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Biomedical subjects

V K Mittal

Publications and source records attributed to V K Mittal.

At least 55 records · Page 3Linked to original sources
PubMed1983

Total parenteral nutrition in renal transplantation. Experimental observations.

The nutritional support of the transplant recipient as a means of improving the allograft response after transplantation has not been investigated. This experimental study was designed in an attempt to define the role of malnutrition and total parenteral nutrition (TPN) on the rejection of canine renal allografts. Twenty-three mongrel dogs (18-23 kg) received kidney transplants from unrelated donors. All animals were minimally immunosuppressed with azathioprine (5.0-2.5 mg/K/day). Daily serum creatinines, biweekly complete blood counts, serum protein, and total iron binding capacity (TIBC) were determined. Postmortem examination was performed on all animals. Four groups of animals were compared: Group I (n = 5) served as a control and was maintained postoperatively on a regular balanced diet (RBD). Group II (n = 6) and Group IV (n = 6) were gradually malnourished prior to operation by diet leading to 12 to 22 per cent loss of weight, decreased albumin (2.0-2.6 mg/dl) and decreased TIBC (greater than 30%). After transplantation, Group II was maintained on 50 per cent RBD, and in Group IV, TPN was started two days prior to transplantation. The rejection times were 6.2 +/- 1.2, 9.5 +/- 3.5, 12.0 +/- 3.9, and 9.1 +/- 4.1 (mean +/- SD) days, respectively, for Group I through IV. TPN was not detrimental or beneficial to the allograft response of canine kidneys. Malnutrition, however, delayed significantly (P less than 0.005) the appearance of rejection after transplantation. Our findings appear to suggest that TPN could be safely used prior to and after transplantation if indicated, since it does not significantly alter the dog allogenic response following transplantation.

Animals↗
PubMed1982

Segmental pancreatic transplantation: donor and recipient operation.

Although the role of pancreatic transplantation in halting the progression of the secondary complications of insulin-dependent diabetes has not been completely defined, the application of segmental pancreatic transplantation for treatment of juvenile diabetes has increased. Five patients with insulin-dependent, nonuremic diabetes and definite evidence of progression of other secondary complications underwent segmental pancreatic transplantation (donor and recipient operations) with cyanoacrylate duct occlusion. No evidence of pancreatic function was seen in the first case because of ischemic and perfusion damage. The four other cases showed immediate normal pancreatic response after grafting. Several weeks thereafter, rejection appeared; no reversal was obtained despite antilymphoblast globulin or corticosteroid treatment. Rejection and pancreatitis remained the two most important obstacles in successful pancreatic transplantation. Modifications in the current immunosuppressive regimen might allow for prolonged pancreatic transplant survival.

Adult↗
PubMed1982

Scintigraphy of pancreatic transplants.

Five patients with insulin-dependent diabetes mellitus that received extraperitoneal segmental pancreatic transplants were functionally assessed by 75Se-selenomethionine imaging. The radionuclide findings were correlated with fasting plasma glucose and complete clinical course. This study demonstrates that 75Se-selenomethionine imaging seems to be a reliable tool for the assessment of function of extraperitoneal segmental pancreatic transplants in the first weeks after transplantation. An excellent correlation between the radionuclide accumulation and the transplant function was seen. The relative limits of this technique, however, are related to cost, since a plasma glucose will give similar information as far as organ function is concerned. Furthermore, the findings encountered with this technique will only confirm previous laboratory data, but would not be used alone to alter the clinical treatment of the patient.

Diabetes Mellitus↗
PubMed1982

Clinical segmental pancreatic transplantation.

Pancreatic transplantation is still partly experimental. Its role in halting the progression of secondary complications of insulin-dependent diabetics has not been completely defined. Although pancreaticoduodenal transplantation has been used since 1966, it was not until 1977 that modifications in the surgical technique allowed for encouraging results when segmental pancreatic transplantation was utilized. During the last year, we have performed five segmental pancreatic transplants in insulin-dependent, preuremic juvenile diabetics. Postoperatively these patients received immunosuppression consisting of azathioprine, prednisolone and antilymphoblast globulin (ALG). These patients were followed-up by serial pancreatic echograms and pancreatic scans. All patients except the first one became normoglycemic following transplantation. Serum insulin reached normal levels within a few days post-transplantation. Pancreatitis was evident in the immediate postoperative period. The last four patients showed evidence of rejection in the form of increasing blood sugar levels and need of insulin for control of hyperglycemia. Two of these patients were treated with ALG (10 doses) and local radiation to the graft (150 r x 3), and the other two patients were treated with high doses of oral and intravenous steroids. Postoperative pancreatitis and rejection are still the two main problems that are seen after pancreatic transplantation. Better immunosuppressive agents are needed to improve long-term results.

Adult↗
PubMed1980

Primary malignant tumors of the small bowel.

Primary malignant tumors of the small bowel are uncommon and are often diagnosed at an advanced stage. A 10 year survey (1967 to 1977) of the clinical records at one hospital revealed 39 cases of primary malignant tumors of the small bowel. The most common symptoms were abdominal pain (89.7 percent) and weight loss (77 percent). Six patients presented with complications of enterovesical fistula, bleeding and perforation. Preoperative diagnosis was suspected in 27 cases (69.2 percent). Adenocarcinoma was the most common tumor, followed by carcinoid tumor, lymphoma, leiomyosarcoma and melanoma. The treatment of choice was surgical resection whenever possible. Curative resection was attempted in 25 cases. Adjuvant radiotherapy and chemotherapy was used in four patients with lymphoma. Twenty-seven patients (69.2 percent) are alive from 1 to 6 years after diagnosis and treatment. The 5 year survival rate is 35 percent. Earlier diagnosis is essential if the prognosis for patients with small bowel malignancy is to be improved.

Adenocarcinoma↗
PubMed1980

New techniques of gastrointestinal anastomoses using the EEA stapler.

A new instrument for performing end-to-end, inverted stapled anastomoses in the gastrointestinal tract is described. Its advantages and disadvantages are also discussed. Techniques to avoid a proximal enterotomy or colotomy are described in Billroth I gastrectomy and end-to-side ileocolostomy, and experience with 30 anastomoses, their hazards, and complications are reported. The instrument creates a better anastomosis and shortens the operative time.

Colectomy↗
PubMed1980

Use of probenecid in ticarcillin-induced hypokalemia.

Probenecid has been suggested as a prophylactic treatment of penicillin-induced hypokalemia, the proposed mechanism being that penicillin will be prevented from acting as a nonreabsorbable anion binding potassium and resulting in increased urinary losses. A rapidly occurring hypokalemia, unresponsive to intravenous replacement of potassium, can be explained by redistribution rather than urinary wastage. We report a case where probenecid was administered for ticarcillin-induced hypokalemia without any significant benefits.

Child↗