PubMed Health⌕ Search

Biomedical subjects

P Puri

Publications and source records attributed to P Puri.

At least 19 recordsLinked to original sources
PubMed1992

Mucosal neuroendocrine cell abnormalities in the colon of patients with Hirschsprung's disease.

We studied the distribution of mucosal neuroendocrine (NE) cells in the colon from 13 patients with Hirschsprung's disease (HD) and from 8 controls. Immunohistochemical studies were carried out using monoclonal and polyclonal antibodies against chromogranin A and synaptophysin (general markers of NE cells), 5-hydroxytryptamine (5-HT) (a marker of amine), peptide YY (PYY), and somatostatin (markers of neuropeptides). Chromogranin A immunoreactive cells were significantly increased in the aganglionic bowel compared with ganglionic bowel and controls (P less than .05). There was an increase in the number of synaptophysin immunoreactive cells in the aganglionic bowel compared with ganglionic bowel and controls but the results were not statistically significant. 5-HT immunoreactive cells were also significantly increased in the aganglionic bowel compared with ganglionic bowel and controls (P less than .05). The immunostaining for PYY demonstrated abundance of this NE cell type in the aganglionic bowel and this was highly significant compared with ganglionic bowel and controls (P less than .001). There was a significant increase in somatostatin immunoreactive cells in the aganglionic bowel compared with ganglionic bowel (P less than .01). The increase in neuroendocrine cells was found over the entire length of the aganglionic segment in rectosigmoid HD as well as in long-segment HD. These results demonstrating the increased levels of NE cells in the mucosa of aganglionic colon suggest that the NE cells may have a role in regulating the sustained contraction of the aganglionic intestine in HD.

Antibodies, Monoclonal↗
PubMed1992

Early induction of IL-6 in infants undergoing major abdominal surgery.

Cytokines are immunoregulatory molecules that are important mediators of the host response to stress and infection. Infants and children undergoing major surgery are particularly at risk of developing sepsis and have altered metabolic responses to surgical stress compared to adults. We have investigated the temporal sequence of cytokine responses in six infants (mean age, 11 +/- 7.5 months) undergoing pull-through operation for Hirschsprung's disease and correlated them with hemodynamic and biochemical parameters. Tumor necrosis factor (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured by ELISA preoperatively, intraoperatively (hourly), and 24 and 48 hours postoperatively. IL-6 levels increased significantly in all cases within 2 hours of commencement of the operation (P less than .01) and were maximal 24 hours postoperatively. No significant changes in IL-1 beta levels (mean range, 70 to 110 pg/mL) were seen in these patients. TNF levels were undetectable (less than 20 pg/mL) throughout the study. Cortisol levels were increased in all patients during operation. Serum C-reactive protein levels were first detected 24 hours postoperatively and continued to increase 48 hours postoperatively. Hemodynamically, heart rate increased during the first 3 hours of operation and correlated with increase in IL-6 levels. Blood pressure and temperature changes did not correlate with cytokine levels. This study identifies IL-6 as the earliest detectable cytokine response associated with major surgery in infants. It also suggests that IL-6 can be unregulated, independently of other cytokines, in response to surgical stress.

C-Reactive Protein↗
PubMed1992

Delayed primary anastomosis for esophageal atresia: 18 months' to 11 years' follow-up.

In 1977 we started treating babies with isolated esophageal atresia by delayed primary anastomosis and in 1981 reported our early experience in five cases treated between 1977 and 1979. Since 1979, 11 further consecutive cases have been managed by initial gastrostomy followed by delayed primary esophageal anastomosis. Their mean gestation was 35 weeks (range, 28 to 40 weeks) and mean birth weight was 2,040 g (range, 1,140 to 2,720 g). The esophageal gap between the two ends when assessed initially at fluoroscopy ranged from 2.2 to 4.5 cm (mean, 3.2 cm). Age at delayed primary anastomosis ranged from 6 to 20 weeks. Anastomotic leak occurred in three babies in the immediate postoperative period and all were successfully managed conservatively. Eight of the 11 patients developed anastomotic strictures; seven cases required 1 to 5 esophageal dilatations. One patient who did not respond to multiple esophageal dilatations required resection of an esophageal stricture. One patient died at 15 months of age of unrelated causes. The 10 surviving patients have been followed-up from 18 months to 11 years. At follow-up, seven patients were eating normally. Three patients had swallowing difficulties and all three were found to have esophageal strictures on barium swallow, two of them also had gross esophageal reflux and hiatus hernia. The height and weight in the 10 patients varied from 3rd centile to 75th centile. Delayed primary anastomosis is feasible in cases of isolated esophageal atresia and the patient's own esophagus is the best. A more aggressive approach should be applied to gastroesophageal reflux in these patients.

Anastomosis, Surgical↗
PubMed1992

Mucosal immune defence mechanisms in enterocolitis complicating Hirschsprung's disease.

