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Biomedical subjects

R Bajaj

Publications and source records attributed to R Bajaj.

At least 19 recordsLinked to original sources
PubMed2000

Giant fundic polyp complicating attenuated familial adenomatous polyposis.

This case details the development of a rapidly growing polypoid mass in the proximal stomach in a patient with known attenuated familial adenomatous polyposis. Surgical resection was required and histology showed hyperplasia with extensive areas of dysplastic adenomatous change. This case illustrates that patients with the attenuated form of familial adenomatous polyposis are at risk for multiple neoplasia distinct from those patients with the classic form of familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed2000

Elective stenting of extracranial carotid arteries.

OBJECTIVES: In symptomatic and asymptomatic patients with significant carotid artery stenosis, surgical endarterectomy has been shown to be beneficial when compared with medical management. Carotid stenting is evolving as an alternative technique for treating such patients. This prospective study was designed to assess the feasibility and safety of carotid angioplasty and stenting. METHODS: Fourteen patients (15 carotid arteries) with significant carotid artery stenosis were enrolled. These patients were in the age range 46 to 84 years (mean 60.9 +/- 7 years) and there were 12 males (86%). All of these patients were symptomatic with either TIA (n = 8) or stroke (n = 6). Wallstents were used in all the cases to stent the carotid arteries. One patient underwent bilateral carotid artery stenting. RESULTS: Carotid angioplasty and stenting was successful in 13 out of 14 (92.8%) patients and 14 out of 15 (93.3%) carotid arteries, with reduction in mean (+/- SD) stenosis from 86 +/- 6% to 3 +/- 3%. There was one episode of minor stroke, no major stroke or death during the initial hospitalization. Another patient had a minor stroke with patent ipsilateral carotid artery (on repeat angiography) during the first 30 days after the procedure. This patient was also found to have asymptomatic thrombus formation in the contralateral carotid stent which resolved with intravenous anticoagulation. During a mean follow up of 6 +/- 2 months there has been no recurrence of symptoms. CONCLUSIONS: Based upon our limited experience we believe that percutaneous carotid angioplasty with stenting is feasible with low periprocedural complication rate.

Aged↗
PubMed1999

Bladder agenesis with urometrocolpos.

A 20-day-old female presented in acute renal failure with an absent bladder and vaginal atresia. The right ureter opened into the uterus, resulting in a urometrocolpos, and the left ureter opened through a stenotic opening into the introitus. The literature is reviewed for reported cases and the embryo-pathology of bladder agenesis is discussed.

Abnormalities, Multiple↗
PubMed1998

Roundworm obstruction of the hepatic limb of a Roux-en-Y anastomosis.

A 7-year-old female with a type I choledochal cyst underwent an exploratory laparotomy. A Roux-en-Y choledochojejunostomy was done following cyst excision. The patient was re-explored 8 days later for an anastomotic bile leak and high fever. A round-worm was found obstructing the jejunal lumen at the porta hepatis, resulting in a biliary leak. Various aspects of biliary ascariasis are discussed along with the case report.

Anastomosis, Roux-en-Y↗
PubMed1998

Covered exstrophy: a rare variant.

A case of covered exstrophy without sequestration of a bowel segment is reported. A 4-year-old female presented with dribbling of urine. Treatment to date has been simple excision of the covered membrane with functional closure of the bladder and bilateral posterior iliac osteotomies, with reconstruction of the bladder neck and genitalia to be performed at a later date. The embryogenesis of this rare variant, a review of the reported cases, and management options are discussed. Keyword Covered exstrophy. Exstrophy. Bladder variants

Bladder Exstrophy↗
PubMed1996

Use of dopamine in prevention of contrast induced acute renal failure--a randomised study.

