Electrocardiographic changes in catastrophic abdominal illness mimicking acute myocardial infarction.
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Abdomen, Acute↗
Biomedical subjects
V P Kumar
Publications and source records attributed to V P Kumar.
Local muscle flaps in the treatment of chronic osteomyelitis--the introduction of new vasculature.
Four cases of chronic osteomyelitis successfully managed with local muscle flaps after sequestrectomy are reported. The success of this method in controlling chronic osteomyelitis lies in the introduction of a new vasculature, which provides nutrients, sufficient antibiotics, host defence system and osteoprogenitor cells to the post-sequestrectomy bed. The osteoprogenitor cells are responsible for the incorporation of residual avascular bone into the adjacent living bone by creeping substitution.
Adult↗
Progesterone derivatives that bind to the digitalis receptor: synthesis of 14 beta-hydroxyprogesterone. A novel steroid with positive inotropic activity.
The synthesis of 14-hydroxy-14 beta-pregn-4-ene-3,20-dione (14 beta-hydroxyprogesterone) is described. This novel steroid is about 10 times more potent than progesterone and one-tenth as potent as ouabagenin in an [3H]ouabain radioligand binding assay and is the first in a series of progesterone congeners that interact at the cardiac glycoside receptor both to possess the C/D cis ring junction and to enhance contractility of isolated cardiac tissue.
Animals↗
Stress fractures of the tibia in osteoarthritis of the knee.
Three women with osteoarthritis of the knee presented after sudden worsening of their symptoms. In each case this was found to be due to a stress fracture of the tibia. With treatment by rest and reduced activity, the fracture healed uneventfully in all three patients.
Aged↗
The natural history of anterior cruciate ligament injuries.
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Adolescent↗
Tikhoff procedure in recurrent chondrosarcoma following free vascularised fibular graft.
A forty year old housewife presented with a recurrent chondrosarcoma in a vascularised fibular transplant for a tumour in the proximal humerus. The Tikhoff-Linberg procedure was carried out with satisfactory results. The case report serves to emphasize the need to be aggressive in the initial management of malignant bone tumours. Careful planning and execution of a further aggressive procedure in the presence of a recurrence, ensures adequate clearance of tumour while still preserving a functional and useful limb.
Adult↗
Anterior cruciate ligament injuries. To counsel or to operate?
Untreated anterior cruciate ligament injuries in 97 knees of 87 patients were reviewed after a mean interval of six years. After their initial recovery 63% of the patients were able to return to their pre-injury sport, but six years later 27% of them had deteriorated to the extent that they could not cope with the same level of sport. Radiological deterioration was maximal in those that had had a meniscectomy more than five years before review. Knees with intact menisci were often radiologically normal despite continuing instability.
Adolescent↗
Osteochondritis dissecans following Perthes' disease. Arthroscopic-operative treatment.
Osteochondritis dissecans is seen after skeletal maturity is reached in approximately 3% of adults who have had Legg-Calvé-Perthes disease as children. This diagnosis should be considered in the patient with hip pain, locking or catching, or early degenerative joint disease. In a series of 465 patients treated for Perthes' disease, 14 later developed osteochondritis dissecans. In asymptomatic hips, no treatment is indicated. In symptomatic patients, arthroscopic surgery of the hip has been employed to remove the loose osteocartilaginous fragment and to diagnose degenerative joint disease. Although removal of the osteocartilaginous fragment may not be indicated in patients with severe degenerative arthritis, an osteotomy to redirect the femoral head (valgus extension osteotomy) may be beneficial.
Adolescent↗
The role of atmospheric pressure in stabilising the shoulder. An experimental study.
The role of atmospheric pressure in providing static stability of the shoulder was studied experimentally in 24 cadaveric shoulders. Atmospheric air was allowed to enter the joint after puncturing the capsule. Three types of experiment were performed: in the first, the capsule was punctured after sequential division of the muscles; in the second, atmospheric air was let in by percutaneous puncture of of the capsule without dividing the muscles; and in the third, air was first let into the joint by percutaneous puncture of the capsule and then the muscles of the shoulder were divided. It was found that the intact shoulder subluxated after percutaneous puncture even without division of the overlying muscles or the capsule. Our findings suggest that negative pressure and muscle tone are the main static stabilisers of the shoulder, rather than the joint capsule.
