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Biomedical subjects

R Sharma

Publications and source records attributed to R Sharma.

At least 109 records · Page 6Linked to original sources
PubMed1999

Dermatofibrosarcoma protuberans metastasizing to lymph nodes: a case report and review of literature.

Dermatofibrosarcoma Protuberans (DFSP) is an uncommon cutaneous soft tissue tumor. It is locally invasive and is known to recur. Metastases are rare and occur most commonly to the lungs. Metastasis to lymph nodes is extremely rare with only a few case reports in literature. The management strategy for such lymph node metastases remains controversial because of rarity of the condition. We report a case of DFSP of the lower limb with definite inguinal node secondaries managed by loco-regional surgery. We recommend that block dissection of lymph nodes should be performed in all cases with secondaries. J. Surg. Oncol. 1999;72;178-180.

Adult↗
PubMed1999

Safety profile of ultrasmall superparamagnetic iron oxide ferumoxtran-10: phase II clinical trial data.

The safety data from the phase II clinical trial of ferumoxtran-10, an ultrasmall superparamagnetic iron oxide contrast agent, are presented. One hundred and four patients with focal liver or spleen pathologies underwent ferumoxtran-10-enhanced magnetic resonance (MR) imaging at doses of 0.8, 1.1, and 1.7 mg Fe/kg. Overall, 15% patients reported a total of 33 adverse events, regardless of causality. The adverse events most frequently seen were dyspnea (3.8%), chest pain (2.9%), and rash (2.9%). No serious adverse events were reported during the 48 hour observation period. There were no clinically significant effects on vital signs, physical examination, and laboratory results. Ferumoxtran-10 is a safe and well tolerated MR contrast agent.

Contrast Media↗
PubMed1999

Radial artery in CABG: could the early results be comparable to internal mammary artery graft?

BACKGROUND: The accidental detection of patency of radial artery grafts, by Acar, which had been labeled as blocked 18 years earlier, has led to its revival as a conduit in coronary artery bypass surgery. We used radial artery as one of the grafts in 287 patients from February 1996 to June 1998. Here we present our early clinical experience and the midterm angiographic follow up of the initial 62 patients. METHODS: A no touch, atraumatic harvesting technique coupled with gentle hydrostatic and pharmacological dilatation of the radial artery graft was employed. Radial artery was used to revascularize coronary vessels with >80% proximal stenosis. Postoperatively, the patients were administered a low dose nifedipine that was continued for 6 months thereafter. The patients were followed up clinically after discharge from the hospital and angiographic evaluation of the grafted radial artery by selective injection was done at a mean interval of 16.2 +/- 5.1 months (3-24 months) postoperatively. RESULTS: There was no perioperative or late myocardial infarction or mortality. No significant complications related to the harvesting of radial artery were encountered. Angiographically, the radial artery grafts were found to be patent in 96.8% of patients (60/62). Mild distal anastomotic narrowing was seen in angiogram of one patient with good filling of the target vessel. Another patient showed diffuse spasm of radial artery graft. The patency of the pedicled left internal mammary grafts was also 98.2% (56/57). All the patients were asymptomatic. CONCLUSIONS: Radial artery seems to be an excellent alternate arterial conduit for myocardial revascularization with early and midterm patency rates equivalent to that of pedicled internal mammary artery, and it should be used more often for myocardial revascularization as an adjunct to pedicled internal mammary artery graft.

Adult↗
PubMed1999

Repair of total anomalous pulmonary venous connection in infancy: experience from a developing country.