We report the use of dopamine in renal doses (5 micrograms/kg/min) to prevent contrast induced nephropathy (CIN). Forty patients with diabetes mellitus who were undergoing coronary angiography were randomly divided into two groups. Gr I (20 patients) was infused with dopamine starting 30 min before cardiac catheterization and continued for 6 h thereafter. Gr II (20 patients) did not receive dopamine. Baseline blood chemistry was performed before catheterization and then repeated 24 h after the procedure. The mean age and sex distribution were similar in both the groups. Urograffin (76%; 120-150 ml) was used in all the cases. The mean serum creatinine and blood urea nitrogen (BUN) levels in Gr I patients before catheterization were 1.5 +/- 0.32 mg % and 16.3 +/- 8.05 mg %, respectively. The corresponding values for Gr II were 1.52 +/- 0.68 mg % and 19.6 +/- 13.4 mg %, respectively. After angiography, Gr I patients did not show significant changes in renal parameters (serum creatinine, 1.37 +/- 0.25 mg % and BUN, 14.7 +/- 5.5 mg %) while Gr II patients showed a significant rise (serum creatinine, 1.96 +/- 1.2 mg % and BUN, 23.25 +/- 12.7 mg %; P = 0.01 and P = 0.05, respectively). Ten patients in Gr II (50%) developed a 25% rise in serum creatinine levels within 24 h of injection of the contrast. None of the patients developed renal failure severe enough to warrant dialysis. Hence alterations of renal function are common after cardiac catheterization. Dopamine in renal doses appears to be an effective means to prevent deterioration in renal function induced by contrast.

Acute Kidney Injury↗
PubMed1994

Ursodeoxycholate conjugates protect against disruption of cholesterol-rich membranes by bile salts.

BACKGROUND/AIMS: Ursodeoxycholic acid attenuates hepatocellular injury in cholestatic disorders, possibly by counteracting membrane disruptive effects of endogenous bile salts. The possible physicochemical basis of this protective effect was explored by using model membranes composed of egg phosphatidylcholine and cholesterol. METHODS: Large unilamellar vesicles containing trapped 3H inulin were prepared by extrusion and gel filtration. Vesicle disruption (release of trapped inulin) was quantified using rapid centrifugal ultrafiltration. RESULTS: Disruption of membranes increased with bile salt concentration, hydrophobicity, and increasing ionic strength. Disruption decreased with a decreasing bile salt/phospholipid ratio or an increasing cholesterol/phospholipid ratio. Vesicle disruption by taurodeoxycholate (3 alpha, 12 alpha-dihydroxy-5 beta-cholanoyl taurine) was reduced in a concentration-dependent manner by addition of tauroursodeoxycholate (3 alpha,7 beta-dihydroxy-5 beta-cholanoyl taurine) (TUDC) when the cholesterol/phospholipid ratio was > or = 0.5, but TUDC was not protective at a cholesterol/phospholipid ratio < or = 0.2. Glycoursodeoxycholate (3 alpha,7 beta-dihydroxy-5 beta-cholanoyl glycine) was somewhat less protective than TUDC, and unconjugated ursodeoxycholate (3 alpha,7 beta-dihydroxy-5 beta-cholanoate) (UDC) had little effect. Taurine conjugates of several other hydrophilic bile salts were also protective, but protection was not strictly proportional to hydrophilicity. CONCLUSIONS: Conjugates of UDC and other hydrophilic bile salts can reduce disruption of cholesterol-rich model membranes by more toxic bile salts via a purely physicochemical mechanism. UDC conjugates in vivo may protect the cholestatic liver by preventing bile salt disruption of the cholesterol-rich canalicular membrane.

Bile Acids and Salts↗
PubMed1994

Multiple anomalies of caval veins in a patient with pulmonic stenosis.

Anomalies of the supra-diaphragmatic portion of the inferior caval vein are rare in patients with normal sinus. We recently encountered a patient with situs solitus and infundibular pulmonic stenosis who had bifurcation of the supra-diaphramatic portion of the inferior caval vein with anomalous high insertion of one portion into the mid-right atrium. The other division joined the coronary sinus which also received a persistent left superior caval vein and left hepatic veins. Biplane angiography was used to delineate the anatomy. Pre-operative delineation is required as this anomaly complicates cardio-pulmonary bypass.

Abnormalities, Multiple↗
PubMed1993

Atrio-ventricular regurgitations in constrictive pericarditis: incidence and post-operative outcome.