Adult↗
Benign Chondroblastoma.
Eight cases of benign chondroblastoma seen between 1957 and 1980 were reviewed. The majority presented between the age of 10 and 25. There was no male preponderance. All except one lesion occurred in the epiphysis but biansagression across epiphyseal plate into the metaphysis was not uncommon. In only one case the lesion was entirely in the metaphysis of the middle phalanx of a finger. Radiologically, the lesion appeared cystic with mottled calcification and a peripheral sclerotic margin. Microscopically, all lesions were benign with three characteristic features: round a polygonal chondroblast, areas of cell necrosis with intra and extra-cellular calcification and giant cells in response to the dead cells. Thorough curettage and bone grafting resulted in complete resolution in all cases without recurrence. For the lesions of the femoral head, an approach through the fovea of the head after division of the ligamentum teres and dislocation of the hip anteriorly was preferred. Adequate curettage could be dome without the risk of avascular necrosis or femoral neck fracture otherwise encountered with the transcervical approach.
Adolescent↗
Nirodh: a contraceptive of the future.
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Advertising↗
Stereoselective reduction of C-2 substituted steroid C-3 ketones with lithium tris-(R,S-1,2-dimethylpropyl)-borohydride and sodium borohydride.
The effect of C-2 substitution on the stereoselective reduction of steroid C-3 ketones with lithium tris-(R,S-1,2-dimethylpropyl)-borohydride and sodium borohydride was investigated. The C-2 mono- and di-substituted chloro and methyl derivatives were predominantly reduced to one of the epimeric alcohols. The 2 alpha-chloro and 2 alpha-methyl derivatives of 17 beta-acetoxy-5 alpha-androstan-3-one undergo stereoselective reduction with lithium tris-(R,S-1,2-dimethylpropyl)-borohydride to the axial (3 alpha) alcohol as observed in the unsubstituted compound, whereas sodium borohydride gives predominantly the equatorial (3 beta) alcohol. The 2 beta-chloro, 2 beta-methyl, 2,2-dichloro, and 2,2-dimethyl derivatives are reduced predominantly to the equatorial (3 beta) alcohol by both reagents.
Borohydrides↗
Structure-activity relationships of progesterone derivatives that bind to the digitalis receptor: modifications in A and B rings.
A number of progesterone derivatives, having a 17 alpha-acetoxy group and various functions at C-3 and C-6, interact at the cardiac glycoside (CG) binding site, using [3H]ouabain in a radioligand binding assay (RBA) with membranes from dog myocardium. We now report on results of structure-activity studies concerned with modification of the A and B rings as they influence potency in the RBA. Some progesterone derivatives with 5 alpha- or 5 beta-stereochemistry show weak receptor competing activity. Among the congeners highest potency is associated with the presence of C-4 or C-4,6 unsaturation and a C-6 substituent (CH3, Cl, Br) whose importance appears to reside in its steric rather than electronic character. The C-3 function may be carbonyl, 3 beta-hydroxy or 3 beta-acetoxy when associated with C-4 or C-4,6 unsaturation. In compounds with other substituents that promote activity, C-6 alpha substitution with -CH3, -Cl, or -Br strongly enhances activity; -F, -OCH3, carbonyl, or the unsubstituted compound promotes weak binding; and -OC2H5, -OAc, -OCOOCH3, or -OH eliminates binding activity. Receptor interaction with the double bond at C-4, but not C-5, appears to be particularly important for binding. The most potent analog identified thus far is chlormadinone acetate (17 alpha-acetoxy-6-chloropregna-4,6-diene-3,20-dione), which has 1/20 the potency of ouabain in the RBA. Studies to determine optimal structural requirements for CG-receptor binding by these hormonal steroid congeners, in conjunction with appropriate biological assays, may provide insight into the nature of a putative endogenous counterpart, lead to a better understanding of the mode of action of the CG and yield CG-like compounds with superior therapeutic properties.
Animals↗