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Biomedical subjects

L Shankar

Publications and source records attributed to L Shankar.

At least 19 recordsLinked to original sources

The uterine compression suture--a valuable approach to control major haemorrhage at lower segment caesarean section.

The aim of this article is to review the efficacy of a modified uterine compression suture in controlling major haemorrhage at lower segment caesarean section. This is a descriptive study of patients who had major obstetric haemorrhage where a compression suture was used to control bleeding at the two obstetrics unit in Cardiff between January 1998 and December 2003 (n = 11).

Adult↗

Noninvasive in vivo fluorescence measurement of airway-surface liquid depth, salt concentration, and pH.

The concentration of salt in the thin layer of fluid at the surface of large airways, the airway-surface liquid (ASL), is believed to be of central importance in airway physiology and in the pathophysiology of cystic fibrosis. Invasive sampling methods have yielded a wide range of ASL [NaCl] from 40 to 180 mM. We have developed novel fluorescent probes and microscopy methods to measure ASL thickness, salt concentration, and pH quantitatively in cell-culture models and in the trachea in vivo. By rapid z-scanning confocal microscopy, ASL thickness was 21 +/- 4 microm in well-differentiated cultures of bovine tracheal epithelial cells grown on porous supports at an air-liquid interface. By ratio imaging fluorescence microscopy using sodium, chloride, and pH-sensitive fluorescent indicators, ASL [Na+] was 97 +/- 5 mM, [Cl-] was 118 +/- 3 mM, and pH was 6.94 +/- 0.03. In anesthetized mice in which a transparent window was created in the trachea, ASL thickness was 45 +/- 5 microm, [Na+] was 115 +/- 4 mM, [Cl-] was 140 +/- 5 mM, and pH was 6.95 +/- 0.05. Similar ASL tonicity and pH were found in cystic fibrosis (CFTR-null) mice. In freshly harvested human bronchi, ASL thickness was 55 +/- 5 microm, [Na+] was 103 +/- 3 mM, [Cl-] was 92 +/- 4 mM, and pH was 6.78 +/- 0.2. These results establish by a noninvasive approach the key properties of the ASL and provide direct evidence that the ASL is approximately isotonic and not saltier in cystic fibrosis.

Animals↗

Pathology of Madras type of motor neuron disease (MMND)--a histological and immunohistochemical study.

A neuropathological report of Madras type of motor neuron disease (MMND) is presented and the differences from other forms of MND are discussed. An 18-year-old girl presented with nerve deafness and slowly progressive bulbo-spinal muscular atrophy, characteristic of MMND. Post-mortem examination of the spinal cord showed a severe loss of anterior horn cells, prominent dilatation of vessels, diffuse, but sparse sprinkling of microglial cells and lymphocytes, and demyelination and sclerosis of the ventrolateral columns. Neuronal depletion and marked gliosis was noted in the cochlear nucleus on both sides, while other bulbar motor nuclei were also involved. The cochlear nerve showed demyelination and axonal loss. Trigeminal and vestibular ganglia revealed features of ganglionitis. The possibility of an inflammatory aetiology for MMND needs to be considered.

Adolescent↗

Monitoring glutamate and ascorbate in the extracellular space of brain tissue with electrochemical microsensors.

This paper describes electrochemical microsensors for the in vivo measurement of glutamate and ascorbate in the extracellular space of brain tissue. To prepare glutamate microsensors, carbon fiber microelectrodes (10 microns in diameter and 300-400 microns long) were modified with a cross-linked redox polymer film containing enzymes. The microsensors were coated with a thin Nafion film before use. The glutamate microsensors were both selective and sensitive toward glutamate, with detection limits in the low micromolar range. Physiologically relevant concentrations of several electroactive compounds found in brain tissue produced no response at the glutamate microsensors and also did not affect their glutamate response, the only exception being glutamine, for which a small response was observed in the absence, but not in the presence, of glutamate. The ascorbate microsensors were used in conjunction with cyclic voltammetry. They were sensitive and selective toward ascorbate, but did exhibit a small sensitivity toward the dopamine metabolite, dihydroxyphenylacetic acid. The in vivo measurements performed establish the ability of the glutamate microsensors to monitor the component of the basal extracellular glutamate level that is derived from the neuronal activity of brain tissue.

Ascorbic Acid↗

The mysterious case of persistent malocclusion.

We report an unusual case of malocclusion following a history of apparently blunt trauma. No maxillary or mandibular fractures were identified. The malocclusion persisted for several days. Finally computed tomography was performed, which revealed a foreign body in the infratemporal fossa. A 4-cm pencil was extracted from the patient's right temporomandibular joint.