BACKGROUND: Corrective surgery for total anomalous pulmonary venous connection in infancy still carries high morbidity and mortality rates in developing countries. The present study evaluates the factors responsible for it. METHODS: Seventy-three infants were operated on for total anomalous pulmonary venous connection from January 1987 through October 1997. Age ranged from 5 days to 12 months (mean, 3.9+/-0.24 months), with 10 (13.7%) patients younger than 1 month old. Patient weight varied from 2.0 to 5.2 kg (mean, 3.7+/-0.27 kg). Most (90.5%) patients were small for their ages (< 50th percentile). Anomalous connection was supracardiac in 42 (57.5%), cardiac in 18 (24.7%), infracardiac in 4 (5.5%), and mixed in 9 (12.3%) patients. Thirty-five patients had obstructed drainage. Preoperatively, 30 patients received antibiotic therapy for respiratory tract infection, 3 patients had balloon atrial septostomy, and 4 patients required mechanical ventilation. Fifteen patients (20.5%) were operated on as an emergency procedure. For supracardiac and infracardiac connections, a posterior approach was used for anastomosis. In cardiac type, coronary sinus was unroofed and the resultant defect along with atrial septal defect was closed with a single patch. RESULTS: The operative mortality rate was 23.3% (17 of 73). Pulmonary hypertensive crisis was the cause of death in 10 patients. Emergency operation and weight less than the 25th percentile were the important risk factors for operative mortality. Young age (< 1 month) and type of drainage did not affect the mortality. Follow-up ranged from 1 to 108 months (mean, 56.4+/-26.0 months). There were two late deaths. The actuarial survival (Kaplan Meier) at 9 years was 72.87%+/-5.39%. CONCLUSION: Failure of early recognition, and thus delayed referral, accounted for onset of cardiac cachexia, respiratory tract infection, and severe pulmonary hypertension, which had a major effect on unfavorable outcome.

Body Weight↗
PubMed1999

Pulmonary autograft: should it be used in young patients with rheumatic disease?

BACKGROUND: Although pulmonary autograft is being increasingly used to replace the diseased aortic valve with excellent long-term results, its use in the population with rheumatic disease still needs careful evaluation. PATIENTS AND METHODS: From October 1993 through March 1998, 102 patients underwent aortic valve replacement with a pulmonary autograft (Ross procedure). The mean age was 27.9 +/- 4.2 years (range, 0.8-56 years). The cause was rheumatic disease in 75 patients (73%), bicuspid aortic valve in 26 patients (26%), and myxomatous aortoarteritis in 1 patient (1%). The root replacement technique was used in all. In addition, 31 patients had 33 associated procedures: mitral valve repair (n = 15 patients), open mitral commissurotomy (n = 15 patients), tricuspid repair (n = 2 patients), and homograft mitral valve replacement (n = 1 patient). RESULTS: Operative mortality was 6.9% (7 patients). Late mortality was 7.8% (8 patients). Follow-up ranged from 1 to 60 months (mean, 25.3 +/- 15.4 months) and was 98% complete. Two patients required reoperation for failed mitral valve repair, and 2 other patients underwent reoperation for failure of both the autograft and mitral valve repair. Echocardiographic assessment showed moderate to severe aortic regurgitation in 13 patients, along with thickening of the autograft. All of these patients had rheumatic disease and were young (<30 years). Ten of these patients had undergone associated mitral valve procedure. Morphologic and histopathologic examination of explanted autografts showed features compatible with rheumatic valvulitis. CONCLUSION: Pulmonary autograft is susceptible to rheumatic involvement. Young age (<30 years) and associated mitral valve disease are significant risk factors for autograft failure in patients with rheumatic disease. Use of pulmonary autograft in this subgroup of patients requires a cautious approach.

Adolescent↗
PubMed1999

Double switch for congenitally corrected transposition of the great arteries.

