Biomedical subjects
Publications and source records attributed to P Jain.
Secondary amyloidosis as a complication of Hodgkin's disease has been described as being unusual to rare in occurrence. We report a case in which the clinical picture was that of a renal failure, etiology of which could not be determined but which proved to be amyloidosis secondary to clinically unrecognised Hodgkin's disease.
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The structure of alkaloid 223A (1), the first member of a new class of amphibian alkaloids, purified by HPLC from a skin extract of a Panamanian population of the frog Dendrobates pumilio Schmidt (Dendrobatidae) has been established as (5R,6S,8R,9S)- or (5S,6R,8S,9R)-6,8-diethyl-5-propylindolizidine, based on GC-MS, GC-FTIR, and 1H-NMR spectral studies. Three higher homologs of 223A, namely alkaloids 237L (2), 251M (3), and 267J (4), have been detected in other extracts, and tentative structures are proposed.
The peak expiratory flow rate is an objective measure of airflow obstruction that patients can learn with little difficulty, and which provides physicians objective information for assessing a patient's condition. We outline how to use peak flow monitoring as part of an asthma treatment plan.
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Renal angiomyolipoma with tuberous sclerosis has not yet been reported in Indian literature. We report a case of bilateral angiomyolipoma associated with tuberous sclerosis in a 25 year old man.
PURPOSE: To evaluate the effect of four proprietary dentin desensitizing agents on dentin tubular occlusion, chemical composition changes on the dentin surface, and the effect of saliva and toothbrushing on these agents. MATERIALS AND METHODS: Fifty dentin discs, obtained from 50 freshly extracted human premolar and molar teeth were used in this study. These were divided into five groups of 10 discs each. Five discs from each group were treated with the desensitizing agents, viewed under the SEM and subjected to energy dispersive X-ray analysis. The other five discs were treated with the desensitizing agents, immersed in artificial saliva, subjected to simulated toothbrushing equivalent to 3 weeks of normal brushing and viewed under the SEM. The agents studied were Sensodyne Dentin Desensitizer, Therma-Trol Desensitizer Gel, Gluma Desensitizer and All-Bond DS. RESULTS: The Kruskal-Wallis test followed by the Wilcoxon signed-rank test showed that Sensodyne Dentin Desensitizer exhibited the greatest amount of tubular occlusion among the unbrushed samples, followed by Therma-Trol Desensitizer Gel, Gluma Desensitizer and All-Bond DS (P < 0.05) in that order. Toothbrushing increased tubular occlusion in all cases except the Sensodyne Dentin Desensitizer treated samples.
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The deliverable catheter length of the Palmaz-Schatz stent delivery system is significantly limited by the protective sheath and clamshell device. This limitation must be considered when planning distal stent placement, especially in bypass graft lesions. A technique for shortening the guide catheter without losing guidewire position is described.
Ten patients (median age 36 yr, 5 male) with idiopathic IVC obstruction underwent balloon angioplasty followed by placement of a self-expanding stent due to unfavourable lesion characteristics. Six had total occlusion, 5 had restenosis (including 2 with total occlusion), and 1 had a suboptimal result after initial dilatation. Median minimum IVC diameter increased from 0 to 14.5 mm, and the median gradient across the lesion decreased from 16.5 to 1 mmHg. Follow-up venography (median interval 69 d) in six patients revealed no restenosis with further enlargement at the lesion site (median 4.5 mm) and abolition of gradients. Follow-up ultrasound in nine patients revealed no restenosis in the IVC. One patient died 6 mo after the procedure with acute Budd-Chiari syndrome due to hepatic vein occlusion. Autopsy revealed a widely patent stent with hepatic vein thrombus. Stent implantation is useful in the management of IVC obstruction with prior restenosis, total occlusion, or suboptimal result of balloon angioplasty.