Adolescent↗

Histopathological & immunohistochemical evaluation of ageing changes in normal human brain.

As age related changes in the brain have not been systematically studied in the Indian population though there is an impression that they are less frequent, we studied 52 brains collected at autopsy from individuals above the age of 60 yr. The incidence of senile plaques (SPs) and neurofibrillary tangles (NFTs) together were found to increase with age from 21 per cent in the seventh decade to 33 per cent in the eighth decade and 54 per cent in the ninth decade, the increasing incidence of NFTs being statistically significant. The SPs were found both in the hippocampus and frontal cortex while NFTs were seen only in the hippocampus in non-demented aged individuals. In contrast, in the three cases of Alzheimer's disease (symbol: see text) AD studied, the NFTs and SPs were found in high density in both hippocampus and frontal cortex. By immunohistochemistry, various morphological forms of SPs were found to have beta amyloid protein consistently, while ubiquitin and phosphorylated neurofilament occurred variably. More number of SPs could be labelled by amyloid immunostaining than by conventional silver stains. The NFTs contained ubiquitin and phosphorylated neurofilament protein as the antigenic components, both in AD and normal ageing. The incidence of age related changes and their antigenic character in the limited sample studied from south India appears to be comparable to findings from the West. Multicentric studies on a large sample derived from different ethnic groups in India are needed to further evaluate these features.

Aged↗

Histological, histochemical and autoradiographic evidence of in vitro neurotoxic effects of the novel antitumor agent, 9-methoxy-N2-methylellipticinium acetate.

9-Methoxy-N2-methylellipticinium acetate (MMEA) exhibits selective cytotoxicity towards glial-derived human brain tumor cell lines comprising the U.S. National Cancer Institute preclinical drug screen. Neurotoxic potential of MMEA has been demonstrated in an in vitro model employing sagittal slices of rat brain. Histochemical staining of rat brain slices for lactate dehydrogenase (LDH) activity revealed decreased staining intensity following incubation with increasing concentrations of MMEA (0.1-100 microM). Cytological evaluation of paraffin sections stained with Cresyl Fast Violet revealed neuronal damage delineated by cytoplasmic vacuolation, and distention and fraying of the plasma membrane. No glial or vascular pathology could be discerned. Autoradiography, following exposure to 14C-MMEA, revealed distinct labelling of the large neurons of the brain stem, neurons in the thalamus and pyramidal neurons of the hippocampus, indicating neuronal uptake of the drug.

Animals↗

Renal dysfunction detected by beta-2 microglobulinuria in sick neonates.

OBJECTIVE: To assess renal involvement in sick neonates referred to Neonatal Intensive Care Unit (NICU) using standard renal parameters and urinary beta 2 microglobulin (B2M) excretion. DESIGN: Descriptive study. SETTING: Level II NICU and Nephrology Division of Pediatric Tertiary hospital. SUBJECTS: Forty six term sick neonates transferred for neonatal care and forty healthy term neonates who served as normal controls for urinary B2M excretion. METHODS: Standard tests including estimation of BUN, serum creatinine, blood pH, serum bicarbonate, serum and urinary electrolytes, urine output, and urinalysis. Urinary B2M levels were estimated from urine collected on day 1 (D1) and day 3 (D3) in all and 18 neonates were tested on day 7 (D7) by radio-immunoassay method. RESULTS: Statistically significant elevation of mean values of urinary B2M were noted when sick neonates were compared with normal controls irrespective of primary disease, indicating tubular dysfunction (41/46 = 90%), whilst only 7 of these (17%) had abnormalities indicating renal involvement when judged by standard tests. Very high levels of urinary B2M were noted with birth asphyxia (n = 9), sepsis (n = 8) and renal disease (n = 7). Transient elevation of urinary B2M was noted in meconium aspiration syndrome (n = 4). Ten surgical cases with non renal congenital malformations showed high urinary B2M and 12/18 tested on D7 had persistently high urinary B2M due to multiple factors. CONCLUSIONS: Elevated urinary B2M in 90% sick neonates with apparently normal renal parameters in majority (34/41) indicates subclinical proximal tubular dysfunction especially in neonates with asphyxia, sepsis and congenital malformations. Persistent elevation of urinary B2M appear to be a sensitive diagnostic indicator for defining a group of neonates with subtle renal tubular dysfunction, the clinical relevance of which on long term basis is a subject for future study.

Biomarkers↗

Petrous carotid canal stenosis in malignant osteopetrosis: CT documentation with MR angiographic correlation.

