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K Kothari

Publications and source records attributed to K Kothari.

31 records · Page 2Linked to original sources

Radiochemical studies of 99mTc complexes of modified cysteine ligands and bifunctional chelating agents.

The synthesis of four novel ligands using the amino-acid cysteine and its ethyl carboxylate derivative is described. The synthetic method involves a two-step procedure, wherein the intermediate Schiff base formed by the condensation of the amino group of the cysteine substrate and salicylaldehyde is reduced to give the target ligands. The intermediates and the final products were characterized by high resolution nuclear magnetic resonance spectroscopy. Complexation studies of the ligands with 99mTc were optimized using stannous tartrate as the reducing agent under varying reaction conditions. The complexes were characterized using standard quality control techniques such as thin layer chromatography, paper electrophoresis, and paper chromatography. Lipophilicities of the complexes were estimated by solvent extraction into chloroform. Substantial changes in net charge and lipophilicity of the 99mTc complexes were observed on substituting the carboxylic acid functionality in ligands I and II with the ethyl carboxylate groups (ligands II and IV). All the ligands formed 99mTc complexes in high yield. Whereas the complexes with ligands I and II were observed to be hydrophilic in nature and not extractable into CHCl3, ligands III and IV resulted in neutral and lipophilic 99mTc complexes. The 99mTc complex with ligand II was not stable and on storage formed a hydrophilic and nonextractable species. The biodistribution of the complexes of ligands I and II showed that they cleared predominantly through the kidneys, whereas the complexes with ligands III and IV were excreted primarily through the hepatobiliary system. No significant brain uptake was observed with the 99mTc complexes with ligands III and IV despite their favorable properties of neutrality, lipophilicity, and conversion into a hydrophilic species. These ligands offer potential for use as bifunctional chelating agents.

Animals↗

Combined topical-peribulbar anesthesia for cataract surgery.

PURPOSE: To evaluate the anesthetic effect of single-point low-volume peribulbar anesthesia supplemented by topical anesthesia. SETTING: Private ambulatory ophthalmic practice. METHODS: Five hundred consecutive patients received 4 cc of lidocaine 2% with 200 units hyaluronidase as 1-point peribulbar anesthesia. This was supplemented by lidocaine 4%, 1 drop every 3 to 5 minutes for 3 instillations. Phacoemulsification and intraocular lens implantation were performed through a scleral tunnel or clear corneal approach. All patients were evaluated for intraoperative akinesia, lid closure, and anesthesia. One hour after surgery, the eye patch was removed and patients were evaluated for pain, discomfort, foreign-body sensation, diplopia, and lid closure. RESULTS: All patients had no pain to mild discomfort during surgery; 34% had total and 58% partial akinesia; 78% had poor orbicularis action (lid closure); 12% had subconjunctival hemorrhage. Postoperatively, 42% of patients had foreign-body sensation caused by conjunctival coaptation by diathermy or corneal edema. Diplopia occurred in 32% of patients but resolved within 1 hour after eye-patch removal, and partial ptosis occurred in 58%, resolving within 2 hours of patch removal. All patients had normal lid closure when the eye patch was removed. CONCLUSIONS: Low-volume 1-point peribulbar anesthesia supplemented by topical anesthesia was safe and effective and provided early visual recovery. Topical therapy can be started 1 hour postoperatively.

Administration, Topical↗

Estimation of fasting and post oral glucose serum insulin levels in hypertensive and obese subjects.

Insulin resistance and consequent hyperinsulinemia has been documented as a frequent occurrence in hypertension and obesity. Fasting and post oral glucose serum insulin levels serve as reliable markers of the state of insulin resistance. In this study, fasting serum insulin levels, as measured by radio-immunoassay method, were found to be more increased in obese individuals than in those with hypertension alone. While, post-oral glucose load serum insulin levels increased more in hypertensive individuals than those with obesity alone. In subjects who had obesity and hypertension together, the fasting serum insulin levels did not show much change while post oral glucose load serum insulin levels greatly increased suggesting a compounding effect.

Adult↗

Clinicopathologic significance of p53 immunostaining in adenocarcinoma of the breast.

Methanol/acetone-fixed frozen sections of 87 breast carcinomas were studied with a panel of three anti-p53 monoclonal antibodies that had specificities for wild-type, mutant, or combined wild-type plus mutant epitopes by using the avidin-biotin method. Nuclear staining was present in 13 (15%) of 87 cases with the mutant-specific antibody. The combined-specificity antibody stained 28 (32%) of 87 cases, including all but one of the tumors that was positive with the mutant-specific antibody. None of the cases reacted with the wild-type-specific antibody. Immunostaining for mutant form p53 was strongly correlated with adverse clinicopathologic factors, including poor differentiation, absence of estrogen receptor protein, nodal metastases, and large tumor size. In groups that were stratified by axillary node status, disease-free survival (52-month mean follow-up) was worse among cases with positive staining for either antibody. This difference was statistically significant in node-positive patients with the combined-specificity antibody (disease free, 22% [p53+] vs recurred, 57% [p53+]). We concluded that (1) immunostaining for mutant forms of p53 characterizes a clinically aggressive subset of breast tumors and may have prognostic utility in some patient populations, and (2) antibody-dependent-staining patterns for p53 may reflect epitope specificities of various mutant forms.

