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Biomedical subjects

P Puri

Publications and source records attributed to P Puri.

At least 73 records · Page 4Linked to original sources
PubMed2001

Indocyanine green augmented transpupillary thermotherapy in the management of choroidal metastasis from breast carcinoma.

PURPOSE: To demonstrate the efficacy of indocyanine green augmented transpupillary thermotherapy (TTT) in the management of choroidal metastasis from breast carcinoma. METHODS: A retrospective study was performed on 4 women aged 39-59 years with solitary choroidal metastasis from breast carcinoma in whom choroidal metastasis was managed using mTT. All patients had undergone indocyanine green (ICG) augmented TTT using a diode laser (810 nm) treatment to these lesions and had a mean post-treatment follow-up of 13.2 months. RESULTS: In all the patients there was a gradual regression of the lesion over a mean follow-up of 13.2 months with retention of good visual acuity. CONCLUSION: Indocyanine green augmented transpupillary thermotherapy is a viable alternative for management of solitary choroidal metastasis from breast carcinoma.

Adult↗
PubMed2001

Conservative management of appendix mass in children.

BACKGROUND: The management of an appendix mass in children is controversial. An experience of conservative management of appendix masses in a paediatric population over the last 19 years is reviewed. METHODS: The medical records of all children who presented with an appendix mass to one of three children's hospitals between 1982 and 2000 were reviewed. In that interval 427 children with a mean age of 7.3 years (range from 2 months to 18 years) presented with an appendix mass. Sixteen children had an immediate appendicectomy. The remaining 411 children were treated conservatively by close observation and antibiotics, with intravenous fluids and nasogastric suction if required. Once the child was well enough for discharge home, elective appendicectomy was booked for 4-6 weeks later. RESULTS: Three hundred and forty-six (84.2 per cent) of the children responded to initial conservative management and were discharged after a median stay of 6 (range 3-24) days. The children returned 4-6 weeks later for elective appendicectomy. The complication rate for elective appendicectomy was 2.3 per cent (eight patients). Those who had an uncomplicated elective appendicectomy had a median hospital stay of 3 (range 1-6) days. Histological examination demonstrated acute or subacute inflammation in 50.8 per cent of appendices removed at elective appendicectomy. CONCLUSION: Non-operative management of an appendix mass followed by elective appendicectomy is a safe and effective method of management.

Adolescent↗
PubMed2001

Squamous carcinoma of the thyroid metastatic to the choroid: a report.

Cancers metastatic to the eye are the most common intraocular malignancies. Breast, lung and gastrointestinal malignancies are the most common to the eye, with others forming a smaller group. This communication presents a very rare case of a choroidal secondary from a squamous cell carcinoma of the thyroid.

Carcinoma, Squamous Cell↗
PubMed2001

Three-dimensional morphology of gut innervation in total intestinal aganglionosis using whole-mount preparation.

BACKGROUND: Total intestinal aganglionosis (TIA) is a rare form of Hirschsprung's disease (HD). The aim of this study was to examine the 3-dimensional morphology of the myentric plexus of the entire gastrointestinal tract in a newborn with total intestinal aganglionosis. METHODS: Whole-mount preparations were made of the entire gastrointestinal tract using NADPH-diaphorase histochemistry and c-kit (a marker of interstitial cells of Cajal) immunohistochemistry. RESULTS: Whole-mount preparations of the esophagus, stomach, and duodenum showed 3-dimensional morphology of the myenteric plexus forming a meshlike network of nerve fibers, connected to each other and to ganglia. There were large numbers of NADPH-diaphrase-positive nerve fibers between the muscle fibers in the circular muscle layer. In esophagus, stomach, and duodenum, c-kit-positive interstitial cells of Cajal (ICC) formed a 3-dimensional network between the two muscle layers and also were abundant within the circular muscle layer. In the jejunum, ileum, and colon, the myenteric plexus was absent and was replaced by hypertrophic nerve bundles that stained weakly with NADPH-diaphrase. Circular muscle layer completely lacked NADPH-diaphrase-positive nerve fibers. The c-kit-positive ICCs in the jejunum, ileum, and colon were sparse and localized mainly around the nerve trunks between the circular and longitudinal muscle layers. CONCLUSIONS: Whole-mount preparation is an elegant 3-dimensional technique in which the relationship of branching and interconnecting nerve fibers to each other and to muscle can be seen clearly. Absence of myenteric plexus, lack of nitrergic innervation, and depletion of interstitial cells of Cajal in the bowel wall throughout the small and large bowel contribute to the inability of the smooth muscle to relax, thereby causing lack of peristalsis in TIA.

