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Biomedical subjects

R B Gujral

Publications and source records attributed to R B Gujral.

At least 19 recordsLinked to original sources
PubMed2005

Endovascular management of pseudoaneurysms of the splenic artery: experience with six patients.

The purpose of this paper was to describe our experience with the endovascular management of splenic artery pseudoaneurysms (SAPA). Seven patients with documented SAPA on CT and/or angiography were considered for endovascular treatment. The pseudoaneurysms were located in the main splenic artery (n = 4) or its branches (n = 3). In one patient in whom the pseudoaneurysm was located in a hilar branch, selective catheterization of splenic artery failed. Metallic coils (n = 1), gelfoam and hydrogel particles (n = 1), metallic coils and gelfoam (n = 2), metallic coil, gelfoam and acrylic glue (n = 2) were used as embolization material in the remaining six patients. These patients were followed for a mean period of 11.3 months. Transcatheter embolization was successful in five patients with no procedure-related complications. In one patient, embolization was incomplete and the patient underwent surgery, but died on the 10th postoperative day because of irreversible shock. Another patient, after successful embolization, underwent surgery for management of an associated pseudocyst. Endovascular treatment is a safe and effective method of management of SAPA.

Adult↗
PubMed2003

MRI features of tuberculosis of peripheral joints.

The aim of this article is to present the magnetic resonance imaging (MRI) features of peripheral tubercular arthritis. The clinical presentation of peripheral tubercular arthritis is variable and simulates other chronic inflammatory arthritic disorders. MRI is a highly sensitive technique which demonstrates fine anatomical details and identifies the early changes of arthritis, which are not visible on radiographs. The MRI features of tubercular arthritis include synovitis, effusion, central and peripheral erosions, active and chronic pannus, abscess, bone chips and hypo-intense synovium. These imaging features in an appropriate clinical setting may help in the diagnosis of tubercular arthritis. Early diagnosis and treatment can effectively eliminate the long-term morbidity of joints affected by tuberculosis.

Abscess↗
PubMed2001

Intra-arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy.

The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.

Aneurysm, False↗
PubMed2001

A study of bone densitometry in patients with complex regional pain syndrome after stroke.

INTRODUCTION: This study was undertaken to evaluate the bone mineral density (BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after stroke, and to correlate it with various clinical and neurophysiological parameters. PATIENTS AND METHODS: Twenty patients with CRPS-I after stroke were included and a detailed neurological evaluation was carried out. The severity of CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients underwent bone mineral densitometry of paralysed and non-paralysed forearm by dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared with that of age matched healthy controls. Neurophysiological tests included sympathetic skin response in both upper and lower limbs and median somatosensory evoked potentials. RESULTS: The mean age of patients was 57.2 (45-75) years and eight were females. Eight patients had severe weakness and 12 had moderate weakness of grade 2 on the hemiplegic side. There was significant reduction in BMD in the patients compared with controls (p<0.01). The bone density reduction correlated well with duration of illness (r = -0.673, p<0.01), shoulder hand syndrome score (r = -0.804, p<0.01), and Canadian neurological scale score (r = -0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all patients. Median somatosensory evoked potentials were not recordable in seven out of 20 patients who also had higher grade of CRPS-I. CONCLUSION: Our results show significant reduction of BMD in patients with CRPS-I after stroke. The reduction in BMD correlates with the severity of shoulder hand syndrome score, degree of weakness, duration of hemiplegia, and the severity of stroke.

Absorptiometry, Photon↗
PubMed2000

Sonographic findings in renal parenchymal malacoplakia.

Malacoplakia of the kidney is a rare inflammatory disorder. We describe a case of bilateral renal malacoplakia in which the patient had diffuse involvement of the left kidney and a focal lesion in the right kidney. Sonography showed a diffusely echogenic, enlarged left kidney with loss of corticomedullary differentiation and a single anechoic lesion measuring 1.8 x 1.6 x 1.3 cm in the right kidney. A left nephrectomy was performed, and the right kidney was managed conservatively with sonographic monitoring.

Adult↗
PubMed2000

Temporary balloon occlusion of internal carotid artery : a simple and reliable clinical test.

