (1.4-3.6 mmHg) and diastolic (3.6-3.8 mmHg) pressure, whether it was used before or after physician consultation. No reduction in 'white coat' hypertension was thus apparent. There was considerable variability between recordings made by the two methods on the same individual. Digit preference was apparent with physician readings, with zero recorded in 57.8% of systolic readings compared with 12.2% using the machine. Different management decisions would have been taken in 20 (13.6%) patients had the UA-751 recordings been used. The device is thus of no value in patient management in the setting of the hypertension clinic.

Blood Pressure Determination↗
PubMedDate not supplied

Isotope renography in the investigation of renal artery stenosis in hypertensive patients.

Isotope renography is a commonly used investigation for the detection of renal artery stenosis (RAS) in hypertensive patients, although its predictive accuracy is poor in an unselected population with a low prevalence of RAS. The aim of the present study was to identify characteristics of hypertensive patients that raise the clinical suspicion of underlying RAS, and which are predictive of an abnormal isotope renogram. The characteristics of 75 patients who had undergone either conventional or ACE-inhibitor-enhanced renography were retrospectively assessed and correlated with the renogram results. The presence of a raised serum creatinine, severe systolic hypertension at presentation and the requirement for triple drug therapy best predicted abnormalities on renography. However, it would appear that the false-positive rate of this investigation is high and its predictive accuracy is poor even in a highly selected group of patients. We conclude that isotope renography is of no practical value in the screening of hypertensive patients for RAS. Renal angiography remains the investigation of choice.

Female↗
PubMedDate not supplied

Clinical pharmacology and classification of antiarrhythmic drugs.

Despite major contemporary strides in the treatment of cardiac arrhythmia, the bedrock for many patients management is still rooted in chronic drug therapy. In the last 10 years considerable changes in patterns of drug use has affected every aspect of these agents down to the basic level of drug classification and assessment of their clinical pharmacology. This review looks at the systems of antiarrhythmic drug classification currently used and the rationale for adopting newer approaches.

Anti-Arrhythmia Agents↗