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Biomedical subjects

R Saxena

Publications and source records attributed to R Saxena.

285 records · Page 16Linked to original sources
PubMedDate not supplied

Evaluation of bilioenteric anastomosis using quantitative hepatobiliary scintigraphy.

BACKGROUND/AIMS: The patterns of quantitative hepatobiliary scintigraphy for bilioenteric anastomoses have not been objectively defined. This study was undertaken to establish the patterns of quantitative hepatobiliary scintigraphy in the patients with bilioenteric anastomoses performed for repair of postcholecystectomy benign biliary strictures. METHODOLOGY: 37 patients with bilioenteric anastomosis (Study group) and 10 postcholecystectomy healthy subjects (Controls) underwent quantitative hepatobiliary scintigraphy. Study group patients were further categorized into: Group A (n=27) - normal clinical and biochemical parameters, and Group B (n=10) - abnormal clinical and/or biochemical parameters. On scintigraphy, time of maximal activity and time of clearance of half of the activity was calculated at the liver parenchyma and hepatic hilum. Time of appearance of activity in the intestine was also recorded. RESULTS: There was no significant difference in the scintigraphic parameters between Group A and Controls except for earlier appearance of activity in the intestines (p=0.036) in Group A. In Group B there was significant increase in the time of clearance of half of the activity at the liver parenchyma and hepatic hilum compared to Controls (p=0.003 and 0.036 respectively), and at the liver parenchyma compared to Group A (p=0.002). CONCLUSIONS: Quantitative hepatobiliary scintigraphic patterns in patients with bilioenteric anastomosis were similar to those of postcholecystectomy controls. Patients with abnormal biochemical parameters had significant delay in clearance of activity. Significance of these scintigraphic patterns in this subset of patients can be determined only on long-term follow-up.

Adolescent↗
PubMedDate not supplied

Evaluation of factors predisposing to arterial thrombosis in coronary artery disease.

Estimation of antithrombin III, alpha 2 macroglobulin and alpha 1 antitrypsin in patients with stable and unstable angina and acute myocardial infarction (15 cases each) were carried out. Twenty age, sex and weight matched healthy subjects were included as controls. Mean platelet factor 4(PF4) levels measured in 10 cases of each subgroup were significantly elevated in myocardial infarction (MI) (48.4 +/- 15.16 ng/ml) and III unstable angina patients (44.7 +/- 15.9 ng/ml) as compared to controls (25.42 +/- 12.47 ng/ml; P less than 0.01). Mean antithrombin III (AT III) levels were markedly reduced in all patients with MI (39.65 +/- 12.8% of normal pooled plasma) and unstable angina (37.9 +/- 16.6% of normal pooled plasma) and in 9 patients with stable angina. Alpha I antitrypsin and alpha 2 macroglobulin levels in these cases showed no significant difference compared to normals. Reduced AT III in coronary artery disease suggests a prethrombotic tendency in these patients. Raised PF4 levels in acute phase of the disease suggests heightened platelet activation.

Adult↗
PubMedDate not supplied

Diverticular disease of colon; Indian variant.

Diverticular disease of colon is a rare entity in our country; true incidence of which is not known. We present three cases of diverticular disease, two with lower gastro-intestinal (GI) hemorrhage and one with sigmoid colon perforation and peritonitis. All three patients underwent emergency surgical treatment. Two patients survived and one died. No further complications were noted on follow up.

Aged↗
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Exercise induced ST segment depression preceding ST segment elevation.

A case of exercise induced ST segment depression preceding ST segment elevation in precordial leads and persistent ST segment depression in inferior leads is reported. Such an exercise response should suggest significant fixed coronary stenosis in addition to coronary spasm.

Angina Pectoris, Variant↗
PubMedDate not supplied

Role of vagus in thermal panting.

In dogs anaesthetised with pentobarbitone sodium, raising the body temperature from 37 degrees C to 42 degrees C increased the rate of respiration and pulmonary ventilation but decreased the tidal volume. A similar change though of a lower magnitude, was observed in these parameters after cold blocking the vagi. At 40 degrees C body temperature, however, the vagal block was not effective in reducing the rate. The significance of hyperthermic panting mechanism dominating the Hering-Breuer mechanism at 40 degrees C has been discussed. It has been postulated that the vagi carry temperature dependent afferents that have effect opposite to the Hering-Breuer reflex. At 42 degrees C when respiratory failure usually sets in the temperature regulating function of respiration is the last to be lost.

Animals↗
PubMedDate not supplied

Role of vagus during exercise in thermal panting.

In dogs anaesthetised with pentobarbitone sodium raising the body temperature from 37 degrees C during mild exercise increased the rate of respiration and pulmonary ventilation but decreased the tidal volume. Cold blocking the vagi during the exercise resulted in decrease in respiration rate and minute ventilation, but increase in tidal volume. At 40 degrees C body temperature vagal block was not effective in decreasing the respiration rate and minute ventilation, which may be due to stimulation of lung irritant receptors through hyperthermia.

