Continuing diagnostic challenge of acute appendicitis: evaluation through modified alvarado score: comment.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
P Prasad
Publications and source records attributed to P Prasad.
The successful use of telemedicine in acute variceal hemorrhage.
Explore the source record for details and available documents.
Adult↗
GFP chimeras of E-MAP-115 (ensconsin) domains mimic behavior of the endogenous protein in vitro and in vivo.
E-MAP-115 (ensconsin) is a microtubule-associated protein (MAP) abundant in carcinoma and other epithelia-derived cells. We expressed chimeras of green fluorescent protein (GFP) conjugated to ensconsin's N-terminal MT-binding domain (EMTB), to study distribution, dynamics, and function of the MAP in living cells. We tested the hypothesis that behavior of expressed GFP-EMTB accurately matched behavior of endogenous ensconsin. Like endogenous MAP, GFP-EMTB was associated with microtubules in living or fixed cells, and microtubule association of either molecule was impervious to extraction with nonionic detergents. In cell lysates both GFP-EMTB and endogenous ensconsin were dissociated from microtubules by identical salt extraction conditions, and both molecules remained bound to a calcium-stable subset of Taxol-stabilized microtubules. These data show that microtubule association of ensconsin was affected neither by the absence of domains other than its microtubule-binding domain, nor by the presence of appended GFP. We took advantage of this finding to generate constructs in which additional GFP moieties were attached to EMTB, to obtain a more intensely fluorescent reporter of in vivo MAP binding. We show here that expression of chimeric proteins consisting of five GFP molecules attached to a single EMTB molecule produces brightly labeled microtubules without compromising the behavior of the MAP or the microtubules to which it is attached. Thus, we have demonstrated the utility of chimeric proteins containing GFP multimers as authentic reporters of ensconsin distribution and dynamics; expression of these GFP-EMTB chimeric molecules also provides a non-perturbing label of the microtubule system in living cells.
Animals↗
Trauma scoring in a developing country.
AIM OF STUDY: The aim of the study was to evaluate the efficacy of trauma scoring systems in a developing country. METHOD: Trauma Score (TS) and Trauma and Injury Severity Score (TRISS) were used to predict the survival of 462 trauma patients during the period January 1996 to July 1996. RESULTS: TS had a sensitivity of 53.9% and a specificity of 98.8% whereas TRISS had a sensitivity of 46% and a specificity of 98.7%. Significant differences in mortality were observed compared with the baseline Major Trauma Outcome Study (MTOS) norms (Z = 4.17, p < 0.001). CONCLUSION: Present injury severity instruments using MTOS coefficients do not accurately predict survival of trauma patients in a developing country, thus highlighting the need for developing new coefficients for trauma scoring in these countries.
Developing Countries↗
Typhoid intestinal perforation in Nigerian children.
Explore the source record for details and available documents.
Child↗
Haemangiopericytoma of the adult male breast.
Haemangiopericytoma is an uncommon, usually benign, soft tissue tumour which has been rarely reported to occur in the female breast. Haemangiopericytoma of the adult male breast has been reported only once before. We report another such case.
Breast Neoplasms, Male↗
Free versus pedicled omental grafts for limb salvage in Buerger's disease.
BACKGROUND: Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study. METHODS: Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar Lal Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared. RESULTS: There were no statistically significant differences in the relief of intermittent claudication (80% vs 82%), rest pain (82% vs 91%), coldness (83% vs 87%), discolouration (80% vs 82%), ulceration (75% vs 78%) and post-amputation ulcer healing (75% vs 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups. CONCLUSIONS: These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.
Adult↗
Angiogenic potential of perivascularly delivered aFGF in a porcine model of chronic myocardial ischemia.
A number of heparin-binding growth factors, including basic (bFGF) and acidic (aFGF) fibroblast growth factors have been shown to promote angiogenesis in vivo. In this study, we employed a sustained-release polymer extravascular delivery system to evaluate the angiogenic efficacy of a novel form of genetically modified aFGF in the setting of chronic myocardial ischemia. Fifteen Yorkshire pigs subjected to Ameroid occluder placement on the left circumflex (LCX) artery were treated with perivascularly administered aFGF in ethylene vinyl acetate (EVAc) polymer (10 micrograms, n = 7) or EVAc alone (controls, n = 8). Seven to nine weeks later, after coronary angiography to document Ameroid-induced coronary occlusion, all animals underwent studies of coronary flow and global and regional left ventricular function. Microsphere-determined coronary flow in the Ameroid-compromised territory was significantly increased in aFGF-treated compared with control animals, and this improvement in perfusion was maintained during ventricular pacing. Left ventricular function studies demonstrated improved global and regional function in aFGF-treated animals. We conclude that local perivascular delivery of genetically modified aFGF results in significant improvement in myocardial flow and regional and global left ventricular function.
Animals↗
Typhoid enteric perforation.
