Liver transplantation in Polysplenia syndrome.
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Child, Preschool↗
Biomedical subjects
P Srinivasan
Publications and source records attributed to P Srinivasan.
Sclerosing encapsulating peritonitis after orthotopic liver transplantation.
BACKGROUND: The etiology of abdominal cocoon (a rare cause of intestinal obstruction) is unknown. It has occurred in adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients undergoing peritoneal dialysis. We report our experience with patients after orthotopic liver transplantation (OLT). METHODS: Five patients (4 male, 1 female, aged 16 to 57 years) underwent OLT (3 whole liver, 2 right lobe grafts) and subsequently developed abdominal cocoon. RESULTS: All developed pyrexia by 66 +/- 21 hours posttransplant. Additional symptoms (epigastric discomfort and intermittent vomiting) occurred 12 +/- 10 days later. Bacterial peritonitis was confirmed by microbiology in 2 cases and diagnosed by exclusion in the others. C-reactive protein levels were persistently elevated in all patients (35 to 82 mg/L). While abdominal CT consistently demonstrated marked ascites with the small intestine confined to a particular area of the abdomen, intestinal contrast studies and ultrasound were not diagnostic. All patients underwent surgical removal of the cocoon membrane by 58 +/- 22 days after transplant. CONCLUSIONS: Sclerosing peritonitis may complicate liver transplantation and occurs because of low-grade intra-abdominal sepsis.
Adolescent↗
Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management.
AIM: Hepatic artery pseudoaneurysm (PA) is an uncommon complication of liver transplantation. We report a series of 13 patients, the largest published review including outcome. The presenting features, risk factors and role of radiology in the diagnosis and management of this frequently fatal complication are discussed.
Adolescent↗
Successful outcome of orthotopic liver transplantation in patients with preexisting malignant states.
Preexisting malignancy is considered a relative contraindication to orthotopic liver transplantation (OLT) because of the risk of tumor recurrence. The purpose of this study is to assess the outcome of OLT in patients with a preexistent malignant state. Of 1,097 OLTs performed between 1989 and 1999 at King's College Hospital (London, UK), 18 patients had a pretransplantation malignant state, including 6 cases of myeloproliferative disorder (MPD) presenting as Budd-Chiari syndrome. Those patients with solid-organ malignancies had their tumor detected at an early stage and underwent curative treatment before or during OLT. Patients were followed up for a median of 71 months (range, 1 to 119 months) post-OLT, and the rates of rejection and malignancy were compared with those of transplant recipients without preexisting malignancy during the same period. One patient had a recurrence of his primary malignancy (non-Hodgkin's lymphoma) after 27 months, whereas another patient developed a de novo posttransplant lymphoproliferative disorder after 57 months. One patient with MPD developed acute leukemia 72 months after OLT. In comparison, of 1,079 OLTs performed in patients without preexisting malignancy during the same period, there were 34 cases of de novo malignancies. The rate of rejection in patients with and without preexisting malignancy was similar. Successful medium-term outcome after OLT can be achieved in carefully selected patients with preexisting malignancy providing the malignancy is amenable to curative treatment before or at OLT. Primary MPDs responsible for Budd-Chiari syndrome should not be considered a contraindication to OLT.
Adult↗
Living related liver transplantation in biliary atresia with absent inferior vena cava.
The success of the triangulation technique for hepatic venous anastomosis in left lateral segment liver transplantation has led to standardization of this procedure. We report a case of syndromic biliary atresia with absent inferior vena cava in which we constructed a neo cava to implant a living related left lateral segment graft by using the triangulation technique.
Biliary Atresia↗
Amylase-resistant starch plus oral rehydration solution for cholera.
BACKGROUND: Although standard glucose-based oral rehydration therapy corrects the dehydration caused by cholera, it does not reduce the diarrhea. Short-chain fatty acids, which are produced in the colon from nonabsorbed carbohydrates, enhance sodium absorption. We conducted a study to determine the effects of an orally administered, nonabsorbed starch (i.e., one resistant to digestion by amylase) on fecal fluid loss and the duration of diarrhea in patients with cholera. METHODS: We randomly assigned 48 adolescents and adults with cholera to treatment with standard oral rehydration therapy (16 patients), standard therapy and 50 g of rice flour per liter of oral rehydration solution (16 patients), or standard therapy and 50 g of high-amylose maize starch, an amylase-resistant starch, per liter of oral rehydration solution (16 patients). The primary end points were fecal weight (for every 12-hour period during the first 48 hours after enrollment) and the length of time to the first formed stool. RESULTS: The mean (+/-SD) fecal weights in the periods 12 to 24 hours, 24 to 36 hours, and 36 to 48 hours after enrollment were significantly lower in the resistant-starch group (2206+/-1158 g, 1810+/-1018 g, and 985+/-668 g) than in the standard-therapy group (3251+/-766 g, 2621+/-1149 g, and 2498+/-1080 g; P=0.01, P= 0.04, and P=0.001, respectively). From 36 to 48 hours after enrollment, fecal weight was also significantly lower with the resistant-starch therapy than with the rice-flour therapy (985+/-668 g vs. 1790+/-866 g, P=0.01). The mean duration of diarrhea was significantly shorter with the resistant-starch therapy (56.7+/-18.6 hours) than with standard therapy alone (90.9+/-29.8 hours, P=0.001) or the rice-flour therapy (70.8+/-20.2 hours, P=0.05). Fecal excretion of starch was higher with the resistant-starch therapy (32.6+/-30.4) than with the standard therapy (11.7+/-4.1 g, P=0.002) or the rice-flour therapy (15.1+/-8.4 g, P=0.01). CONCLUSIONS: The addition of a resistant starch to oral rehydration solution reduces fecal fluid loss and shortens the duration of diarrhea in adolescents and adults with cholera.