OBJECTIVE: To compare the utilization of echocardiography as a diagnostic tool by internists and cardiologists. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. METHODS: Indications and clinical utility of echocardiographic studies ordered by cardiologists (group A, n = 301) and internists (group B, n = 297) were compared by chart review. The two groups of patients were analyzed to determine if the studies detected new cardiac pathology and/or altered patient management. RESULTS: The proportion of studies with abnormal results were similar in both groups (19% versus 14%, P > 0.05). The results of echocardiography, however, led to a change in management more often when the study was ordered by cardiologists (16% versus 10%, P < 0.05). A significantly greater proportion of studies were ordered for evaluation of valvular function by internists (44% versus 33%, P < 0.05). Echocardiography detected valvular abnormalities in a similar proportion of cases in groups A and B (14% versus 10%, P > 0.05). However, diagnostic yield was very poor when the study was performed in patients with suspected mitral valve prolapse in both groups. Cardiologists utilized echocardiography more often for evaluation of left ventricular function (35% versus 18%, P < 0.01) and in the setting of atherosclerotic heart disease for detecting wall motion abnormalities (14% versus 5%, P < 0.01). CONCLUSION: Diagnostic yield of echocardiography is similar when ordered by internists and cardiologists. With the information obtained, management is altered in a slightly greater proportion of cases involving a cardiologist. This may be due to utilization of echocardiography more often for estimating left ventricular function and for detecting wall motion abnormalities by cardiologists.
A major alkaloid, 217A, in skin extracts of a mantelline frog (Mantella baroni) was isolated by HPLC and the structure defined by 1H-NMR spectral analysis as (1R,4S,10S)- or (1R,4R,10R)- 1-methyl-4-(Z)-(1-pent-2-en-4-ynyl) quinolizidine (1). Four other alkaloids-207I (2), 231A (3), 233A (4), and 235E' (5)-detected in frog skin extracts are proposed to be 1,4-disubstituted quinolizidines based on diagnostic mass and FTIR spectra.
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BACKGROUND: Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum. METHODS: To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy-en-Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease. RESULTS: Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re-operation. There were two deaths: one with massive haematemesis and one with pre-existent multi-organ failure and sepsis. CONCLUSIONS: Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in this regard.
We describe a case of diabetes mellitus induced by megestrol acetate in a patient with the acquired immunodeficiency syndrome. Metabolic studies including an arginine infusion test excluded an insulinopenic state and suggested insulin resistance as the underlying mechanism for hyperglycaemia. Withdrawal of megestrol acetate resulted in rapid correction of all metabolic abnormalities and eliminated the need for exogenous insulin therapy.
After myocardial infarction (MI), the noninfarcted myocardium undergoes significant hypertrophy as part of the post-MI structural remodeling. Electrophysiological changes associated with the hypertrophied remodeled myocardium may play a key role in arrhythmia generation in the post-MI heart. We investigated the cellular and ionic basis of arrhythmias in remodeled left ventricular (LV) myocardium 3 to 4 weeks after MI in the rat. We analyzed (1) the incidence of induced ventricular tachyarrhythmias (VTs) in the in vivo heart, (2) action potential characteristics and arrhythmia mechanisms in multicellular preparations and isolated remodeled LV myocytes, and (3) the density and kinetics of the L-type Ca2+ current (ICa-L) and the fast and slow components of transient outward K+ currents (Ito-f and Ito-s, respectively). The results were compared with those from sham-operated rats. In vivo, programmed stimulation induced sustained VT in 80% of post-MI rats but not in sham-operated rats. The capacitance of post-MI hypertrophied myocytes was significantly increased compared with myocytes from sham-operated rats. Post-MI myocytes had prolonged action potential duration (APD) with marked heterogeneity of the time course of repolarization. The prolongation of APD could be explained by the significant decrease of the density of both Ito-f and Ito-s. There was no change in the kinetics of both currents compared with control. Both the density and kinetics of ICa-L were not significantly different in post-MI remodeled myocytes compared with control. The cellular studies showed that reentrant excitation secondary to dispersion of repolarization and triggered activity from both early and delayed afterdepolarizations are potential mechanisms for VT in the post-MI remodeled heart.