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Biomedical subjects

R Kulkarni

Publications and source records attributed to R Kulkarni.

69 records · Page 4Linked to original sources
PubMed1982

Multiple splenic aspergillomas in a patient with acute lymphoblastic leukemia.

A case of multiple splenic aspergillomas (mycetomas) without systemic involvement is a patient with acute lymphoblastic leukemia is described. The patient underwent splenectomy without concomitant antifungal therapy. There has been no recurrence of the disease for over two years. Granulocytopenia and airborn contamination may have played a role in the acquisition of this disease. The value of serology, radionuclide scans and cultures in the diagnosis of Aspergillus infections is explored. The role of granulocyte transfusions, antifungal chemotherapy and the achievement of bone marrow remission in localization of the fungal disease is discussed.

Adolescent↗
PubMed1976

Bilateral interstitial pneumonia in acute lymphoblastic leukemia.

Of 148 children with acute lymphoblastic leukemia (ALL) 34 had bilateral interstitial pneumonia (BIP). Their records were reviewed retrospectively to evaluate the incidence of this pneumonia and delineate the various etiologic factors involved. All but 1 were in remission; 82% of the episodes occurred within the first 6 months, the majority of these occurring during the first 3 months of diagnosis of ALL; 16 were receiving methotrexate (MTX), and 14 were receiving combination chemotherapy with vincristine, prednisone and 6-mercaptopurine (6-Mp) and 4 were on no systemic therapy. Thirty patients with 35 episodes recovered within an average period of 18 days, including clearance of radiologic findings; 4 died. Four had open lung biopsies without complications. There was a single case of pneumocystis carinii infection diagnosed postmortem. Laboratory data and histopathologic findings (of 4 biopsies and 3 remaining autopsies) were suggestive of a viral etiology. The incidence of BIP in ALL at Children's Hospital of Michigan is 22.9% with a mortality rate of 10.3%. The incidence of pneumocystis carinii infection appeared to be low. Hypersensitivity to MTX was not substantiated.

Child↗
PubMedDate not supplied

Central venous catheter infections in pediatric patients--in a community hospital.

We reviewed the records of 23 pediatric patients who had received at least one central venous catheter during a two-year period. Nine patients had acute lymphoblastic leukemia (ALL), nine had other hematologic/oncologic diagnoses, and five had cystic fibrosis. Twenty-nine of 65 febrile episodes in 16 patients were associated with a catheter-related infection. Twenty of 40 catheters were associated with an infection over a period of 7,229 catheter days. For every 1,000 catheter days, four episodes of infections were observed. The number of infections/1,000 catheter days, the average life of a catheter (approximately equal to 180 days), and mean number of days elapsing before the first infection were not significantly different in the three diagnostic groups. Broviac catheters were used most often (24/40), followed by Quinton (9/40) and Port-a-Cath (7/40). Broviac catheters lasted twice as long (224 days, p less than 0.01) as Quinton and Port-a-Cath. Gram-positive cocci were isolated most frequently and Staphylococcus epidermidis was the most common pathogen. No consistent relationship between an absolute neutrophil count of less than 1,000/mm3 and infection with gram-positive cocci was seen. However, seven of eight episodes of gram-negative bacillary infections occurred in patients with an absolute neutrophil count of less than 1,000/m3 (p less than 0.005). Those patients who were not considered terminally ill responded well to antimicrobials. Catheter removal was necessary in only two instances.

Bacterial Infections↗
PubMedDate not supplied

Venous thromboembolism.

Incidence of venous thromboembolism (VTE) in children is rapidly rising. Frequent use of central venous lines (CVLs) in children with a variety of disease processes has contributed to increased incidence of VTE. In addition, increased detection of VTE has been possible due to the availability of sensitive imaging studies such as Color Duplex/Doppler ultrasound, lineogram and venogram. Heightened awareness of congenital prethrombotic disorders may help identify children at higher risk of thrombosis. Anticoagulation with heparin, low molecular weight heparin (LMWH) and oral anticoagulant such as warfarin are used for the treatment of VTE. Thrombolytic therapy may be indicated in some cases. Clinical presentation, management and pathogenesis including role of congenital prethrombotic disorders in pediatric VTE are discussed.

Anticoagulants↗
PubMedDate not supplied

Pediatric transfusion therapy: practical considerations.