We studied 33 surgically proven cases of constrictive pericarditis during the period 1989-1991 by color Doppler echocardiography and angiography to look for incidence and postoperative outcome of atrioventricular regurgitation. The mean age was 27.2 + 16.5 years (21 males, 12 females). There was a very high incidence of mitral (79%, trivial in 13, mild in 11 and moderate in 2) and tricuspid (73%, trivial in 7, mild and moderate in 6 each and severe in 5) regurgitation. There was good correlation between 'color Doppler' and angiography for detection and quantification of these regurgitations (r = 0.89 for mitral and 0.76 for tricuspid regurgitation, respectively). There were no preoperative clinical or hemodynamic predictors for the incidence or severity of these regurgitations. Immediate postoperative (7-10 days) evaluation by color Doppler did not show any change in these regurgitations. A follow-up study (by color Doppler and angiography) in 18 patients at a mean period of 229 + 105 days revealed regression of these regurgitations by at least 1 grade in 50% of patients. Patients with persisting regurgitations had persisting hemodynamic abnormality and relatively longer duration of symptoms. The presence of atrio-ventricular regurgitations should not be taken as evidence favoring diagnosis of restrictive cardiomyopathy and against that of constrictive pericarditis. The mechanism of these regurgitations is not clear to us.

Adult↗
PubMed1993

N-(phosphonacetyl)-L-aspartate synergistically enhances the cytotoxicity of 5-fluorouracil/interferon-alpha-2a against human colon cancer cell lines.

Recombinant interferon-alpha (IFN) enhances the cytotoxic effects of the fluorinated pyrimidine, 5-fluorouracil (5FU), against two human colon cancer cell lines. The aspartate transcarbamylase (ATCase) inhibitor, N-(phosphonacetyl)-L-aspartate (PALA), was studied in combination with 5FU/IFN to determine whether further anti-pyrimidine effects would result in greater cytotoxicity. By median effects analysis PALA synergistically augmented the cytotoxic effects of 5FU/IFN against both human colon cancer cell lines. This occurred in the absence of any effects of 5FU/IFN on ATCase and without further potentiation of the PALA-mediated inhibition of ATCase. To explore the mechanism by which this interaction occurred, detailed studies of pools of dNTPs were performed. Both 5FU/IFN and PALA/5FU/IFN treatments resulted in early (2-8 hr) depletion of pools of dTTP, but no effects on pools of dCTP. PALA had no effect on dTTP pools either alone or in the combination. In contrast, both PALA and PALA/5FU/IFN treatments resulted in later (12-24 hr) depletion of pools of dCTP. 5FU/IFN treatment had no effect on these pools. When pools of dCTP and dTTP were repleted by treatment with cytidine or thymidine, 20 microM, however, there was only partial reversal of cytotoxicity induced by 5FU/IFN + PALA, suggesting that the synergy observed did not result solely from a sequential anti-pyrimidine effect. The incorporation of 5FU into RNA was also studied; PALA enhanced the incorporation of [6-3H]5FU into RNA by 83-150%, but not into DNA, suggesting an alternative mechanism of drug interaction.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study.

Thirty-one patients with chronic severe anemia of more than 3 months' duration (hemoglobin less than 7 gm/dl) and no underlying heart disease were studied by means of M-mode, two-dimensional, and Doppler echocardiography; an equal number of normal control subjects was also studied. There are conflicting reports regarding the influence of chronic severe anemia on systolic myocardial function, but diastolic function has not been systematically assessed. It is also uncertain whether anemia alone can cause heart failure in a structurally normal heart. We therefore performed a detailed study of echocardiographic indexes of systolic and diastolic left ventricular function in these patients. We found that patients with anemia have significantly faster heart rates and lower diastolic and mean blood pressures than normal subjects. They also have a significantly elevated cardiac output and stroke volume and larger left ventricles. Left ventricular contractility, assessed by the end-systolic stress-dimension relationship, was enhanced. There was no systematic evidence of diastolic dysfunction by Doppler assessment of mitral inflow. There was also no clinical evidence of congestive heart failure. We conclude that chronic severe anemia leads to a hyperdynamic state with systolic hyperfunction and no impairment of diastolic function. Anemia does not lead to congestive heart failure in the absence of underlying heart disease.