Adolescent↗
The pediatric forum: breastfeeding education of pediatric residents: A national survey.
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Attitude of Health Personnel↗
Oxysterols: 27-hydroxycholesterol and its radiolabeled analog.
We describe a convenient and stereoselective route to the synthesis of 27-hydroxycholesterol. Also its radiolabeled analog, 22, 23 di [(3)H]-27-hydroxycholesterol with high specific radioactivity (55 Ci/mmol) was synthesized by this method. Julia condensation of steroidal 22-sulfone with aldehyde, led to the addition of the 23-27 carbon side chain building block to the steroid backbone. Formed in this reaction beta-hydroxysulfone moiety was reduced by sodium amalgam generate 22-23 unsaturated bond. Further reduction either by hydrogen or tritium furnished substrates for the synthesis of title compounds.
Chromatography, High Pressure Liquid↗
Mini-papad containing cheese powder--a novelty snack food.
The present work reports on attempts to develop mini-papads containing cheese powder to create a novel taste, with potential for urban and export markets. Cheese powder was added to black gram flour at 0-50% levels and papads were prepared in the conventional manner by rolling the dough and drying. These papads were deep-fat fried at 180 degrees C. Upto 20% addition of cheese powder gave no perceptible change in taste or flavour of the mini-papads. At 30% addition brown colouration was observed which decreased the sensory appeal. At 40 and 50% levels, although the mouthfeel and flavour of cheese was desirable, browning increased markedly, which drastically lowered the overall acceptability. Ascorbic acid addition at 0.5-1.0% markedly decreased the browning. The papads had a higher fat content on frying as compared to the control but were excellent organoleptically, suggesting them to be a tasty and crunchy snack food.
Ascorbic Acid↗
Liver transplantation with monosegments.
BACKGROUND: Shortage of size-matched pediatric donors led to the development of surgical techniques to reduce or split livers and thus increase the potential pool of donors. Despite this, neonatal transplantation remains a problem because of the small size of the recipients. Further reduction of the left lateral segment is possible to provide a single segment graft (segment III). We report our experience of transplanting 6 babies using this technique. METHODS: Of 310 children transplanted in our center between October 1989 and March 1998, 6 patients, 2 male and 4 female, median age 37.5 days (range 5 to 92 days), median weight 3.45 kg (range 2.45 to 5.46 kg) were transplanted with a monosegment. The cause of liver failure was neonatal hemochromatosis in 4, retransplantation for hepatic artery thrombosis in 1, and hepatitis B in one. The donor liver was reduced or split to a left lateral segment. Segment II was then resected and discarded before transplantation. RESULTS: Overall, graft and patient survival is 83.3%. Five patients are alive with good graft function at a mean follow-up of 30.4 months (range 8 to 82 months). One child who was transplanted for hepatic artery thrombosis died from sepsis and multiorgan failure 48 hrs after transplant. None of the survivors had vascular or biliary complications. CONCLUSIONS: Monosegment liver transplantation with segment III appears to be a satisfactory option for treating small babies with liver failure.
Female↗
Exploring the UMLS: a rough sets based theoretical framework.
The Unified Medical Language System (UMLS) [1] has a unique and leading position in the evolution of thesauri and metathesauri. Features that set it apart are: its composition from more than fifty component health care vocabularies; the sophisticated UMLS ontology linking the Metathesaurus with structures such as the Semantic Network and the SPECIALIST lexicon; and the high level of social collaboration invested in its construction and growth. It is our thesis that in order to successfully harness such a complex vocabulary for text retrieval we need sophisticated methods derived from a deeper understanding of the UMLS system. Thus we propose a theoretical framework based on the theory of rough sets, that supports the systematic and exploratory investigation of the UMLS Metathesaurus for text retrieval. Our goal is to make it more feasible for individuals such as patients and health care professionals to access relevant information at the point of need.