Over the past decade, safety of blood has increased tremendously because of better donor screening as well as testing of the units for transmissible diseases. Component therapy has allowed more effective and economic use of blood. Whole blood is rarely used; instead, packed red cells, platelets, and fresh frozen plasma (FFP) are the most common components used. These products are further refined using irradiation and microaggregate filters and in the case of FFP, viral inactivation. Irradiation prevents transfusion-associated graft versus host disease, whereas microaggregate filters remove leukocytes, decreasing the rates of alloimmunization, febrile nonhemolytic (FNH) reactions, and cytomegalovirus (CMV) transmission. Autologous donation in older children probably provides the safest blood as far as transmissible diseases are concerned. More families request a directed donation and solicit physician help in deciding as well as making arrangements for autologous and/or directed donations. Transfusions of blood and blood components in children are often challenging and require a knowledge of physiologic changes in hemoglobin and blood volumes during different ages. The unique needs of neonates, immunocompromised patients, and patients with congenital hemolytic anemia (sickle cell, thalassemia) mandate that the pediatrician have an appropriate knowledge of transfusion volumes and choice of blood product as well as indications for transfusion.

Adolescent↗
PubMedDate not supplied

Estimation of porous media flow functions using NMR imaging data.

Nuclear magnetic resonance (NMR) imaging data measured during two-phase displacement experiments on porous rock core samples are used in an inverse problem methodology to estimate the two-phase flow functions relative permeability and capillary pressure. Nuclear magnetic resonance imaging data contain valuable information about variation of fluid states within the core sample and are therefore important for accurate estimation of these properties. A precise agreement between measured data, which also includes pressure drop across the core samples, and the data simulated by using the estimated flow functions is found, indicating accurate flow function estimates.

Alkanes↗
PubMedDate not supplied

The effect of wait time on T2 distributions from NMR experiments.

Nuclear magnetic resonance (NMR) relaxation curves for both T1 and T2 on two brine-saturated core plugs have been measured at 1 MHz. T2 distributions were extracted from Carr-Purcell-Meiboom-Gill (CPMG) measurements using different wait times between consecutive echo sequences. The analysis was performed with both a limited number of exponentials and a continuous B-spline basis. The distributions depend strongly on wait time. The distributions were generally restored to the true distributions when a wait time correction was applied.

Humans↗
PubMedDate not supplied

NMR characterization of hydrocarbon gas in porous media.

Laboratory investigations of nuclear magnetic resonance (NMR) relaxation properties of methane gas in bulk and in porous media are reported. Measurements were performed for methane alone and together with water in glass bead packs and Bentheimer sandstone. Results indicate that surface relaxation effects can be significant and that diffusion effects dominate observed T2 relaxation.

Gases↗
PubMedDate not supplied

Interactions of rifampin and trimethoprim in vitro.

Combination of rifampin and trimethoprim (TMP) has been suggested as a means of preventing the emergence of bacterial resistance to the individual agents and of achieving synergistic antimicrobial activity. By means of standard techniques of antimicrobial susceptibility testing, combinations of rifampin and TMP were tested against clinical isolates of a variety of aerobic bacteria. Synergism was defined as a fourfold or greater decrease in the minimal inhibitory concentration (MIC) of the more active agent in the combination. Antagonism was defined as a fourfold or greater increase in the MIC of the more active agent. No change or, at most, a twofold change was considered to represent indifference. Combinations of rifampin and TMP in ratios of 7:1, 7:2, and 1:1 demonstrated synergistic activity against 12%, 13%, and 28% of 440 isolates, respectively. Antagonism was observed in 10%, 9%, and 8% of strains tested against the above ratios. Killing curves determined with selected organisms failed to demonstrate synergistic antibacterial activity. Combinations of rifampin and TMP failed to prevent the emergence of resistance to both drugs when selected strains of various bacteria were exposed to serial, subinhibitory concentrations. Thus, synergism of rifampin and TMP was observed in only a minority of strains tested, and combination of the two agents failed to prevent the emergence of drug resistance in vitro.

Bacteria↗
PubMedDate not supplied

Penicillin-resistant Streptococcus mitis as a cause of septicemia with meningitis in febrile neutropenic children.

PURPOSE: The purpose of this report is to emphasize the importance of occurrence of Streptococcus mitis meningitis in febrile neutropenic children with hematopoietic malignancy. PATIENTS AND METHODS: Symptoms of meningitis and sepsis (fever, headache, changes in mental status) were seen in three patients who were severely neutropenic and undergoing cytotoxic chemotherapy for CNS relapse of their underlying malignancy (acute lymphoblastic leukemia (ALL), n = 2; Burkitt's lymphoma, n = 1). Chemotherapy had included cytosine arabinoside administered 7-14 days prior to presenting with sepsis and meningitis. All three patients had buccal mucositis or sinusitis. Blood cultures and CSF cultures showed S. mitis resistant to penicillin but sensitive to vancomycin. Vancomycin, at a dosage of 60 mg/kg/day to maximize CNS levels of antibiotic, was administered to all three children. RESULTS: Two of the patients recovered from S. mitis meningitis; recovery was associated with an improvement in their peripheral granulocyte counts. One patient, who remained neutropenic, died despite being treated with both intravenous and intraventricular vancomycin. CONCLUSION: Physicians caring for patients who are neutropenic and febrile need to be aware of the risk of meningitis occurring with S. mitis sepsis. Early treatment with high dosages of vancomycin (60 mg/kg/day) and an attempt to limit the duration of neutropenia are important factors in the outcome of such patients.

