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Biomedical subjects

D K Mitra

Publications and source records attributed to D K Mitra.

At least 55 records · Page 3Linked to original sources
PubMed1999

T-lymphocyte subsets in the contralateral testis after unilateral blunt testicular trauma in pre-pubertal mice.

Although spermatozoa express antigens, they normally do not produce an immunological response because of the blood-testis barrier and the predominance of CD8(+) T-lymphocytes in the rete testis. Unilateral blunt testicular trauma (UBTT) has been reported to decrease fertility. The present study was designed to evaluate the sub-populations of T-lymphocytes in mice with testicular trauma. Twenty male mice aged 20 days were randomized into control and test groups. At about 70 days of age the contralateral testis was harvested, cell suspensions were prepared, and immunofluorescence staining was performed for detection of CD4(+ )and CD8(+) T-lymphocytes by flow-cytometry. The ratio of CD8(+) and CD4(+) lymphocytes was significantly higher (P < 0.001) in the control mice compared to the UBTT group (1.3 +/- 0.3 vs 0.5 +/- 0.01). The results suggest that UBTT alters the CD8(+)/CD4(+) ratio in the contralateral testis, which may have an important bearing on the pathogenesis of infertility in cases of testicular injury.

Animals↗
PubMed1999

Pyloric atresia associated with epidermolysis bullosa, malrotation, and high anorectal malformation with recto-urethral fistula: a report of successful management.

Pyloric atresia (PA) is an uncommon anomaly that may be associated with many other congenital anomalies, the commonest of which is junctional epidermolysis bullosa (JEB). Most of the cases of PA associated with JEB (Herlitz syndrome) reported have been fatal. A case of PA associated with JEB, malrotation, and a high anorectal malformation with a rectourethral fistula, which was hitherto undescribed, was successfully managed at our institution.

Anus, Imperforate↗
PubMed1999

Bladder-neck repair in urinary bladder exstrophy.

A simple modification of an existing technique for bladder-neck reconstruction in exstrophy of the urinary bladder is reported. The technique involves tubularization of the posterior urethra up to just below the ureteric orifices. It differs from other techniques in that no part of the bladder tissue is used for buttressing the repair, but all is utilized for enhancing the bladder volume. Only 2 of 20 patients remained incontinent after bladder-neck reconstruction; the remaining 18 have achieved socially acceptable continence.

Bladder Exstrophy↗
PubMed1999

Primary reconstruction of a congenital anterior urethral diverticulum.

A new technique for primary reconstruction of a congenital anterior urethral diverticulum is described. This operation eliminates the obstruction caused by the distal lip of the diverticulum and at the same time strengthens the unsupported urethral wall using tissue from the walls of the diverticulum. It has been used very effectively in two boys.

Child, Preschool↗
PubMed1999

Urodynamic evaluation in boys treated for posterior urethral valves.

This study describes the urodynamic findings in 22 patients with posterior urethral valves and discusses their association with urinary incontinence, age, mode of primary treatment, renal function, and changes in the upper tracts. The patients' ages ranged from 3 to 26 years and 27% were either adolescents or older. The urodynamic findings were categorized into 5 main patterns, although mixed patterns were also observed; (1) normal capacity and compliance with normal detrusor contractility (2/22 patients, 9.1%); (2) small-capacity, hypocompliant bladder (8/22 patients, 36.4%); (3) unstable bladder (2/22 patients, 9.1%); (4) large-capacity, hypotonic bladder with decreased detrusor contractility (2/22 patients, 9.1%); and (5) normal capacity and compliance but with decreased detrusor contractility (8/22 patients, 36.4%). More than one-half of the patients (57.1%) evacuated their bladders incompletely, and this seemed to be associated with post-treatment episodes of urinary-tract infection. The commonest symptom was daytime frequency, urgency, and leak with nocturnal enuresis, which urodynamically correlated with a small-capacity, hypocompliant or unstable bladder or to incomplete evacuation of the bladder, leading to significant post-void residue. Significant detrusor dysfunction was identified in 2 asymptomatic patients as well, emphasizing the need to perform a routine urodynamic work-up on all valve patients. Urodynamic properties seemed to be associated with age. Small, hypocompliant, and unstable bladders were almost always seen in prepubertal boys and in the first 5 years following undiversion, whereas large, hypotonic bladders with impaired contractility were seen in post-pubertal boys. While the current policy is to avoid high diversion, data in this study suggest that disorders of detrusor capacity, compliance, and contractility exist in children treated by primary valve ablation and vesicostomy and that abnormal detrusor dynamics seem to be a reflection of inherent developmental detrusor dysfunction consequent to congenital infravesical obstruction.

