Pro: Pediatric anesthesiologists should be the primary echocardiographers for pediatric patients undergoing cardiac surgical procedures.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
A Mahajan
Publications and source records attributed to A Mahajan.
A formalism for independent checking of Gamma Knife dose calculations.
For stereotactic radiosurgery using the Leksell Gamma Knife system, it is important to perform a pre-treatment verification of the maximum dose calculated with the Leksell GammaPlan (DLGP) stereotactic radiosurgery system. This verification can be incorporated as part of a routine quality assurance (QA) procedure to minimize the chance of a hazardous overdose. To implement this procedure, a formalism has been developed to calculate the dose DCAL(X,Y,Z,dav,t) using the following parameters: average target depth (dav), coordinates (X,Y,Z) of the maximum dose location or any other dose point(s) to be verified, 3-dimensional (3-dim) beam profiles or off-centerratios (OCR) of the four helmets, helmet size i, output factor Oi, plug factor Pi, each shot j coordinates (x,y,z)i,j, and shot treatment time (ti,j). The average depth of the target dav was obtained either from MRI/CT images or ruler measurements of the Gamma Knife Bubble Head Frame. DCAL and DLGP were then compared to evaluate the accuracy of this independent calculation. The proposed calculation for an independent check of DLGP has been demonstrated to be accurate and reliable, and thus serves as a QA tool for Gamma Knife stereotactic radiosurgery.
Biophysical Phenomena↗
Colour Doppler flow imaging of focal hepatic lesions.
Fifty-four patients with focal liver lesions were evaluated with colour Doppler flow imaging (CDFI) and CT to assess whether CDFI could be used to differentiate various types of lesions based on the flow pattern in terms of peritumoral and intratumoral blood flow. Peritumoral flow was found to be of no significance in the differential diagnosis of various liver lesions. Intratumoral flow was graded into mild, moderate or marked depending on the relative number of blood vessels demonstrated within the lesion. Marked intratumoral flow on CDFI was seen in 12.5% of primary hepatic malignancies and in infantile haemangioendothelioma, while a moderate flow pattern was seen in 56.2% of primary hepatic malignancies and in 18.7% of metastases. Mild flow was seen in 33.3% of primary malignancies; 18.7% of metastases; and 16.7% of haemangiomas. No intratumoral flow was seen in 100% of inflammatory lesions; 83.3% of haemangiomas; 62.5% of metastases; and only one hepatocellular carcinoma (5.6%). It was therefore concluded that the presence or absence of flow on CDFI is not a reliable feature for differential diagnosis of focal liver lesions when it is used alone. The flow pattern as assessed on CDFI may point to the nature of the lesion and, when used along with other morphological imaging features, can assist in diagnosis or in narrowing the list of different diagnoses in a particular clinical situation.
Blood Flow Velocity↗
Gamma knife radiosurgery as a primary treatment for prolactinomas.
OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.
Humans↗
The contemporary role of the use of radiation therapy in the management of sarcoma.
In this article the current role of radiation therapy in the management of soft-tissue sarcoma is evaluated. The importance of a multidisciplinary approach in the management of these patients is emphasized. The available literature supporting the possibility of limb salvage is reviewed. Finally, the newest developments in radiotherapy technology are also addressed.
Amputation, Surgical↗
Traditional processing treatments as a promising approach To enhance the functional properties of rapeseed (Brassica campestris var. toria) and sesame seed (Sesamum indicum) meals.
Different processing treatments were applied to rapeseed and sesame seed meals, and the functional properties of these products were assessed. All treatments except puffing for both meals and pressure cooking in sesame meal increased water absorption capacity (WAC). Fat absorption capacity (FAC) of rapeseed meals was enhanced significantly by all treatments. The full-fat meals of both sources showed maximum protein solubility when fermented and minimum protein solubility when pressure-cooked. Germinated and microwave-cooked meals enhanced foaming properties of rapeseed meals. Heat treatments, except microwave cooking, considerably reduced emulsifying properties of both meals. Fermentation and germination increased the specific viscosity of rapeseed meals, whereas processed sesame meals showed lower viscosity than dry sesame meals.
Absorption↗
Polymicrobial etiology of dental caries.
The present study was carried out to establish the normal bacterial oral flora and the aerobic and anaerobic bacterial flora from deep seated dental caries, and to determine the antimicrobial sensitivity of the clinical isolates so obtained Streptococcus mutans (48%) and Streptococcus sanguis (20%) were the main aerobic isolates whereas Lactobacillus spp. (52%), Veillonella spp. (24%) and Actinomyces spp. (12%) were the major anaerobic isolates. Hundred percent of the samples from dental caries yielded polymicrobial isolates while in two samples from healthy individuals S. mutans was the sole isolate. As the flora changed from healthy tooth to dental caries it changed from one predominated by anaerobic gram-positive cocci to anaerobic gram-positive bacilli. All the anaerobes isolated were sensitive to metronidazole and cefotaxime, whereas all the isolated streptococci were sensitive to penicillin, erythromycin and clindamycin. Incorporation of the antibiotics in baseline restoration, if technically feasible, has been advocated.
