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Biomedical subjects

R Juneja

Publications and source records attributed to R Juneja.

At least 55 records · Page 3Linked to original sources
PubMed1998

Autonomic functions in restrictive cardiomyopathy and constrictive pericarditis: a comparison.

BACKGROUND: This study was undertaken to analyze autonomic functions in restrictive cardiomyopathies. Restrictive cardiomyopathies have clinical and hemodynamic similarity with chronic constrictive pericarditis. Autonomic dysfunction has been described in the latter. METHODS AND RESULTS: Autonomic function analysis has not been reported in restrictive cardiomyopathy. Six consecutive patients with restrictive cardiomyopathy were included in this study (5 men, 1 woman, mean age 35+/-5.4 years). The tests performed were designed to test the sympathetic efferent pathway, that is, by cold hand immersion and loud noise tests, parasympathetic efferent pathway by Valsalva ratio and expiration/inspiration ratio and the baroreceptor function by testing their sensitivity slope. The results were compared with 20 patients with chronic constrictive pericarditis and with 10 healthy age- and sex-matched control subjects previously studied. The rise of systolic blood pressure after cold hand immersion and sudden loud noise was not significantly different compared with control subjects. The expiration/inspiration ratio was 1.1+/-0.01 compared with 1.57+/-0.1 in the control group (p < 0.01). The Valsalva ratio was significantly lower (1.1+/-0.04) compared with control subjects (1.83+/-0.1, p < 0.01). The baroreceptor sensitivity was not reduced compared with that in control subjects. In comparison to constrictive pericarditis, sympathetic efferent pathway is preserved in restrictive cardiomyopathy (p < 0.0001). The parasympathetic efferent pathway is borderline abnormal in restrictive cardiomyopathy but not significantly as compared with constrictive pericarditis (p=not significant). The baroreceptor sensitivity slope is normal in patients with restrictive cardiomyopathy as compared with significant depression seen in constrictive pericarditis (p < 0.05). Autonomic functions are better preserved in patients with restrictive cardiomyopathies compared with chronic constrictive pericarditis. CONCLUSIONS: Autonomic dysfunction is localized to parasympathetic efferent pathway. This is in comparison to constrictive pericarditis, in which severe autonomic dysfunction is a universal feature and includes all segments of autonomic nervous system.

Adolescent↗
PubMed1998

Haemodialysis for end-stage renal disease in Southern India--a perspective from a tertiary referral care centre.

BACKGROUND: There is little information available regarding the practice of haemodialysis, its population characteristics or outcomes in India. These aspects were studied in a cohort of end-stage renal disease (ESRD) patients enrolling in a maintenance haemodialysis (MHD) programme in a tertiary referral centre in S. India, over a 1 year period. RESULTS: A total of 463 ESRD patients enrolled on MHD during the 1 year period. The mean (SD) age was 38.6 (13.9) years. Definitive renal replacement therapy was instituted in 34% of these patients, including renal transplantation in 22.8%. The median duration to transplant was 93 days, and there was a 50% reduction of the original cohort by 1 month. The largest fraction left the programme (59.7%). Renal transplantation as an outcome was determined by a younger age and a planned referral from outside the state of Tamil Nadu; continuation of any form of renal replacement therapy again was more likely in the younger patient who had external financial support. Dialysis therapy was empiric but uniform for all patients, and only 50% of the dialyses delivered a single pool Kt/V > or = 1. The overall mortality was 9.5%, but 58% of the deaths took place within a week of starting dialysis, a quarter being related to severe uraemic complications. CONCLUSIONS: Haemodialysis in India is mainly a short-term measure to support the ESRD patient to transplantation. Economic factors play an important role in outcome, the majority undergoing discharge from the programme. Early mortality is disproportionately high. Subclinical underdialysis is common. The requirement for pre-dialysis care and earlier referral from the community is apparent. Prospective studies to define standards and optimize the practice of dialytic therapy against appropriate short-term outcomes, within prevalent economic frameworks, need to be undertaken.

Adolescent↗
PubMed1998

Prostaglandin E1 in infants with congenital heart disease: Indian experience.