Enterocolitis remains an important cause of morbidity and mortality in Hirschsprung's disease. The aetiology of enterocolitis is uncertain-ischaemic and bacterial causes and recently, rotavirus infections, have been suggested. Bowel tissue from 12 patients with Hirschsprung's disease who underwent Swenson's operation (five of whom had clinical evidence of enterocolitis) and colon from six controls subjects were examined to investigate possible immunopathological mechanisms associated with the disease. IgA, IgM, and J chain (but not IgG) containing plasma cells were significantly increased in the lamina propria along the entire length of resected bowel in enterocolitis patients, compared with non-enterocolitis patients and controls (p less than 0.01). Luminal secretory component staining of the anganglionic segment of colon from enterocolitis patients was considerably reduced. Lamina propria CD68 positive monocyte/macrophages and CD45RO positive leukocytes were increased in enterocolitis patients compared with non-enterocolitis patients (p less than 0.01). CD57 positive natural killer (NK) cells showed a unique distribution pattern compared with other cell types. Patients with enterocolitis showed a significant increase in CD57 positive NK cells in the lamina propria of ganglionic bowel only (p less than 0.05). NK cell values in ganglionic bowel of non-enterocolitis patients and in aganglionic bowel in all patients were similar to controls. The diversity of altered local immune response seen in this study may reflect a multifactorial microbial aetiology in enterocolitis associated with Hirschsprung's disease.

Antigens, CD↗
PubMed1992

Effect of coingestion of paracetamol on glycaemic response.

Rate of gastric emptying is a frequently measured variable in glycaemic response studies. One of the indices employed for measurement of the gastric emptying rate is the blood level of paracetamol at frequent intervals of time following coingestion of paracetamol with the meal. But the effect of paracetamol itself on glycaemic response is not known. The present study was performed on ten healthy and five NIDDM subjects. Each subject underwent two meal tolerance tests in random sequence. On one occasion the meal was white bread; on the other occasion, the meal consisted of the same quantity of white bread and 1.5 g paracetamol. The postprandial glycaemica following the two meals was not significantly different. Thus the results validate the use of the paracetamol technique for gastric emptying in glycaemic response studies.

Acetaminophen↗
PubMed1991

Glycaemic response to maize, bajra and barley.

The postprandial glycaemic response to maize (Zea mays), bajra (Pennisetum typhoideum) and barley (Hordeum vulgare) was studied in a pool of 18 healthy volunteers and 14 patients having non-insulin-dependent diabetes mellitus (NIDDM). In response to maize, none of the variables examined was significantly different as compared to white bread. The glycaemic response to bajra was significantly lower than that to white bread in healthy subjects, but the two responses were indistinguishable in NIDDM subjects. The insulinaemic responses to bajra and white break were not significantly different in either group of subjects. The glycaemic response to barley was significantly lower than that to white bread in both groups of subjects. But the insulinaemic response to barley was significantly lower than that to white bread only in healthy subjects. In NIDDM subjects, there was a tendency for the response to barley to be higher than that to white bread 0.5 h after ingestion. Barley, with a low glycaemic index (68.7 in healthy and 53.4 in NIDDM subjects) and a high insulinaemic index (105.2) in NIDDM subjects seems to mobilize insulin in NIDDM. This makes it a specially suitable cereal for diabetes mellitus.

Adult↗
PubMed1990

Endoscopic correction of primary vesicoureteric reflux by subureteric injection of polytetrafluoroethylene.

91 children (143 ureters) with primary vesicoureteric reflux (VUR) treated endoscopically by subureteric injection of 'Polytef' (polytetrafluoroethylene) paste were followed up for 2 to 5 1/2 years. 94% of the patients were treated as day cases. Reflux ceased in 113 (79%) of the 143 ureters after a single injection of polytef paste. 20% of ureters in this series required more than one endoscopic injection of polytef paste to correct reflux. Nearly 80% of the 113 ureters corrected after a single injection of polytef required less than 0.3 ml of paste per ureter to correct reflux. 88% of ureters continue to show absence of reflux 2 to 5 1/2 years after endoscopic correction. More than half of the recurrences were only of grade I or grade II severity and required no treatment. 7 ureters had recurrent grade III or IV reflux and were reinjected without any difficulty. The correction of vesicoureteric reflux by endoscopic injection of polytef paste is an outpatient procedure that requires 15 min of anaesthetic time. It is safe, simple, and effective in correcting all grades of reflux. Best results are obtained when the paste is injected precisely into the floor of the submucosal ureter.

Adolescent↗
PubMed1990

New insights into the pathogenesis of appendicitis based on immunocytochemical analysis of early immune response.

