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Biomedical subjects

D S Kittur

Publications and source records attributed to D S Kittur.

At least 19 recordsLinked to original sources
PubMed2006

A new vascular anastomosis model: relation between outcome and experience.

BACKGROUND: Vascular anastomosis is a complex task that requires multiple skills. Existing training methods lack the ability to objectively quantify surgical skill. In this study we tested a new vascular anastomosis model for bench training. MATERIALS AND METHODS: Surgical performance was assessed based on the new vascular anastomosis training model. Thirty- eight subjects were asked to (1) close the end of a 6-mm polytetrafluoroethylene (PTFE) graft, using a continuous suturing technique with 6-0 polypropylene; (2) perform end-to-end and (3) end-to-side anastomosis using the same materials and techniques. RESULTS: The mean age (sd) of all participants was 28.3 (2.1) years. More surgically experienced trainees did better in all measures of technical skill. Although there was a tendency for those with previous experience with the training model to do better in terms of the technical outcomes, these differences were not statistically significant. Multivariable analysis revealed that level of surgical training and type of anastomosis were the only significant factors related to completion time. CONCLUSIONS: Our study confirmed the impact of increasing surgical experience on the technical skills of surgical trainees. Trainees with higher levels of training made fewer errors and completed the procedures faster than those with lower levels of training.

Adult↗
PubMed2005

Angiocidal effect of Cyclosporin A: a new therapeutic approach for pathogenic angiogenesis.

AIM: Angiogenesis is essential in the development of several disorders such as cancer, arthritis, and autoimmune diseases. Several agents prevent angiogenesis but only a few destroy established angiogenesis. In this study we tested whether local or systemic administration of Cyclosporin A (CyA) would inhibit as well as destroy established angiogenesis in an in vivo assay of angiogenesis. METHODS: We utilized an in vivo assay of angiogenesis in which an angiogenic mixture of Matrigel, FGF, VEGF, and heparin was injected subcutaneously into mice. Angiogenesis in the subcutaneous plugs was quantified by ANOVA. CyA or the vehicle for CyA was administered to the experimental or the control groups by three routes: by addition to the angiogenic mixture, by local injection into the angiogenic plug at various time points or by systemic administration at high doses. Angiogenesis was quantified by pointing method and expressed as an angiogenic index (AI). RESULTS: In control animals the subcutaneous plug of Matrigel with the angiogenic mixture revealed exuberant angiogenesis at day 4 and day 7. This angiogenesis was completely inhibited when CyA was included in the angiogenic mixture; the vehicle for CyA had no such effect. Angiogenesis that had progressed was found to regress after local subcutaneous injection of CyA at day 4 and 7. Similar regression of angiogenesis was noted when CyA was administered systemically after allowing angiogenesis to proceed for 4 days. CONCLUSIONS: Our experiments strongly suggest that CyA is both angiocidal and angiostatic in vivo. These results provide a basis for future therapy directed against established angiogenesis in malignancies and autoimmune diseases.

Animals↗
PubMed2003

Late abscess formation after spilled gallstones masquerading as a liver mass.

The most common complication during laparoscopic cholecystectomy is the spillage of stones into the abdominal cavity. Although spillage occurs in 30% of cases, the potential adverse effects of this event are rare and generally manifest within months. When complications do occur, however, they may cause significant morbidity for the patient. We report an unusual case in which an inflammatory mass mimicking a liver tumor developed 5 years after the stones had been lost during a laparoscopic cholecystectomy. We therefore urge all surgeons to make every attempt to retrieve gallstones from the abdominal cavity once they have been accidentally dropped.

Abdominal Abscess↗
PubMed2000

Laparoscopic live donor nephrectomy: the recipient.