OBJECTIVE: To evaluate the early and medium term results of operations for congenitally corrected transposition of the great arteries (CCTGA) wherein the left ventricle becomes the systemic ventricle. METHODS: Fourteen patients with CCTGA who underwent anatomic repair from 1994 to 1998 were placed in one of two groups: those without pulmonic stenosis (PS) (N = 7) and those with PS (N = 7). Main associations in the group without PS were: severe left atrioventricular (AV) valve regurgitation (N = 4), ventricular septal defect (VSD) (N = 4), criss-cross AV connection (N = 1), and hypoplasia of the morphologic RV (N = 1). Main associations in the group with PS were: VSD (N = 7), anomalous pulmonary venous drainage (N = 2) and major aorto-pulmonary collaterals (N = 1). All patients in the group without PS underwent an arterial switch operation and all except one had a modified senning repair for atrial rerouting for anatomic correction. All seven patients with PS underwent a Rastelli repair and all except one needed a modified senning repair. RESULTS: Early survivorship in both groups was 6/7. Follow-up ranges from 1 month to 48 months. The mean left ventricular ejection fraction (LVEF) in the arterial switch and senning patients was 65% and in the Rastelli and atrial rerouting was 52%. None of the survivors except one have any significant mitral regurgitation (MR). The one exception resulted from iatrogenic damage to a chorda during VSD closure. All except two patients are class I symptomatic and all are in normal sinus rhythm. CONCLUSION: Satisfactory early and mid term results of anatomic repair support the double switch option as the procedure of choice for patients of CCTGA amenable to biventricular repair.

Adolescent↗
PubMed1999

Characteristics of transport systems of L-alanine in mouse mammary gland and their regulation by lactogenic hormones: evidence for two broad spectrum systems.

The characteristics of the transport systems of L-alanine in lactating mouse mammary gland and their regulation by lactogenic hormones have been studied. L-alanine uptake was mediated by three Na(+)-dependent and one Na(+)-independent systems. The 2-(methylamino)isobutyric acid-sensitive component of Na(+)-dependent uptake exhibited the usual characteristics of system A. Cl- dependency has been established for system A. The other two Na(+)-dependent systems, which we have named BCl(-)-dependent and BCl(-)-independent, are described for the first time. These are systems with broad specificity and were distinguished on the basis of inhibition analysis, Cl- dependency and the effect of preloading mammary tissue with amino acids. The Na(+)-independent route was identified as system L, which operates independent of Cl-. The A, L and BCl(-)-independent transport systems were upregulated in pregnant mouse mammary tissue cultured in vitro in the presence of lactogenic hormones (insulin plus cortisol plus prolactin). Insulin alone also upregulated systems A and L to some extent in pregnant mouse mammary tissue. BCl(-)-dependent activity was not detected in pregnant mouse mammary tissue and was not induced by lactogenic hormones in vitro.

Alanine↗
PubMed1999

Pelvi-calyceal cast formation following silver nitrate treatment for chyluria.

A case of chyluria is reported in which anuria followed instillation of 3% silver nitrate into the collecting system of both kidneys, with unusual radiographic features. Plain radiographic, ultrasound and computed tomographic findings are discussed. To the best of the authors' knowledge this has not been previously described in the literature.

Adult↗
PubMed1999

Residual pituitary enlargement in primary hypothyroidism despite 1 1/2 years of L-thyroxine therapy.

Pituitary hyperplasia consequent to untreated primary hypothyroidism undergoes impressive regression following thyroxine therapy. We describe a young man with primary hypothyroidism and pituitary hyperplasia, who showed significant but incomplete regression of pituitary enlargement despite 18 months of L-thyroxine therapy (1 year in replacement dose (150 micrograms/day) and an additional 6 months in suppressive dose (300 micrograms/day)).

Adult↗
PubMed1999

Magnetic resonance evaluation of idiopathic scoliosis: a prospective study.

The objective of the present study was to determine the incidence of unsuspected intraspinal pathology and to assess the value of atypical clinical features as predictors of these intraspinal pathologies, in patients with idiopathic scoliosis. Twenty-five consecutive patients (13 boys, 12 girls) with idiopathic scoliosis were prospectively evaluated with MRI. Magnetic resonance imaging detected intraspinal pathology in seven patients (28%), which included syringohydromyelia with Chiari I malformation (n = 5), and syringomyelia and dumb-bell neurofibromas in one patient each, respectively. Dural ectasia was also present in five patients. Atypical features, described in the literature as pointers to intraspinal pathologies such as the age < 11 years at presentation, presence of pain, hyperkyphosis, severe curves and the presence of the left thoracic or thoracolumbar curves, were seen to be equally distributed between the two groups (those with and without intraspinal pathologies), thus raising doubts about the importance of these features.

