Subclavian artery laceration and acute hemothorax on attempted internal jugular vein cannulation.
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Acute Disease↗
Biomedical subjects
P Kumar
Publications and source records attributed to P Kumar.
Parascapular fasciocutaneous flap for covering an above-elbow amputation stump.
The successful use of a parascapular fasciocutaneous flap to cover an above-elbow amputation stump with exposed bone is described. Better stability of the stump to pressure (or manipulations), a relatively early one-stage surgical procedure and diminished possibility of later contracture leads to a better long-term outcome.
Amputation Stumps↗
Finite-element analysis of oxygen transport in the systemic capillaries.
A mathematical model is formulated for the transport of O2 in the systemic capillaries and surrounding tissue. The model takes into account molecular diffusion, the convective effect of the blood, the nonlinear effects of oxyhaemoglobin, and the consumption of O2 in the metabolic process. A finite-element formulation for solving the equations governing the mass transfer in the capillary is described. A fixed-point iterative technique is used to deal with the nonlinearities in the model. The concentration of O2 is found to decrease from the axis of the capillary to the periphery of the tissue. It is shown that, owing to the nonlinear effects of oxyhaemoglobin, the partial pressure of oxygen (PO2) in the capillary and tissue increases. It is also shown that the tissue PO2 increases as (i) the arterial blood PO2 increases, (ii) the Péclet number increases, and (iii) the diffusive flux of O2 from the capillary decreases.
Capillaries↗
Psychological responses to thermal stress in a glass bangle factory.
Behavioural studies were conducted on a random sample of 38 glass bangle workers engaged in various occupations and exposed to high ambient temperature (38.2 +/- 3.4 degrees C) and radiant heat (46.2 +/- 5.1 degrees C) during their work in the glass bangle industries at Firozabad, India. Twenty-two control subjects of similar age and socio-economic status unexposed to heat during their work were also studied for comparison. The digit span test, digit symbol test, Bourdon-Wiersma vigilance test, flicker fusion test and Maudsley personality inventory (MPI) were used to assess the behavioural changes induced by the existing heat stress. The mean scores of immediate memory were much lower in the exposed population than in the controls thereby indicating impairment of immediate memory in the study group. The visuo-motor coordination and vigilance were also significantly affected. Visual perception showed a downward trend among the glass bangle workers, although the MPI test indicated no personality changes.
Adolescent↗
The immune system in hereditary hemochromatosis: a quantitative and functional assessment of the cellular arm.
The objective of this investigation was to evaluate certain quantitative and functional characteristics of the effector cells of the cellular arm of the immune system in hereditary hemochromatosis (HH) with respect to treatment status. Two observations were consistent with the postulate that the elevated levels of storage iron has in vivo immunoregulatory properties: (1) the absolute number of CD8-positive T cells were significantly elevated in untreated HH patients (n = 7) and reduced in treated patients (n = 7), as compared with controls; and (2) the proliferative response of peripheral blood mononuclear cells from untreated HH patients to mitogens was suboptimal but the response of peripheral blood mononuclear cells (PBM) from treated HH patients was normal. Furthermore, immunoglobulin secretion by PBM from treated HH patients as compared to controls was altered. Finally, one T effector cell abnormality was unrelated to treatment status in that a subset of mature, non-activated T lymphocytes aberrantly formed thermostable erythrocyte-rosettes (TE-R), a lymphoid surface marker usually expressed on thymocytes or activated T cells. Taken together these data define certain immune alterations that are consistent with the interpretation that cellular immunity may be influenced by the high level of storage iron in HH patients.
Antibody Formation↗
Facial clefts in Saudi Arabia: an epidemiologic analysis in 179 patients.
