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Biomedical subjects

R Arora

Publications and source records attributed to R Arora.

At least 73 records · Page 4Linked to original sources
PubMed2000

False-positive exercise stress electrocardiogram due to accessory pathway in the absence of manifest preexcitation.

False-positive exercise testing in patients with an accessory pathway has been described only in patients with manifest preexcitation during exercise. We describe a patient in whom marked ST-segment changes were seen during an exercise test in the absence of any preexcitation of the QRS complexes. The role of the accessory pathway in producing the ST changes was reaffirmed by absence of this abnormality following catheter ablation of the accessory pathway.

Catheter Ablation↗
PubMed2000

Expression of complement regulatory proteins in diffuse proliferative glomerulonephritis.

This study assessed the expression of complement receptor 1 (CR1), decay accelerating factor (DAF) and membrane inhibitor of reactive lysis (CD59) on the erythrocytes and glomerulus of diffuse proliferative glomerulonephritis (DPGN) of systemic lupus erythematosus (SLE) patients using flow cytometry and immunofluorescence techniques to elucidate their role in the pathogenesis of DPGN. Expression of CR1 on the erythrocytes and glomerulus of DPGN patients was reduced compared with expression in normal subjects. However, expression of DAF and CD59 was increased on both erythrocytes and glomerulus of DPGN patients, suggesting the generation of a protective response against complement-mediated injury.

Adolescent↗
PubMed2000

Message framing and credibility: application in dental services.

This study uses an experimental approach to test the influence of message framing and credibility on the attitude toward a dental exam and consumers' intention to use the dental office. The findings indicate a strong effect of credibility on attitude as well as intention. The influence of framing is also statistically significant. Implications for marketers in terms of message strategy are discussed.

Advertising↗
PubMed2000

Mitral regurgitation following percutaneous transvenous mitral commissurotomy: a single-center experience.

BACKGROUND AND AIM OF THE STUDY: Percutaneous transvenous mitral commissurotomy (PTMC) has revolutionized the treatment of patients with symptomatic mitral stenosis and is now established as the procedure of choice. Despite high technical expertise in PTMC using the Inoue balloon, mitral regurgitation (MR) remains a major procedure-related complication. We retrospectively analyzed our data of PTMC using the Inoue balloon with regard to the incidence of MR, its likely causative mechanism, and follow up of these patients. METHODS: During the past ten years, PTMC was performed in 3,650 patients (median age 26 years; range: 8-76 years), of whom 910 (24.9%) were juveniles. Preprocedure mitral valve area (MVA) was 0.9 +/- 0.4 cm2 (range: 0.3-1.3 cm2); MR was mild in 1,396 cases (38.2%), moderate in 394 (10.8%) and severe in 22 (0.6%). None of the patients was rejected on the basis of echocardiographic score. RESULTS: The procedure was successful in 3,276 (89.8%), with post-procedure MVA of 1.7 +/- 0.6 cm2 (range: 1.4-2.6 cm2), and without development of any major complication. Severe MR was seen in 120 patients (3.3%), of whom 66 (1.8%) required urgent mitral valve replacement (MVR). Echocardiography in these latter patients showed leaflet rupture in 48 (72.7%), chordal rupture in 12 (18.2%) and excessive commissural tear in six (9.1%). Fifty-four patients (1.5%) with severe MR post PTMC were followed with medical treatment; echocardiography in these patients revealed chordal rupture in 40 (74.1%) and excessive commissural tear in 14 (25.9%). Follow up data were available in 49 patients (1.3%); 30 (0.8%) required MVR and 19 (0.5%) were in NYHA class II at a median follow up of 24 months. Moderate MR was seen in 188 cases (5.1%), with predominant causative mechanisms of excessive commissural tear in 120 (63.8%) and chordal rupture in 68 (36.2%). Severity of MR worsened in 30 cases (0.8%), of which 20 (0.6%) required elective MVR on follow up. MR decreased in 58 patients (1.6%), in whom excessive commissural tear was the causative mechanism. CONCLUSION: Significant MR (moderate or severe) after PTMC was seen in 308 patients (8.4%), of whom 116 (3.2%) required MVR urgently or on follow up. All patients with leaflet rupture during PTMC developed severe MR and required urgent MVR. There was a tendency for the severity of MR to decrease with time in cases where excessive commissural tear was the causative mechanism.