Balloon test occlusion of internal carotid artery has been frequently used in preoperative evaluation of patients with carotid aneurysms, fistulas and skull based neoplasms in whom arterial sacrifice is planned or considered as a possible part of therapy. We present our experience of the test in 28 patients. The test was positive in four and negative in twenty four patients. The results are compared with cross-compression angiography and the outcome following internal carotid artery sacrifice. There were no complications related to the test and the results accurately predicted the tolerance to occlusion of artery. We found the test safe, simple to perform and reliable to preoperatively detect patients at risk of ischaemic stroke following surgical ligation or endovascular occlusion of internal carotid artery.

Adolescent↗
PubMed1998

MR demonstration of a giant cavernous carotid aneurysm with occlusion of the contralateral intracranial carotid artery: an unusual complication of cavernous sinus thrombosis.

We present an unusual combination of vascular complications of cavernous sinus thrombosis in a 7-year-old girl. MRI and MR angiography showed occlusion of the intracranial portion of the left internal carotid artery and a contralateral giant cavernous carotid aneurysm. This combination of vascular findings may influence the management in such cases.

Aneurysm, Infected↗
PubMed1997

Iatrogenic renal vascular injuries and their radiological management.

Twenty-nine patients with significant haematuria after a renal invasive procedure (27 of whom had undergone a percutaneous renal procedure and 2 surgical pyelolithotomy) were investigated with angiography. Out of the 21 patients with evidence of arterial injury, 19 were treated by transarterial embolization with gelfoam with or with hydrogel particles; (n = 11), steel coils with gelfoam (n = 4), hydrogel particles (n = 1), surgicel (n = 2), silk with gelfoam (n = 1). The efficacy and technique of the therapeutic embolization procedure is emphasized.

Aneurysm, False↗
PubMed1996

Arterial complications of pancreatitis and their radiological management.

Arterial haemorrhage from pseudoaneurysm in pancreatitis patients is a formidable complication with a high mortality rate. We encountered six patients in whom a pseudoaneurysm was demonstrated at angiography. Drainage of associated pseudocyst facilitated visualization in one patient. Four patients had pseudoaneurysms arising from the proximal part of the major peripancreatic vessels and were treated by steel coil embolization (n = 3) and surgically (n = 1). There was no episode of rebleeding in these patients during a follow-up period of 10-18 months. Of the two patients with distal small peripancreatic branch vessel involvement hydrogel particle and gelfoam embolization was successful only temporarily in one patient and unsuccessful in the other patient. The literature is reviewed and the efficacy of steel coil embolization is emphasized.

Adolescent↗
PubMed1996

Gastrointestinal bleeding from a false aneurysm of the hepatic artery after cholecystectomy.

Acute gastrointestinal bleeding due to penetration of a partially thrombosed hepatic artery aneurysm into the duodenal bulb is rare but has been reported. Ultrasound, computed tomography, and angiography are the methods of choice for aneurysm detection. If clinical review and endoscopy are inconclusive in determining the cause of upper gastrointestinal bleeding, and no usual diagnosis can be established, a search for arteriointestinal fistula must be initiated.

Adult↗
PubMed1995

The magnetic resonance renogram in renal transplant evaluation using dynamic contrast-enhanced MR imaging.

To assess the role of the dynamic gadolinium DTPA (Gd-DTPA) magnetic resonance (MR) renogram in differentiating various causes of renal allograft dysfunction, contrast-enhanced MR imaging studies were performed in 5 normal renal allografts, 5 patients with acute rejection (AR), and 7 patients with cyclosporine nephrotoxicity. Time-versus-signal intensity (SI) curves were plotted. Normal renal allografts showed a rapid increase and slow decay, with a definite peak in cortical (CX) SI curves (peak mean signal intensity (Amax 338.6 +/- 46.5). The outer medullary (OM) (Amax 306.5 +/- 59) and inner medullary (IM) (Amax 263.4 +/- 47.4) curves did not show a definite peak. The OM curve slowly reached a steady state and caught up with the CX curve. AR episodes were characterized by a blunted uprise and delayed peak of CX (Amax 180 +/- 70.9) and a low-amplitude vascular phase with a slow constant uprise of the inner medullary curve (Amax 120.35 +/- 42.4). The OM signal intensity curve (Amax 150.73 +/- 78) failed to catch up with the CX curve. The maximum amplitude of SI curves in CsA-induced allograft dysfunction were low, with no definite peak, and CX, OM, and IM curves ran parallel to each other with a constant gap. Dynamic Gd-DTPA, MR imaging is a noninvasive technique that shows distinct characteristics in acute rejection, cyclosporine nephrotoxicity, and normally functioning renal allografts.

