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Biomedical subjects

R R Varma

Publications and source records attributed to R R Varma.

53 records · Page 3Linked to original sources
PubMed1972

Renal and intrarenal blood flow in non-cirrhotic portal hypertension.

The effect of portal hypertension or the consequent portal circulatory changes on renal haemodynamics was studied using the (133)xenon washout technique. Renal blood flow was reduced in nine of 11 patients with non-cirrhotic portal hypertension and this was accompanied by a redistribution of intrarenal blood flow, the distribution to and flow rate through the outer cortex being reduced while juxtamedullary and medullary flow was maintained. With slight or moderate decreases in cortical flow glomerular filtration was normal but poor cortical perfusion was associated with low creatinine clearances. These findings raise the possibility that portal hypertension or portal circulatory changes may play a role in the pathogenesis of the renal haemodynamic changes and functional renal failure which frequently complicate advanced hepatic cirrhosis.

Adolescent↗
PubMed1972

The effect of octapressin on renal and intrarenal blood flow in cirrhosis of the liver.

The effect of octapressin (2-phenylalanine-8-lysine vasopressin) on renal and intrarenal blood flow was studied in 11 normotensive cirrhotic patients with abnormal renal perfusion. Renal haemodynamic changes were assessed with the (133)Xenon washout technique. Of the six patients given suppressor doses of octapressin intravenously renal blood flow improved in one only. A further three patients responded to the drug in a dose which increased the mean arterial pressure by 5 or more mm Hg. The increase in mean renal blood flow was accompanied by an improvement in renal cortical perfusion. In two patients renal blood flow decreased after the administration of octapressin. These findings, in conjunction with previous reports, suggest that octapressin will only consistently improve renal perfusion in cirrhotic subjects who are hypotensive and in whom the mean arterial blood pressure is raised by the drug, but do not exclude the possibility that octapressin may have a direct renal circulatory effect in some patients.

Adult↗
PubMed1972

Renal blood flow in malignant disease of the liver.

Although functional renal failure has been reported in patients with malignant disease of the liver, renal haemodynamics and function have not been investigated. Renal and intrarenal blood flow was measured using the (133)Xenon washout technique and creatinine clearances by the standard method in 14 patients with a variety of primary and secondary tumours of the liver in the absence of cirrhosis and without evidence of renal disease. In 11 patients renal and outer cortical blood flow was reduced and this was sometimes accompanied by a reduction in glomerular filtration rate. The pattern of renal circulatory changes was similar to that seen in renal dysfunction associated with hepatic cirrhosis. Possible causes of these disturbances and their significance in relation to the aetiology of functional renal failure in liver disease are discussed.

Adult↗
PubMed1971

Portal hypertension in primary biliary cirrhosis.

Evidence of portal hypertension was found in 50 out of 109 patients (47%) with primary biliary cirrhosis, and of these 32 bled from oesophageal varices. In four patients portal hypertension was the initial manifestation of the disease and this complication was recognized in a further 17 within two years of the first symptom of primary biliary cirrhosis. The development of portal hypertension was associated with a poor prognosis and death could frequently be attributed to variceal bleeding; the mean duration of survival from the time that portal hypertension was recognized was 14.9 months. Portal decompression operations may have improved the immediate prognosis in some patients but did not otherwise influence the progression of the disease. In 47 patients the histological findings in wedge biopsy or necropsy material were correlated with the presence or absence of varices. An association between nodular regeneration of the liver and varices was confirmed, but, in the absence of nodules, no other histological cause for portal venous obstruction could be found.

Adult↗
PubMed1970

A case of the Dubin-Johnson syndrome complicated by acute hepatitis.

A patient is described in whom the Dubin-Johnson syndrome was diagnosed after an attack of acute hepatitis at the age of 21. In the eight years following the hepatitis Dubin-Johnson pigment, initially scanty, developed to classical proportions. The defect in intracellular transport of bilirubin was thought to precede the attack of acute hepatitis.

Acute Disease↗
PubMedDate not supplied

Halothane hepatitis without halothane: role of inapparent circuit contamination and its prevention.