Anti-Bacterial Agents↗
Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation.
Hypothermia during orthotopic liver transplantation (OLT) is common despite measures to prevent this complication. We retrospectively analyzed two groups of patients; those managed with (n = 113) or without (n = 109) a heat exchanger (HE) incorporated in the venovenous bypass (VVB) circuit to test the hypothesis that normothermia before liver reperfusion minimizes hypotension during reperfusion and decreases neohepatic transfusion requirements. Use of the HE resulted in significantly warmer patients during reperfusion and at the end of surgery (P < .001). An increase in neohepatic transfusion requirement was observed in patients with HE use: packed red blood cells, 4 +/- 4 versus 3 +/- 3 units; fresh-frozen plasma, 5 +/- 5 versus 4 +/- 4 units; platelets, 8 +/- 8 versus 6 +/- 7 units; and cryoprecipitate, 5 +/- 7 versus 3 +/- 5 units. There was no difference between the two groups in the untoward hemodynamic events during reperfusion of the liver (P = .31). We conclude that during OLT, the use of an HE in a nonheparinized VVB circuit helps maintain normothermia. Our limited experience suggests that its use is safe but does not improve hemodynamic stability during reperfusion or decrease blood loss during the neohepatic period.
Chi-Square Distribution↗
Combining aspirin with angiotensin converting enzyme inhibitors in heart failure: how safe is it?
The above discussion on the interaction of aspirin and ACE inhibitors seems to suggest that aspirin in high doses may have adverse interaction with ACE inhibitors in patients with heart failure but the data obtained is not sufficient or conclusive to recommended omission of aspirin in patients with heart failure. This raises a query in the mind of the physician whether to use a combination or not? The role of aspirin in the early period after myocardial infarction is well established so is the role of ACE inhibitors. Hence in patients with myocardial infarction and preserved left ventricular function it would not be wrong to administer combination of ACE inhibitors and aspirin. Albeit at a lower dose. In patients with large myocardial infarction or heart failure, warfarin may be an option but still needs to be documented in large trials. As suggested long term use of aspirin after infarction is still ambiguous and may be harmful in patients with heart failure with its anticedent side effects. But long term benefits of ACE inhibitors in heart failure are well documented. Hence if a choice has to be made whether to discontinue either of the two drugs it would be preferable to stop the aspirin. To answer the issue of use of aspirin in patients with heart failure it would be essential to conduct a double blind randomized trial comparing known anti-thrombotic treatment, aspirin and anti-coagulants on mortality in patients with heart failure, especially caused by coronary artery disease. Such a trial is underway at the present and till the results are available it should be left to clinical judgement of the physician whether to administer aspirin in patients with heart failure after weighing the benefits versus risk.
Angiotensin-Converting Enzyme Inhibitors↗
Minimal change nephrotic syndrome associated with extrarenal neurilemmoma.
Nephrotic syndrome may be associated not only with malignant neoplasia, but also rarely with benign solid tumours. Here we report a case of a young woman suffering from nephrotic syndrome, histologically classed as a minimal change glomerular lesion, associated with a posterior mediastinal neurilemmoma (ancient neurilemmoma). Surgical removal of the tumour led to complete cure of the nephrotic syndrome with total symptomatic improvement within 6 months. Scanning of the literature revealed only one case report of an association of spinal neurilemmoma with nephrotic syndrome.
Adult↗
Intravascular haemolysis after aluminium phosphide ingestion.
Explore the source record for details and available documents.
Adult↗
Visual evoked responses in megaloblastic anemia.
Pattern shift visual evoked responses (PSVER) were studied in thirty patients suffering from severe megaloblastic anemia (mean Hb level was 4.25 +/- 1.22 g/dL) of nutritional origin. All patients lacked clinical stigmata of visual and neurologic impairment. Mean P100 latency in thirty age and sex matched controls was 96.35 +/- 6.75 ms (range 86-108 ms) and mean amplitude was 10.37 +/- 3.88 microV (range 4.8-20.8 microV). Mean P100 latency in megaloblastic anemia was 114.77 +/- 11.68 (range 91-142) ms, P < 001 vs. control) and mean amplitude was 8.85 +/- 2.8 microV (range 5.1-16.2 microV). Seventy percent cases had prolonged latency of P 100. After correction of anemia with therapeutic doses of vitamin B12 and folic acid in three months (mean Hb level was 12.08 +/- 1.86 g/dL), the mean P100 latency was 105.13 +/- 9.30 ms (range 92-121 ms P < 0.001 vs. controls) and mean amplitude was 10.72 +/- 4.13 microV (range 5.1-21.4 microV). There was significant improvement in P100 latency after correction of anemia (P < 0.01). There was a negative correlation between P100 latency and hemoglobin levels, though it was statistically not significant.
