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Biomedical subjects

D Gopaul

Publications and source records attributed to D Gopaul.

15 recordsLinked to original sources
PubMed2006

Long-term outcome of high-dose melphalan and autologous stem cell transplantation for AL amyloidosis.

Light chain (AL) amyloidosis is the result of a clonal plasma cell expansion, in which amyloidogenic monoclonal light chains deposit in various tissues resulting in organ dysfunction and organ failure. The median survival of patients with AL amyloidosis without therapy is 10-14 months. Several phase II studies report haematological and clinical remission in up to 50% of patients after high-dose melphalan and autologous stem cell transplantation. We analysed retrospectively the long-term outcome of 19 patients treated in this way between August/1996 and December/2001. We observed a relatively high treatment-related mortality of 26%, but 12 patients (63%) were high-risk candidates. Eight patients (42%) surviving longer than 100 days achieved haematological remission and long-term survival, whereas 6 (32%) obtained no clear benefit from high-dose therapy. However, 62% of patients survived beyond 2 years and the median survival from transplant was 48 months (range 0-104 months).

Adult↗
PubMed2004

Outcome of local excision of rectal carcinoma.

PURPOSE: This study was designed to determine the results of patients with rectal adenocarcinoma treated with local excision. METHODS: A retrospective, chart review was conducted for all patients treated with local excision for rectal adenocarcinoma from 1984 to 1998. RESULTS: Sixty-four patients were retained for analysis. The median follow-up was 37 (range, 9-125) months. There were 15 local failures with a median time to local failure of 12 months. Seven patients were salvaged with further operation (4 by repeat local excision, 4 by abdominoperineal resection, and 1 by low anterior resection). The incidence of local recurrence increased with advancing stage of the carcinoma (T1, 13 percent; T2, 24 percent; T3, 71 percent), histologic grade of differentiation, (well, 12 percent; moderately, 24 percent; poorly, 44 percent), and margin status (negative, 16 percent; close (within 2 mm), 33 percent; positive, 50 percent). Sixteen percent of carcinomas < or = 3 cm failed compared with 47 percent for carcinomas > 3 cm. Nine percent (1/11) of T2 patients treated with adjuvant radiation therapy recurred locally compared with 36 percent (5/14) without radiation therapy. Three of four T3 patients who received radiation therapy failed locally compared with two of three who did not. Using the Kaplan-Meier method, the overall survival at five years was 71 percent, and disease-free survival was 83 percent. Actuarial local failure was 27 percent and freedom from distant metastasis was 86 percent. The sphincter preservation rate was 90 percent at five years. CONCLUSIONS: Local excision alone is an acceptable option for well-differentiated, T1 carcinomas, < or = 3 cm. Adjuvant radiation is recommended for T2 lesions. The high local recurrence rate in patients after local excision of T3 lesions with or without adjuvant radiotherapy would mandate a radical resection.

Adenocarcinoma↗
PubMed1999

Determination of domperidone in human serum and human breast milk by high-performance liquid chromatography-electrospray mass spectrometry.

A sensitive and selective method for the determination of domperidone in human breast milk and serum has been developed. The same method may be successfully applied to both matrices to a lower limit of quantitation of 0.5 ng/ml. Samples are processed by a liquid-liquid extraction, and analyzed by LC-ESI-MS in positive ion mode. There was no interference, on the domperidone quantitation, from over 30 drugs. Samples from patients, at various times post-dose, were analyzed and a large number showed significant levels of domperidone in the breast milk as well as in the serum.

Antiemetics↗
PubMed1996

Urine culture screening in lithotripsy compared with traditional methods.

The authors compare biochemical screening tests with microscopy, cultures, and patient symptoms in 257 patients who visited the Urology-Lithotripsy Unit. They conclude that strip screening and microscopy were poor methods to screen for UTI in patients with stents and raise the question whether all stent patients or just symptomatic stent patients should have urine cultures. The authors also suggest that UTI can be eliminated as a diagnosis in 45% of non-stent patients by using strip screening and not doing further testing. These recommendations have quality improvement and cost effectiveness implications.

Acute Disease↗
PubMed1995

Improving quality and resource utilization through the clinical technologist.

This paper reports on the significant benefits realized during the implementation of a Clinical Technologist position in two wards of a major teaching hospital. In addition to efficient and effective handling of specimens and test results, the program results in significant savings and in enhanced patient care.

Cost Savings↗
PubMed1992

Refinement of the structure of Escherichia coli-derived rat intestinal fatty acid binding protein with bound oleate to 1.75-A resolution. Correlation with the structures of the apoprotein and the protein with bound palmitate.

