Biomedical subjects
Publications and source records attributed to A Marwah.
Parachute abnormality of mitral valve frequently occurs with left sided obstructive lesions though occasionally may occur as an isolated lesion. Symptoms depend upon the severity of stenosis and associated lesions. Parachute abnormality of the tricuspid valve has rarely been reported and its association with left to right shunts has not been described so far.
Qualitative and quantitative analysis of dehydroepiandrosterone and its conjugates in biological matrices and establishment of their relationships with physiological functions is a very active field. This review article discusses methods of separation and quantification of dehydroepiandrosterone and its conjugates using high-performance liquid chromatographic techniques.
A simple and fast yet highly sensitive and specific method based on HPLC coupled to electrospray ionization mass spectrometry has been developed for the quantitation of corticosterone in rat plasma. After extraction of rat plasma (100 microl) with diethyl ether using 5-pregnen-3beta-ol-20-one-16alpha-carbonitrile (Sigma) as internal standard, HPLC was performed on a short C8 column (Zorbax-Eclipse, 50x4.6 mm I.D.) using a steep methanol-water gradient (methanol 54% to 90% in 6 min). Detection was performed on a single quadruple mass spectrometer in selected ion monitoring mode (m/z 369 for corticosterone and 364 for the internal standard). The detection limit of the assay was 9 fmol (3 pg) of corticosterone on column. In vitro data were subjected to curve fitting (cubic, r2=0.9999). Recovery of corticosterone after extraction ranged from 81 to 93%. The relative standard deviations for intra- and inter-assay precision ranged from 0.8 to 3.6% and 5.2 to 12.9%, respectively. Corticosterone did not undergo any appreciable degradation when stored in plasma at -20 degrees C for 2 months. The assay is routinely used in our laboratory to examine corticosterone levels as a marker of stress in rats and may also be used for the determination of 18-hydroxy-11-deoxycorticosterone.
The aim of the study was the assess feasibility of closing large patent arterial ducts (PDA) in infants and children using the new Amplatzer Duct Occluder. All patients diagnosed to be having PDA were considered as potential candidates to undergo the device closure. 19 patients were diagnosed to be having PDA larger than 4 mm. There were 10 males and 9 females, their age ranged from 6 months to 120 months with a mean of 45 months. Mean body weight was 14.5 kg with a range from 7 kg to 23 kg. The procedure was carried out under Ketamine sedation and local anesthesia. The device was implanted by the transvenous route in all. Mean PDA diameter was 5 mm (range 4 mm-6.7 mm). Complete closure was achieved in 16/18 (88%) within 24 hours of the procedure. All patient have been followed for 3 months, and have documented complete closure, there is no evidence of aortic or left pulmonary stenosis in any of our patients. The unsuccessful attempt was in a malnourished patient (weighing 4.7 kg) with an arterial duct measuring 6.7 mm on angiography. This duct was considered too big for device closure and the procedure was abandoned. This patient subsequently has undergone successful surgical ligation. Catheter closure of large PDA in small children is feasible, safe and efficacious. However, it may still not be possible to close large PDA in very small or underweight children, for the fear of causing obstruction to the descending aorta. Further long-term is follow-up required to show sustained benefits without any side effects.
The 7-oxo derivative of dehydroepiandrosterone is more active than the parent steroid and is devoid of adverse side effects in rats, monkeys and humans. In anticipation of possible therapeutic use we have sought more active, longer lasting forms of 7-oxo- and 7beta-hydroxydehydroepiandrosterones. The 7-oxo- and 7-hydroxy steroids have been converted to glucuronides, ethers and carbonate esters. The syntheses of these compounds are described and their ability to induce the formation of liver thermogenic enzymes when fed to rats is reported. Some of the new derivatives were found to be somewhat more effective than the equimolar amounts of 7-oxo-DHEA with which they were compared in each experiment.
Breast carcinoma occurs rarely in men. Its imaging by mammography is difficult because male breast tissue is normally small in volume and adequate compression is not possible, which is a prerequisite for performing mammography. The authors describe a 65-year-old man with a right breast mass in whom the result of fine-needle aspiration cytology was inconclusive. A mammogram was also noncontributory because adequate compression was not possible as the mass was tender. Tc-99m tetrofosmin scintimammography showed intense focal uptake in the right breast. Excision biopsy confirmed the diagnosis of breast carcinoma.
Ectopic thyroid glands generally occur in the midline as a result of abnormal median migration, and their presence lateral to the midline is rare. A 12-year-old boy had a swelling in the left submandibular region that imaging techniques showed to be an ectopic thyroid gland, although no thyroid tissue was seen in the normal location. Only eight cases of lateral aberrant thyroid tissue have been reported. The importance of being aware of the possibility of ectopic thyroid tissue as a submandibular region swelling has an important bearing on disease management. A pertinent review of the literature and its management is included.