Adolescent↗
PubMed2000

Disposable contact lenses in penetrating keratoplasty.

PURPOSE: To evaluate the therapeutic efficacy of disposable contact lenses in management of complications after keratoplasty. METHODS: Twenty-eight patients with various post keratoplasty complications were fit with disposable contact lenses (45% Vifilcon A and 55% water content). Indications for lens use included persistent epithelial defects, wound leak, graft edema, dry eye and protection of normal corneal epithelium. RESULTS: Success was obtained with the therapeutic use of disposable lenses in 20 of the 28 cases. The best results were seen in maintenance and restoration of healthy ocular surface and small wound leaks. Stromal graft edema with no epithelial involvement was the major area of therapeutic failure. CONCLUSIONS: Disposable contact lenses are an attractive low cost option in the management of complications after keratoplasty. They are particularly useful in maintaining a healthy ocular surface, providing symptomatic relief and avoiding resurgery in patients with small wound leaks.

Adult↗
PubMed2000

Intralenticular foreign bodies: report of eight cases and review of management.

PURPOSE: The management of intralenticular foreign bodies (ILFBs) with or without cataract has varied from time to time in the last century. We evaluated the surgical removal of the ILFBs with cataract extraction as a single-stage procedure. METHODS: Eight consecutive cases with intralenticular foreign bodies presenting to the trauma centre at our institute, were included in the study. Planned ILFB removal with cataract extraction and IOL implantation as a single-stage procedure was done in all the patients. They were followed up from 2 months to 2 years after the surgery. RESULTS: ILFBs were removed with Kelman-Mcpherson forceps in seven cases and in one it was expressed with the nucleus during extra capsular cataract extraction. Co-existent posterior capsular tears were seen in two eyes, of which only one needed a localized vitrectomy. Posterior chamber intraocular lens implantation was possible without any complication in all the cases. Postoperative uveitis seen in three cases was easily controlled with periocular steroids. Best corrected visual acuity at last examination was 6/9 or better in 7 cases and 6/12 in one case with posterior capsular opacification. CONCLUSIONS: Timing and necessity of ILFB removal may be adjusted according to the foreign body characteristics and associated ocular trauma, choosing, as far as possible, the least traumatic procedure. Use of forceps rather than magnets is safer for the removal of the ILFB. Co-existent posterior capsular tears need to be anticipated and dealt with when encountered.

Adolescent↗
PubMed1999

Thrombogenic factors and recurrent coronary events.

BACKGROUND: Thrombosis is a pivotal event in the pathogenesis of coronary disease. We hypothesized that the presence of blood factors that reflect enhanced thrombogenic activity would be associated with an increased risk of recurrent coronary events during long-term follow-up of patients who have recovered from myocardial infarction. METHODS AND RESULTS: We prospectively enrolled 1045 patients 2 months after an index myocardial infarction. Baseline thrombogenic blood tests included 6 hemostatic variables (D-dimer, fibrinogen, factor VII, factor VIIa, von Willebrand factor, and plasminogen activator inhibitor-1), 7 lipid factors [cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, lipoprotein(a), apolipoprotein (apo)A-I, and apoB], and insulin. Patients were followed up for an average of 26 months, with the primary end point being coronary death or nonfatal myocardial infarction, whichever occurred first. The hemostatic, lipid, and insulin parameters were dichotomized into their top and the lower 3 risk quartiles and evaluated for entry into a Cox survivorship model. High levels of D-dimer (hazard ratio, 2.43; 95% CI, 1.49, 3.97) and apoB (hazard ratio, 1.82; 95% CI, 1.10, 3.00) and low levels of apoA-I (hazard ratio, 1.84; 95% CI, 1.10, 3.08) were independently associated with recurrent coronary events in the Cox model after adjustment for 6 relevant clinical covariates. CONCLUSIONS: Our findings indicate that a procoagulant state, as reflected in elevated levels of D-dimer, and disordered lipid transport, as indicated by low apoA-1 and high apoB levels, contribute independently to recurrent coronary events in postinfarction patients.

Adult↗
PubMed1999

Immediate and delayed effects of successful percutaneous transvenous mitral commissurotomy on global right ventricular function in patients with isolated mitral stenosis.

