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Biomedical subjects

R Gupta

Publications and source records attributed to R Gupta.

At least 91 records · Page 5Linked to original sources
PubMed2001

A comparison of 5-day and 8-day drainage following mastectomy and axillary clearance.

AIMS: Mastectomy and axillary clearance are standard operations for the treatment of breast carcinoma. Drainage of the mastectomy site and axilla is often required to allow accumulating blood and inflammatory fluids to escape. However, there is a lack of data relating to how long suction drains should stay in situ after major breast surgery. In our study we have tried to address this deficit by comparing the efficacy of 5-day post-operative drainage with 8-day post-operative drainage. METHODS: Patients requiring mastectomy and axillary clearance were randomized to having drains removed on day 5 or day 8 post-operatively. The number of lymphoceles, aspirations and total aspiration volumes in chest and axillary drains were compared. RESULTS: From a total of 121 patients enrolled into the study, 64 patients were randomized to the 5-day group and 57 to the 8-day group. There were significant differences regarding the number of aspirations and total aspiration volumes in chest and axillary drains between the two groups, favouring 8-day drainage. However the number of lymphoceles drained in the 5-day group was significantly higher than the 8-day group. CONCLUSIONS: Five-day post-operative drainage is as safe as 8-day post-operative drainage in the management of patients undergoing major breast surgery, but results in an increase in lymphocele aspiration and aspiration volume.

Axilla↗
PubMed2001

Might patients benefit from oral iron therapy following operative treatment of breast carcinoma?

AIMS: To assess the changes in blood haemoglobin concentration and serum iron indices as a consequence of breast operations for cancer in our unit. METHODS: Haematological parameters were measured in 109 patients undergoing definitive operative treatment for breast carcinoma. RESULTS: A mean fall in haemoglobin of 2.1 g (P=0.001) occurred in patients undergoing mastectomy and axillary clearance and of 1.3 g (P<0.001) in patients undergoing wide local excision and axillary clearance. The transferrin saturation (serum iron/total iron binding capacity) in both sets of patients after surgery fell on average to levels that would be expected to impair subsequent red cell production. CONCLUSION: The changes in iron indices that occurred were unrelated to the degree of blood loss consistent with a possible inflammatory effect of the operation. Oral iron therapy is unlikely to be of benefit to operative breast patients if they have normal pre-operative iron stores.

Anemia, Iron-Deficiency↗
PubMed2001

Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry.

Twenty-three toe-to-hand transfers performed in 21 children were monitored after surgery using differential pulse oximetry for 4 to 12 days. Pulse rate recorded by the pulse oximetry monitored the patency of the arterial anastomosis, whereas oxygen saturation (SaO(2)) corresponded to the patency of the venous anastomosis; these were both compared with the systemic pulse rate and oxygen saturation recorded by a second control pulse oximeter probe attached to a contralateral finger or toe. All 23 toe transfers were ultimately successful, but 2 required re-exploration for anastomotic problems detected by the pulse oximeter. Based on this experience, the following criteria have been developed for the nursing and junior medical staff: if the arterial pulse of the toe transfer is lost completely or if the pulse rate differs significantly from the systemic pulse rate, measured by the second control pulse oximeter, thrombosis of the arterial anastomosis should be suspected. If the oxygen saturation of the toe transfer decreases below the oxygen saturation measured by the control pulse oximeter and this differential is sustained over a period of time, thrombosis of the venous anastomosis should be suspected. Differential pulse oximetry appears to be superior to temperature monitoring and percutaneous and laser Doppler monitoring and provides the most simple and continuous technique of noninvasive postoperative monitoring of toe-to-hand transfers in children requiring reconstruction of traumatic or congenital deformities.

Adolescent↗
PubMed2001

Evaluation of an acute nerve compression injury with magnetic resonance neurography.

Although magnetic resonance (MR) imaging is performed routinely, current techniques offer little for evaluation of the peripheral nervous system. An animal model was developed to evaluate the appearance and geographic changes associated with an acute nerve compression injury by MR neurography. Several measurements of signal intensity were made for the contralateral noninjured nerve and each sciatic nerve proximal to the site of compression (PN), at the site of compression (CN), and distal to the site of compression (DN) injury. Mean (+/-SEM) values of the MR nerve/muscle signal intensity ratio were 2.24 +/- 0.08 for normal nerve, 2.29 +/- 0.12 for PN, 3.11 +/- 0.31 for CN, and 4.33 +/- 0.47 for DN. There was a statistically significant geographic variation of nerve/muscle signal intensity ratios along the course of the nerve relative to the site of injury that MR neurography could detect. Magnetic resonance neurography may have significant potential to provide more information about problems such as brachial plexus injuries and peripheral nerve compression.