Colon↗
PubMed2001

Internal anal sphincter achalasia: outcome after internal sphincter myectomy.

BACKGROUND: Internal anal sphincter achalasia (IASA), also referred to as ultrashort segment Hirschsprung's disease (HD), is a clinical condition with presentation similar to HD, but with the presence of ganglion cells on rectal biopsy. The diagnosis of IASA is made on anorectal manometry, which shows the absence of rectosphincteric reflex on rectal balloon inflation. Altered intramuscular innervation has been reported in IASA. The purpose of this study was to review the outcome after internal sphincter myectomy in patients with IASA. METHODS: Fifteen consecutive patients (age range, 2 years to 12 years) with IASA underwent posterior internal sphincter myectomy. All patients presented with severe constipation with or without soiling. The diagnosis of IASA was made by anorectal manometry. HD was excluded in these cases by the presence of ganglion cells and normal acetylcholinesterase activity on suction rectal biopsies. Internal sphincter (IS) specimens were examined using immunohistochemistry for the general neuronal marker PGP 9.5 and synapsin 1 (a presynaptic marker) and using general histochemistry for NADPH-diaphorase. All patients underwent follow-up for periods from 2 years to 6 years. RESULTS: PGP 9.5, synapsin 1 and NADPH-diaphorase positive nerve fibers were either absent or markedly reduced in IASA specimens compared with controls, confirming previous reports of defective intramuscular innervation in IASA. At the time of follow-up, 7 patients have regular bowel motions and are not on any laxatives. Six patients have normal bowel habits but are on small doses of laxatives. One patient is able to stay clean with regular enema regimen. One patient required resection of dilated and redundant sigmoid colon and now has normal bowel habits with laxatives. CONCLUSION: The majority of patients with internal anal sphincter achalasia can be treated successfully by internal sphincter myectomy.

Anal Canal↗
PubMed2001

Structural immaturity of the heart in congenital diaphragmatic hernia in rats.

PURPOSE: The form and function of the heart are the final result of an integration of cells, tissues, and extracellular material. The extracellular matrix (ECM) is a complex array of different molecular components, and it plays an important role for the transfer of mechanical force in both contraction and relaxation phases in the cardiac cycle. ECM plays also a significant role in the development of the heart. The aim of this study was to evaluate the expression of important ECM components in the heart of rats with induced CDH to test the hypothesis that an alteration of ECM may contribute to the cardiac maldevelopment, which recently has been identified as a contributive factor for the high mortality rate in babies with congenital diaphragmatic hernia (CDH). METHODS: CDH model was induced in pregnant rats after administration of 100 mg of nitrofen on day 9.5 of gestation (term, 22 days). In control animals the same dose of olive oil was given without nitrofen. Cesarean section was performed on day 21 of gestation. The fetuses were divided into 2 groups: normal control (n = 10) and nitrofen-induced CDH (n = 10). Reverse transcription polymerase chain reaction (RT-PCR) was performed to evaluate the relative amount of tropoelastin and alpha1 (I) procollagen mRNA expression. Elastin protein content was measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: There was a reduction in tropoelastin mRNA (P <.05) and procollagen mRNA (P <.05) in CDH compared with controls. The cardiac alpha-elastin content also was reduced in CDH (P <.01). CONCLUSIONS: The reduced cardiac tropoelastin and procollagen gene expression and the reduced alpha-elastin content indicate that the heart in CDH structurally is immature. The reduced production of cardiac ECM may contribute to a contractile dysfunction, which makes the heart unable to respond to the hemodynamic load accompanying persistent pulmonary hypertension (PPH).

Abnormalities, Multiple↗
PubMed2001

Jejunoileal atresia and associated malformations: correlation with the timing of in utero insult.

