Biomedical subjects
S K Gupta
Publications and source records attributed to S K Gupta.
Bioefficacy of a progesterone monoclonal antibody in mice.
Explore the source record for details and available documents.
Bypasses to plantar arteries and other tibial branches: an extended approach to limb salvage.
During the past 6 years, we have encountered 24 cases in which all major infrapopliteal arteries were occluded as determined by adequate preoperative angiography. Each patient initially had critical ischemia, 14 had a previous failed ipsilateral distal bypass, and seven had an unsuccessful lumbar sympathectomy. Instead of resorting to an amputation, we attempted to perform a bypass using patent branches of distal vessels. Of the 24 bypasses, 14 were to the lateral or medial plantar branches, three were to the deep plantar branch (plantar arch), three were to the lateral tarsal branch, and four were to unnamed branches of the proximal one third of the posterior tibial arteries (two) or anterior tibial arteries (two). All bypasses were performed with reversed saphenous vein with origins at or distal to the superficial femoral artery. Eight bypasses (four plantar and four unnamed branches) became thrombosed up to 30 months postoperatively, resulting in four below-knee amputations. Fifteen bypasses (all plantar branches) have been patent from 6 to 52 months (mean 26 +/- 13 months). The remaining patient required a below-knee amputation at 2 months despite a patent graft. These results underscore the value of this extended approach to limb salvage in situations previously believed to be indications for major amputations. Although bypasses to unnamed branches of the proximal tibial arteries did not fare well, those to the plantar branches and lateral tarsal branch resulted in excellent graft patency and limb salvage.
Left atrial clot mimicking thickened inter atrial septum.
Explore the source record for details and available documents.
Tricuspid atresia: angiographic and hemodynamic profile of 26 cases.
Explore the source record for details and available documents.
The first published case of sarcoidosis in India.
Explore the source record for details and available documents.
Strokes in young in west-central India: some observations on changing trends in morbidity and mortality.
Explore the source record for details and available documents.
A model to account for the variation in cyclosporin binding to plasma lipids in transplant patients.
The usefulness of therapeutic monitoring for cyclosporin in transplant patients is still open to question due to variability of the data. One source of variability, the binding within plasma, was examined in renal transplant patients undergoing cyclosporin therapy. The fraction unbound varied between 0.04 and 0.13. A model based on physiochemical principles, involving concurrent partition of the drug between water, cholesterol, and triglyceride, was used to account for the variation in binding. Simulations using this model indicate that plasma cholesterol is a major factor contributing to the variability in fraction unbound and that the effect of triglyceride is less by a factor of four.
Transendoscopic needle aspiration cytology--technical note.
Explore the source record for details and available documents.
A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts.
During the past 15 years, we have employed a modified classification and management plan to treat infections involving nonaortic peripheral arterial prosthetic grafts (PAPGs) without graft removal whenever possible. Sixty-eight infected wounds potentially involving PAPGs were initially treated by excision of necrotic and infected wound tissue in the operating room (wound excision). This was sufficient for all 34 minor infections that did not directly involve the graft. In the 34 remaining infected wounds with graft involvement (major infections), partial removal of a PAPG in 13 cases allowed preservation for up to 15 years of a functioning arterial segment and its collaterals. Ten other grafts were entirely saved. Only 11 of 34 major graft infections ultimately required total graft removal. This approach to infection complicating PAPGs resulted in only two deaths (6%) and directly led to limb loss or amputation at a higher level in eight patients (24%). Total removal of an infected PAPG is often unnecessary and may increase mortality and morbidity.
Pulmonary atresia with ventricular septal defect in adult patients.
Hemodynamic data and angiograms of 15 adult patients with pulmonary atresia and ventricular septal defect were reviewed to assess the pulmonary circulation and other associated features. The most common variety of pulmonary atresia was that of pulmonary valve, main pulmonary artery, and the confluence of pulmonary arteries (6 cases, 40%). The collateral vessels to the lungs were well developed in all cases; selective injections into the collateral vessels were of great value in their delineation. The left ventricle was well developed in 11 cases (73.3%). Congestive heart failure was seen in 8 (53.3%), tricuspid regurgitation in 10 (66.7%), and aortic regurgitation in 7 (46.7%) cases. The long survival in these patients was related to the favorable anatomy of central pulmonary arteries (12 cases, 80%) and adequate pulmonary collateral circulation.