Adolescent↗
Assessment of pulmonary functions in young adults--three cross-sectional studies.
This study reports the results of 3 cross-sectional surveys and demonstrates a birth cohort effect for pulmonary functions in students admitted to our Institute in 1974, 1986 and 1991. Improvement in height, weight and haemoglobin of students was accompanied with improvement in ventilatory (FVC, FEV1/FVC%,FEF25-75%) as well as diffusion functions (TLCO(SB), Dm, VC), specially in Group 2 and 3. Study of some vital statistics of state of Haryana from 1974 to 1992 significantly visualizes this period as period of green revolution and industrialization of the state. These quantitative indices are responsible for improvement of physical parameters and pulmonary functions of younger subjects. It is concluded that in view of the expected improvement in socio-economical status of developing countries and health of their individuals, physical and functional norms reported by different laboratories must be periodically reviewed.
Adolescent↗
Long source-skin distance rectal irradiation technique: a review of results.
PURPOSE: This study reports the clinical outcome of fifteen patients with low rectal adenocarcinoma treated with the long source-skin distance (SSD) of endorectal irradiation technique. This method was designed at McGill University in 1986 as an alternative to the standard short SSD rectal irradiation that was developed by Papillon (Proc. R. Soc. Med. 66: 1179-1181, 1973). METHODS AND MATERIALS: Between April 1986 and May 1993, six females and nine males were treated with this technique. Fourteen patients were treated with curative intent and one woman for palliation. The median total dose was 85 Gy (range 60-135 Gy) in a median of 3 fractions (range 3-5) over a median treatment time of 5 weeks (range 2-9.5 weeks). RESULTS: With a mean follow-up of 39 months and a median of 24 months (range 3 months-8.7 years), actuarial overall survival and disease-free survival rates are 50.8% and 71.4%, respectively, at 8.7 years. No patients have died of recurrent disease, but one patient has distant metastatic disease. One patient treated with curative intent required an abdominoperineal resection for progressive disease. Treatments were tolerated well by all patients. Four patients required steroid enemas for localized proctitis for a short period of time. They all responded well and had complete resolution of symptoms. CONCLUSIONS: Our results are comparable with those in other reports in the literature. The complications are similar in type and frequency to other published series. The long SSD technique may be an acceptable alternative to the standard short SSD technique.
Adenocarcinoma↗
Use of calcium channel blockers in acute ischemic cerebrovascular disease.
Explore the source record for details and available documents.
Acute Disease↗
AIDS phobia.
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
Comparison of single breath and steady state methods for measurement of lung transfer factor for CO in normal subjects and smokers.
Pulmonary diffusing capacity (lung transfer factor for carbon monoxide) has been assessed by the single breath (TLCOSB) and steady state (TLCOSS) techniques in well matched 90 females, 31 non-smoker and 29 smoker males, 18-50 years of age. Both TLCOSB and TLCOSS are significantly lower in females compared to non-smoker males (P < 0.001). Tobacco smoking statistically significantly reduces TLCOSB as well as TLCOSS in smokers as compared to non-smokers. There is a statistically significant correlation of age with TLCOSS and TLCOSB in all the three groups (r = -0.702, -0.360 and 0.300 for TLCOSB and r = -0.481, -0.355 and 0.380 for TLCOSS in non-smoker males, smoker males and females respectively). TLCOSB is 30.43 +/- 4.89, 27.29 +/- 4.54 and 26.13 +/- 3.60 ml/mmHg/min, while TLCOSS is 19.47 +/- 5.26, 16.69 +/- 3.27 and 18.24 +/- 3.78 ml/mm/Hg/min in non-smoker males, smoker males and females respectively. A fairly good correlation between the TLCOSB and TLCOSS in male, both non-smoker and smoker, as well as the female subjects was observed. TLCOSS is lower than TLCOSB in all the three groups. Even in smokers of moderate intensity both of these tests are influenced to a nearly similar extent.
Adolescent↗
Management of isoniazid poisoning--case report.
A young girl was admitted with generalized tonic clonic seizures and unconsciousness, four hours after ingestion of 12 gm of isoniazid (INH). In the absence of injectable preparation of pyridoxine, she was treated with oral pyridoxine and made a complete recovery.
Adult↗