Although appendicitis is the most common condition requiring emergency surgery, the pathogenesis of this disease is poorly understood. In this study, local immune responses in acute appendicitis were investigated, using an experimental rabbit model, as well as in different grades of appendicitis in humans. Polymorphonuclear leukocyte (PMN) and plasma cell isotypes infiltration was measured in 24 New Zealand-bred white rabbits following experimental obstruction of the appendiceal lumen for periods ranging from 30 minutes to 24 hours. Significant infiltration of PMNs, IgM, and IgG plasma cells was noted at 30 minutes following obstruction, and IgA plasma cells were noted at 2 hours after obstruction. The immunopathological features observed in the study of human appendicitis clearly demonstrated the role of plasma cell infiltration in the immunopathogenesis of appendicitis. IgA and IgG plasma cells were significantly increased in the lamina propria of both focal and acute suppurative appendicitis, compared with controls (P less than .001). In focal appendicitis, in which the focus of inflammation is confined to only a few serial sections, the increased IgA and IgG plasma cell infiltration was present throughout the entire length of the resected organ. The possibility, as seen in this study, that antigen stimulation of the effector immune system could give rise to appendicitis, provides new insights into the diversity of inflammatory responses contributing to diseases of the intestinal tract. This previously unrecognised concept in the pathogenesis of appendicitis requires further elucidation of the stimulating agent, and in particular the T-cell recognition process.

Animals↗
PubMed1990

Semen analysis in patients operated on for impalpable testes.

Semen analysis was performed on 48 men who had undergone orchiopexy, 40 for unilateral impalpable testes and 8 for bilateral impalpable testes. Patients with unilateral impalpable testes had varying sperm analysis; 18 (86%) of the 23 patients with unilateral impalpable canalicular testes had normal sperm analysis. All patients with bilateral impalpable testes were azoospermic. The subsequent quality of the semen is dependent upon the original anatomical positions of the undescended testes.

Adolescent↗
PubMed1990

Relationship of primary site of testis to final testicular size in cryptorchid patients.

Testicular volume was examined in men who had undergone orchiopexy at or after 7 years of age; 159 men with 187 cryptorchid testes were available for estimation. The mean age at orchiopexy was 9.8 years (range 7-13.6) and the mean age at follow-up was 24.3 years (range 18-41). The data showed that surgically treated cryptorchism was associated with testes that are significantly smaller than normal. The most important factor in relation to subsequent testicular size was whether or not the testes were palpable. Testes found in the superficial inguinal pouch were approximately 85% of normal testicular volume. Contralateral testicular volume in unilaterally cryptorchid patients was not significantly different from that of controls.

Abdomen↗
PubMed1979

Lymphocyte response after surgery in the neonate.

Fourteen neonates born with congenital malformations were investigated for lymphocyte function before and after surgery. Total leucocyte and absolute lymphocyte counts were unaltered after surgery. The mean percentage of T-lymphocytes observed either pre- or postoperatively was considerably lower than that reported in older children and adults. While there was an increase in the percentage of B-lymphocytes after operation in the infants, the absolute number of B-cells remained unchanges. The preoperative transformation response of lymphocytes to PHA (mean 12.9 +/- 5.4 X 10(3) counts/min) was little different from the postoperative values (mean 12.4 +/- 4.4 X 10(3) counts/min). These results suggest that the neonate is immunologically different from older children and adults in its response to anaesthesia and surgery.

Anesthesia, Inhalation↗
PubMed1979

Immunological studies in neonates with spina bifida.

Fifteen neonates with spina bifida were investigated prior to surgery for T and B lymphocytes subpopulations and mitogen responsiveness to PHA. Results were compared to similar studies in 30 normal healthy neonates. The mean percentage of T-lymphocyes in spina bifida patients was 44.6% compared to 48.9% in normal neonates. A normal dose response to PHA was obtained in all patients. These results suggest no impairment of lymphocyte function in neonates born with spina bifida.

B-Lymphocytes↗
PubMed1978

Appendicitis in infancy.

One percent (40 infants) of all the children treated for acute appendicitis at Our Lady's Hospital for Sick Children presented during the first 2 yr of life. Nineteen of the 40 children had an appendix mass at the time of the diagnosis. Conservative management of the appendix mass followed by delayed elective appendectomy is a safe and effective method of treatment.

Acute Disease↗
PubMed1978

Duodenal ulcer in childhood: a continuing disease in adult life.

Thirty-one of the 37 children with duodenal ulcers were available for follow-up. Of the 28 patients treated medically, 22 had persistence of symptoms over periods up to 18 yr after the time of the initial diagnosis. Five patients required surgery elsewhere for complications, thirteen showed ulcer crater or duodenal deformity on a follow-up barium meal studies. Earlier surgery is recommended in chronic ulcer disease.

Adolescent↗
PubMed1978

Hirschsprung's disease: an appraisal of histochemically demonstrated acetylcholinesterase activity in suction rectal biopsy specimens as an aid to diagnosis.

Suction rectal biopsy specimens, from a series of 168 infants and children with constipation and other gastrointestinal problems, were stained with a sensitive acetylcholinesterase method, and the results were compared with routine histology, radiology, anorectal manometry, and the final diagnosis. In all cases of Hirschsprung's disease, there was an increase in numbers and sizes of cholinergic nerves in the lamina propria and muscularis mucosae. No false-positive or false-negative results were found. The test was found to be more reliable and consistent than other methods available.

Acetylcholinesterase↗