Adenocarcinoma↗

Gadopentetate dimeglumine-enhanced chemical-shift MR imaging of the breast.

Standard T1-weighted MR images enhanced with gadopentetate dimeglumine show relatively minimal enhancement of breast lesions due to the high background signal from fat in the breast. Strongly enhancing lesions may become isointense relative to the fat signal and become invisible or indistinct after contrast administration. Fat-suppressed chemical-shift imaging (CSI) combined with administration of gadopentetate dimeglumine improves lesion detection and characterization in other areas of the body where a strong lipid signal is present. We evaluated this technique in the breast. Twenty patients with mammographic lesions were studied with standard unenhanced T1- and T2-weighted images and enhanced T1-weighted images, as well as with CSI before and after administration of gadopentetate dimeglumine. The series were ranked independently for border and matrix characteristics. The border was assessed for a smooth, irregular, or spiculated margin. The matrix or internal substance was evaluated for visibility and type of enhancement, homogeneous or inhomogeneous. The enhanced CSI images were superior to all other images in the depiction of border and matrix characteristics. Of 20 patients, a corresponding mass was detected on MR in 14. In two of the 14 patients, the lesion was seen only in the enhanced CSI images. Chemical-shift artifacts on enhanced T1-weighted images obscured border detail in several cases. Enhanced CSI improves visualization of breast lesions as compared with conventional MR imaging with or without enhancement. The enhanced CSI technique produces differential enhancement between glandular tissue and lesions while suppressing the signal from fat. This improves the visualization of border and matrix characteristics and depicts lesions that otherwise might be obscured.

Breast Neoplasms↗

Luxatio erecta.

Luxatio erecta or inferior dislocation of the shoulder joint is rare and is caused by a hyperabduction injury. The clinical appearance is characteristic, with the arm locked in an elevated position. Radiographically, the shaft of the humerus is directed upwards and the humeral head lies inferior to the glenoid fossa, although not in contact with it. Attention should be given to possible complication, particularly concurrent fractures, as well as injury to the brachial plexus or the axillary artery.

Adolescent↗

Milk-of-calcium renal cyst, evaluated by ultrasound and computed tomography.

Milk-of-calcium renal cysts, which when asymptomatic need no treatment, sometimes pose diagnostic problems by conventional radiography. Two such cases are here reported. The first case was further evaluated by ultrasonography only, the second case also by computed tomography and cyst puncture, because of an irregularity in the cyst wall. Both imaging modalities added valuable information.

Calcium↗

Preoperative radiographic evaluation of hypernephroma.

Computed tomography (CT) of hypernephroma is compared with arteriography in terms of accuracy and cost. Computed tomography is shown to be as accurate as arteriography with respect to identification and diagnosis of most renal masses. In selected cases, it has been more accurate than arteriography because of the definition of adjacent retroperitoneum and tumor extent. Most of our patients having CT have required supplemental inferior vena cavography preoperatively, and a few selected cases have required arteriography. Nevertheless, the renal arteriogram can be omitted in most cases because CT is effective in diagnosing and staging hypernephroma, in addition to being noninvasive and more cost-effective.

Adenocarcinoma↗

Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx.

A retrospective review of 333 previously untreated patients from 1965 to 1986, with primary squamous cell carcinoma of the oropharynx or hypopharynx, was undertaken to ascertain the prevalence of neck node metastases by neck level. The 333 patients underwent 344 classical radical neck dissections. Patients were grouped by clinical neck status at the time of neck dissection: elective dissection in the N0 neck (N = 71), and immediate therapeutic dissection in the N+ neck (N = 259). Detailed analysis was performed for each group based on the specific primary site. This revealed a predominance of neck node metastases in levels II, III, and IV for both oropharyngeal and hypopharyngeal primaries. Isolated "skip" metastases outside of levels II, III, or IV occurred in only 1 patient (0.3%). Otherwise, level I or V involvement was always associated with nodal metastases at other levels (ie, N2 disease). These data support the trend toward selective limited neck dissection (anterior modified) in N0 patients. Furthermore, they provide the foundation for planning of future prospective trials to assess the efficacy of modifications in the extent of neck dissection for carcinomas of the oropharynx or hypopharynx.

Adolescent↗