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Biomedical subjects

M Kalra

Publications and source records attributed to M Kalra.

At least 19 recordsLinked to original sources
PubMed2006

Effect of bariatric surgery on obstructive sleep apnoea in adolescents.

Obese adolescents, particularly those with extreme obesity (body mass index > or =40 kg/m(2)), are developing serious medical complications at an unexpectedly high rate. As non-operative approaches to weight loss have shown less than optimal results, paediatric patients are increasingly seeking bariatric surgical intervention. Bariatric surgical procedures are designed to restrict stomach size or impair macronutrient absorption. They typically result in substantial weight loss. As with adult studies, paediatric studies generally report good obstructive sleep apnoea (OSA)-related outcomes after bariatric surgery. Therefore, in patients meeting eligibility criteria, bariatric surgery can be a valuable approach for achieving significant weight loss and resolution of serious comorbidities such as OSA. Studies that focus on long-term assessment of OSA are needed to understand whether OSA resolution after adolescent bariatric surgery is sustainable over the lifetime.

Adolescent↗
PubMed2002

Antibiotic prophylaxis in surgery of the intervertebral disc. A comparison between gentamicin and cefuroxime.

Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy. Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.

Adult↗
PubMed2001

Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults.

Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures.

Adolescent↗
PubMed2001

An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts.

PURPOSE: To compare 2 techniques for optimizing joint congruency for miniature osteochondral autografting in the knee: intrinsic postoperative forces acting on overdrilled autografts protruding from the femur versus alignment by a surgeon at the time of grafting. TYPE OF STUDY: Controlled animal model experiment. METHODS: A full-thickness cartilage defect was created on the weight-bearing surface of the medial femoral condyle of 13 mature sheep. Three 4.5 x 10 mm cylindrical autografts were inserted into 14-mm deep recipient holes such that the grafts were held in place by side-wall friction alone. One treatment group received grafts that were delivered flush with the surrounding cartilage and the second group received grafts that were left 2-mm proud of the joint surface. RESULTS: Three months postoperatively, the proud grafts had been repositioned by weight bearing but perigraft fissuring and fibroplasia, and subchondral cavitations were serious complications. It is suspected that these complications were caused by excessive motion between the graft and recipient site in the proud grafts. CONCLUSIONS: Grafts should be delivered flush with the joint surface when performing osteochondral transfers to avoid graft micromotion and the consequent interference with graft integration and function.

Animals↗
PubMed2001

Limb salvage after successful pedal bypass grafting is associated with improved long-term survival.

OBJECTIVES: Assessments of outcome after reconstruction for critical limb ischemia frequently ignore functional result and long-term morbidity and mortality. This study was undertaken to identify factors affecting long-term clinical outcome and survival after pedal bypass grafting. METHODS: The clinical data of 256 consecutive patients who underwent pedal bypass grafting for critical limb ischemia over a 12-year period were retrospectively analyzed. RESULTS: A total of 174 men and 82 women (median age, 70 years; range, 30-91 years) underwent 280 pedal bypass graft placements with autologous vein. Seventy-five percent of the patients were diabetic, and 20% had renal insufficiency (serum creatinine level > 2 mg/dL). The in-hospital mortality rate was 1.6% (4/256). The mean follow-up was 2.7 years (range, 0.1-10.1 years). Rates of primary and secondary patency, limb salvage, and survival at 5 years were 58%, 71%, 78%, 60%, respectively. A total of 160 limbs (57%) required additional interventions. Nineteen early graft thrombectomies/revisions and nine early amputations were performed. One hundred thirty-eight late interventions included 31 graft salvage procedures, 27 wound debridements, and 34 minor and 42 major amputations. At last follow-up or death, 219 (78%) limbs were being used for ambulation. End-stage renal disease (ESRD) and composite vein grafts predicted limb loss (P <.001, P <.001, respectively). Overall survival at 5 years was 60%. Survival after amputation was 79%, 53%, and 26% at 1, 3, and 5 years. Amputation and ESRD predicted higher mortality (P =.014, P =.0001, respectively). CONCLUSIONS: Pedal bypass grafting resulted in good functional limb salvage, but at the expense of multiple interventions in more than half the cases. ESRD and composite vein graft were associated with poor long-term limb salvage. Amputation after bypass grafting was associated with significantly worse long-term survival.

