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Biomedical subjects

R C Shukla

Publications and source records attributed to R C Shukla.

At least 19 recordsLinked to original sources
PubMed2001

Prolonged epidural infusions of ropivacaine (2 mg/mL) after colonic surgery: the impact of adding fentanyl.

UNLABELLED: We evaluated the safety and efficacy of a 72-h epidural infusion of ropivacaine and measured the impact of adding fentanyl 2 microg/mL to the required infusion rate, on the quality of postoperative pain relief and the incidence of side effects, after colonic surgery. One hundred fifty-five patients scheduled for elective colonic surgery were randomized in this trial. Epidural infusions of ropivacaine 2 mg/mL with fentanyl 2 microg/mL (R + F) and without fentanyl (R) were commenced during surgery and continued for 72 h postoperatively. This was a prospective, randomized, double-blinded, multi-center trial. The median infusion rate required was less in the R + F group (9.3 vs 11.5 mL/h, P < 0.001). Median pain scores at rest and on coughing were lower in the R + F group (P < 0.0001). The incidence of hypotension was more in the R + F group (P = 0.01). Time to readiness for discharge was delayed in the R + F group (median 6.6 vs 5.5 days, P = 0.012). The addition of fentanyl to ropivacaine resulted in decreased infusion rates and enhanced pain control; however, adverse effects were increased and readiness to discharge was delayed. IMPLICATIONS: Epidural infusions of ropivacaine with and without fentanyl were administered to patients to control pain after colonic surgery. Patients who received ropivacaine with fentanyl had better pain control, increased side effects, and delayed readiness to discharge. This study questions the value of adding opioids to epidural infusions of local anesthetics.

Adult↗
PubMed2000

Carcinoma of the gallbladder: role of sonography in diagnosis and staging.

PURPOSE: In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology. Patients and Methods Patients with proven gallbladder cancer presenting to a single surgical unit between 1991 and 1995 were identified through a records search. All patients underwent sonographic examination followed by fine-needle aspiration (FNA), biopsy, or laparotomy for establishing the diagnosis. RESULTS: A mass in the gallbladder and gallbladder wall thickening (> 12 mm) were cardinal sonographic findings of carcinoma. Liver infiltration was correctly identified in all patients who had it. Sonography was highly accurate for detecting mass lesions, gallstones, liver infiltration, metastasis, and ascites. However, visualization of lymph nodes, common bile duct infiltration, and peritoneal dissemination was poor. CONCLUSIONS: Sonography was found to be a good diagnostic tool for carcinoma of the gallbladder; however, its sensitivity was poor for staging nodal spread of the disease.

Adenocarcinoma↗
PubMed1998

The value of sonography for estimation of liver volume by using a simple geometric formula ascertained in cadaveric livers.

Accurate assessment of liver size and its volume are important. However, as the clinical methods do not produce reliable results especially when the liver is shrunken, and the previous attempts to accurately assess liver volume by radio-isotopes, CT scans and computer assisted ultrasonography have not gained popularity due to high cost and complex techniques, the need to devise a simpler technique for estimation of liver volume continues. In doing so, we estimated volume of 10 cadaveric livers by water displacement technique to serve as the reference value. Thereafter, assuming the shape of liver like a right-angled pyramid, we calculated its volume by a simple geometric formula of '1/2 abc'. However, a reduction of 15% was made from this to compensate for depression on the inferior surface of liver. This method was subsequently implemented to assess liver volume of 14 healthy individuals and 20 patients of fulminant hepatic failure (FHF) by using ultrasonography. Our findings revealed smaller liver volume in Indians as compared to the reported Western figures, and a significantly smaller liver volume in females as compared to males. The liver volume of 6 FHF patients who died was significantly smaller (696.5 +/- 143.5 cm3) as compared to that of the 14 FHF patients who survived (1083 +/- 365.3 cm3). Moreover, mortality rate was 100 per cent in 3 patients of FHF who showed markedly shrunken globular liver with a liver volume of less than 500 cm3. Thus, a markedly reduced liver size in FHF patients suggests a poor prognosis. However, since the number of FHF patients in the present series is small, it is our contention that a larger series is mandatory to confirm the findings of the present study.

Adult↗
PubMed1993

The effects of unilateral stellate ganglion blockade on human cardiac function during rest and exercise.

