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Biomedical subjects

F Patel

Publications and source records attributed to F Patel.

At least 37 records · Page 2Linked to original sources
PubMed1994

Comparison of chorionic villus sampling and amniocentesis for fetal karyotyping at 10-13 weeks' gestation.

We did a prospective study of women with singleton viable pregnancies at 10-13 weeks' gestation who requested first-trimester fetal karyotyping because of advanced maternal age, parental anxiety, or family history of chromosomal abnormality. Women were counselled as to the available options of non-invasive screening or invasive testing by mid-trimester amniocentesis, early amniocentesis (EA), or chorionic villus sampling (CVS), or randomisation to EA or CVS at 10-13 weeks. EA was done in 731 patients (493 by choice and 238 by randomisation) and CVS in 570 (320 by choice and 250 by randomisation). Both procedures were done by transabdominal ultrasound-guided insertion of a 20-gauge needle. The rate of successful sampling was the same for both procedures (97.5%). Spontaneous loss (intrauterine or neonatal death) was significantly higher after EA (total group mean = 5.3%, 95% CI 3.8-7.2; randomised subgroup mean = 5.9%, 3.3-9.7) than after CVS (total group: mean = 2.3%, 1.2-3.9; randomised subgroup: mean = 1.2%, 0.3-3.5). The gestation at delivery and birthweight of the infants after EA and CVS were similar. In the EA group the incidence of talipes equinovarus (1.63%), was higher than in the CVS group (0.56%), but this difference was not significant.

Adult↗
PubMed1994

Diabetic death bed: post-mortem determination of hypoglycaemia.

The post-mortem biochemical determination of hypoglycaemia in the practice of forensic medicine is notoriously imprecise and attracts perennial criticisms, particularly from those who may be alien to the peculiarities of medical jurisprudence. There has been re-emphasis recently on the neuropathological pathoclisis ascribed to prolonged hypoglycaemia. Unfortunately, the value perceived is limited by pathognomonic unreliability owing to agonal multifactorial influences and rapidly fatal nocturnal hypoglycaemia. The predicament is oppressive to a consideration of preponderant evidence and an unpopular diagnosis of peri-mortem hypoglycaemia, unless audacious, may be precluded simply because the proof is difficult. This is likely to contribute to diagnostic under-estimation of enigmatic diabetic deaths. A suspected case of lethal nocturnal hypoglycaemia in a young diabetic on 'animal' insulin is presented to restore some perspective to the clinico-pathological deference for an endangered post-mortem diagnosis of hypoglycaemia inferred from minimal evidence.

Adult↗
PubMed1994

Artefact in forensic medicine: postmortem rodent activity.

The human body may be attacked by a variety of animals. It is a potential source of confounding marks for forensic practitioners when unmasking criminal activity. A case that posed some problems for the crime scene investigators on discovering a dead body indoors, which had both ears missing is discussed. The suspicion initially was that of homicidal mutilation of the corpse. A general awareness of artefactual postmortem animal activity may avoid their misinterpretation. This short report acknowledges a persistent paucity in the forensic literature on the subject of human remains and postmortem animal activity.

Aged↗
PubMed1993

Artefact in forensic medicine. Fetal congenital abnormality.

A case of congenital defect in an abortus is described and the forensic implications of unawareness of childhood artefactual abnormalities which may appear to have a cryptogenic criminal etiology are reiterated. This is apparently the first case reported in which gastroschisis had been misconceived to be criminal abortion.

Abdominal Muscles↗
PubMed1992

Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.

Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.

Brachytherapy↗
PubMed1992

A matter of large body passing through a small hole: the holeproof out the window.

A baffling case of fall-from-height is described focusing on aspects of a human body passing through a small hole, within a holeproof window. It is a classic example of an unsatisfactory outcome when a scene of death is modified adversely due to delay in the commencement of scene management. The operative factors may be entirely outside the control of scene investigators. The primary medical attendant is reminded of the forensic obligations at a scene of unnatural death. Reporting this case might encourage forensic practitioners having experience of a similar case to respond through this journal.

Adult↗
PubMed1992

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement: a forensic presentation.

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement (CVR) are apparently unreported in the recent literature. An uncommon example of delayed non-valvular lethal complication of CVR occurring in the early out-patient period is reported here. The forensic aspects of wound dehiscence in cardiovascular surgery for cardiac valve replacement are discussed, and complemented by a study of the fracture ends of suture material in wound breakdown associated with the suture failure.

Adult↗
PubMed1992

The fatal paracetamol dosage--how low can you go?

Popular texts and forensic literature pertaining to paracetamol toxicology advocate an acceptable minimal dose or lower limit of the blood level 'normally' associated with a fatal single overdose. A case of fatal, acute paracetamol poisoning from a minimal single dose, within the recommended therapeutic daily total and associated with a zero blood paracetamol level, is reported. It also emphasizes the common knowledge that the toxicological tabulated reference data available on fatal levels of most drugs is merely a guide. The proper interpretation of the analytical results thus requires the full consideration of the circumstances surrounding the death in each case. The clinico-pathophysiology and toxicology of paracetamol poisoning is briefly reviewed in an attempt to establish how low a fatal paracetamol dosage can go. The phenomenon of fatal dose and blood level is in a paracetamol limbo.

Acetaminophen↗
PubMed1992

Fatal self-induced hyperinsulinaemia: a delayed post-mortem analytical detection.

The inconspicuous number of cases of self-induced hyperinsulinaemia reported in the literature may suggest that many are obscure enough to escape their detection. A case of fatal suicidal hyperinsulinaemia in a non-diabetic is reported here, and in whom only a retrospective biochemical analysis provided an explanatory cause of death. A quantitative radioimmuno assay (RIA) estimation of the refrigerated postmortem blood sample stored at 4 degrees C for three weeks gave a positive insulin yield. It reiterates the need, in forensic cases, for a very low threshold of suspicion and a good back-up for the appropriate body fluid analysis or tissue microexamination, especially when full details of the circumstances surrounding the death are not available at the autopsy. A brief résumé on insulin is presented as a background to the current forensic interest in the apparent increase in sudden deaths in young diabetics amidst the controversy about the bio-designed 'human' insulin and subjective unawareness of severe hypoglycaemia.

Adult↗
PubMed1992

Yeasts at different mucosal sites in patients with carcinoma cervix before and following radiotherapy.

The yeasts isolated from four superficial sites and blood were studied before and during radiotherapy in patients with carcinoma of the cervix. Significant yeast growth increased markedly in all four superficial sites during the 1st and 2nd week following radiotherapy. By the 4th week the count had decreased in all samples except in stool of 4 patients. Candida albicans was the most frequent isolate (54.3%) followed by C. tropicalis (28.3%).

Candida↗
PubMed1992

Acallosal brain in sudden infant death syndrome (SIDS).

A definitive explanation of "crib" or "cot" death remains unknown. An unusual incidental autopsy finding of agenesis of the corpus callosum in a case presenting as "near miss" sudden infant death syndrome (SIDS) is discussed. Hitherto, only a single case associated with SIDS has been reported in the literature. The condition may be easily missed outside the interest in neuropathology.

Agenesis of Corpus Callosum↗