Adult↗
PubMed2000

Adventitial versus intimal liposome-mediated ex vivo transfection of canine saphenous vein grafts with endothelial nitric oxide synthase gene.

PURPOSE: Experiments were designed (1) to evaluate liposome-mediated endothelial constitutive nitric oxide synthase (ecNOS) transfection in vein grafts and (2) to compare intimal and adventitial routes of transfection. METHODS: Male mongrel dogs (N = 36) underwent bilateral femoral artery bypass grafting with the lateral saphenous vein. In each animal one vein was transfected with plasmid (pVR1012) containing the ecNOS gene, and another vein was transfected with plasmid alone (control). Gene transfer was performed from either the intimal surface (Group I, n = 18) or the adventitial surface (Group II, n = 18). In each group there were three transfection subgroups (n = 6 each): (a ) 10 microg/mL naked plasmid DNA, (b ) 10 microg/mL plasmid DNA + liposome (LipofectAMINE PLUS), and (c ) 100 microg/mL plasmid DNA + LipofectAMINE PLUS. Grafts were harvested on the third postoperative day, and the transfection was assessed with molecular techniques and enzyme assay for activity of NOS by conversion of tritiated l-arginine to tritiated l-citrulline. Proliferating cells were quantified with a digital analysis of histologic sections after nuclear antigen Ki-67 (MIB1) immunohistochemistry. RESULTS: Transgene was identified with polymerase chain reaction in all ecNOS-transfected grafts, regardless of transfection modality. However, significant transcription of the ecNOS transgene was observed only in Group IIc (mean ecNOS messenger RNA, 8.7+/-1.7 vs. 3.1+/-0.7 x 10(-2) attomole/microL, in transfected compared with control grafts, respectively, P =.01). NOS activity increased approximately twofold in this group (11.58+/-2.1 and 6.3+/-1.0 pmol tritiated l-citrulline per milligram protein per hour in transfected and control grafts, respectively, P = .05). Numbers of proliferating cells did not differ among ecNOS-transfected and control grafts in any transfection group. CONCLUSION: These results suggest that ecNOS transfection of vein grafts is feasible through intimal and adventitial routes with naked DNA or a liposomal vector. However, efficient transcription of the transgene is evident at postoperative day 3 only after adventitial transfection of 100 microg/mL of the gene.

Animals↗
PubMed1999

An evaluation of myelography with non-ionic water soluble contrast medium-iohexol.

Iohexol myelography was performed in 25 cases of suspected spinal cord compression. Out of these, 24 cases gave optimally informative myelogram, while one case showed quasi-informative myelogram. Myelographic efficacy regarding the level of lesion was correct in all cases. On final evaluation 15 cases were diagnosed as extradural lesions, 9 cases as intradural extramedullary type and one case as diastematomyelia. Only single case which was diagnosed as intramedullary lesion on myelography was, in fact, an extradural lesion. There were only minor side-effects in the form of headache and paraesthesia in the lower limb. It was concluded that iohexol is a safe contrast medium with high efficacy and minimal side-effects for the total examination of spinal canal.

Contrast Media↗
PubMed1998

Exploring negative dating experiences and beliefs about rape among younger and older women.

Although there is extensive research describing negative dating experiences and rape myth beliefs among university- and college-age women, there is little exploration of these issues among older dating women. An exploratory study that extends existing research by investigating rape myth beliefs and negative dating experiences of women ranging in age from 18 to 85 years is described. Participants (N = 115) completed a questionnaire which included a standardized measure of rape myth adherence (R-Scale; Costin, 1985), and a series of questions that assessed concerns about the potential for negative experiences while dating and actual negative dating experiences (ranging from unwanted affection to rape). There were remarkable similarities among younger and older women with respect to their dating behaviors and experiences. Women from both age groups reported being the target of negative dating experiences and being concerned about these experiences--with older women expressing slightly more concern. Older women, however, endorsed rape myths to a greater extent. This suggests that older women may be at greater risk for self-deprecation because they may be more likely to attribute the negative experiences they encounter to personal faults. Findings highlight the need for more life-span research of dating experiences and attitudes towards dating violence.

Adolescent↗
PubMed1994

Comparison of measurement of stump pressure and transcranial measurement of flow velocity in the middle cerebral artery in carotid surgery.