Analysis of Variance↗
PubMed2001

Ultrasonographic femur-tibial length ratio: a marker of Down syndrome from the late second trimester.

An observational prospective study reported that newborn babies with Down syndrome (DS) had short upper limbs that reach up to their pelvis. The shortening was most marked in the forearm (the middle segment of the upper limb) and this relative shortening resulted in an alteration of the proximal to middle segment length ratio. This study assumes that there is a similar alteration in the ratio of the lower limb. We propose to study the proximal to middle segment ratio in the lower limb in normal fetuses at different gestational ages. Against these norms we propose to study the ratio in fetuses with DS to see at what stage in intrauterine life the altered ratio becomes evident. We also propose to take postnatal measurements of upper and middle segments of both upper and lower limbs of babies born with DS and compare them with normal babies. Fetal femoral and tibial lengths were measured by routine antenatal ultrasound scans at a General hospital with 6000 deliveries a year. All babies delivered were examined for phenotypical evidence of DS. The in utero measurements recorded of babies born with DS were compared with the measurements in normal babies. Postnatal measurements of the arm and forearm, and the thigh and leg of babies with DS were taken soon after birth. These were compared with a control group of 20 consecutive normal babies born over 2 days. There were 3690 readings of 3075 normal fetuses and 8 measurements of 7 Down fetuses. The leg, the upper arm, and arm of newborns with DS were significantly shorter than controls (p<0.01). The upper limb reached up to the pelvis in infants with DS and not up to mid thigh as in normal babies. The forearm was shorter than the arm in infants with DS. This is a reversal of the ratio seen in controls. The ratio of femoral to tibial length remains near constant at 1.1 after 13 weeks' gestation in normal fetuses. It rises from 1.2 to 1.4 from 22 weeks' to 38 weeks' gestation in fetuses with DS. The mean standard deviation score of fetuses with DS was 4.53 compared with norms (SD 1.7, p<0.01). Conclusions of this study are: (1) short upper limbs (reaching only up to the pelvis) is a clinical feature of DS at birth; and (2) after 20 weeks' gestation, the ratio of femoral-tibial length can be a marker of DS in utero.

Adult↗
PubMed2001

Low-voltage paper electrophoretic study of ion-pair formation and electrochromatography of inorganic anions on papers impregnated with titanium (IV) tungstate.

The ion-pair formation and electrochromatographic behavior of 22 anions are studied on plain and titanium (IV) tungstate impregnated papers using 0.1 N and 1 N solutions of NaNO3, Mg(NO3)2, Al(NO3)3, Cr(NO3)3, and Co(NO3)2 as background electrolytes. The effect of ion-pair formation on the migration of anions is studied. In general, the mechanism of migration is explained in terms of adsorption, precipitation, and complex formation. A number of binary and ternary separations are achieved. In Mg(NO3)2 media, the migration is correlated with the solubility of their magnesium salts for SO3(2-), C2O4(2-), SeO3(2-), AsO4(3-), and Fe(CN)6(4-).

Journal Article↗
PubMed2001

Detection of coronary artery disease by stress thallium scintigraphy in diabetic patients.

We investigated the efficacy of exercise stress thallium in the diagnosis of coronary artery disease in patients with diabetes mellitus. Forty-three patients with known diabetes and suspected of having coronary artery disease were included in the study. All the patients underwent coronary angiography, 24 had significant coronary artery stenosis and 19 had normal coronaries. Out of the 24 patients with a positive angiographic finding, thallium scintigraphy was positive in 21 patients (sensitivity, 87.5%); and false negative in only three of the 24 patients. Out of the 19 patients with normal angiography findings, 16 patients had a normal thallium scan (specificity, 84.2%) and the remaining three had a positive thallium scan. This gives thallium scintigraphy a positive predictive value of 87.5% and negative predictive value of 84.2% when compared with coronary angiography. The findings of this study suggest that stress thallium scintigraphy is a useful modality in screening of coronary artery disease in diabetic patients.