Adolescent↗
PubMed1999

Unilateral blunt testicular trauma in pre-pubertal rats.

Injury to the testis breaching the tunica albuginea is known to affect fertility. Blunt testicular trauma with an intact tunica albuginea has been reported to have no effect on contralateral testicular histology and Johnsen testicular maturation score. However, sensitive techniques like DNA flowcytometry have not been utilized so far to evaluate contralateral testicular germ-cell changes. Sixty-four male Wistar rats aged 20 days were randomized into groups I (control), II (unilateral blunt testicular trauma, UBTT), III (UBTT and excision of ipsilateral testis at 6 h), and IV (UBTT and cyclosporine for 30 days). Fertility, DNA flow cytometry of contralateral testicular tissue, and anti-sperm antibodies (ASA) were evaluated. Fertility and haploid-cell percentage of the contralateral testis were significantly decreased compared to controls in early adulthood (100 days). Around 150 days of age, as ASA decreased significantly, fertility and contralateral testicular haploid-cell population recovered and were comparable to the controls. Excision of the traumatized testicle around 6 h after injury or administration of cyclosporine for 30 days protected fertility and the contralateral testis. In contrast to group II rats, ELISA for ASA was negative in group III and IV rats. UBTT affects the contralateral testis and fertility. ASA mediate this damage. Orchidectomy performed around 6 h after trauma or short-term cyclosporine therapy prevents the damage.

Animals↗
PubMed1999

Experimental unilateral undescended testis: gubernaculectomy and anchoring or direct suture fixation?

This study was designed to evaluate whether creation of a unilateral undescended testis (U/L UDT) in rats by direct fixation of the testis can lead to changes in the contralateral (C/L) descended testis, and if so, whether this inherent problem of the model could be eliminated by anchoring the divided gubernaculum to indirectly fix the testis. Thirty male newborn rats were divided into three groups of 10 each and the procedure done on the 2nd day of life to create U/L UDT according to the group allocated: group I: sham-operated; group II: anchoring the gubernaculum after gubernaculectomy; group III: Direct suture fixation of the testis. Fertility, C/L testicular weight (TW), Johnsen score, seminiferous tubular diameter (STD), DNA flow cytometry, and serum anti-sperm antibodies (ASA) were studied. Fertility, C/L TW, Johnsen score, STD, and haploid cell population were significantly reduced in group III compared to group II, while significantly higher titers of ASA were found in group III. Gubernaculectomy and anchoring the gubernaculum to the anterior abdominal wall is a better technique of creation of experimental UDT, as direct fixation of the testis is potentially detrimental to the C/L normal, descended testis.

Animals↗
PubMed1999

Total colonic aganglionosis: diagnosis and management in a 12-year-old boy.

Total colonic aganglionosis (TCA) is an unusual form of Hirschsprung's disease, and most of these present within the first few weeks and nearly all by the end of the first year of life. Very few cases presenting in older childhood or adulthood have been reported. Without a high index of suspicion these cases can easily be missed and, therefore, patients undergo repeated laparotomies for subacute intestinal obstruction without relief of symptoms. The diagnosis is suspected on operative findings and confirmed by histological evaluation of seromuscular biopsy specimens. Proper diagnosis will prevent loss of bowel length caused by inadvertent resection and will help in performing an optimal procedure to treat these patients. Discussed herein is another case of TCA in a 12-year-old boy with review of relevant literature.