PURPOSE: Duodenal atresia is associated with a higher incidence of associated congenital malformations than jejunoileal atresia, supporting the hypothesis that the duodenal obstruction occurs early in fetal life. In this study, the authors analyzed the incidence of major associated malformations in jejunal atresia (JA) and ileal atresia (IA) to determine if there is a positive correlation between the proximity of the intestinal atresia and the association of other major anomalies. METHODS: Records of all patients with jejunoileal atresias treated at the authors' institution between 1980 and 1997 were examined. RESULTS: There were 83 patients with jejunoileal atresias, 38 with JA, and 45 with IA. Sixteen (42%) of the JA patients had an associated major congenital malformation, whereas only 1 (2%) of the IA patients had an associated malformation. A single atresia was found in 18 (47%) of JA patients and 41 (91%) of IA patients. Twenty (53%) of the JA patients had either multiple or apple-peel atresia. Thirteen patients (16%) died, 11 with JA, and 2 with IA. Of the 11 patients with JA who died, 6 had multiple atresias, 4 had cystic fibrosis, and 1 had small bowel volvulus. CONCLUSION: The higher incidence of associated major congenital extraintestinal malformations in JA compared with IA patients suggests that some cases of JA may arise from a malformative process.

Abnormalities, Multiple↗
PubMed2001

Intestinal neuronal dysplasia: results of treatment in 33 patients.

PURPOSE: Intestinal neuronal dysplasia (IND) is a disease of the enteric nervous system, which clinically resembles Hirschsprung's disease. The authors reviewed their experience of IND over an 8-year period. METHODS: Between 1992 and 1999, 418 patients underwent rectal suction biopsy for persistent constipation. Thirty-three (7.8%) patients had histologic evidence of IND. There were 26 boys and 7 girls (age range, 1 week to 10 years). The diagnosis of IND was based on the presence of hyperganglionosis of the submucous plexus and giant ganglia and at least one of the following features in rectal biopsies: (1) ectopic ganglia, (2) increased acetylcholinesterase (AChE) activity in the lamina propria, and (3) increased AChE nerve fibers around the submucosal blood vessels. All patients were started on laxatives with or without enemas after the diagnosis was made. Patients have been followed up from 1 to 8 years (mean, 2.4 years). RESULTS: Twenty-one (64%) patients had a good response to conservative management and currently have normal bowel habits. Twelve patients (36%) underwent internal sphincter myectomy after failed conservative management. Seven of these patients now have normal bowel habits. Two patients are able to stay clean with regular enemas. Three patients who continued to have persistent constipation after myectomy and underwent resection of redundant and dilated sigmoid colon now have normal bowel habits. CONCLUSION: The majority of patients with IND can be treated successfully with conservative treatment.

Acetylcholinesterase↗
PubMed2001

Selective neurotrophin deficiency in infantile hypertrophic pyloric stenosis.

BACKGROUND/PURPOSE: Increasing evidence suggests that the enteric nervous system is under the control of neurotrophins. Nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4/5 (NT-4/5), promote differentiation, growth, and survival of various central and peripheral nervous system neurons. The biological effects of neurotrophins are mediated by the interactions with high-affinity tyrosine kinase receptors (TrkA, TrkB, TrkC). Recently, abnormalities of intramuscular innervation have been reported in infantile hypertrophic pyloric stenosis (IHPS). To further understand the reported abnormalities in pyloric innervation in IHPS, the authors analyzed the expression of Trk receptors and the neurotrophins content in IHPS. METHODS: Full-thickness muscle biopsy specimens were obtained from 8 IHPS patients (age range, 23 to 41 days) at pyloromyotomy and from 8 age-matched controls without gastrointestinal disease at autopsy performed within 12 hours after death. Indirect immunohistochemistry was performed using ABC (Avidin Biotin peroxidase Complex) method with anti-Trk specific antibodies (A,B,C). Quantitative analysis was performed using sandwich-type ELISA for NGF, BDNF, NT-3, and NT-4/5. RESULTS: The intensity of staining of the myenteric plexus for TrkA, TrkB, and TrkC was similar among IHPS and controls. There was a lack of TrkA-positive nerve fibers in IHPS compared with controls. The quantity of total NGF, NT-3, and BDNF in IHPS was significantly lower than in controls. CONCLUSIONS: The reduced production of neurotrophins in IHPS may be responsible for the delay in the functional and structural maturation of pyloric innervation in IHPS. The lack of TrkA-positive nerve fibers in pyloric muscle may explain the abnormal intramuscular innervation in IHPS.

Analysis of Variance↗
PubMed2001

Cardiac gene expression and synthesis of atrial natriuretic peptide in the nitrofen model of congenital diaphragmatic hernia in rats: effect of prenatal dexamethazone treatment.