Halothane and other halogenated anesthetic agents are liquids which are highly soluble in rubber and plastic materials widely used as components of anesthesia machines. These agents must be administered using machines equipped with vaporizers. We report a patient with a past history of halothane hepatitis in whom recurrence was suspected despite the fact that halothane had been avoided purposely during the subsequent operation. Circumstances led us to believe that inapparent circuit contamination of vaporizer-equipped anesthesia machine with halothane may be responsible for the inadvertant rechallenge and recurrence of halothane hepatitis. Vaporizer-equipped machines were tested for inapparent contamination with halothane and enflurane using Perkin-Elmer mass spectrometer. Oxygen alone was passed through the anesthesia circuits, and gas in the efferent limbs of the machines was tested for halothane (in eight machines) and enflurane (in two machines) which were found in various concentrations in all machines so tested. Our findings suggest that inapparent contamination may be widely prevalent in vaporizer-equipped anesthesia machines. The validity of this conclusion was confirmed in five patients with previous diagnosis of halothane hepatitis who subsequently underwent operations under general anesthesia during which machines never equipped with vaporizers were successful in preventing recurrence of hepatitis. We conclude that patients with a prior history of halothane hepatitis are at risk of inapparent circuit contamination-induced recurrent hepatitis. Unless such contamination can be confidently excluded, vaporizer-equipped machines should not be used to administer general anesthesia in these susceptible patients.

Anesthesia, General↗
PubMedDate not supplied

Intensive chemotherapy in children with stage IV neuroblastoma.

A retrospective analysis of effectiveness of sequential chemotherapy with cyclophosphamide, doxorubicin, cisplatin and etoposide in children with stage IV neuroblastoma was undertaken. Study group included 17 children of mores than one year old with median age of 3 years (range 18 months to 7 years). Fourteen were males and three females. Sites of primary tumor were abdomen in 12 patients, pelvis in 3, paravertebral in 1 and unknown in 1. Metastatic sites included bone marrow (88%), bone (82%), orbit (29.4%) and lymph node (11.7%). One patient had brain parenchymal disease and another had cerebrospinal fluid positivity for malignant cells. Fifteen of the 17 patients had major response with chemotherapy (complete response in two and partial response in 13). Ten of the 15 patients completed four courses of chemotherapy and five patients progressed while on chemotherapy and died. Only two of the ten patients, who had four courses chemotherapy are alive after 2 years. Hence the 2-year survival in this series is 11.7%. There was no toxic death in this study.

Child↗
PubMedDate not supplied

Exchange transfusion in Reye's syndrome with saline-washed red blood cells.

Reye's syndrome (RS) consists of encephalopathy, fatty degeneration of viscera, and elevation of ammonia, certain amino acids, and liver enzymes in the blood. It is most characteristically a disease of children and has been considered to have a poor prognosis despite the use of various treatment regimens. Exchange transfusion (ET) with fresh blood (less than 24 hours old) for the removal of toxic metabolic byproducts in TS is a relatively recent development which appears to have improved the survival rates. However, because RS may occur in epidemic proportions at any time the demand for fresh blood can place an excessive stress on blood resources. We have, therefore, utilized saline-washed (to remove potentially toxic metabolites) red blood cells (RBC's) less than six days old, and fresh frozen citrate-phosphate-dextrose (CPD) plasma in treating this disorder. Nine patients in the Milwaukee community with severe encephalopathy secondary to RS were treated with ET. These patients collectively required 151 units of washed RBC's for 21 ET. Eight of nine patients survived without sequelae. Age of blood used did not correlate with the number of exchanges required or the eventual outcome. A continual computerized EEG in five patients provided objective evidence of the effectiveness of ET. We conclude that ET with saline-washed RBC's reconstituted with fresh frozen plasma (FFP) is a fast, safe, and effective means of treating patients with RS.

Brain Diseases↗
PubMedDate not supplied

Clear cell sarcoma kidney: clinical features and outcome.

Clear cell sarcoma of kidney (CCSK) is a rare, highly malignant tumor. The clinical features and treatment outcome of 12 patients with CCSK are reported. From 1982 through December 1996, 12 cases of CCSK were seen at the Regional Cancer Centre, Trivandrum, India. Patients were staged according to NWTS III recommendation. They were treated with chemotherapy containing vincristine, actinomycin, and Adriamycin and radiotherapy. The survival curve was calculated by the Kaplan-Meier method. Mass and pain in the abdomen were the presenting symptoms. Male/female ratio was 3:1. Six had stage I, 4 had stage II, and 2 had stage III disease. Of the 12, 10 were evaluable, 6 are alive, and 3 recurred in 9 evaluable. Six patients are alive free of disease 10 to 108 months after diagnosis. The overall survival and disease-free survival of the 10 patients are 64 and 56%. It would appear that combined modality treatment can cure two thirds of children with CCSK. Effective treatment needs to be developed for children who fail after first line treatment.

Child↗