BACKGROUND: Laparoscopic live donor nephrectomy offers advantages to the donor in terms of decreased pain and shorter recuperation. Heretofore no detailed analysis of the recipient of laparoscopically procured kidneys has been performed. The purpose of this study was to determine whether laparoscopic donor nephrectomy had any deleterious effect on the recipient. METHODS: A retrospective review was conducted of all live donor renal transplantations performed from January 1995 through April 1998. The control group received kidneys procured via a standard flank approach (Open). Rejection was diagnosed histologically. Creatinine clearance was calculated using the Cockroft-Gault formula. RESULTS: A total of 110 patients received kidneys from laparoscopic (Lap) and 48 from open donors. One-year recipient (100% vs. 97.0%) and graft (93.5% vs. 91.1%) survival rates were similar for the Open and Lap groups, respectively. A similar incidence of vascular thrombosis (3.4% vs. 2.1%, P=NS) and ureteral complications (9.1% vs. 6.3%, P=NS) were seen in the Lap and Open groups, respectively. The incidence of acute rejection for the first month was 30.1% for the Lap group and 31.9% for the Open group (P=NS). The rate of decline of serum creatinine level in the early posttransplantation period was initially greater in the Open group, but by postoperative day 4 no significant difference existed. No difference was observed in allograft function long-term. The median length of hospital stay was 7.0 days for both groups. CONCLUSIONS: Laparoscopic live donor nephrectomy does not adversely effect recipient outcome. The previously demonstrated benefits to the donor, and the increased willingness of individuals to undergo live kidney donation, coupled with the acceptable outcomes experienced by recipients of laparoscopically procured kidneys justifies the continued development and adoption of this operation.

Acute Disease↗
PubMed1996

Organ donors and nondonors. An American dilemma.

The principal motive for organ donation in the United States remains altruism. Surveys suggest that if the life-threatening and critical shortage of cadaveric donor organs were appropriately understood by the public, an altruistic response would lead to increased donation. However, despite intense educational efforts appealing to altruism, cadaveric organ donation has not increased substantially while the number of patients in need of a life-saving organ has grown markedly. To understand why organ donation has not increased, a telephone survey and focus group sessions of volunteers who were either for or against donation (donors and nondonors, respectively) were reviewed. The focus group nondonors demonstrated a remarkable lack of trust in the fairness of organ allocation and in the success of transplantation; indeed, this mistrust extended to the entire medical profession. The donors in the focus groups, on the other hand, believed that the system worked equitably, although their knowledge about organ donation and transplantation was equivalent to that of nondonors. For organ donation to increase, efforts must be directed toward those who are not convinced that donation is for the common welfare. One way to increase organ donation is for physicians to educate their patients better regarding the equity and success of transplantation.

Comprehension↗
PubMed1994

Does high MHC class II gene expression in normal lungs account for the strong immunogenicity of lung allografts?

Clinical experience has demonstrated that lung allografts are considerably more immunogenic than liver allografts although both organs contain equivalent amounts of lymphoreticular tissue. Northern blot analysis of MHC class II gene expression in various murine organs with I-AB and I-EB gene-specific oligonucleotide probes revealed that MHC class II expression in lungs is semiquantitatively higher than in the liver and other organs with the exception of the spleen. We conclude that this high MHC class II expression strongly suggests that the lymphoreticular tissue in the lungs is in a state of activation. This may be an important reason for the strong immunogenicity of lung allografts.

Animals↗
PubMed1992

Transplantation of half kidneys in swine: I. Long-term survivors of hemirenal autotransplants.

We describe a novel model of hemirenal transplantation in swine wherein one-half of one kidney is autotransplanted by modifications of standard vascular anastomoses and ureteropyelostomy. Two pigs with hemirenal transplants performed in this manner have not only survived but have grown normally and had decreased but stable renal function for more than 1 year. The model confirms that one-fourth of the total renal mass is sufficient to sustain life and growth in pigs. It is anticipated that this model could be used to study the effects of renal ablation on remnant nephrons in pigs.

Anastomosis, Surgical↗
PubMed1992

Graft-specific MHC class II gene expression in response to allogeneic stimulus in heterotopic murine cardiac allografts.

Although, major histocompatibility complex (MHC) class II antigen expression in allografts is thoroughly studied, regulation of the genes for these antigens is not fully understood. The graft-specific MHC class II genes are potentially important in determining the immunogenicity of graft but their detection in a mixed-cell population such as in the allograft would require unambiguous differentiation of graft-specific class II expression from those in host lymphoid cells. With an oligonucleotide probe that specifically hybridizes to I-Ab mRNA from H-2k haplotype mice, we have studied I-A gene expression in cardiac allografts heterotopically transplanted from B10.Br (H-2k) to B10.D2 (H-2d) mice. Normal B10.Br hearts do not have appreciable I-Ab transcripts as determined with this probe, but 4 days after allografting, a substantial increase in I-Abk messenger RNA (mRNA) content was noted in the allografted hearts which persisted for the next 2 days and then decreased concomitant with destruction of the heart. The increase in I-Abk mRNA preceded the expression of surface Iak antigens on dendritic and endothelial cells in the allograft. These data indicate increased transcription of the I-Ab gene in cells of graft origin suggesting that transcriptional regulation is the initial mechanism for expression of class II genes in allografts. The sustained rise in graft-specific class II mRNA also seen in these allografts suggests that increased mRNA stability may be another mechanism for the increased density of class II antigens in allografts undergoing rejection.