BACKGROUND: E-type prostaglandins (PGE1) can effectively maintain the patency of the ductus arteriosus in neonates. Its use, therefore and be life saving in infants born with ductus dependent congenital heart disease. Although PGE1 is available for over two decade in western world, it has been introduced in India only since April, 1995. OBJECTIVE: To assess the efficacy of PGE1 at our center. SETTING: Hospital based. METHOD: 65 infants with ductus dependent congenital heart disease were included. Age at time of starting PGE1 infusion ranged from 18 hours to 39 days. Forty two of these were more than a week of age, 19 were more than 14 days, and two were above one month. PGE1 was started in an initial dose of 0.05 microgram/kg/min, decreased to 0.005-0.01 microgram/kg/min for maintenance. The indications for use of PGE1 were to increase pulmonary blood flow in 33 cases with pulmonary atresia, tricuspid atresia or critical pulmonic stenosis (Group I); to increase systemic blood flow in 15 cases with coarctation of aorta, hypoplastic left heart and interruption of aortic arch (Group II); to improve mixing in 13 cases of transposition of great arteries (Group III) and for improving the left ventricular volumes by keeping the duct open in 4 cases of transposition of great arteries with intact ventricular septum (Group IV). The efficacy of the drug was assessed by a rise on PaO2 and SaO2% determined for Group I & III, and by appearance of lower limbs pulses in Group II. Left ventricular volumes were serially measured by echocardiography in Group IV cases. RESULTS: The drug was successful in 62 of the 65 cases. There were two failures. One was a 39 days old baby with Ebstein's anomaly of tricuspid valve and pulmonary atresia and other was an eight days old baby with coarctation of aorta and renal failure. In addition, PGE1 could not be continued in another baby due to development of a linear skin rash locally. Side effects included apnea in 5 (9%) of 56 spontaneously breathing patients. Necrotizing enterocolitis, hyperpyrexia and jitteriness was sent in one case each. Six patients died. Two were related to PGE1, one due to failure, another due to its side effects. Definitive procedure were performed in 51 cases electively. PGE1 was used upto 13 days with sustained benefit. CONCLUSIONS: PGE1 is an effective drug for keeping the ductus open in infants with ductus dependent congenital heart disease. It can be used for neonates beyond the first week of life with efficacy. Apnea is a major side effect and close monitoring is essential.

Age Factors↗
PubMed1998

Coarctation of Aorta Mimicking Aortic Arch Interruption and its Successful Dilatation by an Innovative Approach.

Balloon dilatation for coarctation of the aorta is an established alternative to surgery in older children and young adults with a high success rate and a low incidence of restenosis.1Ð4 However, balloon dilatation has to be performed with extreme caution when the coarct segment involves the major branches of the aortic arch or when the coarct has an atypical anatomy. Herein, we report an unusual case which was suggestive of aortic arch interruption on descending thoracic aortography and could not be crossed retrogradely. Brachial approach for ascending aortography revealed that this was indeed a coarct with a distorted anatomy and also made possible crossing of the coarct antegradely. After exteriorizing the guide wire across the coarct with the help of a snare device advanced through the femoral arterial sheath, the coarct could be dilated from the femoral route as is routinely done.

Journal Article↗
PubMed1997

Mammary-coronary artery anastomosis without cardiopulmonary bypass through a minithoracotomy.

BACKGROUND: Coronary artery bypass grafting has been based on cardiopulmonary bypass, myocardial protection, and the median sternotomy. The recent concept of minimally invasive coronary artery bypass grafting in selected patients has dramatically affected surgical management of coronary artery disease. Coronary artery bypass grafting of anterior coronary arteries with in situ internal mammary artery through a limited anterior thoracotomy is a procedure that is gaining acceptance. METHODS: Fifty-one patients were operated on by minithoracotomy and direct coronary artery bypass grafting without cardiopulmonary bypass. Left internal mammary artery-to-left anterior descending coronary artery anastomosis was done in 50 patients, and in 1 patient, left internal mammary artery-to-left anterior descending artery and right internal mammary artery-to-right coronary artery anastomoses were constructed through bilateral minithoracotomies. Left anterior minithoracotomy through the fourth intercostal space and right anterior minithoracotomy through the fifth intercostal space were used for left internal mammary artery and right internal mammary artery dissection, respectively. With this approach, a 4- to 6-cm length of mammary artery was easily dissected. Mammary-to-coronary anastomosis was performed on a beating heart without cardiopulmonary bypass through window pericardiotomy. RESULTS: Twenty-five patients were extubated in the operating room and 26 in the intensive care unit 4 to 6 hours after operation. None of these patients required blood transfusion or inotropic support. Postoperative predischarge angiography in 42 patients revealed adequate mammary-to-coronary flow in 40 patients. Doppler flow studies were also in accordance with angiographic findings. Forty-five patients are in our regular follow-up (mean follow-up, 6.23 +/- 1.34 months); 44 of them are in functional class I. CONCLUSION: In our experience minithoracotomy is a safe, simple, and minimally invasive procedure. Favorable cost/benefit ratio has been achieved owing to no early or late mortality and minimal early morbidity. Postoperative angiography and Doppler flow study revealed excellent predictive long-term results.

