Biomedical subjects
Publications and source records attributed to P Kumar.
This joint conference of the Royal College of Physicians of London, the Royal College of Surgeons of England and the Royal Society of Medicine took place on 1 November 1999 at the Royal Society of Medicine in London.
BACKGROUND: The present study aimed to assess the impact of inhaled nitric oxide on survival following correction of congenital heart defects with residual pulmonary arterial hypertension. METHODS AND RESULTS: Inhaled nitric oxide was utilized for the management of residual pulmonary hypertension in 24 children following surgical correction of their underlying heart defects. Their ages ranged from 15 days to 14 months (median 5 months). Pulmonary artery hypertension was diagnosed either by direct pulmonary artery pressure monitoring or by echocardiography. Inhaled nitric oxide was used electively in 22 patients when the ratio of the mean pulmonary arterial pressure and mean systemic arterial pressure exceeded 0.5. In the remaining 2 patients, nitric oxide was used only to manage a pulmonary hypertensive crisis. Inhaled nitric oxide was also used a second time in 2 patients who developed delayed pulmonary hypertensive crisis. Twenty-two patients showed an initial response to therapy and the pulmonary artery pressures dropped significantly. Of the patients on direct pulmonary artery pressure monitoring, a pulmonary artery to systemic artery pressure ratio below 0.3 on prolonged therapy was associated with a survival ratio of 4/6 (including 1 neurological death and one reoperation); that between 0.3 and 0.5 with a survival ratio of 3/4. Three out of four patients with sustained echocardiographic and clinical response also survived and were discharged from the hospital. All the patients who showed a lack of response to (n=2), tolerance to (n=1), or dependence on (n=6) the use of inhaled nitric oxide died. In addition, all 5 patients who had a pulmonary hypertensive crisis died, 3 in spite of successful resuscitation with nitric oxide. Thus, excluding one neurological death and one re-operation, only 9 (41%) out of 22 patients survived. CONCLUSIONS: Though inhaled nitric oxide is effective in lowering pulmonary pressure, it does not appear to improve the survival rate following repair of congenital heart disease in those with associated severe pulmonary hypertension. A randomized trial between the use and non-use of inhaled nitric oxide is warranted to determine its exact role in influencing survival in patients with residual pulmonary hypertension following surgical repair.
Thirty four of 10168 school going children were found to have rheumatic heart disease (RHD) in a school survey conducted in the rural areas of Churu district in Rajasthan. The prevalence rate was 3.34/1000. A high prevalence of RHD was found in 11 to 15 year age group. Maximum prevalence of RHD was in low socioeconomic group. Out of these thirty four cases of RHD, isolated mitral stenosis was present in sixteen, isolated mitral regurgitation in four, combined mitral stenosis and mitral regurgitation in ten patients.
1-(4-Iodo-4-deoxy-beta-L-xylopyranosyl)-2-nitroimidazole (Iodoazomycin Pyranoside; IAZP) was synthesized, labelled with radioiodine(123I, 125I) and evaluated for non-invasive assessment of tumor hypoxia. A biodistribution study with Balb/c mice bearing EMT-6 tumors showed a tumor-to-blood ratio of 13.9, representing 0.5 percent of injected dose per gram of tissue, at 24 hours post injection. This ratio is the highest for any 2-nitro-imidazole reported to date in this tumor model. Rapid elimination of radioactivity from the whole-body was noted (greater than 97% in 24 hours) and thyroid radioactivity at 24 hours was much lower than with other analogues of this series. No toxicity was observed in Balb/c mice at a dose 100 times higher than the anticipated human dose required for scintigraphic imaging. Planar, whole-body gamma scintigraphic images in the murine Balb/c EMT-6 tumor model clearly delineated tumor tissue at 24 hours post injection. These observations suggest that IAZP may be a suitable agent for non-invasive, clinical assessment of tumor hypoxia.
A study of DNA content by flow cytometry revealed a significant difference between rhabdomyosarcomas, which were mainly non-diploid, and other sarcomas of children which were mainly diploid (p = 0.01). There was no association between DNA ploidy and survival or aggressive behaviour of the tumour as indicated for example by advanced clinical stage or unfavourable histology. While DNA ploidy correlated with age, it did not correlate with any other clinical characteristic. The apparent lack of prognostic value of DNA content may have been masked by some high CV values and overridden by the effect of chemotherapy which was the most significant variable in determining a patient's survival (p = 0.00005).
Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.