BACKGROUND/PURPOSE: The aim of this study was to determine the gene and protein levels of atrial natriuretic peptide (ANP) in the heart of nitrofen-induced congenital diaphragmatic hernia (CDH) in rats and to evaluate the effect of antenatal dexamethazone (Dex) treatment. METHODS: CDH model was induced in pregnant rats after administration of 100 mg of nitrofen on day 9.5 of gestation (term, day 22). Dexamethazone (Dex, 0.25 mg/kg) was given by intraperitoneal injection on days 18.5 and 19.5 of gestation. Cesarean section was performed on day 21 of gestation. The fetuses were divided into 3 groups: group I, control (n = 10); group II, nitrofen-induced CDH (n = 10); group III, nitrofen-induced CDH with antenatal Dex treatment (n = 10). ANP protein was measured using enzyme-linked immunosorbent assay (ELISA) technique. Reverse transcription polymerase chain reaction (RT-PCR) was performed to evaluate the relative amount of atrial natriuretic peptide (ANP) mRNA expression. RESULTS: There was a significant reduction in ANP mRNA (P <.05) and protein (P <.01) levels in heart of group II (CDH) compared with group I. Antenatal Dex treatment significantly increased both ANP mRNA and protein levels in the heart of CDH animals (P <.05). CONCLUSIONS: The reduced cardiac ANP gene expression and ANP synthesis indicates that the heart in CDH is functionally immature and may be unable to respond to hemodynamic load accompanying persistent pulmonary hypertension (PPH). ANP or drugs such as steroids, which raise endogenous ANP levels, may have a therapeutic application in CDH complicated by PPH.

Animals↗
PubMed2001

Altered gene level expression of thyroid hormone receptors alpha-1 and beta-1 in the lung of nitrofen-induced diaphragmatic hernia.

PURPOSE: Thyroid receptor alpha-1 (TR-alpha1) and thyroid receptor beta-1 (TR-beta1) are thought to be essential for the fetal and postnatal development of the lung. The authors investigated gene level expression of TR-alpha1 and TR-beta1 in the lung of nitrofen-induced congenital diaphragmatic hernia (CDH) using reverse transcription polymerase chain reaction (RT-PCR). METHODS: CDH was induced in pregnant rats after administration of 100 mg nitrofen on day 9.5 of gestation. Cesarean section was performed on day 21 of gestation. The fetuses were divided into 3 groups: normal controls (n = 16), nitrofen-induced CDH (n = 16), and nitrofen-treated without CDH (n = 16). mRNA was extracted from the left lung in each group. RT-PCR was performed to evaluate mRNA expressions of TR-alpha1 and TR-beta1. Levels of mRNA were expressed as a ratio of the band density divided by that of beta-actin, a house-keeping gene. RESULTS: TR-alpha1 mRNA expression was decreased significantly in CDH lung (1.618 +/- 0.148) compared with controls (2.658 +/- 0.251; P <.01) and nitrofen-treated without CDH lung (2.232 +/- 0.193; (P <.05). TR-beta1 mRNA expression also was significantly decreased in CDH lung (2.223 +/- 0.270) compared with controls (3.569 +/- 0.262; P <.01) and nitrofen-treated without CDH lung (3.235 +/- 0.299; P <.05). CONCLUSION: These data suggest that the downregulation of thyroid hormone signaling pathway through altered expression of TR-alpha1 and TR-beta1 during lung morphogenesis may be a contributory factor in the pathogenesis of pulmonary hypoplasia in nitrofen-induced CDH.

Animals↗
PubMed2001

Bacterial colonization of the prepuce in boys with vesicoureteral reflux who receive antibiotic prophylaxis.

Culture swabs were taken from the periurethral area of 59 consecutive uncircumcised boys with vesicoureteral reflux (VUR) and 36 boys undergoing circumcision. A pure growth of a uropathogen was isolated in 22 (37%) boys with VUR who were receiving antibiotic prophylaxis and in 10 (28%) boys who underwent circumcision. Antibiotic prophylaxis in patients with VUR was not effective in reducing the bacterial colonization of the prepuce. We recommend circumcision in boys, particularly infants with VUR, to reduce the risk of urinary tract infections.

Anti-Infective Agents, Urinary↗