Global right ventricular function of the pressure-overloaded right ventricle in patients with mitral stenosis and pulmonary hypertension after successful percutaneous transvenous mitral commissurotomy (PTMC) has not been well-defined. With the use of a recently developed Doppler method for estimating right ventricular function in human beings, we studied 25 consecutive patients with isolated rheumatic mitral stenosis before, immediately after (mean, 40+/-12 h) and at a mean follow-up of 11.5 months after PTMC. Immediately after percutaneous mitral commissurotomy, there was a significant increase in mitral valve area (P = 0.000017) along with a decrease in mean pulmonary pressure (P = 0.001). The index was not affected immediately after successful PTMC (0.70+/-0.25 vs., 0.58+/-0.18; P = 0.06); however, at follow-up of about one year, the index showed a significant decrease (0.697+/-0.28 vs. 0.380+/-0.13; P = 0.0008, n = 24). The change in the index was characterised by a significant prolongation of the right ventricular ejection time, with a decrease in the isovolumic intervals. The Doppler index of combined right ventricular function was significantly correlated to the mean pulmonary artery pressure (r = 0.695, P<0.001) and systolic pulmonary artery pressure (r = 0.60, P = 0.007) before PTMC and also immediately after the procedure; however, at follow-up, the index had no correlation with the Doppler estimated pulmonary artery systolic pressure (r = 0.07). Despite a larger mitral valve area following PTMC, right ventricular isovolumic indices remain abnormal on mid-term follow-up, although global function tends to normalise in two-thirds of the patients.

Adult↗
PubMed1999

Percutaneous mechanical mitral commissurotomy with a newly designed metallic valvulotome: immediate results of the initial experience in 153 patients.

BACKGROUND: Percutaneous balloon valvotomy has become a common treatment of mitral stenosis, but the cost of the procedure remains a limitation in countries with restricted financial resources, leading to a frequent reuse of the disposable catheters. To overcome this limitation, a reusable metallic valvotomy device has been developed with the goals of both improving the mitral valvotomy results and decreasing the cost of the procedure. METHODS AND RESULTS: The device consists of a detachable metallic cylinder with 2 articulated bars screwed onto the distal end of a disposable catheter whose proximal end is connected to an activating pliers. By the transseptal route, the device is advanced across the valve over a traction guidewire. Squeezing the pliers opens the bars up to a maximum extent of 40 mm. The clinical experience consisted of 153 patients with a broad spectrum of mitral valve deformities. The procedure was successful in 92% of cases and resulted in a significant increase in mitral valve area, from 0.95+/-0.2 to 2. 16+/-0.4 cm2. No increase in mitral regurgitation was noted in 80% of cases. Bilateral splitting of the commissures was observed in 87%. Complications were 2 cases of severe mitral regurgitation (1 requiring surgery), 1 pericardial tamponade, and 1 transient cerebrovascular embolic event. In this series, the maximum number of consecutive patients treated with the same device was 35. CONCLUSIONS: The results obtained with this new device are encouraging and at least comparable to those of current balloon techniques. Multiple uses after sterilization should markedly decrease the procedural cost, a major advantage in countries with limited resources and high incidence of mitral stenosis.

Adolescent↗
PubMed1999

Prognostic significance of myocardial enzyme release after coronary interventions.

Mild to moderate periprocedural elevation in CK with concurrent CK MB elevation result in increased subsequent myocardial infarction and mortality. However the potential risks that percutaneous revascularization interventions pose must be evaluated in light the risks of alternative procedures and the risks of continued medical management. Prospective clinical trials examining the relationship of periprocedural enzyme elevations to long term prognosis will need to address this issue.

Angioplasty, Balloon, Coronary↗
PubMed1999

Transcatheter device closure of ventricular septal defects: immediate results and intermediate-term follow-up.