We investigated the efficacy of exercise stress thallium in the diagnosis of coronary artery disease in patients with diabetes mellitus. Forty-three patients with known diabetes and suspected of having coronary artery disease were included in the study. All the patients underwent coronary angiography, 24 had significant coronary artery stenosis and 19 had normal coronaries. Out of the 24 patients with a positive angiographic finding, thallium scintigraphy was positive in 21 patients (sensitivity, 87.5%); and false negative in only three of the 24 patients. Out of the 19 patients with normal angiography findings, 16 patients had a normal thallium scan (specificity, 84.2%) and the remaining three had a positive thallium scan. This gives thallium scintigraphy a positive predictive value of 87.5% and negative predictive value of 84.2% when compared with coronary angiography. The findings of this study suggest that stress thallium scintigraphy is a useful modality in screening of coronary artery disease in diabetic patients.
OBJECTIVES: Our aim was to assess the immediate and short term results of closure of moderate and large patent arterial ducts using the self-expanding and repositionable Amplatzer device. METHOD: We attempted closure in 25 patients (10 Females and 15 males) using the Amplatzer occluder. Their median age was 48 months with a range from 8 months to 26 years and median weight of 14 kg with a range from 4.5 kg to 48 kg. The mean ductal diameter was 4.1 mm (S.D 1.51 mm). A 6F/7F long sheath was used to deliver the device. Follow up was performed with colour- flow mapping of the pulmonary trunk within 24 hours, at 3 months, and 6 months of closure. RESULTS: Of the 25 patients, the device was placed successfully in 23. Concurrent angiography showed immediate closure in 12 patients, while 8 had trivial shunting and 3 had mild shunting. Within 24 hours, Doppler examination revealed complete closure in all but three patients, who had a mild residual shunt. Two attempts were unsuccessful. Both these patients underwent successful surgical ligation. All except one patient were discharged on the next day. Of the 23 patients, 15 (65%) have been followed up for 3 months, while 8 (35%) have completed 6 months of follow-up. Of the three patients initially with mild residual flow, two had completely closed at 3 months The one remaining patient is yet to be seen at the 3 month follow-up. Thus, at 3 months, all patients studies had shown complete closure. CONCLUSION: Antegrade transcatheter closure using the Amplatzer duct occluder is an efficacious treatment for bigger patent arterial ducts. Long-term follow-up is necessary to show sustained benefits and confirm the absence of side effects.
Dual ectopic thyroid glands rarely occur, and only six cases have been reported in the literature. The authors describe a 14-year-boy who had a midline neck swelling for 8 to 9 years. The swelling increased gradually, but he had no pressure symptoms. The thyroid hormone profile showed a moderately increased thyroid-stimulating hormone value and normal T3 and T4 levels. A Tc-99m sodium pertechnetate thyroid scan showed dual ectopic thyroid glands in the sublingual and subhyoid regions.
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OBJECTIVES: To evaluate the safety and pharmacokinetics of 3-acetyl-7-oxo-DHEA (3beta-acetoxyandrost-5-ene-7,17-dione) given orally. DESIGN: A randomized, double blind, placebo-controlled, escalating dose study. SETTING: The Chicago Center for Clinical Research. PARTICIPANTS: Twenty-two healthy men. STUDY METHOD: The participants received placebo (n = 6) or 3-acetyl-7-oxo-DHEA (n = 16) at 50 mg/d for 7 days followed by a 7-day washout; 100 mg/d for 7 days followed by a 7-day washout; and 200 mg/d for 28 days. OUTCOME MEASURES: Safety parameters, evaluated at each dose level, included measurement of total testosterone, free testosterone, dihydrotestosterone, estradiol, cortisol, thyroxin and insulin levels. Analyses for 7-oxo-DHEA-3beta-sulfate (DHEA-S), the only detectable metabolic product of the administered steroid, were conducted on plasma drawn from all subjects at 0.25, 0.5, 1, 2, 4, 6 and 12 hours after the final 100 mg dose of 3beta-acetyl-7-oxo-DHEA. RESULTS: There were no differences in the clinical laboratory values or in reported minor adverse experiences, between treatment and placebo groups. In general, blood hormone concentrations were unaffected by the treatment with 3beta-acetyl-7-oxo-DHEA and remained within the normal range. No changes in vital signs, blood chemistry or urinalysis occurred during treatment with 3beta-acetyl-7-oxo-DHEA compared to placebo. The administered steroid was not detected in the blood but was rapidly converted to 7-oxo-DHEA-S, the concentrations of which were proportional to dose. This steroid sulfate did not accumulate; plasma concentrations 12 hours after the 3beta-acetyl-7-oxo-DHEA dose at 7 and 28 days on the 200 mg/d dose were 15.8 and 16.3 microg/L respectively. The mean time to peak plasma level of 7-oxo-DHEA-S was 2.2 hours; the mean half life was 2.17 hours. The apparent clearance averaged 172 L/h, and the apparent mean volume of distribution was 540 L. CONCLUSION: These results indicate that 3beta-acetyl-7-oxo-DHEA is safe and well tolerated in normal healthy men at doses up to 200 mg/d for 4 weeks.