INTRODUCTION: Left-sided stellate ganglion predominance has been proposed as a mechanism responsible for lethal ventricular arrhythmias, due to heterogenous ventricular repolarization. To determine the cardiovascular effects of such asymmetric sympathetic ganglion innervation in man, studies were performed in 15 patients undergoing unilateral stellate ganglion blockade for the management of chronic arm pain. METHODS AND RESULTS: Standard 12-lead ECGs, systemic blood pressure, body surface potential mapping, and radionuclide angiography were performed during rest and graded exercise before and after blockade. Successful unilateral blockade was accomplished in 13 of the patients, 11 of whom had right-sided blockade and two left-sided blockade. No significant changes due to blockade of stellate ganglia, including QT intervals, were detected during rest or graded exercise in standard ECGs. No cardiac rhythm disturbances occurred in these states. Body surface potential maps and arterial blood pressure were similar during resting supine and upright positions, as well as immediately after exercise before and after blockade. Unilateral ganglionic blockade did not modify resting or exercise cardiac ejection fractions. CONCLUSION: Unilateral stellate blockade in man does not induce untoward cardiovascular effects during rest or exercise.

Adult↗
PubMed1979

Demonstration of the intermediate cells of Billingham and Medawar in the epidermis of Macaca mulatta and rhesus monkey.

The digest of the pure epidermis preparation from Macaca mulatta demonstrated three types of dendritic cells i.e. (1) dopa-positive melanocytes, (2) dopa-negative Langerhans' cells and (3) weakly dopa-positive intermediate cells of Billingham and Medawar. The last type of cell was found to have characteristics being intermediate between those of the melanocytes and of the Langerhans' cell. A similar digest prepared from the epidermis of the rhesus monkey demonstrated isomorphous dendritic cells which were all dopa-negative. Here also the intermediate cells of Billingham and Medawar with characteristics intermediate between those of the melanocytes and of the Langerhans' cells were identified.

Animals↗
PubMed1977

The nature of dendritic cells of the epidermis of the white guinea pig.

The melanocytes, the intermediate cells of Billingham and Medawar and the Langerhans' cells of the epidermis of the white guinea pig were found to be positive to Bielschowsky's silver and Gomori's acetylcholinesterase reactions. The melanocytes were full of Nissl substance. On these evidences, supported by other morphological and histochemical characteristics, the dendritic cells of the epidermis were considered to be nervous structures.

Animals↗
PubMed1977

Regeneration of the basal melanocytes of the human skin.

The stages of regeneration of the basal melanocyte of human skin after Feulgen reaction were found to be granule, unipolar cell, bipolar cell and bidendritic, tridendritic and quadridendritic melanocyte, in that order. The last mentioned cell either divided by mitosis to form two daughter melanocytes or matured to form a replica of the original basal melanocyte of the human skin.

Adult↗
PubMed1976

Morphological, histochemical, autoradiographic and topographical evidences of the origin of the Langerhans' cell from the melanocyte in the skin of the guinea pig.

The microscopic anatomy of the nucleus, Golgi substance, mitochondria, etc. of type 1, 2, 3 and 4 albino melanocytes, type 01 and 011 albino intermediate cells of Billingham and Medawar and type I, II, III and IV albino Langerhans' cells of the albino guinea pig, is presented in detail. The study has demonstrated that the albino melanocytes degenerate through sequential stages of intermediate cells of Billingham and Medawar, type I, II and III Langerhans' cells to ultimately from type IV Langerhans' cells. It has been shown that all the dendritic cells of the epidermis belonged to one class of cells. Autoradiographic techniques have shown that type 3 and type 4 melanocytes, respectively, bearing 6 and 5 round-tipped dendritic processes, divide by mitosis to form two daughter cells. One of these two daughter forms the intermediate cell of Billingham and Medawar. This cell, while transforming sequentially into type I, II, III and IV Langerhans' cells, moves up through the Malpighian and granular layers of cells, to the stratum corneum. This type IV Langerhans' cell is ultimately extruded out of the stratum corneum by exfoliation. The other daughter melanocyte remains at its place in the sub-basal zone to function as a mature melanocyte. The time for the passage of the daughter melanocyte to travel from the sub-basal zone to the stratum corneum layer was found to be 15 days.

Animals↗