Bacteremia↗
PubMedDate not supplied

Intracranial and extracranial hemorrhages in newborns with hemophilia: a review of the literature.

PURPOSE: Intracranial hemorrhage (ICH) and extracranial hemorrhage (ECH) in newborns with hemophilia were reviewed with respect to incidence, anatomic location, clinical presentation, and relationship to the mode of delivery and type of hemophilia. MATERIALS AND METHODS: A MEDLINE search from 1964 to 1996 of all reports of neonatal hemophilia and head bleeds in children from birth to 1 month old was performed. ICH was defined as any bleed occurring within the cranial cavity, and ECH was defined as hemorrhage occurring outside of the cranial cavity, including subgaleal and cephalhematoma. The mode of delivery, type and severity of hemophilia, and clinical presentation were also noted. RESULTS: One hundred two newborns with hemophilia and cranial bleeds were described in 33 publications. The cumulative incidence of ICH and ECH was 3.58% in 5 studies that reported the total newborn population or that examined birth records. The type of hemophilia was reported for 40 of 102 newborns and was hemophilia A in 87%. The mode of delivery was recorded in 46% (47 of 102) of the patients. Of these, 13% had cesarean delivery, and 87% were delivered vaginally (40% had spontaneous vaginal delivery, and 47% had vaginal delivery with vacuum extraction or forceps). There were 109 episodes of ICH and ECH (65% were ICH, 35% were ECH, and 5.8% were a combination of both). Common clinical features of ICH and ECH included anemia, hypotension, shock, and lethargy. However, only patients with ICH were reported to have neurologic deficits (15%) and late neurologic sequelae (38%). CONCLUSION: In neonates with hemophilia and cranial bleeds, ICH occurs more often and is often associated with late neurologic deficits.

Cerebral Hemorrhage↗
PubMedDate not supplied

Nondisclosure of human immunodeficiency virus and hepatitis C virus coinfection in a patient with hemophilia: medical and ethical considerations.

This article discusses a medical and ethical dilemma: whether to disclose a positive HIV (human immunodeficiency virus)/HCV (hepatitis C virus) coinfection to an adolescent boy without symptoms with hemophilia despite the objections of his parents. An actual case history is presented and the dilemma faced by the medical team is discussed. Numerous family conferences, all excluding the patient, held during the last 5 years discussed the medical team's obligation for full disclosure, the emerging autonomy of the patient, and the potential for medical disaster (e.g., HIV transmission) if full disclosure were not permitted. Despite this, the family did not agree to allow disclosure. The patient and parents assured us of his sexual inactivity. Legal opinion was sought from the university counsel. The dilemmas are multiple. Is there a convincing argument to insist on disclosure of these facts to this patient, particularly when there is ambiguity regarding the appropriateness of HIV and HCV treatment? Does the ethical argument that he is at potential risk for transmitting HIV/HCV outweigh the rights of the family? What are the rights of the rest of the family? What are the rights of the minor? Is it our ethical responsibility to disclose a probably fatal diagnosis?

Adolescent↗
PubMedDate not supplied

Familial cryptorchidism and testicular tumors in non-twin brothers.

This paper reports simultaneous occurrence of cryptorchidism and testicular tumor in three brothers within a single family. Two of the brothers had seminoma and the third brother had embryonal carcinoma. Tumor markers such as alpha fetoprotein, assay for beta subunit of human chorionic gonadotrophic hormone, and carcinoembryonic antigen were all negative. The simultaneous occurrence of familial cryptorchidism and testicular tumor has not been reported, although familial occurrence of both entities has been described separately. Because of the known risk of testicular malignancy in cryptorchidism, aggressive screening and examination are recommended in the form of either serial palpation or serial testicular biopsies. Hormonal replacement with testosterone cypionate is recommended for pubertal patients undergoing bilateral orchiectomy as a result of tumor removal. The overall prognosis of patients with cryptorchidism and abdominal testicular tumor seems to be good provided an early diagnosis is made.

Adolescent↗