Aged↗
PubMed2001

The innervation of the triangular fibrocartilage complex: nitric acid maceration rediscovered.

Injury to the triangular fibrocartilage complex (TFCC) is frequently implicated in the etiology of ulnar-sided wrist pain. This study examines the nervous anatomy of the TFCC using a nitric acid maceration technique and attempts to correlate this information with known tear patterns. Ten fresh frozen cadaveric specimens were studied in detail. Gross dissection of each upper-extremity specimen included removal of all flexor and extensor tendons. After identification and labeling with permanent color of the ulnar nerve, dorsal sensory branch of the ulnar nerve, posterior interosseous nerve, anterior interosseous nerve, and median nerve, an en bloc excision of the distal radioulnar region was performed. Digestion of the soft tissue was performed with nitric acid at sequential concentrations of 50% and 33% for 9 of 10 specimens. The digestion was halted by immersing the specimen in a mixture of 10% formaldehyde and 1% glycerine. After removal of bone, the specimens were fixed in paraffin, sectioned, and stained with hematoxylin and eosin. Nine of the 10 specimens were studied microscopically to determine the contribution of the grossly identified nerves to each zone of the triangular fibrocartilage complex as defined by Palmer's classification of acute TFCC tears. The anterior interosseous, median, and superficial radial nerves did not contribute to the innervation of the TFCC. The intraarticular course of the peripheral nerves could not be defined in the one specimen that was not digested with nitric acid. Nitric acid maceration is a rediscovered technique for identifying the nervous anatomy of soft tissues. The study showed that the triangular fibrocartilage complex is innervated by branches of the posterior interosseous, ulnar, and dorsal sensory ulnar nerves in a fairly consistent manner. Improved treatment of TFCC tears may result from an enhanced understanding of the supporting structures' innervation and mechanical function.

Cartilage, Articular↗
PubMed2001

Prevalence of hepatopulmonary syndrome in cirrhosis and extrahepatic portal venous obstruction.

OBJECTIVE: Hepatopulmonary syndrome (HPS) is characterized by arterial hypoxemia in patients with chronic liver disease caused by abnormal intrapulmonary vasodilations. Data on its frequency vary from 5% to 29%. Most of these studies are from the West and in patients with cirrhosis. We, therefore, studied the prevalence of HPS in patients with liver cirrhosis and extrahepatic portal venous obstruction (EHPVO). METHODS: We studied 54 consecutive patients with liver cirrhosis (42 men and 12 women; mean age = 44.2 +/- 13 yr; Child grade A: 13, B: 22, and C: 19) and 50 patients with EHPVO (31 men and 19 women; mean age = 23.3 +/- 7.8 yr) Diagnosis of cirrhosis was made by history, liver function abnormalities, endoscopy, and sonography, whereas EHPVO was diagnosed by demonstration of a block in the splenoportovenous axis on sonography. Each of the patients underwent chest x-ray, arterial blood gas analysis, contrast-enhanced echocardiography (CEE), and pulmonary function tests. HPS was diagnosed in a patient with positive CEE, in the presence of hypoxia (PaO2 < 70 mm Hg) and/or elevated alveolar arterial oxygen gradient of > 20 mm Hg in the absence of any underlying cardiopulmonary disease. RESULTS: Ten of 54 patients (18.5%) with cirrhosis were positive on CEE compared with two of 50 patients (4%) with EHPVO. Six of the 10 patients positive with cirrhosis for CEE had associated hypoxia, whereas only one EHPVO patient with positive CEE had an elevated pulmonary alveolar arterial oxygen gradient of > 20 mm Hg. Thus, the incidence of HPS was 11.1% in patients with cirrhosis, compared with 2% in patients with EHPVO. One patient with HPS and cirrhosis had clinical cyanosis. CONCLUSION: HPS occurs more commonly in patients with cirrhosis but can also be seen in patients with EHPVO.

Adolescent↗
PubMed2001

The burden of drug-resistant tuberculosis and mechanisms for its control.

Drug resistance in tuberculosis is largely a man-made phenomenon caused by erroneous prescribing practices on the part of physicians and noncompliance on the part of patients. The global epidemiology of drug-resistant TB, the impact of standardized short-course chemotherapy (SSC), and the potential future evolution of MDR TB are discussed in this chapter.

Animals↗
PubMed2001

Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management.

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.

Adolescent↗