One hundred and seventy-nine consecutive cases of facial clefts that were treated at the King Khalid University Hospital, in Riyadh, Saudi Arabia, were analyzed for an epidemiologic study. Isolated cleft lip was present in 38 percent, cleft of lip and palate in 37.4 percent, and cleft of the posterior palate in only 22.4 percent. There was a male preponderance in all types. In cases of cleft lip with or without cleft palate, the more commonly affected side was the left, followed by bilateral cases. Associated malformations were present in 13.4 percent. A positive family history was found in 26.8 percent of cases. A significant number of patients (7.8 percent) were first seen at more than 10 years of age. The incidence of facial clefts at this hospital was 0.3 per 1000 live births, computed over a period of 6 years. This incidence is significantly lower than that reported from European and Far Eastern countries.
Abnormalities, Multiple↗
Abundance of DR2/DR3 and DR2/DR7 heterozygotes in Caucasian patients with systemic lupus erythematosus from USA.
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HLA-DR2 Antigen↗
Vaginal adenosis without exposure to diethylstilbesterol: a case report.
Vaginal adenosis is an unusual condition seen more in females with diethylstilbesterol (DES) exposure in utero, vaginal adenosis in absence of DES exposure is unusual. A case of vaginal adenosis is presented and the literature is reviewed.
Adenocarcinoma↗
Development of respiratory chemoreflexes in response to alternations of fractional inspired oxygen in the newborn infant.
1. We studied the reflex respiratory response to breath-by-breath alternations of fractional inspired oxygen (FI,O2) in full-term human infants delivered either vaginally or by caesarian section at 3-10 h (n = 6), 12-24 h (n = 12), 24-48 h (n = 18), 3-4 days (n = 21) and 5-8 days (n = 7) postnatally. 2. Respiration was measured by inductance plethysmography (Respitrace) and respiratory variables for each breath were calculated on-line by a microcomputer. Test runs (with alternations of FI,O2 between 0.21 and 0.16) and control runs (with an FI,O2 of 0.21) of 50-100 breaths were carried out during quiet sleep. For each respiratory variable the magnitude of the reflex breath-by-breath alternation was compared between control and test runs. 3. There was little respiratory response during control runs at any postnatal age. However, there was a significantly greater response to test runs in all infants studied and at all ages. 4. There were no significant differences in the degree of alternation during test runs between infants of similar postnatal ages delivered by caesarean section and those born vaginally. 5. In all infants the magnitude of the respiratory response increased with postnatal age, presumably reflecting postnatal increases in the hypoxic sensitivity of the peripheral arterial chemoreceptors. 6. The results indicate that in human infants the alternate breath method can be used to detect developmental changes in peripheral chemoreflexes between birth and postnatal day 8.
Cesarean Section↗
Effect of waveforms of inspired gas tension on the respiratory oscillations of carotid body discharge.
The responses of carotid body chemoreceptor discharge to repeated ramps (20- to 60-s forcing cycle durations) of inspired gas tensions were studied in spontaneously breathing and in artificially ventilated pentobarbitone-anesthetized cats. In all animals the mean intensity of chemoreceptor discharge followed the frequency of the forcing cycle, and superimposed on this were oscillations at the frequency of ventilation (breath-by-breath oscillations). The amplitude of the breath-by-breath oscillations in discharge was often large, and it waxed and waned with the forcing cycle. It was greatest when the mean level of discharge was falling and smallest near the peak of mean discharge. No qualitative differences were observed between PO2-alone forcing in constant normocapnia and PCO2-alone forcing in constant hypoxia. The variation in the amplitudes of breath-by-breath oscillations was shown to be due primarily to variations in the amplitudes of the downslope component of the discharge oscillation. Variations in the upslope component of individual oscillations were small. The factors responsible for the breath-by-breath oscillations are discussed, and it is concluded that the shape of the waveform of arterial gas tensions that stimulate the peripheral chemoreceptors departs markedly from that of a line joining end-tidal gas tensions. This causes breath-by-breath oscillations of discharge to be very large after an "off" stimulus. Reflex studies involving the forcing of respiratory gases should therefore include consideration of these effects.
Animals↗
Identification and functional significance of troponin I isoforms in neonatal rat heart myofibrils.