OBJECTIVE: To assess the feasibility and early results of Amplatzer septal occluder in children withy secundim atrial septal defect. SETTING: Tertiary care referral hospital in New Delhi. METHODS: Forty nine children under 12 years of age were diagnosed to be having fossa ovalis atrial septal defect. Forty nine patients underwent detailed 2D-Echocardiography and color Doppler interrogation for the possibility of non-surgical closure of ASD. Sixteen children between age 2.5-12 years (mean 6.5 years) were enrolled into the study. Their weight ranged from 10 kg to 42 kg and there were 9 males and 7 females. The remaining 33 were not considered suitable for device closure in echocardiography and were referred for surgery. RESULTS: All patients had more than 1.8 : 1 shunt. The device was successfully deployed in 13/16 patients. ASD stretched diameter ranged between 13 mm-30 mm (mean 15 mm) and the device size ranged between 14 mm-22 mm. One patient had fenestrated ASD, in this patient the largest of the defect was crossed and closed with 24 mm device resulting in closure of all three defects. We failed in three of our attempts, on one there were deficient inferior margins while in the other two cases the ASD stretched size was such that the device would have encroached upon adjacent structures, hence the procedure was abandoned. All these patients have been operated successfully. Complete abolition of shunt was seen in 38% patients in the immediate post deployment period. At 24 hours complete closure was seen in 12/13 (92%) patients while one patient had trivial residual shunting across the device. This patient also achieved complete closure of atrial shunting when evaluated at three months follow-up. CONCLUSION: Device closure of ASD is emerging as an alternative to surgical closure. However, with the currently available device only a limited number of atrial septal defects can be closed. Long-term studies are required to show sustained benefits and absence of side effects of this device.
OBJECTIVE: To present short and intermediate results of catheter closure of patent ductus artereiosus using spring coils and Amplatzer duct occluder. SETTING: Tertiary care referral hospital in New Delhi. METHOD: 121 patients were diagnosed to be having patency of the arterial duct between October 1996 and December 1999. Their ages ranged between 4 mo and 480 mo (mean 80.5 mo). Before August 1998 only spring coils were used as an alternative to surgical closure of the duct, whereas between August 1998 and December 1999 both coils and device were used. RESULTS: Spring coils were attempted in 48, Amplatzer duct occluder in 44 and 29 patients were referred for surgery. Coils were successfully deployed in 42/48 (87.5%) and device in 42/44 (95.5%) patients. Complete closure of the arterial duct was seen in 96% patients in the coil closure group at the end of one year and 100% closure was achieved in the device closure group at the end of 3 months in all the patients followed. Coil embolised in 11 patients, significant stenosis of left pulmonary occurred in one patient and severe hemolysis requiring blood transfusion occurred in one patient after coil closure. Six patients required a second procedure to close the residual shunt within 6 months of the initial coil deployment. One patient had loss of femoral artery pulses in right leg after device closure and required heparin infusion for 48 hours. There were 8 failed attempts. All these patients have been operated successfully. CONCLUSION: Percutaneous closure of the patent ductus arteriosus using Coils or the Amplatzer device is an acceptable method. Small residual shunts are common after the initial procedure especially after coil deployment but most close spontaneously.
A new, simple, reproducible and reliable high-performance liquid chromatography method with ultraviolet absorbance detection at 240 nm was developed and validated for the determination of 7-oxo-dehydroepiandrosterone-3beta-sulfate in human plasma. The method was based upon solid-phase (C18) extraction of plasma after addition of 17beta-hydroxy-3beta-methoxyandrost-5-en-7-one as internal standard. Using 1 ml of plasma for extraction, the detection limit of the assay was 3 ng/ml. The standard curve was linear over the concentration range 10-1000 ng/ml. Stored at -20 degrees C for about 4 months at various concentrations in plasma, 7-oxo-dehydroepiandrosterone-3beta-sulfate did not reveal any appreciable degradation. Also included herein is a method for the simultaneous detection and determination of 7-oxo-dehydroepiandrosterone and 7-oxo-dehydroepiandrosterone-3beta-acetate in plasma.
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