Supernumerary right coronary artery.
A rare case of a patient with supernumerary right coronary artery in whom the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other is presented. The smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery whereas the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. This is the first case report in the English literature.
Seasonal changes in the oviduct of the pied myna (Aves: Sturnidae).
Study of the oviduct of the pied myna (Sturnus contra contra) throughout the year reveals that oviductal weight, length, surface epithelial height and glycogen content are low during August to January (nonbreeding phase), partially increase during February to April (pre-breeding phase), maximally increase in May (breeding phase) and decrease in June and July (post-breeding phase). In the nesting cycle, there is greatest growth in all the regions of the oviduct from early nest-building to the egg-laying period and this is followed by rapid involution during incubation and nestling periods. Some notable features in the oviduct of the pied myna are described: 1) All five regions of the oviduct (infundibulum, magnum, isthmus, uterus, and vagina) are clearly distinguishable when studied from serial sections of the oviduct even during the nonbreeding phase of the annual ovarian cycle. 2) There is a strong correlation between initiation of tubular gland formation and the onset of nestbuilding activity. 3) The distal part of the magnum is differentiated into a 'mucous region' having well developed basal nonciliated cells. 4) A sixth zone can be identified between the magnum and isthmus. Sperm hostlike glands exist at the cranial end of the zone. 5) Several circular epithelial invaginations are evident in the intermucosal folds and their size decreases in centripetal order in the vagina. 6) The pattern and degree of regression are different in various regions of the oviduct. A close synchrony between ovarian and oviducal cycles is indicated in the pied myna (Sturnus contra contra).
Outflow resistance measurement during infrainguinal arterial reconstructions: a reliable predictor of limb salvage.
Criteria for abandoning infrainguinal arterial reconstructions in favor of major amputations should include reliable predictors not only of graft patency, but more importantly, of limb salvage. To evaluate the efficacy of intraoperative outflow resistance measurements in predicting limb salvage after infrainguinal bypasses, we have reviewed 134 such operations (64 femoropopliteal and 70 femorodistal bypasses) performed for critical ischemia. Outflow resistance measurements were divided into quartiles for femoropopliteal bypasses (Group A 0.17 mm Hg/ml/min or less, Group B 0.18 to 0.24 mm Hg/ml/min, Group C 0.25 to 0.4 mm Hg/ml/min, and Group D greater than 0.4 mm Hg/ml/min) and femorodistal bypasses (Group A 0.4 mm Hg/ml/min or less, Group B 0.4 to 0.58 mm Hg/ml/min or less, Group C 0.6 to 1 mm Hg/ml/min, and Group D 1 mm Hg/ml/min or greater). One year limb salvage rates for patients who underwent femoropopliteal bypass were 95 percent, 92 percent, 87 percent, and 67 percent from the lowest to the highest quartile (difference not statistically significant), and for those who had femorodistal bypass, they were 51 percent, 75 percent, 48 percent, and 0, respectively (p less than 0.05). Interestingly, 12 month graft patency and limb salvage rates for patients who underwent femorodistal bypass with outflow resistances between 0.59 and 1 mm Hg/ml/min did not correlate well (22 percent and 48 percent, respectively), whereas for those with outflow resistance greater than 1 mm Hg/ml/min, they were 22 percent and 22 percent, respectively. Thus, measurement of intraoperative outflow resistance is a very accurate predictor of limb salvage after infrainguinal bypass operations.
Lateral approach to the popliteal artery.
Techniques for exposure of the popliteal artery via lateral approaches above and below the knee are described. These techniques were used successfully in 21 patients who required secondary arterial reconstructions in the presence of extensive scarring, infection, or both in the standard medial access routes.
Cyclosporin-phenytoin interaction: re-evaluation using metabolite data.
1 Freeman et al. (1984) evoked enzyme induction to explain the lower plasma concentration of cyclosporin following phenytoin co-administration in man. 2 We have examined the whole blood concentration data of two metabolites of cyclosporin, as well as unchanged drug, all measured by h.p.l.c., associated with the above mentioned study. 3 Phenytoin produced no significant effect on either the terminal half-life of both metabolites or the ratio of area under the concentration-time curve of metabolite to parent drug. 4 These data strongly suggest that phenytoin reduces the absorption of cyclosporin; they do not generally support the idea that phenytoin induces cyclosporin metabolism.