BACKGROUND: Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery in managing these patients needs to be assessed. METHODS: The records of 110 cases of typhoid enteric perforation treated at JLN Hospital, Ajmer between 1990 and 1995 were reviewed. RESULTS: A total of 42.7% of the patients were in the 21-30-year age group, and 83.6% were male. All patients presented with the classic features of typhoid enteric perforation. A total of 83.6% were operated on within 36 h of perforation. Surgical management consisted of primary closure of the perforation (74.5%), closure with omental graft (14.5%), resection and anastomosis (3.6%), and only drainage (7.3%). A total of 79.1% of patients developed wound infection and 10% of patients developed faecal fistula. The overall mortality rate was 16.4%. Increasing the time interval between perforation and operation significantly increased the mortality (P < 0.05). The mortality was least with early primary closure of the perforation. Patients with postoperative faecal fistula had higher mortality rates (P < 0.001). CONCLUSIONS: Early limited surgery with thorough peritoneal lavage provides optimal results, faecal fistula is a grave complication, and the use of the McBurney incision may provide better results in terms of subsequent wound healing.
Adolescent↗
Foot and ankle severity scale (FASS)
Increasing use of air bags and seat belts has led to the saving of many lives. However, the orthopaedic surgeon is now left to manage increasing numbers of serious foot and ankle trauma. It is important to injury prevention programs to have an injury severity scale for these injuries. The Abbreviated Injury Scale is used widely; however, it is intended primarily to gauge possibility of death after accidents. It is not sensitive enough to give meaningful data about the foot and ankle trauma epidemic. The Trauma Committee of the American Orthopaedic Foot and Ankle Society has developed a rank order list of 91 foot and ankle injuries that commonly occur in vehicular crashes. The injuries are ranked according to severity (FASS-S). Estimated long-term impairment is also given for each injury (FASS-I). This scale is designed as a guideline to help rank importance and impairment of vehicular crash injuries. It is expected that the scale will be modified as future validity testing and other research dictates.
Accidents, Traffic↗
Basic fibroblast growth factor in a porcine model of chronic myocardial ischemia: a comparison of angiographic, echocardiographic and coronary flow parameters.
Recently, a number of growth factors including basic fibroblast growth factor (bFGF) have been shown to promote angiogenesis in vivo. In this study, we evaluated dose-dependent effect of bFGF administration in the setting of chronic myocardial ischemia. A total of 18 Yorkshire pigs subjected to ameroid occluder placement on the left circumflex artery were randomized to treatment with 10 (n = 6) or 100 microg (n = 5) of bFGF incorporated into heparin-alginate microspheres or inactive control pellets (n = 7). Eight weeks later, all animals underwent angiographic evaluation of collateral development as well as studies of coronary flow and global and regional left ventricular function. Both bFGF groups had significantly higher angiographic collateral index, TIMI flow scores and coronary flow in the ameroid-compromised territory compared with controls. Left ventricular function studies demonstrated improved global and regional function in both fibroblast growth factor groups with significantly better preservation of regional wall motion in high dose (100 microg) bFGF animals. We conclude that local perivascular delivery of bFGF results in significant improvement in myocardial function in the setting of chronic myocardial ischemia.
Animals↗
Primary mesenteric fibromatosis.
Primary mesenteric fibromatosis is a rare condition. We report a 46-year-old man with this condition.
Fibromatosis, Abdominal↗
Blunt trauma abdomen: a study of 63 cases.
63 cases of blunt abdominal trauma were studied. It was more common in males and in the age group 21-30 years. Majority of the injuries were due to automobile accidents. Commonly presenting feature was pain abdomen and vomiting. Abdominal paracentesis revealed haemoperitoneum in 40 cases which was subsequently confirmed on laparotomy in all the cases. 40 cases had no visible external injury but subsequent laparotomy revealed internal visceral injury in 29 cases. Exploratory laparotomy was carried out in 43 cases, remaining were treated conservatively. Liver was found to be the commonest organ injured. Post operative complications developed in 5 cases and deaths occurred in 7 cases mainly due to associated extra-abdominal injuries, poor pre-operative general condition, delayed diagnosis and management. We conclude that a multipronged approach towards early diagnosis and vigorous management should be adopted to reduce the morbidity and mortality in patients with blunt abdominal trauma.
Abdominal Injuries↗
Breath-hold 3D STAR MR angiography of the renal arteries using segmented echo planar imaging.