Adolescent↗
PubMed1999

Pineal cyst presenting with intracystic and subarachnoid haemorrhage: report of a case and review of the literature.

A case of a benign pineal cyst in a 70-year-old man who presented with hydrocephalus and apoplexy is reported. Surgical exploration revealed subarachnoid and intracystic haemorrhage. The patient also had bilateral impairment of hearing which improved after excision of the cyst. Patients with a pineal cyst with apoplexy or subarachnoid bleed reported in the literature are reviewed.

Aged↗
PubMed1999

Delayed Tc-99m citrate scintigraphy in the evaluation of palpable breast masses.

The aim of this study was to evaluate the potential of Tc-99m citrate as a new tumor-localizing agent in palpable breast masses. Scintimammography was performed in 43 female patients. Of these, 10 women (group A) were considered to be healthy with no palpable breast masses, and the remaining 33 patients (group B) had palpable breast masses. All patients with palpable breast masses underwent fine-needle aspiration cytology and subsequent biopsy within 2 weeks of the study. Nine patients had a primary malignant lesion of the breast, whereas 24 patients had benign disease. The patients with breast cancer underwent surgery, and subsequently a histopathologic diagnosis was made. Sensitivity, specificity, and accuracy values obtained in our study were 87%, 100%, and 90%, respectively. Scintimammograms were performed in these patients up to 24 hours. Initial uptake at 1 and 3 hours was noted in all the breast masses. However, benign masses did not show persistence of tracer uptake at 24 hours, whereas those that were malignant continued to show persistent radionuclide concentration. Thus, the uptake and outflow pattern seemed to differentiate benign breast disease from breast cancer. The study shows the potential of Tc-99m citrate for imaging and evaluating breast masses.

Adolescent↗
PubMed1999

Cyanoacrylate tissue adhesive augmented tenoplasty: a new surgical procedure for bilateral severe chemical eye burns.

PURPOSE: To report on cyanoacrylate tissue adhesive augmented tenoplasty, a new surgical procedure for bilateral severe chemical eye injuries. METHODS: A 26-year-old man presented with bilateral severe (grade IV) chemical burns involving the eye, periorbital tissues, face, and neck. Despite adequate medical therapy, corneal, limbal, and scleral ulceration progressed in both eyes. Secondary Pseudomonas keratitis necessitated therapeutic penetrating keratoplasty in the right eye. Tenoplasty and glued-on rigid gas permeable contact lens were unsuccessful to arrest progression of corneolimboscleral ulceration in the left eye. We applied n-butyl cyanoacrylate tissue adhesive directly on the ulcerating corneal, limbal, and scleral surface to augment tenoplasty. RESULTS: The left ocular surface healed with resultant massive fibrous tissue proliferation and symblepharon on the nasal side. Ocular surface rehabilitation resulted in a vascularized leukomatous corneal opacity with upper temporal clear cornea. The patient achieved visual acuity of 6/36 in the left eye. CONCLUSION: We suggest that cyanoacrylate tissue adhesive-augmented tenoplasty can be undertaken to preserve ocular integrity and retain visual potential in a severe chemical eye injury.

Adult↗
PubMed1999

Role and limitations of magnetic resonance imaging in the diagnostic work-up of patients with liver cancer.