BACKGROUND: Transcatheter closure is an accepted mode of treatment in selected cases of congenital heart disease. Lately, this technology has been applied to closure of ventricular septal defect (VSD). METHODS AND RESULTS: We performed percutaneous transcatheter closure of VSD in 30 patients. The location of VSD was perimembranous in 28 patients and muscular trabecular in 2. Two (7%) patients also had left ventricular-right atrial communication. There were 17 male subjects and 13 female subjects, with an age range of 5. 5 to 33 years (mean +/- SD, 12.9 +/- 5.7; median 12.2). The diameter of VSD ranged from 3 to 8 mm (mean +/- SD 4.7 +/- 1.3; median 4.5). In 5 (17%) patients, the pulmonary to systemic blood flow (Qp/Qs) was >/=2.1 (range 2.0 to 2.6). The defect was at least 6 or 8 mm from the aortic valve in patients in whom a 12- or 17-mm Rashkind double umbrella device was deployed, respectively. In 1 patient, the defect was closed with a detachable stainless steel coil, size 8 mm, with 4 loops (8 x 4). The devices were successfully deployed in 87% of patients. In 6 (20%) patients, the procedure had to be repeated primarily because of the use of undersized umbrella deices. Unsuccessful deployment of the device occurred in 4 (13%) patients. In one of these procedures, the coil embolized to the left pulmonary artery, and it was successfully retrieved. A minimal residual shunt seen as a thin streak on transthoracic color flow mapping persisted in 8 (30%) patients, which remained unchanged over a follow-up period of 5 to 28 (17.1 +/- 6.4) months. Both patients with left ventricular/right atrial communication showed complete abolition of the shunt. No patient developed new-onset aortic or tricuspid regurgitation or intravascular hemolysis. At follow-up, no patient had developed infective endocarditis, bundle branch block, or late valvular insufficiency. CONCLUSIONS: Transcatheter closure is safe and efficacious in selected cases of perimembranous and muscular VSD.

Adolescent↗
PubMed1999

Scleral-fixated intraocular lens implantation in unilateral aphakic children.

OBJECTIVE: To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. INTERVENTION: Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. RESULTS: Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). CONCLUSION: Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.

Aphakia, Postcataract↗
PubMed1999

Child abuse and dentistry: a study of knowledge and attitudes among dentists in Victoria, Australia.

Child abuse is a disturbingly common finding in society today. In view of the high proportion of orofacial injuries seen in victims of child abuse, dentists are in a strategic position to recognize and report suspected cases. The present study of 347 dentists in Victoria, Australia, assessed the level of knowledge and attitudes among dental professionals on the important issue of child abuse. While a high level of interest was shown by the participants towards this issue, a need for further information and training in the recognition and reporting of child abuse was seen in the survey findings. While dentists at present are not legally mandated in all states of Australia to report suspected cases of child abuse, the dental profession is in a key position to play an active role in the identification and reporting of this substantial community problem.

Adolescent↗
PubMed1999

Transcatheter closure of ventricular septal defect using detachable steel coil.

Transcatheter closure has been attempted in selected cases of ventricular septal defects using Lock clamshell device, Rashkind umbrella device, and Sideris buttoned device. A small perimembranous ventricular septal defect with aneurysm of membranous septum in a 12 year old girl was closed successfully with a detachable steel coil of 8 mm diameter with four loops, after failure of deployment of a Rashkind double umbrella device.

Child↗
PubMed1999

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients.

PURPOSE: To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. MATERIALS AND METHODS: A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. RESULTS: All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. CONCLUSION: A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.

Adult↗
PubMed1999

Influence of pain-free dentistry and convenience of dental office on the choice of a dental practitioner: an experimental investigation.

Fear of dental pain or dental anxiety is not an uncommon phenomenon. Evidence supports dental patients' concern for dental pain. This study examines the influence of dental pain and convenience of dentist's office on attitude towards the dentist as well as the intention to switch to the dentist. The results reveal a strong effect of dental pain on patients' attitudes. The intention to switch to a pain-free dental facility, however, depends on satisfaction with the current dentist.

Attitude to Health↗
PubMed1998

Calcified subaortic left ventricular aneurysm causing right pulmonary artery obstruction in a child.

A 14-year old asymptomatic boy was diagnosed as having a large calcified subaortic left ventricular aneurysm that was found to obstruct flow across the right pulmonary artery during systole. Surgical patch closure of the neck of the aneurysm resulted in relief of obstruction. The case is reported for its rarity, massive calcification, absence of aortic regurgitation and dynamic compression of the right pulmonary artery.

Adolescent↗