The structure of rat intestinal fatty acid binding protein (I-FABP) with bound oleate (C18:1) has been refined with x-ray diffraction data to a resolution of 1.75 A. The protein contains 10 anti-parallel beta strands composed of 99 residues and 2 short helices of 14 residues. Oleate is located in the interior of the protein in a bent conformation with C1-C12 more ordered than C13-C18. Two of the eight ordered waters in I-FABP:oleate are part of a hydrogen bond network that includes the carboxylate of oleate, the guanidinium group of Arg106, the nitrogen of the indole group of Trp82, and the side chain of Gln115. Most of the methylenes of bound oleate reside in a crevice formed by hydrophobic and aromatic side chains. Tyr70 and Tyr117 envelop the acyl chain from C3 to C8 forming contacts with both the convex and concave faces of its van der Waals surface. The hydroxyls of each phenolic side chain hydrogen bond to ordered water molecules. Two ordered waters make van der Waals contact with the concave face of the bound fatty acid. The omega-terminal methyl of oleate is oriented so that it points toward the center of the benzene of Phe55 allowing it to form van der Waals interactions with its component methylenes. Comparison of the structure of I-FABP:oleate with a recently refined 1.19-A model of apoI-FABP and an earlier 2.0-A model of I-FABP:palmitate revealed a remarkable degree of similarity in the positions of their main chain and side chain atoms and in the conformations of the bound oleate and palmitate. The principal differences were confined to a few discrete regions of the protein. The helical domain, the type I turn between beta strands C and D, and the ring of Phe55 together form a solvent-accessible portal to the interior of the protein. They are repositioned in I-FABP:oleate (and I-FABP:palmitate) so that the binding cavity is even more accessible to solvent and its volume is increased. The side chain of Phe55 which shows discrete disorder in the apoprotein functions as an omega-terminal "sensing device": moving progressively outward toward the surface as the chain length of the bound fatty acid increases by 2 methylenes. Tyr70 and Tyr117 which also show discrete disorder in the apoprotein structure due to rotation around their C alpha-C beta bonds, are stabilized in a single, well ordered position in the holoproteins.(ABSTRACT TRUNCATED AT 400 WORDS)

Amino Acid Sequence↗
PubMed1992

Comparison of blood cultures with corresponding venipuncture site cultures of specimens from hospitalized premature neonates.

We compared the presence and identities of isolates from blood culture samples obtained by percutaneous venipuncture with those of commensal skin organisms cultured from respective venipuncture sites after skin cleansing; 677 blood and skin site culture pairs from 488 infants were compared. Organisms grew in 58 blood cultures; nine of these cultures had corresponding venipuncture site cultures that also grew organisms. Forty-two blood culture isolates were coagulase-negative staphylococci; five of these were associated with similar venipuncture site cultures. According to restriction-endonuclease fingerprinting of chromosomal DNA and plasmid analysis, three pairs of blood and venipuncture site cultures were identical and two pairs were different. Thus only 7% (3/42) of coagulase-negative staphylococcal blood isolates were associated with identical contamination at the venipuncture site. We conclude that, if the venipuncture site has been carefully cleansed, the growth of coagulase-negative staphylococci in blood cultures of specimens from premature neonates indicates bacteremia rather than skin contamination in the vast majority of cases.

Bacteremia↗
PubMed1991

Isolation of Agrobacterium radiobacter from a central venous catheter.

A case of septicemia caused by Agrobacterium radiobacter is reported in a patient undergoing chemotherapy treatment who had recently been neutropenic. Agrobacterium radiobacter was isolated from the Hickman line blood culture. The patient responded favorably to removal of the Hickman catheter and treatment with amikacin and piperacillin. The molecular and biochemical characteristics of the isolate are presented.

Amikacin↗
PubMed1988

Isolation of Rhodococcus rhodochrous from a chronic corneal ulcer.

Organisms belonging to Rhodococcus species have been isolated as the causative agent of infections in many animals and humans. The majority of the human infections so far reported have been limited to immunocompromised patients including AIDS patients. We report an elderly woman with a chronic corneal ulcer infected with Rhodococcus. To our knowledge there is no previous report on a Rhodococcus infection of the eye. Rarity of this type of infection by Rhodococcus in a locally immunocompromised site in an otherwise healthy individual prompted this case history.

Aged↗
PubMed1986

Determining productivity and unit costs in a bacteriology laboratory.

This paper describes in detail the process of identification of the "products" of a department of clinical microbiology, the determination of resource requirements, the identification of total resource costs and the calculation of unit costs in order to identify the items which can be regarded as profitable in relation to the OHIP fee scale, as well as those services whose true cost is not met by that scale. The process permits an assessment of the overall profitability of the entire division and provides data for judging the probable gains from contracting out services.

Accounting↗
PubMed1986

Determining productivity and unit costs in a bacteriology laboratory.

This paper describes in detail the process of identification of the "products" of a department of clinical microbiology, the determination of resource requirements, the identification of total resource costs and the calculation of unit costs in order to identify the items which can be regarded as profitable in relation to the OHIP fee scale, as well as those services whose true cost is not met by that scale. The process permits an assessment of the overall profitability of the entire division and provides data for judging the probable gains from contracting out services.

Bacteriology↗