Transcranial Doppler ultrasound measurement of the velocity of blood flow in the middle cerebral artery (MCA) was performed in 24 consecutive patients undergoing carotid endarterectomy. Measurements were performed preoperatively at rest, following common carotid artery compression, and continuously during surgery. In addition, internal carotid artery stump pressures were measured and a subjective assessment of back flow was made. No relationship between MCA flow velocity and stump pressure following carotid clamping was demonstrated. Peak and mean MCA flow velocity was significantly lower in patients with stump pressures < 30 mm Hg (p < 0.03) and those with poor back flow (p < 0.02).

Blood Flow Velocity↗
PubMed1993

Myocardial infarction after reconstruction of the abdominal aorta.

The records of 555 patients who underwent elective abdominal aortic reconstruction were analysed to identify risk factors predisposing to cardiac complications. Perioperative myocardial infarction occurred in 35 patients (6.3 per cent), of whom 12 (2.2 per cent) died. Using multiple logistic regression, four preoperative factors that were independently predictive for postoperative myocardial infarction were identified with the following relative risk ratios: history of transient ischaemic attacks, 5.08; raised serum creatinine level, 3.66; age > 60 years, 3.00; and angina requiring regular treatment, 2.74. A scoring system using these four factors was devised that identified 150 of the 555 patients as at high risk, and included 69 per cent of those with myocardial infarction after operation and 83 per cent of those who died. A clinical risk score is a practical first step in identifying patients at risk of myocardial infarction; it would also reduce the number of patients for whom sophisticated tests of cardiac function were necessary.

Aorta, Abdominal↗
PubMed1993

Autotransfusion in aortic surgery: the Haemocell System 350 cell saver.

Autotransfusion was performed during elective abdominal aortic reconstruction in ten patients using the recently developed Haemocell System 350. A mean of 60 per cent of total blood loss was salvaged, and during operation each patient was autotransfused 1 unit. Good preservation of cellular components, including platelets, was seen after processing with the device, which uses a vortex mixing filter for cell separation. There was no evidence of coagulopathy; mean free plasma haemoglobin levels were slightly raised (17 mg/dl) and plasma heparin concentration was negligible (0.10 units/ml) 4 h after surgery. A transient drop in plasma fibrinogen levels and the appearance of fibrin degradation products in low concentrations (mean 1.5 mg/l) were seen. Oxyhaemoglobin dissociation curves showed the salvaged red blood cells to have a normal affinity for oxygen. Renal and hepatic function remained unaltered and there were no complications attributable to autotransfusion. The device was easy to handle and a trained operator was not required.

Adult↗
PubMed1992

Bladder rehabilitation in spinal cord injury patients.

The relative efficacy of intermittent catheterisation, self or assisted, over indwelling catheterisation was studied on 44 patients of different extent of spinal cord lesions. All the surviving cases (9) of incomplete cord lesion became catheter free irrespective of the method of catheterisation. In these patients urine was also found to be infection free by the 5th week of admission. Twenty-seven cases of complete cord lesion (out of a total of 35) became catheter free, of whom 18 patients were on intermittent catheterisation (out of a total of 20) and 9 patients were on indwelling catheter (out of a total of 15 cases). In the later group incidence of urine infection was higher. Other complications like urethral trauma were comparable between patients with indwelling catheter and patients with intermittent, self or assisted, catheterisation.

Adult↗
PubMed1991

Open management of septic abdomen by Marlex mesh zipper.

Marlex mesh with zipper was used for abdominal closure in 5 of 147 patients with generalized peritonitis seen during a period of 2 years. Residual/recurrent intra-abdominal sepsis necessitating repeated explorations prompted use of this technique followed by frequent peritoneal lavages. Abdominal sepsis was successfully controlled in 4 of 5 patients, although we lost 3 of 5 patients due to multiple factors.

Abdominal Muscles↗
PubMed1989

Surgical significance of non-toxic iodine-avid goitre.

During the period 1970-87, of 1580 patients operated on for non-toxic nodular goitre, 17 satisfied the laboratory criteria for iodine avidity. All of these goitres were non-endemic, with no evidence of enzymatic deficiency. Preoperative thyroxine markedly reduced the surgical morbidity by decreasing the size and vascularity of the gland.

Adolescent↗