A monoclonal antibody, RAP-5, raised against the 21,000d ras-oncogene product, p21, was used in an immunoperoxidase staining procedure to study the expression of p21 in normal children's and foetal kidneys, pre-malignant lesions and benign and malignant childhood renal tumours with good, moderate or poor prognosis. ras-p21 was expressed in both normal and foetal kidneys but its distribution in renal tumours differed markedly (p less than 0.01). A quantitative liquid competition radioimmunoassay (RIA) was used to determine ras-p21 level in tissue homogenates. The results were expressed as pg of ras-p21 per microgram protein of tissue extract. There were significant differences in the levels of ras-p21 among various renal tissue extracts (p less than 0.05). Generally it emerged that the amount of ras-p21 was greater in both malignant renal tumours and foetal kidneys compared to normal kidneys, pre-malignant lesions and benign renal tumours.
The results of percutaneous transluminal coronary angioplasty (PTCA) of 57 distal lesions were compared with 55 proximal lesions in 42 patients, aged 31 to 66 years (mean +/- SD: 51 +/- 9 yrs). Twenty nine (69%) had multivessel and 13 (31%) single vessel disease. The lesions classified as distal were located in left anterior descending (LAD) artery beyond the origin of second diagonal (D2), left circumflex (LCx) after the main obtuse marginal (OM) and right coronary artery (RCA) after the origin of acute marginal branch. Also included in this category were lesions in the second diagonal and obtuse marginal branches, two centimeters from their origin and stenosis in the posterior descending and posterolateral left ventricular branches of RCA. Out of 57 distal lesions 18 were 'complex' because of tandem location (5 patients), ulceration (6 lesions) and intraluminal thrombi (2 lesions). There was no significant difference in the mean luminal diameter stenosis between distal and proximal lesions, before and after PTCA. The primary success rate of angioplasty was 89.5% for the distal and 94.5% for the proximal lesions (P = NS). Inability to position the balloon across the lesion accounted for more failures in distal (3) compared to proximal (1) location. There were no major complications. Our results show that PTCA of distal lesions can be performed with a high rate of success, which is comparable to those with classical proximal lesions in the same patients.
Explore the source record for details and available documents.
A case of Hodgkin's disease who was found to have a hypoplastic lung on investigation is presented here. This co-incidence has not been reported earlier in the literature.
The prevalence of hypertension was studied in a rural community of western Rajasthan comprising of 6840 subjects in the age range of 21-70 years. The overall prevalence of hypertension was 3.8 percent. It was 4.0 percent in males and 3.6 percent in females. The prevalence of hypertension increased with age in a linear fashion.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
An eleven-year-old boy attended this hospital with complaints of low grade fever and dry cough of three months duration. There was no history of any prolonged illness in the past. Child had BCG and other immunisation at appropriate age. General physical examination, respiratory system, cardiovascular system and other systems revealed no abnormal findings.
The radiological appearances of 49 cases of aspergilloma seen over a period of 6 years among 36,340 hospital admissions are described. All the 49 patients had pulmonary tuberculosis as underlying disease with 6 (12.2%) having bacteriologically active disease. One patient had concomitant allergic bronchopulmonary aspergillosis (ABPA). Upper zone distribution, large cavity size, moderately thick cavity wall and overlying pleural thickening were some of the prominent features observed. Two cases of multiple (3 each) and 4 of bilateral aspergilloma were seen. Of 57 aspergillomas 47 were round or oval, 7 oblong, 2 polypoidal and 1 lobulated. Positional movement was observed in 30 cases. Spontaneous lysis was seen in one case. Tomography and lordotic view were found to be very useful techniques when postero-anterior films were unrevealing. The radiologic diagnosis of aspergilloma was confirmed by demonstration of serum precipitins against aspergilli in 44 cases.
Thirty-five patients of chronic stable angina, unstable angina and post MI angina, who were on medical treatment, underwent 24 hours Holter monitoring and coronary angiography to find out the incidence of Silent Myocardial Ischemia (SMI) and its relation to anatomic severity of coronary artery disease. Total duration of Holter monitoring was 835.32 hours (average 23.40 hours per patient) with 48 ischemic episodes out of which 16 were painful and 32 painless. Total duration of painful episodes was 189 minutes and that of painless episodes was 428 minutes (70% was constituted by SMI). Out of 35 patients, 6 (17.14%) had SMI; 2 of 17 (11.7%) of chronic stable angina, 2 of 8 (25%) of unstable angina, and 2 of 10 (20%) of post-infarction angina patients. On analysis of coronary angiogram, all 6 (100%) patients with SMI, and only 22 out of 29 (76%) without SMI, had severe multiple coronary artery disease. Thus, although the overall incidence of SMI in this series is low, its presence invariably indicates a severe degree of coronary artery disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.