We investigated the mechanism(s) responsible for differences in the effects of acidic pH on Ca2+ activation of the activity of adult and neonatal rat heart myofilaments. Studies on preparations of myofilaments reconstituted with adult troponin-tropomyosin (Tn-Tm) and either adult or neonatal thick filaments indicated that the difference in effect of acidic pH is related to differences in Tn-Tm and not other myofilament proteins. Immunoblotting analysis showed that development of the rat heart myofibrils is associated with isoform switching from slow skeletal TnI to cardiac TnI and from a slow mobility isoform of TnT (TnT1) to a faster Mr isoform (TnT2. Expression of slow skeletal TnI was associated with a relative insensitivity of myofilament Ca2+ activation to deactivation by acidic pH. Moreover, the effect of acidic pH on Ca2+ activation of ATPase activity of soleus myofibrils, which contain cardiac TnC and slow skeletal TnI, was essentially the same as the effect of acidic pH on rat cardiac myofibrils in the early neonatal period. Neonatal myofilaments also contained a relative abundance of a set of polypeptides copurifying with the thin filaments. We have identified these proteins as histones. The relative amount of histones among a variety of preparations from different species was not correlated with the pH sensitivity of myofibrillar Ca2+ activation. Shifts in TnT isoforms among these species were also not correlated with an altered response to acidic pH. Our data provide evidence in support of the hypothesis that the relative insensitivity of neonatal myofilament activity to acidic pH is due to the presence of slow skeletal TnI in the thin-filament regulatory complex.
Acids↗
Pressure support. Changes in ventilatory pattern and components of the work of breathing.
To evaluate the interaction between patient and ventilator during widely varying levels of pressure support (PS) ventilation, we studied 33 patients who had undergone aortocoronary bypass. All patients were without preoperative evidence of lung disease and had left ventricular ejection fractions greater than 45 percent. We assessed both changes in ventilatory pattern and the use of an extension of the Campbell technique to determine the components of the mechanical work of breathing (WOB). Patients were placed on 0, 10, 20, and 30 cm H2O of PS. We found that increasing the pressure support level (PSL) did not change minute ventilation, PCO2, or pH despite large changes in both rate and depth of breathing. The inspiratory time fraction was consistently and progressively reduced as PS increased. Although mean inspiratory flow (MIF) increased by 75 +/- 9 (SE) percent as the PSL increased to 30 cm H2O, mean airway pressure rose only 3.5 +/- 0.1 cm H2O. Observed changes in the resistive and elastic components of WOB at PSL greater than 0 were consistent with values predicted from baseline observations and changes in VT and MIF demonstrating that the Campbell technique of separating resistive and elastic components of the patient's WOB during unassisted ventilation can be extended to the analysis of WOB during mechanical ventilation. We were surprised to observe that although inspiratory WOB fell 67 +/- 13 percent as the PSL increased to 30 cm H2O, postinspiratory work by the inspiratory muscles (WOBPIIM) did not show significant change. The persistence and substantial values of WOBPIIM in some patients suggested the presence of significant patient-ventilator dyssynchrony, especially at higher levels of PS. Total inspiratory WOB per minute, including both patient WOB and WOB by the ventilator, increased by 186 +/- 29 percent, demonstrating that PS results in a respiratory pattern requiring substantially greater total mechanical work.
Aged↗
Sequential measurement of beta 2-microglobulin levels, p24 antigen levels, and antibody titers following transplantation of a human immunodeficiency virus-infected kidney allograft.
A renal allograft recipient developed symptoms suggestive of AIDS. Serological studies revealed that the donor was positive for human immunodeficiency virus (HIV). Retrospective testing of stored sequential serum samples showed that the recipient was negative for HIV pretransplant; anti-p24 and anti-p41 antibodies appeared 10 and 49 days posttransplant, respectively. The recipient's serum beta 2-microglobulin levels were elevated 14 days posttransplant, with normal renal function, 35 days before the detection of anti-p24 antibody. p24 Antigen was detected for the first time 21 days posttransplant. In addition to p24 antigen, elevated serum beta 2-microglobulins may be a useful marker for HIV infection prior to seroconversion.