The main objectives of liver imaging are detection and characterization of focal liver lesions. There is a wide range of imaging modalities available for the work-up of patients with liver cancer. In the current environment of cost containment, the most appropriate modality should be chosen to answer the clinical question. Contrast-enhanced computed tomography is currently the modality of choice for liver imaging for routine applications. Until recently magnetic resonance imaging was used only as a problem solving technique for lesions that were equivocal after contrast-enhanced computed tomography. However magnetic resonance with the use of tissue specific contrast agents, has already challenged the role of computed tomography portography in preoperative staging of liver cancer, and may soon completely replace this technique. It is also the primary modality for screening patients with cirrhosis for hepatocellular carcinoma. This review describes the role of magnetic resonance imaging, in the evaluation of patients with liver cancer, and outlines a rational approach for the diagnostic work-up of these patients.

Contrast Media↗
PubMed1999

Confirmation of two magnetoencephalographic epileptic foci by invasive monitoring from subdural electrodes in an adolescent with right frontocentral epilepsy.

PURPOSE: To report our evaluation of interictal two epileptic spike fields on magnetoencephalography (MEG) by using invasive intracranial monitoring in a patient without lesion on magnetic resonance imaging (MRI). METHODS: A 15-year-old left-handed boy with a 9-year history of refractory simple partial seizures, secondarily generalized, and a normal MRI, was studied with MEG to define magnetic spike sources, followed by invasive intracranial monitoring with subdural electrodes to delineate the epileptogenic zone and eloquent function pursuant to focal cortical excision. RESULTS: MEG demonstrated two spike foci on the right middle frontal and inferior rolandic areas adjacent to the sensory area. Ictal recordings during prolonged invasive monitoring from subdural electrodes revealed two epileptogenic zones in the same locations as those defined by MEG. Focal cortical excision was performed of each epileptogenic zone. The patient has been seizure free for 24 months without neurologic deficit. CONCLUSIONS: Magnetic source imaging is a valuable adjunct in the planning of subdural grid placement in epilepsy surgery, particularly in patients in whom conventional imaging fails to reveal a lesion.

Adolescent↗
PubMed1999

Intrapericardial streptokinase in purulent pericarditis.

Six consecutive children with proven purulent pericarditis were treated with pericardial irrigation with streptokinase. Mean (SD) 861 (678) ml (range 240-2000) of thick purulent fluid was drained, and five children had complete clearance of the pus within 3-8 days. One child developed intrapericardial haemorrhage with a submitral pseudoaneurysm and underwent patch closure of the neck of the aneurysm as well as anterior pericardiectomy. Follow up of 13 to 30 months revealed no pericardial constriction.

Child↗
PubMed1999

Na(+)-K(+)-ATPase gene regulation by glucocorticoids in a fetal lung epithelial cell line.

The Na(+) pump, Na(+)-K(+)-ATPase, along with the Na(+) channel is essential for the removal of alveolar solute and fluid perinatally. Because Na(+)-pump mRNA and activity increase before birth and maternal glucocorticoids (GCs) influence Na(+)-K(+)-ATPase mRNA expression in fetal rat lung, we hypothesized that GCs increased Na(+)-K(+)-ATPase gene expression in a fetal lung epithelial cell line. After 24 h of exposure, dexamethasone increased the steady-state levels of Na(+)-K(+)-ATPase alpha(1) and beta(1) mRNA in a fetal rat lung epithelial cell line in a dose-dependent fashion (10(-7) to 10(-5) M). The maximal increase in mRNA levels was 3. 8-fold for alpha(1) and 2.8-fold for beta(1). The increase in mRNA was detected as early as 6 h for the beta(1)-subunit and 18 h for the alpha(1)-subunit, and both peaked at 24 h. This gene upregulation was not due to increased mRNA stability based on mRNA half-life determination after actinomycin D inhibition. Transfection experiments with alpha(1) and beta(1) promoter-reporter constructs demonstrated 3.2 +/- 0.5- and 2.6 +/- 0.4-fold increases, respectively, in promoter activity, consistent with transcriptional activation of the promoter-reporter construct. These findings, increased promoter activity with no change in stability, indicate that GCs increased Na(+)-K(+)-ATPase transcription in a fetal lung epithelial cell line.

Animals↗