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Biomedical subjects

S Mani

Publications and source records attributed to S Mani.

At least 91 records · Page 5Linked to original sources
PubMed1993

Granulocyte-colony stimulating factor therapy in drug-induced agranulocytosis.

Drug-induced agranulocytosis in the outpatient setting is a rare but potentially fatal adverse effect of many classes of medications. Five patients with this disorder presented to Yale-New Haven (Conn) Hospital during 1990 through 1992. Three patients treated with granulocyte-colony stimulating factor and two patients treated with routine care were studied for relevant clinical outcomes. Treatment with granulocyte-colony stimulating factor was associated with a shorter duration of neutropenia and a decreased length of hospital stay, consistent with recent case reports. Despite the high cost of the drug, treatment with granulocyte-colony stimulating factor was found to be cost-effective for patients with uncomplicated drug-induced agranulocytosis.

Adult↗
PubMed1993

Sickle myonecrosis revisited.

This review focuses on the classification of sickle myonecrosis in the context of sickle cell vaso-occlusive crisis. Further, the potential and novel use of magnetic resonance imaging to further clarify the nature of sickle crisis is discussed.

Adult↗
PubMed1993

Isolated amyloidosis of the penile urethra and corpus spongiosum: a case report.

Localized amyloidosis of the penile urethra and corpus spongiosum is rare. The pathogenesis is obscure and optimal management of such patients has not been defined. We report a case that was treated with transurethral removal of amyloid tissue, which was obstructing the urethral outlet. Previously, the patient had been treated with dilation with temporary relief of the symptoms. He was disease-free 1 1/2 years postoperatively.

Adult↗
PubMed1993

Case report: pentamidine and polymorphic ventricular tachycardia revisited.

Pentamidine isethionate has been associated with ventricular tachyarrhythmias, including torsade de pointes. This article reports two cases of this complication and reviews all reported cases to date. Pentamidine-induced torsade de pointes may be related to serum magnesium levels and hypomagnesemia may synergistically induce torsade. Torsade de pointes occurred after an average of 10 days of treatment with pentamidine. In these patients, no other acute side effects of pentamidine were observed. Torsade de pointes can be treated when recognized early, possibly without discontinuation of pentamidine. When QTc interval prolongation is observed, early magnesium supplementation is advocated.

Adult↗
PubMed1993

Role of computed tomography in the staging of primary melanoma.

PURPOSE: To evaluate the role of body computed tomography (CT) for the staging of patients with early melanoma. PATIENTS AND METHODS: A total of 151 new patients with American Joint Committee (AJC) clinical stage I, II, and III melanoma who received a CT scan of at least the chest and abdomen are the subject of this study. CT scans considered suspicious for metastases were reviewed again by one of the investigators (A.McB.C.). RESULTS: Of 151 patients, 63 had AJC clinical stage I, 61 stage II, and 23 stage III disease. In addition, one patient each had primary melanoma of the anal canal, esophagus, or vulva. Twenty-nine (19%) of 151 patients had a CT scan that was considered suspicious for metastases. The most common radiologic findings were single hepatic, and single or multiple pulmonary nodules. Of these 29 patients with suspicious scans, 24 subsequently proved to have benign processes by biopsy or follow-up studies, three had second primary tumors (well-differentiated lymphocytic lymphoma, Hodgkin's disease, and renal cell carcinoma), and only two were found to have metastatic melanoma. Of these two patients, one had regional nodal disease (unsuspected on physical examination) and one had distant nodal metastases. CONCLUSION: Body CT is not a useful imaging study in the detection of occult metastases in patients with primary melanoma. Although body CT commonly shows suspicious radiologic abnormalities in patients with early melanoma, these abnormalities most likely represent benign processes or a second primary tumor, rather than metastatic melanoma. The value of body CT in patients who present with nodal metastases needs further study.

Abdominal Neoplasms↗
PubMed1993

Diagnosis and management of gastrointestinal neuroendocrine tumors.