Adult↗
Mechanical strength of osteochondral junction.
The junction between articular cartilage and bone in adult humans was tested in shear to determine their bonding strength in relation to the tensile strength of full thickness articular cartilage and shear strength of underlying subchondral bone. The site of failures was also studied under light microscope and scanning electron microscope. The junction failed at a shear strength of 7.25 +/- 1.35 MPa (n = 18). On the other hand, the tensile strength of cartilage and shear strength of subchondral bone were 3.75 +/- 0.75 MPa (n = 17) and 2.45 +/- 0.85 MPa (n = 15) respectively. Light and scanning electron microscopic examination revealed that in fact, failures occurred at the tidemark. The ultrastructure of the tidemark suggested that this region might have structural weakness against mechanical stresses. The relevance of the results were discussed in relation to the osteochondral fractures in adult humans.
Adult↗
Reversion of ventricular and supraventricular tachycardia by magnesium sulphate therapy in aluminium phosphide poisoning. Report of two cases.
Two patients with aluminium phosphide poisoning developed supraventricular tachycardia and ventricular tachycardia (one each). These reverted successfully with magnesium sulphate therapy.
Adolescent↗
Synthesis and anti-inflammatory activity of 5-(1,4-dihydropyridyl)-tetrazol-2-acetic acids, esters and amides.
Thirteen 5-[3-(1,4-dihydropyridyl)]-2H-tetrazol-2-acetic acids (18-30), seventeen esters (4-17, 32, 35, 41) and eight amides (31, 32-34, 36-40) were synthesized in order to investigate the effect of alpha-substituents (R1 = H, Me) and 1,4-dihydropyridyl substituents (R2 = aryl, alkyl; R3 = phenoxy, methoxy or amino) on anti-inflammatory activity. The effects of the R1, R2 or R3-substituents were variable but highly interdependent. The relative order of anti-inflammatory potency was generally acid greater than amide and ester. Methyl 2-methyl-2-(5-[3-(4-phenyl-1-carbamoyl-1,4-dihydropyridyl)]-2H- tetrazol-2-yl) acetate (35) was the most effective anti-inflammatory agent in the group, reducing inflammation 96% at 5 hr after a 50 mg/kg po dose, relative to ibuprofen's 52% inhibition at 5 hr after a 100 mg/kg po dose.
Acetates↗
Childhood morbidity and mortality in a large hospital over last four decades.
Pediatric statistics in a 50-year-old large hospital were analysed to find out any change in pediatric admission rate, morbidity and mortality and outcome of common disorders during the last four decades. Information was collected from four block years from each of the last four decades and compared. An increase of almost 250% in the total pediatric admissions as compared to an increase of 150% in total hospital admissions over last four decades suggest an increased awareness of maternal and child health by the community. The pediatric mortality excluding neonates has not shown a significant fall over the last four decades, being 14.6, 12.7 and 13.0% in 1955-1958, 1974-1977 and 1984-1987, respectively. Diarrheal disorders, pneumonia, tetanus and infections of central nervous system continue to remain the common causes of hospital admissions in children. The morbidity and mortality in these disorders, in general, have shown a significant decline though less appreciable in pyogenic meningitis, encephalitis and tetanus cases.
Brain Diseases↗
Pyogenic meningitis and cerebral abscesses after endoscopic injection sclerotherapy.
Infectious complications of endoscopic injection sclerotherapy (EIS) are rare. We report here a case in which pyogenic meningitis and multiple cerebral abscesses developed after a session of EIS. The patient was successfully treated with a combination of parenteral antibiotics and repeated bedside pus aspirations. Prophylactic antibiotics may be considered in such situations for subsequent sessions of EIS.
Adult↗