Adult↗
PubMed1992

Discordance between abdominal and atrial arrangement in a case of complex congenital heart disease.

The report describes a rare case of a complex congenital heart disease wherein the splenic status and the relationship of the suprarenal abdominal great vessels strongly suggested right isomerism, but atrial morphology demonstrated usual atrial arrangement. It emphasises the increasing recognition that the arrangement of the abdominal organs need not accurately reflect atrial arrangement.

Abnormalities, Multiple↗
PubMed1992

Arrhythmias and conduction defects in patients with mitral valve prolapse: a study based on ambulatory monitoring and electrophysiologic studies.

Twenty consecutive symptomatic patients of mitral valve prolapse (MVP) and 20 normal age, sex and symptom matched controls were studied. Ambulatory monitoring studies revealed the presence of atrial premature beats (APC) in 16 subjects in each group. Isolated ventricular premature beats (VPC) were observed in 12 patients with MVP and 15 subjects in control group (p = ns). Complex VPCs (Lown IVa, IVb) were recorded in 4 patients of MVP vs 3 controls (p = ns). There was no correlation between the occurrence of arrhythmias with the degree of MVP or the degree of mitral regurgitation. Likewise, MVP patients with prolonged QTc interval did not show higher incidence of spontaneous arrhythmias when compared to those with normal QTc interval. Nineteen patients underwent electrophysiological studies. Two patients showed evidence of abnormal sinus node function. Both these patients in addition had AV nodal abnormalities, manifested by prolonged AH interval. Programmed stimulation studies induced AV nodal tachycardia in one and non-sustained ventricular tachycardia in two (polymorphic in one and monomorphic in the other). Ambulatory monitoring in both these patients did not show any evidence of complex VPCs or VT, indicating poor correlation between inducibility and presence of spontaneous complex VPCs. Patients with MVP do not have a higher prevalence of spontaneous atrial or ventricular arrhythmias when compared to matched normal controls with similar symptomatology. The presence of mitral regurgitation, severity of MVP and associated prolonged QTc interval is not associated with higher prevalence of arrhythmias. The correlation between spontaneous and inducible arrhythmias is poor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Electrophysiologic effects of oral diltiazem before and after beta blockade.

We conducted electrophysiologic (EP) studies and estimated the sinus node function and atrioventricular (AV) conduction in 10 patients with suspected coronary arterial disease (age range 35-55 years) before and during diltiazem therapy (60 mg thrice daily for 5-7 days). The effect of beta blockade (0.1 mg/kg of intravenous propranolol) was evaluated in both EP studies. The mean spontaneous sinus cycle length (SCL) and the AV nodal Wenckebach cycle lengths (AVWB) were significantly higher (p less than 0.05) after propranolol alone (913 +/- 131 and 504 +/- 197 ms, respectively) compared with baseline values (SCL: 827 +/- 149 ms, AVWB: 439 +/- 173 ms). Diltiazem alone failed to influence the SCL and AVWB significantly. Following the combination (diltiazem + propranolol), SCL (945 +/- 147 ms) and AVWB (533 +/- 148 ms) were significantly higher (p less than 0.05) than baseline and post diltiazem values (SCL: 840 +/- 150 ms; AVWB 457 +/- 103 ms). None of the other parameters (sinoatrial conduction time, corrected sinus node recovery time, AH and HV intervals, AV nodal and atrial effective refractory periods) were significantly influenced by propranolol, diltiazem, or the combination. No patient developed AV block, sinus arrest/sinoatrial exit block, or symptomatic sinus bradycardia following beta blockade after diltiazem administration. Oral diltiazem therapy alone and after beta blockade does not appear to adversely influence the sinus node function and AV conduction in patients below the age of 55 years. The combination of diltiazem and beta blocker thus appears safe in selected patients with coronary arterial disease.

Administration, Oral↗