Three-dimensional (3D), cardiac triggered renal MR angiograms were acquired with excellent background suppression within a single breath-hold of 18 to 30 s using signal targeting with alternating radiofrequency (STAR), a subtraction time-of-flight MR angiography technique, and a 3D scheme combining echo planar imaging (EPI) readouts and k-space segmentation. The 3D STAR sequence was evaluated on 17 healthy individuals, 3 potential renal donors, and 2 patients with suspected renovascular hypertension. An inversion tag through the aorta was applied to produce the vascular contrast. After a suitable inflow time, 16 to 64 sections were encoded. An additional presaturation pulse applied over the imaging volume prior to tagging permitted improved background suppression by reducing signal variations from involuntary motion and changes in the cardiac period during breath-holding. Intrarenal branches were observed consistently in all healthy individuals. Longer inflow times provided better depiction of the intrarenal vessels while shorter delays delineated the proximal renal branches with better signal-to-noise ratio. Breath-hold and diastolic data collection reduced both blurring and flow related dephasing. Our results demonstrate excellent visualization of the renal arteries to the level of intrarenal branch vessels using the proposed technique.
Adult↗
Coupling of a finite element human head model with a lumped parameter Hybrid III dummy model: preliminary results.
A skull-brain finite element model of the human head has been coupled with a multilink rigid body model of the Hybrid III dummy. The experimental coupled model is intended to represent anatomically a 50th percentile human to the extent the dummy and the skull-brain model represent a human. It has been verified by simulating several human cadaver head impact tests as well as dummy head 'impacts" during barrier crashes in an automotive environment. Skull-isostress and brain-isostrain response curves were established based on model calibration of experimental human cadaver tolerance data. The skull-isostress response curve agrees with the JARI Human Head Impact Tolerance Curve for skull fracture. The brain-isostrain response curve predicts a higher G level for concussion than does the JARI concussion curve and the Wayne State Tolerance Curve at the longer time duration range. Barrier crash simulations consist of belted dummies impacting an airbag, a hard and soft steering wheel hub, and no head contact with vehicle interior components. Head impact force, intracranial pressures and strains, skull stress, and head center-of-gravity acceleration were investigated as injury parameters. Head injury criterion (HIC) was also calculated along with these parameters. Preliminary results of the model simulations in those impact conditions are discussed.
Accidents, Traffic↗
In vivo measurement of water diffusion in the human heart.
Existing magnetic resonance methods for diffusion imaging, including echo planar, are ineffective in the beating heart due to motion-induced signal attenuation. To overcome this problem, we used a diffusion-weighted stimulated echo-echo planar magnetic resonance imaging sequence. The two lobes of the diffusion-sensitizing gradient were synchronized to the same point in successive cardiac cycles in order to fix the cardiac position and avoid bulk motion effects. The apparent diffusion coefficients (ADCs) of the interventricular septum in 12 healthy subjects for diffusion gradients along the x-, y-, and z-directions were 1.40 +/- 0.27, 1.48 +/- 0.35, and 1.78 +/- 0.27 x 10(-3) mm2/s. The ADCs of the interventricular septum in a second group of 15 healthy subjects for diffusion gradients along the short axis, horizontal and vertical long axes were 0.92 +/- 0.15, 1.50 +/- 0.15, and 1.10 +/- 0.24 x 10(-3) mm2/s. Because the ADCs were less than the measured values for skeletal muscle and their standard deviations were low, it seems unlikely that bulk motion effects made the dominant contribution to the measured myocardial ADC for the interventricular septum, although motion and/or susceptibility artifacts frequently degraded measurements in the free wall of the left ventricle. Additional evidence that ADC was not predominantly determined by wall motion was obtained in a third group of patients with various cardiac abnormalities, in whom there was only a weak correlation between ADC and ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Abdominal diffusion mapping with use of a whole-body echo-planar system.
PURPOSE: To measure apparent diffusion coefficients (ADCs) of water in liver, spleen, kidney, and muscle. MATERIALS AND METHODS: Ten volunteers (seven women and three men, aged 19-31 years [mean, 24 years]) and nine patients (five women and four men, aged 49-70 years [mean, 62 years]) (liver cyst, n = 3; liver hemangioma, n = 3; liver cirrhosis, n = 2; hepatocellular carcinoma, n = 1; and liver metastasis, n = 1) underwent magnetic resonance (MR) imaging. A stimulated-echo acquisition mode (STEAM)-type excitation and echo-planar imaging (EPI) readout was used in a 1.5-T echo-planar MR imaging system. RESULTS: ADCs measured in volunteers were liver, 1.39 x 10(-3) mm2/sec +/- 0.16; spleen, 0.95 x 10(-3) mm2/sec +/- 0.15; muscle, 1.99 x 10(-3) mm2/sec +/- 0.16; and kidney, 3.54 x 10(-3) mm2/sec +/- 0.47 (mean +/- standard deviation). Distinctive ADC values were found in organs with abnormalities. ADCs in patients with hepatic disease included liver cysts, 3.9-5.3; liver hemangiomas, 2.0-2.8; liver metastases from an islet cell tumor, 1.2; hepatocellular carcinoma, 1.7; and liver cirrhosis, 0.9-1.2 x 10(-3) mm2/sec. CONCLUSION: In vivo diffusion measurements of abdominal organs obtained with MR imaging may prove helpful in the identification and classification of abdominal disease.
Abdomen↗