Adult↗
PubMed1997

Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques.

AIMS: The results of percutaneous mitral valvotomy performed by the antegrade transseptal method using the Inoue balloon (n = 1000; group 1) and by the retrograde non-transseptal technique using a polyethylene balloon (n = 100; group 2) were compared in a retrospective, non-randomized study. METHODS AND RESULTS: Both the groups were similar with respect to baseline characteristics. The success rate was 95% in group 1 and 93% in group 2. There was a significant increase in mitral valve area estimated by Gorlin's equation (Group 1: from 0.8 +/- 0.5 to 2.1 +/- 0.8 cm2; Group 2: from 0.8 +/- 0.3 to 1.9 +/- 0.8 cm2, both P < 0.001) and by Doppler echocardiography using the pressure half-time method (Group 1: from 0.9 +/- 0.4 to 2.2 +/- 0.6 cm2; Group 2: from 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2, both P < 0.001). However, the calculated immediate post-valvotomy mitral valve area was larger with the Inoue technique (2.1 +/- 0.8 vs 1.9 +/- 0.8 cm2; (P < 0.02). Results were considered optimal when the mitral valve area increased to > or = 1.5 cm2, the percentage increase was > or = 50, and mitral regurgitation was < or = 2/4. Out of the total successful procedures, optimal results were obtained in 95% patients in Group 1 and 94% in Group 2. Incidence of significant mitral regurgitation (> or = grade 3/4) was similar in two groups (Group 1: 4% vs Group 2: 5%, P = ns). A significant left to right atrial shunt (Qp/Qs > or = 1.5:1) in 2.5% and tamponade in 2% of cases occurred exclusively with the Inoue technique, while conduction disturbances, such as transient (< 24 h) left bundle branch block (28%) and complete heart block (2%) were noted with the retrograde technique (Group 2). Local complications were significantly higher in Group 2 (3% vs 0.5%, P < 0.01). The procedure time with the Inoue technique was shorter than with the retrograde (Group 1: 15 +/- 8, range 10 to 35 min; Group 2: 22 +/- 14, range 15 to 45 min, P = 0.05). Echocardiographic follow-up at 1 year showed no significant difference in mitral valve area between the two groups (Group 1 (n = 300): 1.8 +/- 0.8 vs Group 2 (n = 60): 1.9 +/- 0.9 cm2; P = 0.3). CONCLUSIONS: Balloon mitral valvotomy using the Inoue balloon and the retrograde non-transseptal technique results in significant immediate haemodynamic and symptomatic improvement. The Inoue technique achieved a larger immediate post-valvotomy mitral valve area, but the difference was not apparent at 1 year follow-up. Incidence of significant mitral regurgitation was similar with both the techniques; however, local complications occurred more frequently with the retrograde technique. Both techniques may complement each other in technically difficult cases.

Adult↗
PubMed1996

Gastric aspiration for diagnosis of pulmonary tubercolosis in adult renal allograft recipients.

Of 213 renal allgraft recipients suspected to have had pulmonary tuberculosis, 132 had sputum examinations and 14 showed acid-fast bacilli. Of the remaining 118 patients, 25 had gastric aspirations, 18 had bronchoalveolar lavage, and 75 did not require further investigation because of spontaneous improvement or confirmation of an alternative diagnosis. While 9 of the 25 patients' gastric aspirate examination was positive, all the 18 who had bronchoalveolar lavage were negative for acid-fast bacilli. Eighty-one patients without expectoration had gastric aspiration directly and 14 showed acid-fast bacilli. Of the remaining 67 patients only 17 had bronchoalveolar lavage, of which three were positive for AFB and the rest did not require further testing for tuberculosis. A total of 106 patients had gastric aspiration. Acid-fast bacillus positivity was significantly more (P<.01) in patients with abnormal chest radiographs as compared with patients with normal chest radiographs as compared with patients with normal chest radiograph results. We suggest gastric aspiration for AFB in all renal transplant recipients who have fever, scanty expectoration, and abnormal chest radiograph with clinical suspicion of pulmonary tuberculosis.

Bacteriological Techniques↗
PubMed1995

Effect of Ca(2+)-channel blockers, Ca(2+)-ionophore and increased pyrene excimer formation on the microsomal glucose-6-phosphatase.