Child↗
PubMed1999

Endoscopic treatment of tracheoesophageal fistula using electrocautery and the Nd:YAG laser.

BACKGROUND: Endoscopy is a well-established means of diagnosis in recurrent and congenital H-type tracheoesophageal fistulas. There is only limited knowledge of its role in the treatment using either electrocautery or laser. Laser application has not yet been reported in the treatment of recurrent tracheoesophageal fistula. METHODS: From 1993 to 1997 five patients with tracheoesophageal fistula (two congenital H-type and three recurrent) were treated endoscopically using a rigid ventilating bronchoscope. The final diagnosis was made on bronchoscopic examination. In two of the patients with recurrent fistulas and one with congenital fistula, the mucosal lining was fulgurated with electrocautery via an insulated wire. In one patient each with recurrent and congenital fistula, the mucosal lining was vaporized with the Nd:YAG laser via a 600 microm bare quartz fiber. RESULTS: Obliteration of the fistula was achieved in both the patients in whom laser was used, but it was unsuccessful in two of the three children in whom electrocautery was used. The obliquity of the congenital H-type fistula renders it more amenable to obliteration compared with the short and direct recurrent fistula. There was significant respiratory distress in the postoperative period after use of electrocautery. However, it was uneventful with the use of laser. CONCLUSIONS: Endoscopic treatment of recurrent and congenital H-type tracheoesophageal fistula is technically easier than open surgical procedures and helps avoid the risks associated with the latter. The Nd:YAG laser is qualitatively better than electrocautery for the obliteration of the fistula.

Adolescent↗
PubMed1999

Pre-operative management of congenital choledochal cyst with ultrasound-guided percutaneous choledochalcystostomy.

Choledochal cyst is a rare congenital anomaly of the biliary system, presenting in infancy. Two cases of choledochal cyst (one infected) with grossly deranged liver function tests and associated biliary atresia, which were successfully managed pre-operatively by sonoguided percutaneous choledochalcystostomy, are reported here. The use of this technique in the treatment of patients such as these is proposed.

Choledochal Cyst↗
PubMed1999

Long-term prognosis of renal function in boys treated for posterior urethral valves.

This paper discusses the long-term prognosis of renal function in 84 boys treated for posterior urethral valves and followed up for a period ranging from 1-21 years. Thirty-one of the 84 patients (39.3%) were either adolescents or had crossed adolescence and this study highlights the changes through adolescence and puberty. Serum creatinine was found to be raised in 53% patients at presentation and 22.5% patients eventually progressed to chronic renal failure. Serum creatinine value 1 year after appropriate decompression of the urinary tract was a more accurate predictor of the eventual renal outcome rather than serum creatinine at presentation. Decompensation at puberty was detected in 3 patients in this study. The predisposing factors identified were the persistence of gross hydroureteronephrosis with voiding dysfunction after treatment in one patient and renal parenchymal disease in the other 2 patients. The "risk factors" for predicting a poor eventual renal function were persistently raised serum creatinine 1 year after decompression by diversion or fulguration, bilateral high grade vesicoureteral reflux, persistent severe upper tract dilatation after treatment, voiding dysfunction and delayed presentation. This study emphasizes the need to diagnose and intervene early, to investigate post-treatment persistent upper tract dilatation for vesicoureteral junction obstruction and for detrusor dysfunction by a complete urodynamic evaluation and to follow up these patients carefully through adolescence and adulthood.

Adolescent↗
PubMed1999

Differential representations of memory T cell subsets are characteristic of polarized immunity in leprosy and atopic diseases.