Animals↗
PubMedDate not supplied

Lupus anticoagulant and anticardiolipin antibodies in systemic lupus erythematosus.

BACKGROUND: Lupus anticoagulant and anticardiolipin antibodies are antiphospholipid antibodies which have been independently associated with a high incidence of thrombotic diseases. However, the importance of their combined occurrence has not yet been examined. METHODS: We investigated 70 patients with systemic lupus erythematosus for the presence of anticardiolipin antibodies paying particular attention to a history of thrombosis and abortion. Lupus anticoagulant was detected using the kaolin clotting time, its mixing tests with normal plasma and the inosithin neutralization test. Anticardiolipin antibodies were detected using the ELISA technique. RESULTS: Lupus anticoagulant was detected in 11 patients (16%) and anticardiolipin antibodies in 13 (19%). Six patients were positive for both lupus anticoagulant and anticardiolipin antibodies. These patients had a higher incidence of thrombosis or recurrent abortion (5 of 6) compared to those with lupus anticoagulant (2 of 5) or anticardiolipin antibodies alone (1 of 7). The amount of inosithin required to neutralize lupus anticoagulant was greater [mean (SD) 27.5 (20.5) micrograms] in patients with both lupus anticoagulant and anticardiolipin antibodies than in patients with lupus anticoagulant alone [mean (SD) 4.0 (5.4) micrograms]. CONCLUSION: The presence of lupus anticoagulant is associated with thrombosis and recurrent abortion which are more frequent when both lupus anticoagulant and anticardiolipin antibodies are present and these patients probably have more severe disease as the amount of inosithin required to neutralize the lupus anticoagulant was greater.

Adolescent↗
PubMedDate not supplied

Platelet function disorders in north India.

BACKGROUND: Platelet function disorders are a fairly common cause of bleeding manifestations. Although their relative types and incidence are well documented, data from India are lacking. METHODS: Between 1970 and 1991, we studied the clinical and laboratory features of 144 north Indian patients who presented to our hospital with a bleeding diathesis in whom coagulation disorders, von Willebrand's disease and a history of drug ingestion were absent. RESULTS: Isolated platelet factor 3 availability defect was the commonest (56 cases) followed by the thrombasthenias (49 cases), arachidonic acid pathway defect (26 cases), storage pool disease (8 cases) and the Bernard-Soulier syndrome (3 cases). Isolated platelet factor 3 deficiency was rare (2 cases). Two varieties of thrombasthenia were seen--the classical Glanzmann's (13 cases) and thrombopathic (36 cases). The latter was characterized by absent or sub-normal platelet aggregation with agonists along with a reduced (to less than 50% of normal) total platelet factor 3 content. This has not been reported from western countries. Patients with classical Glanzmann's thrombopathic thrombasthenia with absent platelet aggregation and isolated platelet factor 3 deficiency were severe bleeders. Their family history suggested an autosomal recessive transmission in Glanzmann's and thrombopathic thrombasthenia and a possible autosomal dominant transmission in isolated platelet factor 3 availability defect and isolated platelet factor 3 deficiency. CONCLUSION: The frequency of various types of platelet function disorders in Indians is similar to that in western populations except that the incidence of thrombopathic thrombasthenias is higher in India.

Adolescent↗
PubMedDate not supplied

Cholecystectomy in high risk patients.

Two hundred and seventy two patients with one or more associated preoperative high risk factors underwent cholecystectomy in the Department of Surgical Gastroenterology, SGPGIMS, Lucknow, between December 89 and November 95. The identified risk factors were advanced age (> 65 years), cardiac diseases, endocrine disorders, respiratory diseases and others. Fifty patients (18%) had two and 6 patients (2.2%) had three risk factors each. During the same period, 1006 patients with no risk factors had simple cholecystectomy done in the department. The morbidity and mortality of cholecystectomy in the high risk group was 27% and 0.4% respectively, and in the group with no risk factors 14% and 0.2% respectively. The morbidity and mortality in the high risk group was significantly greater than that in the no risk group. It is suggested that with good preoperative evaluation close intraoperative monitoring and intensive postoperative care, these figures could be reduced further.

Adolescent↗
PubMedDate not supplied

Bile leak after T-tube removal--a scintigraphic study.