The dependence of microsomal glucose-6-phosphatase (G-6-Pase) activity on Ca2+ as well as the membrane lipid microviscosity was studied by the effect of Ca(2+)-channel blockers (namely verapamil and nifedipine), Ca(2+)-ionophore, A23187 and pyrene excimer formation. Channel blockers depressed the G-6-Pase and Ca(2+)-ATPase while the ionophore increased these activities. Dimethyl sulfoxide, a known membrane surface active agent showed no change. Ca(2+)-uptake into the membrane has expectedly been lowered by the channel blockers while the ionophores facilitated the ion flux. Excimer formation of the fluorescent probe, pyrene as an indicator of increased membrane fluidity, and microviscosity calculated from there on, showed that Ca(2+)- and lipid microenvironment in the membrane significantly influenced the activity of G-6-Pase. Membrane lipid composition such as phospholipid/cholesterol molar ratio which also indicates an increased membrane fluidity is markedly increased with the ionophore but decreased with the channel blockers, while protein/phospholipid ratio remained unchanged. Microsomal G-6-Pase is a multicomponent multifunctional protein. It is argued that Ca2+ may play the role of an obligatory cofactor not only for the hydrolysis of G-6-P (catalytic part of the enzyme) but also involved in the regulation of substrate and product transport in or out of the endoplasmic reticulum lumen.

Animals↗
PubMed1994

Retrograde nontransseptal balloon mitral valvuloplasty for rheumatic mitral stenosis.

Retrograde nontransseptal balloon mitral valvuloplasty is a relatively new technique for dilating stenosed mitral valves, wherein a specially designed steerable catheter is used to enter the left atrium retrogradely. Over a 1-yr period, 52 patients (34 M, 18 F; mean age 26.4 +/- 6.5 yr) with symptomatic noncalcific rheumatic mitral stenosis underwent balloon mitral valvuloplasty by this technique at our center. The procedure was completed in 51 out of the 52 patients and technically successful dilatation was achieved in 47 (90.4%) patients. The mean valve area increased from 0.8 +/- 0.2 cm2 to 1.86 +/- 0.37 cm2 and end diastolic gradients decreased from 21.2 +/- 9.4 mm Hg to 4.0 +/- 2.2 mm Hg. Significant mitral regurgitation (> 2+) developed in two (3.9%) patients, and both remained stable on medical treatment. In two patients, there was a significant decrease in femoral pulse, which improved with thrombolytic therapy. Our study is the first report of this technique from a center other than that of its origin. The results of this study further establish that this new retrograde technique may be a useful alternative to the conventional transseptal techniques for mitral valvuloplasty.

Adult↗
PubMed1994

Effect of serotonin and tricyclic antidepressants on intracellular calcium concentrations in Spisula oocytes.

Microspectrofluorometry and video imaging techniques were used to study and to compare the changes in intracellular calcium concentrations ([Ca2+]i) of individual Fura-2 loaded Spisula oocytes treated with serotonin (5-hydroxytryptamine, 5-HT) or tricyclic antidepressants. In the present study, we showed that 5-HT increased [Ca2+]i in freshly isolated Spisula oocytes suspended in artificial sea water. In the absence of extracellular Ca2+, 5-HT did not influence [Ca2+]i. Stimulation of [Ca2+]i by 5-HT was blocked by calcium channel blocker, e.g. verapamil, and by tricyclic antidepressants. These observations combined with our previous results on the effects of 5-HT, tricyclic antidepressants and verapamil on calcium uptake suggest that the increase in [Ca2+]i induced by 5-HT results from an influx of extracellular calcium through calcium channels, which can be blocked by tricyclic antidepressants. The use of the Fura-2 imaging technique allowed single-cell measurements and defined changes induced by 5-HT in [Ca2+]i which is the net result of calcium uptake and release of intracellular calcium from storage sites in individual Spisula oocytes.

Animals↗
PubMed1994

Abnormal exercise electrocardiogram in an asymptomatic person--what next?

No reasonable guidelines exist for evaluating an asymptomatic individual (without evidence for ischemic heart disease on history or electrocardiography) with a positive exercise ECG. Available data indicate that persons with a strongly positive test should undergo a coronary angiography. In persons with mild to moderately positive results, cinefluoroscopy is indicated and those who show coronary calcification should have a coronary angiogram. Although stress thallium-201 is often done before coronary angiography, its role is limited. Scant data exist in women and suggest that the overall approach may not be markedly different. However, ST changes in women have a low specificity. Recent studies indicate a 95% specificity and sensitivity for positron emission tomography. Despite its high costs it may still be the most cost-effective modality by saving unwanted radionuclide studies and arteriographies.

Adolescent↗