Animals↗
PubMed1991

Laparoscopic repositioning of malfunctioning peritoneal dialysis catheters.

Continuous ambulatory peritoneal dialysis is commonly used for the maintenance of patients with chronic renal failure. A common complication associated with this treatment is outflow obstruction of the catheter. Noninvasive approaches to outflow obstruction such as enemas, infusions of saline, and body position changes are rarely successful in the management of these complications (1). Herein we report a review of our experience with the use of laparoscopy for the evaluation and management of peritoneal dialysis catheters with outflow obstruction.

Adult↗
PubMed1991

Surgical complications of pica: report of a case of intestinal obstruction and a review of the literature.

The authors describe a patient with chronic renal failure who developed intestinal obstruction from talcum powder pica. A literature review found 43 previously reported cases of surgical complications caused by various forms of pica. Most occurred in women, blacks, aborigines, children, or the mentally retarded--all groups in whom pica occurs more frequently than the general population. Intestinal obstruction was the most common clinical presentation and the ileum most often the site of obstruction reported at surgery. Perforation with peritonitis was the next most common presentation but three cases of colon perforation were diagnosed only at surgery or postmortem. Mixed pica (paper, plastic bags, cloth, string) seemed more likely to require surgery and to cause perforation. An accurate preoperative diagnosis was made most often when a history of pica was sought, and opacity on abdominal X rays correctly interpreted. These clues to pica as the underlying cause of abdominal complaints should not be neglected in patients who are members of the groups known to be at higher risk of this compulsive eating disorders.

Abdominal Pain↗
PubMed1990

Surgical aspects of sclerosing encapsulating peritonitis.

Sclerosing encapsulating peritonitis (SEP) is associated with the administration of beta-blocking agents as well as continuous ambulatory peritoneal dialysis. The predisposing factors in the latter group are recurrent peritonitis, presence of acetate in the dialysate, and antiseptics used during bag exchanges. We report a case of SEP following chronic ambulatory peritoneal dialysis and review the literature on this benign yet potentially lethal condition. Sclerosing encapsulating peritonitis frequently leads to intestinal obstruction, small-bowel necrosis, enterocutaneous fistulas, and malnutrition. There is a high incidence of anastomotic failure when a resection and primary intestinal anastomosis is performed in patients with SEP. Although SEP is not commonly reported in the surgical literature, its importance to surgeons is indicated by the fact that the overall mortality rate is close to 60% in patients with SEP who develop surgical complications.

Adult↗
PubMed1990

Soluble interleukin-2 receptors in cerebrospinal fluid from individuals with various neurological disorders.

Soluble interleukin-2 (IL-2R) levels in the cerebrospinal fluid (CSF) were studied in infectious, inflammatory, degenerative, and neoplastic disorders to evaluate their usefulness as a marker for the presence of activated T cells, thus indicating an inflammatory process. CSF from control subjects and patients with stationary, progressive, and treated multiple sclerosis (MS); aseptic meningitis; lymphoid and nonlymphoid central nervous system (CNS) tumors; Alzheimer's disease, as well as serum from MS patients and control subjects were studied for levels of soluble IL-2R. A significant increase in CSF IL-2R levels was observed in patients with MS, meningitis, and lymphoid CNS tumors; the MS group showed the highest values. CSF from individuals with Alzheimer's disease and from patients with nonlymphoid tumors did not show significantly elevated values. Serum IL-2R levels were significantly higher in MS patients than in control subjects, but there was no significant correlation between individual serum and CSF IL-2R levels. This study suggests the presence of activated T-lymphocytes in the CNS of patients with MS.

Biomarkers↗