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Biomedical subjects

S Parikh

Publications and source records attributed to S Parikh.

85 records · Page 5Linked to original sources
PubMed1977

Popliteal aneurysms.

A review of 64 popliteal aneurysms in 43 patients treated over a 14-year period revealed that thrombotic occlusion with ischemia and threatened limb loss was the most frequent complication (68%). Ten major amputations (23%) were necessary, four of which were the primary operations soon after admission. No limb loss occurred after operation in 11 patients with asymptomatic aneurysms. Direct revascularization was successful in 29 limbs (83%). Popliteal aneurysms should be resected, preferably in the asymptomatic stage, unless medical contraindications exist. Once thrombosis occurs, limb loss becomes a threatening likelihood.

Adult↗
PubMed1975

Carotid endarterectomy utilizing the exclusion clamp.

Carotid endarterectomy is useful in the treatment of the uncomplicated pre-stroke patient. Use of the exclusion clamp makes possible a short period of carotid occlusion without the use of either internal or external shunts. Forty-two patients were operated on using this technic.

Adult↗
PubMedDate not supplied

The American Brachytherapy Society perspective on intravascular brachytherapy.

BACKGROUND: Recent clinical studies indicate that intravascular brachytherapy (IVB) can reduce the rate of restenosis substantially after angioplasty procedures. However, no clinical guidelines exist for optimal therapy. METHODS: The members of the IVB Subcommittee of the American Brachytherapy Society (ABS) identified the areas of consensus and controversies in IVB to issue the ABS perspective on IVB, based on analysis of published reports and the clinical experience of the members in brachytherapy. RESULTS: IVB is still experimental. The long-term efficacy, toxicity, the target tissue, and dose required for IVB are not established. The ABS recommends that IVB procedures must be performed, with careful attention to radiation-related issues, in the context of controlled multidisciplinary clinical trials with the approval of the institutional review board, the Nuclear Regulatory Commission, the Food and Drug Administration, and under an Investigational Device Exemption. The therapeutic radiologist, with a qualified radiation physicist, is responsible for dose prescription and delivery and needs to be present during the IVB procedure as part of this multidisciplinary team. The long-term outcome from these studies should be reviewed critically and published in peer-reviewed journals. The ABS endorsed the dosimetric guidelines of the American Association of Physicists in Medicine Task Group 60 (AAPM TG-60) report. The ABS recommends that dose specification be defined clearly; to allow comparisons between studies, the dose should be prescribed at 2 mm from the source for intracoronary brachytherapy and at an average luminal radius of +2 mm for peripheral vascular brachytherapy. The prescription doses at the above point is generally in the 12-18 Gy range. Comprehensive procedures for quality assurance, radiation protection, and emergencies should be in place before initiating an IVB program. Higher energy beta sources, lower energy gamma sources, dose-volume histograms, and correlation of three-dimensional reconstructions of delivered dose with patterns of failure are areas for further research. CONCLUSION: The ABS perspective on IVB is presented to assist the interventional team in developing protocols for the use of IVB in the prevention of restenosis. Long-term outcome data with a standardized reporting system are needed to establish the role of brachytherapy in preventing vascular restenosis. Endovascular brachytherapy is a new and evolving modality, and these recommendations are subject to modifications as new data become available.

Brachytherapy↗
PubMedDate not supplied

External beam radiation therapy to prevent postangioplasty dialysis access restenosis: a feasibility study.

PURPOSE: To evaluate the feasibility and short-term side-effects of postangioplasty external beam radiation for patients with compromised arteriovenous dialysis accesses. MATERIALS AND METHODS: Ten patients with compromised arteriovenous dialysis accesses were studied. Following confirmation of access compromise by an angiogram, patients were treated by a standard angioplasty +/- stent deployment. The target volume incorporated a margin of 1 cm beyond the angioplastied segment. The first 5 patients were treated to a dose of 12 Gy in two 6-Gy fractions spaced 48 h apart, whereas the next 5 patients were treated to 8 Gy in two similarly separated 4-Gy fractions. Five of the patients had at least one prior access that had failed. The current access had been in use for 6-52 months, and 5 of the 10 patients had at least one episode of compromise involving the current access. The length of stenosis ranged from 2 to 9 cm (mean 4.4 cm). All patients were followed clinically for adequacy of dialysis; a radiological follow-up with a fistulogram was performed for all in 3-monthly intervals. Follow-up ranged from 4 to 10 months, with a median follow-up of 6 months. RESULTS: There were no procedure-related complications. Three patients developed a restenosis at the site of the original stenosis, and one patient developed a restenosis at the edge of the stent. As part of the natural history of this process, five patients have also developed new lesions elsewhere in the proximal veins requiring radiological intervention. None of the patients showed any radiation-related side effects, either in the skin/ soft tissues, or in the vasculature on follow-up angiograms. CONCLUSIONS: Several different radiotherapeutic approaches are being currently investigated to prevent postangioplasty restenosis. There are several issues involved with the use of endovascular brachytherapy in these patients. On the other hand, given the superficial location of the dialysis access, we believe that external beam radiation offers a safe and simple method of radiation therapy in this setting. The clinical efficacy of this modality needs to be established through a randomized phase III trial.

Adult↗
PubMedDate not supplied

Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.

Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.