Adult↗
PubMed1995

Brain metabolite changes on in vivo proton magnetic resonance spectroscopy in children with congenital hypothyroidism.

Localized in vivo proton magnetic resonance spectroscopy and imaging were performed in five children with untreated congenital hypothyroidism to look for biochemical markers of abnormal myelin and neuronal development. The patients had high levels of choline-containing compounds, which returned to normal with euthyroidism. These metabolic alterations may reflect blocks in myelin maturation that are reversible by thyroid hormone replacement throughout childhood.

Adolescent↗
PubMed1995

In vivo localized proton magnetic resonance spectroscopy of intracranial tuberculomas.

In vivo proton magnetic resonance spectroscopy (MRS) was performed in ten patients with intracranial tuberculomas with the aim of finding biochemical finger prints which may help in the noninvasive diagnosis of the disease. Diagnosis of tuberculoma was confirmed in all these cases retrospectively. Ex vivo spectroscopy of formalin fixed samples of four granulomas and a normal brain (cerebellar) tissue, was performed to confirm the in vivo resonances. The in vivo study showed resonance at 1.3 ppm and 0.9 ppm assigned to methylene group (CH2)n and terminal methyl groups (-CH3) of fatty acids respectively which was subsequently confirmed by the ex vivo study. Large resonances of fatty acids in in vivo study appeared to be due to high lipid content of caseous material. It is concluded that in vivo proton spectroscopy may be helpful in differentiating tuberculomas from other intracranial mass lesions which have diagnostic difficulties on MR imaging.

Adult↗
PubMed1994

MR imaging and angiography in tuberculous meningitis.

MRI was performed on 26 patients with tuberculous meningitis, with particular reference to document the cranial nerve abnormalities. MR angiography (MRA) was performed in 20 of the patients. Meningeal enhancement in the basal cisterns or over the convexity of brain was seen in all patients; two show ependymal enhancement. Tuberculomas, single (3), multiple (12) or miliary (2) were detected in 17 patients. Of the 9 patients with cranial nerve palsies, 7 showed contrast enhancement with or without thickening of the involved nerve. Abnormality signal intensity of the involved nerve was seen on proton density and T2-weighted images in one of these patients. MRA revealed focal arterial narrowing in 10 patients, the vessels commonly affected being the terminal segment of the internal carotid artery and the proximal segments of the middle and anterior cerebral arteries. One patient also had a small aneurysm of the proximal middle cerebral artery. Infarcts, haemorrhagic (8) or bland (6), were detected in 14 patients; most were the basal ganglia and internal capsules, large middle or anterior cerebral arterial territory infarcts being seen in only two cases.

Adolescent↗
PubMed1994

MRI in intraspinal tuberculosis.

We studied 20 patients with intraspinal tuberculosis (TB), to characterise the MRI features of tuberculous meningitis and myelitis. MRI leptomeningitis and intramedullary involvement in 11 patients, intramedullary lesions alone in 5, leptomeningitis alone in 2, and isolated extradural disease in 2. TB leptomeningitis was characterised by loculation of the cerebrospinal fluid (CSF), nerve root thickening and clumping (seen only in the lumbar region) or complete obliteration of the subarachnoid space on unenhanced images. Gd-DTPA-enhanced images proved useful in 6 cases, revealing linear enhancement of the surface of the spinal cord and nerve roots or plaque-like enhancement of the dura-arachnoid mater complex. Intramedullary lesions included tuberculomas (8), cord oedema (5) and cavitation (3). In seven cases of intramedullary tuberculoma multiple lesions with skip areas were seen, without significant cord swelling. One patient had an isolated lesion in the conus medullaris. The lesions were iso- or hypointense on T1-weighted images, iso-, hypo- or hyperintense on T2-weighted images and showed rim or nodular enhancement with contrast medium.

Adolescent↗