PURPOSE: To study the association between petrous carotid canal (PCC) and internal carotid artery (ICA) stenoses in patients with malignant osteopetrosis. MATERIALS AND METHODS: Mean and minimum PCC diameters obtained from cranial computed tomographic (CT) scans in 20 patients were compared with similar measurements in 52 control subjects. ICA caliber, evaluated with magnetic resonance (MR) arteriography, was correlated with age and PCC dimensions. RESULTS: There was a statistically significant difference between patient and control PCC diameters. There was a strong positive correlation between age and PCC diameter in the control subjects, but only a weakly positive correlation in the patients. One or both ICAs were stenotic on all patient MR arteriograms. MR angiographic stenosis grade correlated positively with age but not with PCC diameters. CONCLUSION: PCC and ICA stenoses occur frequently in patients with malignant osteopetrosis. Bony overgrowth or a "persistent fetal state" may produce the PPC stenoses. The findings do not support progressive PCC narrowing in these patients.

Adolescent↗

Diagnostic imaging of fungal sinusitis: eleven new cases and literature review.

Fungal sinusitis should always be considered in the differential diagnosis of chronic or recurring sinusitis resistant to adequate medical treatment. A high index of suspicion is necessary for the diagnosis, and the clinical examination is rarely conclusive. The definitive diagnosis depends on the pathologist in most cases. We reviewed retrospectively the imaging findings, specifically computed tomography (CT) and magnetic resonance (MR), in a series of fungal sinusitis patients. Non-enhanced CT scan is more sensitive than conventional X-ray in detecting the classical focal areas of hyper-attenuation and calcification seen in soft-tissue masses of fungal sinusitis. MR findings of hypo-intense signals on T1-weighted sequences which progress to signal-void area on T2-weighted sequences, are characteristic features of fungal sinusitis; however, it is reserved for cases where intracranial invasion is suspected or CT findings are inconclusive.

Adult↗

CT imaging in the diagnosis and treatment of sinus disease: a partnership between the radiologist and the otolaryngologist.

We consider that the nasal cavity and the paranasal sinuses cannot be declared completely normal without a normal CT scan. While CT scans are clearly useful in the evaluation of patients with recurrent sinusitis, it is important to emphasize that they should not be employed exclusively for diagnosis. Nasal endoscopy and clinical evaluation still form the basis for the diagnosis of chronic and recurring sinusitis. The CT technique described should be used only to supplement the clinical data obtained during history-taking and the rhinoscopic/endoscopic examination and is essential before functional endoscopic sinus surgery. The complexity of the diagnostic process is simplified to patient benefit when the radiologist and the otolaryngologist form a functional interactive partnership.

Humans↗

CT scanning for functional endoscopic sinus surgery: analysis of 200 cases with reporting scheme.

An analysis of the computed tomograms of the paranasal sinuses from 200 patients with sinonasal complaints is presented. The results of our study are similar to those of other reported series despite a different patient selection. We have developed a simple systematic reporting scheme which includes all of the relevant abnormalities, and which allows a much more detailed picture of the disease pattern to be generated for both clinical use and for analytical studies.

Adolescent↗

A family exhibiting carotid body tumours.

The authors describe the surgery carried out for 11 carotid body tumours (CBTs) that were found in three generations of a Greek family. Eight patients with CBTs were operated upon at St. Joseph's Health Centre, Toronto, within 1 year. Three patients had bilateral CBTs, which were removed in two stages. Only one of the CBTs occurred in a female. Seven CBTs were excised by meticulous subadventitial dissection. In the eighth, a previous attempt at removal in another hospital had proved unsuccessful, and excision of the tumour required ligation of the external carotid artery and partial excision of the carotid bulb. The authors conclude that most CBTs can be excised directly without ligation, shunts or bypasses. In eight operations carried out on five patients, the only complication was a transient neuropraxia of the hypoglossal nerve that resolved within 2 weeks.

Adult↗

Computed tomography versus magnetic resonance imaging and three-dimensional applications.

An attempt has been made to simplify and to provide an understanding of some of the new modalities for evaluation of head and neck pathology. Both CT and MRI are complementary to each other: MRI being superior to CT in evaluating soft tissue, and CT being superior to MRI in assessing fine bony details and in identifying microcalcifications. MRI is the modality of choice for tumor evaluation because it has several advantages over CT in assessing the location, spread, and staging of the disease. HRCT scanning remains the procedure of choice in the evaluation of middle ear and base of the skull, and in the evaluation of benign sinonasal disease. CPA and IAC lesions are best evaluated by MRI. Three-dimensional surface reformations of axial CT scans enable the surgeon to plan the operative approach needed to reduce facial fractures and to repair cranial deformities.

Humans↗