We identified functionally polarized subsets of CD4 memory T cells on the basis of the expression of CD11a, CD45RA and CD62L. Within the several phenotypically distinct subsets of CD4 memory cells are two that, upon stimulation, produce primarily IL-4 (MT(2), CD45RA(-)CD62L(+)CD11a(dim)) or primarily IFN-gamma (MT(1), CD45RA(-)CD62L(-)CD11a(bright)). In addition, four other phenotypically distinct subsets of CD4 cells have unique cytokine profiles. To determine the clinical relevance of the representation of these cell types, we analyzed blood from patients with the chronic diseases leprosy and atopy. These diseases are characterized as immunologically polarized, since T cell responses in affected individuals are often strongly biased towards T(h)1 (dominated by IFN-gamma production) or T(h)2 (IL-4 production). We show here that this polarization reflects homeostatic or differentiation mechanisms affecting the representation of the functionally distinct subsets of memory CD4 T cells, MT(1) and MT(2). Significantly, the representation of the MT(1) and MT(2) subsets differs dramatically between subjects with tuberculoid leprosy (a T(h)1 disease), or lepromatous leprosy or atopic disease (T(h)2 diseases). However, there was no difference in the cytokine profiles of these or any of the other finely resolved CD4 subsets, when compared between individuals across all disease states. Thus, it is the representation of these subsets in peripheral blood that is diagnostic of the polarized state of the immune system.

CD4-Positive T-Lymphocytes↗
PubMed1999

Acute disseminated encehalomyelitis with typhoid fever.

A 45 year old male came with fever, headache, altered sensorium pallor and lower gastrointestinal bleeding. Laboratory investigations confirmed typhoid fever. Magnetic resonance imaging (MRI) was suggestive of acute disseminated encephalomyelitis.

Adult↗
PubMed1998

Mediastinal lymphangiomyoma in a child: report of a case.

Lymphangiomas and lymphangiomyomas are benign abnormal collections of lymphatic vessels which form a cystic mass. The mediastinum is an uncommon location for these hamartomas in children, but may be life-threatening. We report herein the case of a 23-month-old boy who presented with stridor and a history of recurrent respiratory tract infections. Soon after his admission he suddenly developed respiratory failure and was found to have a multiloculated, cystic mediastinal mass which was initially thought to be a lymphangioma. The mass was extensively infiltrative, and histological examination showed prominent smooth muscle proliferation in the walls of the cysts, confirming a diagnosis of lymphangiomyoma. The terminology and relevant literature on the topic are reviewed following the presentation of this case.

Humans↗
PubMed1998

Intra-pancreatic splenic artery pseudoaneurysm. A rare complication of chronic calcific pancreatitis.

The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangio-pancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin.

Aneurysm, False↗
PubMed1998

Acute renal failure in bilateral urinary tract tuberculosis.

A case of bilateral urinary tract tuberculosis presenting with acute renal failure is reported. It is believed to be the first reported instance of the disease presenting in this form. The patient was managed with preliminary high diversion followed by bilateral replacement of the ureters with ileal loops that were anastomosed end-to-side and then implanted into the bladder.

Acute Kidney Injury↗
PubMed1998

Effect of cyclosporine on fertility in male rats.

The effect of cyclosporine (CsA) on fertility has assumed greater importance with the increasing numbers of pediatric transplantations being performed all over the world. Conflicting reports on the effects of CsA on sex hormones are available. This experimental animal study was designed to examine the effect of CsA on testicular weight, sperm counts, seminiferous tubular diameter (STD), testicular morphology, DNA flowcytometry, sex hormone levels, and fertility in male rats. Those rats who received CsA (20 mg/kg per day) showed significant reductions in testicular weight (P < 0.05), sperm count (P < 0.01), Johnsen score (P < 0.05), STD (P < 0.01), serum testosterone levels (P < 0.05), haploid cell population (P < 0. 001) in the testis, and fertility (P < 0.001) compared to those receiving CsA 10 mg/kg per day and control rats. These findings will have an important bearing for children receiving cyclosporine for long periods to guide the physician in optimally adjusting long-term treatment.

Animals↗