Humans↗
Clinical profile of AIDS: a study at a referral hospital.
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Acquired Immunodeficiency Syndrome↗
Ocular malaria. A clinical and histopathologic study.
PURPOSE: Clinical and histopathologic findings of ocular lesions in malaria rarely have been described. This study reports lesions in three patients with malaria, with a histopathologic study of eyes obtained at autopsy of one of these patients. METHODS: Various ocular lesions were documented in three patients with malarial infection, with histopathologic study of one patient. In all three patients, the diagnosis of malaria was confirmed by the demonstration of malarial parasites in peripheral smears and by fluorescent microscopy of acridine orange-stained buffy coat preparations of venous blood. RESULTS: Multiple superficial blotchy retinal hemorrhages over the posterior pole were seen in the first patient, whereas acute bilateral panuveitis and secondary glaucoma were seen in the second, which on resolution showed multiple blotchy superficial retinal hemorrhages with perivasculitis. The third patient had cerebral malaria and was found to have subconjunctival and retinal hemorrhages. This patient died of pulmonary thromboembolism, and the eyes were obtained at autopsy. On gross examination, there were multiple retinal hemorrhages in the posterior pole. Histopathologic study showed cytoadherence of parasitized erythrocytes as well as schizonts and gametocytes of Plasmodium vivax within the retinal and choroidal blood vessels. CONCLUSION: The authors' findings suggest that patients with unexplained blotchy retinal hemorrhages should be investigated for malarial infection, especially if they reside or have travelled in endemic areas.
Acridine Orange↗
Retrieval feedback for query design in MEDLINE. A comparison with expert network and LLSF approaches.
Query design is a vibrant research focus in information retrieval. The objective is to modify a user's original query into one that is more effective for retrieval. Researchers have proposed and investigated a variety of strategies to support query design in MEDLINE. This paper examines a query design method built within the framework of retrieval feedback. In particular, the effectiveness of this method is compared with the effectiveness of competing methods that utilize query mapping functions constructed in an expert network or built using the Linear Least Squares Fit approach. The comparison indicates that retrieval feedback offers an approach that is just as effective as these alternative approaches. Moreover, it has the advantage of being simpler to implement.
Abstracting and Indexing↗
National health policy for traditional medicine in India.
External pressures have combined to erode the practice of India's traditional medical systems to such an extent that they are in danger of becoming extinct. A better balanced national health policy could go a long way towards reversing this trend.
Education, Medical↗
From chart tracking to workflow management.
The current interest in system-wide integration appears to be based on the assumption that an organization, by digitizing information and accepting a common standard for the exchange of such information, will improve the accessibility of this information and automatically experience benefits resulting from its more productive use. We do not dispute this reasoning, but assert that an organization's capacity for effective change is proportional to the understanding of the current structure among its personnel. Our workflow manager is based on the use of a Parameterized Petri Net (PPN) model which can be configured to represent an arbitrarily detailed picture of an organization. The PPN model can be animated to observe the model organization in action, and the results of the animation analyzed. This simulation is a dynamic ongoing process which changes with the system and allows members of the organization to pose "what if" questions as a means of exploring opportunities for change. We present, the "workflow management system" as the natural successor to the tracking program, incorporating modeling, scheduling, reactive planning, performance evaluation, and simulation. This workflow management system is more than adequate for meeting the needs of a paper chart tracking system, and, as the patient record is computerized, will serve as a planning and evaluation tool in converting the paper-based health information system into a computer-based system.
Computer Simulation↗
Structured text representations and relevance judgments: an exploratory study.
This paper presents results of an exploratory study on using a structured text and query model for analyzing relevance judgments made by users on retrieved texts The structured model moves beyond keyword based text representation and retrieval. In particular it allows texts and queries to be represented by concepts embedded within the structural framework of complex objects. These objects preserves important text-based links between the selected concepts. The current study reveals a tendency for user judged relevance potential to decrease as the structure-based similarity between query and text decreases. This indicates that the structure-based retrieval model has the potential to conduct more precise retrieval than keyword based models. This supports our overall research goal of developing and investigating the structured retrieval model.
Information Storage and Retrieval↗
Quality retrieval of the empirical literature: a structured approach.
The extent and growth of medical knowledge is tremendous. As of December 1990, the MEDLINE database had 6.5 million records in its collection, with approximately a third added during the last five years. Despite numerous innovations, retrieval technology has not kept pace with the exploding numbers of authors, articles, journals, books and conferences. A major limiting factor is that the basic mechanisms of retrieval systems almost uniformly rely on keyword representation and searching. These keywords are either assigned to texts perhaps with the assistance of special vocabularies, or appear naturally in these texts. In particular no structural or role information is preserved to connect these keywords to each other. This paper presents an alternative approach wherein role preserving, structured representations are used. This approach has the potential to increase retrieval quality.
Information Storage and Retrieval↗