Adult↗
PubMedDate not supplied

Metabolic response to fasting exercise in adolescent insulin-dependent diabetic subjects treated with continuous subcutaneous insulin infusion and intensive conventional therapy.

The metabolic effects of moderate exercise in the fasting state were examined in 12 insulin-dependent diabetic adolescents treated with continuous subcutaneous insulin infusion (CSII) or intensive conventional therapy (ICT). Six patients received their usual afternoon dose the evening before the study and six received their usual infusion rate during exercise. Insulin was injected subcutaneously in the abdominal wall. Exercise was performed on a bicycle ergometer for 45 min at 50% maximum oxygen consumption. Resting plasma glucose values during both CSII (114 +/- 18 mg/dl, P less than 0.02) and ICT (136 +/- 30 mg/dl, P less than 0.01) were higher than normal (77 +/- 11 mg/dl). Diabetic patients receiving CSII showed a sharp decrease in glycemia after 45 min of exercise (77 +/- 18 mg/dl, P less than 0.02). In contrast, in patients receiving ICT and in control subjects plasma glucose did not change during exercise or recovery. Insulin levels decreased significantly during exercise in the control subjects while there was no change in plasma free insulin levels during exercise in the diabetic subjects. Profiles of intermediary metabolites in response to exercise were similar in all groups with no significant differences in resting values between diabetic subjects and controls. Continuous subcutaneous insulin infusion provides near-normoglycemia in the insulin-dependent diabetic adolescent. However, with the basal insulin infusion rate necessary to achieve near-normal fasting blood glucose levels, moderate exercise in the postabsorptive state may result in hypoglycemia with CSII.

3-Hydroxybutyric Acid↗
PubMedDate not supplied

Accommodating planned exercise in type I diabetic patients on intensive treatment.

To achieve optimal metabolic control in type I diabetic patients treated with continuous subcutaneous insulin infusion (CSII) and multiple subcutaneous injections of insulin (MSI) appropriate adjustments of the insulin prescription should be made for exercise, which is a normal component of everyday life. The present study describes the responses of seven type I diabetic adolescents treated with CSII and six patients treated with MSI to specific insulin dose changes in anticipation of postprandial exercise. The effect of 45 min of cycle ergometer exercise at 55% VO2 on glucose regulation was studied 2 h after morning insulin and a breakfast meal. To quantify the potential benefit of modifying the insulin dose before exercise, the subjects were studied on five different days in a random order: resting control day, postprandial exercise preceded by the usual dose of insulin, postprandial exercise preceded by one-half of the usual dose of insulin, postprandial exercise preceded by two-thirds of the usual dose of insulin, and postprandial exercise without the usual dose of insulin. In all cases insulin was injected or infused subcutaneously in the anterior abdominal wall. When exercise was performed without changing the usual insulin dose, there was a significant fall in glycemia in both groups, with the nadir occurring after 45 min. In the CSII group, the +/- SEM plasma glucose was 57 +/- 5 mg/dl (P less than 0.05 versus rest) with hypoglycemia occurring in four patients. In the MSI group, the mean +/- SEM plasma glucose fell to 65 +/- 10 mg/dl (P less than 0.05 versus rest) and hypoglycemia occurred in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Explantation of silicone plate haptic intraocular lenses.

The stress on small self-sealing incisions in cataract surgery has resulted in the increased use of foldable intraocular lenses (IOL). Plate haptic silicone IOLs implanted with the help of an injector require extremely small incision lengths and are extensively used. The authors discuss difficulties in explanting such lenses, especially in inflamed eyes. Two patients who underwent plate-haptic silicone IOL explantation for postoperative bacterial endophthalmitis are described. Plate haptic IOLs have a tendency to dislocate posteriorly because of poor capsular fixation and increased posterior bowing. Enlarging a small rhexis prior to attempting explantation of these lenses reduces this complication. Difficulties inherent in explanting plate haptic silicone IOLs in inflamed eyes are discussed, along with suggestions to overcome them.

Aged↗
PubMedDate not supplied

Results of coronary artery surgery in young adults.

To study the results of bypass surgery in young adults, 221 patients undergoing myocardial revascularisation aged 40 or less (1979-1989) were reviewed. The study included 200 men and 21 women. Mean age was 36.2 years. Risk factors were essentially cigarette smoking (69.6%) and hyperlipidaemia (52%). One-hundred and eighteen patients (53.4%) had a history of previous myocardial infarction (MI) and 16 were operated on after an episode of preinfarction angina. One-hundred and twenty-nine patients had three-vessel disease, 59 had double-vessel disease and 33 single-vessel disease. Twenty-three had left main stem coronary artery lesions. Four-hundred and forty-six saphenous vein grafts and 79 internal mammary artery grafts were performed, an average of 2.3 grafts per patient. Operative mortality was 2.7% (6 patients). Deaths were caused in 4 cases by MI. Twelve patients (5.5%) had a non fatal perioperative MI. One-hundred and ninety-nine patients were followed up for a mean of 7.4 years (4838 patients-years). Seventeen late deaths occurred. Six were from cardiac causes. Overall survival was 84% at 9 years. Five patients underwent cardiac reoperation at a mean interval of 6.4 years after the primary procedure. Eighty-five% of patients were free of angina and 11.5% were in an improved condition. In conclusion, coronary revascularisation can be performed at a reduced risk in younger patients. Long-term prognosis seems similar to that of the overall group of patients undergoing bypass surgery.

Adult↗