BACKGROUND/AIMS: A prospective study was performed to evaluate the incidence of bile leak after T-tube removal, using 99mTc labelled BULIDA scintigraphy. PATIENTS AND METHODS: Thirty seven patients with choledocholithiasis underwent choledocholithotomy and T-tube drainage. T-tubes were removed on 9--26 postoperative day (mean 13.4 days). RESULTS: Six (16%) patients had scintigraphic evidence of bile leak; 4 patients had leak demonstrated in the early phase only. One patient each had partial persistent leak and complete bile leak. All patients were managed nonsurgically; conservative treatment: (4), percutaneous drainage (PCD) of intra-abdominal collection (1) and endoscopic sphincterotomy and PCD of intra-abdominal collection (1). There was no significant difference in the leak rate when T-tubes were removed at < 2 weeks versus later than 2 weeks (P=.97). CONCLUSIONS: T-tubes should be removed with extreme caution and treatment of symptomatic patients should be guided by clinical and scintigraphic findings.

Bile↗
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Protein kinase C beta II isoform is up-regulated in human proliferative glomerulonephritis.

Cell proliferation is a predominant feature in glomerulonephritis (GN). Recent work has suggested that protein kinase C (PKC) isoforms are responsible, specifically, PKC beta II in part, for cell growth. PKC beta II is expressed during cell growth in early glomerulogenesis and inflammatory mediators of glomerular disease induce PKC beta II expression. We therefore investigated the expression of PKC beta II in kidney biopsy specimens from patients with various types of proliferative (n = 41), nonproliferative GN (n = 23), and in structurally normal kidneys (n = 15). PKC beta II immunoreactivity was exclusively found in proliferative GN whereas PKC expression was not detected in normal glomerular and in nonproliferative disease states. The consistent expression of PKC beta II in proliferative GN suggests a key signaling role for this enzyme in cell proliferation in renal disease.

Adult↗
PubMedDate not supplied

Peripheral nerve abscess in leprosy: report of twenty cases.

During the year 1994-1995, 20 of the 67 leprosy patients attending the dermatology department with any kind of nerve involvement were found to be having nerve abscess. These abscesses occurred in all types of leprosy (except the Indeterminate) and a variety of nerve trunks and cutaneous nerves. In none of the instances the abscess was associated with reaction. All the patients were surgically treated, without any steroid therapy. All cases showed significant improvement whenever there was nerve function deficit. Similarly, pain was relieved in all cases, when it was present.

Abscess↗
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Technical complications of feeding jejunostomy: a critical analysis.

INTRODUCTION: A retrospective review of patients undergoing feeding jejunostomy (FJ) was undertaken in order to evaluate procedure related complications and their impact on final outcome. PATIENTS AND METHODS: Ninety six patients had FJ at the department of Surgical Gastroenterology, SGPGIMS from January 1989 to December 1995. RESULTS: FJ as an adjunct was performed in 89 patients with predominantly oesophageal (n = 62) and pancreatic surgery (n = 17). Seven patients had FJ as the only procedure. Fifteen patients (15.2%) had complications related to FJ. Minor complications (7.2%) included dislodgement (n = 3), blockage of the tube (n = 2) and pericatheter leak (n = 2). Major complications (8.3%) which needed surgical intervention were, detachment of the jejunostomy from the abdominal wall (n = 3), leak into the peritoneal cavity (n = 3), jejunal perforation by the tip of the catheter (n = 1) and peritonitis after removal of the tube (n = 1). Procedure related mortality was 3.2%. CONCLUSIONS: FJ should not be treated as a minor procedure and due attention to the technical details is required in its performance, otherwise it may well become the cause of a poor result following a very successful major operation.

Adolescent↗
PubMedDate not supplied

Recovery of liver functions following surgical biliary decompression in obstructive jaundice.

BACKGROUND/AIMS: Derangement of liver functions in obstructive jaundice has been known to influence surgical outcome. The pattern and time frame of liver function recovery in patients with surgical obstructive jaundice undergoing a bilioenteric anastomosis has not been comprehensively defined in human beings. METHODOLOGY: Fifty patients of obstructive jaundice who underwent a bilioenteric anastomosis had their liver function evaluated done by biochemistry (pre-operatively and postoperatively on day 1,4,7 and 6 weeks) and radionuclide mebrofenin scan (preoperatively and 6 weeks postoperative). RESULTS: The results have shown a constant and significant decline in serum bilirubin levels by day 4 (p=0.04), however the decline in serum levels was not uniformly progressive in 54% patients. The decline in serum alkaline phosphatase levels has been constant and progressive reaching significant levels by day 4(p=0.01). Serum transaminases showed an initial rise followed by a rapid fall, again achieving significant levels by day 4 (p=0.003 & 0.009). Serum albumin decreased on day 1 itself but remained static after that. On isotope scanning hepatic uptake showed uniform improvement with 92% of patients having achieved a normal uptake after 6 weeks. Gastrointestinal excretion of the isotope however was still delayed in 26% patients at 6 weeks. Almost all these patients had an abnormal bilirubin level decline in the immediate postoperative period. CONCLUSIONS: Hepatic functional recovery has been seen to start immediately following bilioenteric anastomosis and has usually completed itself by 6 weeks. Patients who show an abnormal recovery pattern based on bilirubin levels need to be observed for a longer time.

Adolescent↗