Neuroendocrine tumors of the gastrointestinal tract pose substantial diagnostic and therapeutic challenges. The numerous biologically active peptides and amines produced by these lesions generate complex clinical syndromes. Unfortunately, little is known regarding the genesis of these lesions. Recent advances in understanding of the pathobiology of these lesions has facilitated characterization of the biochemistry of tumor secretions. Similarly, pharmacological blockade of tumor bioactivity using somatostatin analogs, pharmacotherapeutic probes, or specific antagonists has enhanced treatment options. Effective biochemical palliation of tumor symptoms has in turn motivated a more aggressive approach to cytoreduction of these tumors by surgery or hepatic embolization. The combination of chemical blockade and surgical therapy may permit more extended and symptom-free survival for a significant proportion of patients. We evaluate the basic principles of diagnosis and management of gastrointestinal neuroendocrine tumors.

Gastrointestinal Neoplasms↗
PubMed1993

Anesthetic management of cerebral aneurysm clipping during pregnancy: a case report.

A 35-week pregnant female presented emergently for clipping of a cerebral aneurysm under general anesthesia. The patient was neurologically stable with an active fetus. Anesthetic goals for this patient included maintenance of uteroplacental perfusion, fetal well-being, and maternal well-being. Maternal monitoring consisted of invasive arterial blood pressure, central venous pressure, and urine output, in addition to the standard monitors for anesthesia. Fetal monitoring consisted of fetal heart rate by external Doppler and uterine activity by external tocometer. Anesthesia care was directed at ensuring optimal maternal and fetal well-being. The aneurysm was clipped, and the patient emerged from anesthesia without neurological deficits. No uterine activity was noted intraoperatively. Fetal heart rate was maintained between 125 and 160 beats per minute. A healthy baby was delivered 11 days postoperatively by cesarean section under regional anesthesia. The Apgar score was 8/9 at 1 and 5 minutes.

Adult↗
PubMed1990

Human immunodeficiency virus infection among homeless men in a New York City shelter. Association with Mycobacterium tuberculosis infection.

The human immunodeficiency virus (HIV) seroprevalence among a selected sample of 169 high-risk homeless men residing in a congregate shelter in New York City, NY, was 62%. Seropositivity for HIV correlated significantly with intravenous drug use (odds ratio, 3.3; 95% confidence interval, 1.4 to 4.4) and active tuberculosis (odds ratio, 7.0; 95% confidence interval, 3.4 to 13.5). Most cases of active tuberculosis were among homeless men with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex; and significant CD4 lymphocyte depletion was associated with active tuberculosis. Total time homeless correlated positively with active and latent tuberculosis infection. Compliance rates with return for HIV antibody test results, medications, and follow-up visits were 70%, suggesting a significant degree of knowledge, awareness, and personal concern regarding HIV infection among homeless men; yet 28% of homeless intravenous drug users continue active drug injection, despite HIV infection. Cohabitation in overcrowded congregate dormitories creates a risk of airborne transmission of tuberculosis, which is a common reactivation infection in HIV-seropositive homeless men. Medically appropriate housing should be provided to such homeless persons, and expanded HIV antibody testing, counseling, and medical services on site should be offered to residents of shelters.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Dilatation of the biliary ductal system: choledochal cysts.

The case described in this report is typical of a patient with a choledochal cyst. Although common in Japan, such cases are being increasingly reported in other countries. Because diagnosis depends most importantly on clinical suspicion, detailed history taking and appropriate early intervention are mandated. Additional radiologic studies may help confirm the diagnosis. The crucial step in management is deciding between cyst excision and internal drainage. The ultimate decision depends on the individual patient profile. Long-term follow-up is mandated by the increased risk of biliary carcinoma.

Adult↗
PubMedDate not supplied

MENTOR: a Bayesian Model for prediction of mental retardation in newborns.

Mental retardation (MR) is a diagnosis that is made with extreme caution because of the many uncertainties in its etiology and prognosis. In fact, most physicians will delay the diagnosis for months or years so that substantial evidence is available to rule the diagnosis in or out. MENTOR is a Bayesian Model for the prediction of MR in newborns that provides probabilities for the full range of cognitive outcomes, ranging from MR to superior intelligence. Using the model to confirm clinical judgment could help physicians decide when to proceed with diagnostic tests. The physician and family could discuss the probabilities for MR, borderline, normal, and superior intelligence, given the child's status in infancy and base their decision about additional testing, in part, on this information.

Adolescent↗