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Biomedical subjects

R Kaushik

Publications and source records attributed to R Kaushik.

35 records · Page 2Linked to original sources
PubMed1991

Extended vertical transatrial septal approach to the mitral valve.

Optimal mitral valve operation requires adequate exposure without impairment of atrial physiology, namely sinus node and atrioventricular node function. We used an extended vertical transseptal atrial approach in 34 consecutive patients. The extended vertical transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly, allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. The right atriotomy is extended superiorly in the right coronary fossa between the right atrial appendage and the atrioventricular sulcus to meet the septal incision. The two joint incisions are extended onto the left atrial roof transversely. At this point, the two semicircular incisions are performed and joined, and mitral valve operation is performed. There were 18 women and 16 men. Five patients had ischemic mitral valve regurgitation, 18 had mitral valve prolapse, and 11 had rheumatic heart disease. The mitral valve was replaced in 17 patients and repaired in 17. There were no perioperative complications associated with the atriotomies, ie, no bleeding, no atrioventricular nodal dysfunction, and no sinus node dysfunction. The extended vertical transatrial septal approach provides good mitral valve exposure without inherent complications.

Adult↗
PubMed1991

Factors predictive of results of direct ablative operations for drug-refractory ventricular tachycardia. Analysis of 80 patients.

During a 9-year period 80 patients with drug-resistant sustained ventricular tachycardia underwent direct surgical ablation of arrhythmogenic myocardium. Sixty-nine were male (86%) and 11 female (14%), with 1.9 +/- 1.1 (standard deviation) ventricular tachycardia morphologies per patient. The mean number of drugs failed was 3.7 +/- 1.6 per patient. The preoperative left ventricular ejection fraction was 36.4% +/- 14.4%. Complete preoperative endocardial mapping data (greater than 4 endocardial sites in each ventricular tachycardia) were available for 60 of the 80 patients (75%) and intraoperative endocardial data in the clinical ventricular tachycardia was obtained in 37 (46.3%) of the patients. In 17 patients mapped intraoperatively by computer-assisted techniques, complete epicardial and endocardial data in the clinical ventricular tachycardia were obtained in 14 patients (82.4%). Overall, 73 of 80 (91.3%) had some mapping data available. Hospital mortality occurred in 10 patients (12.5%) at a mean interval of 13.5 days, range 0 to 62 days. Postoperatively the clinical ventricular tachycardia has not recurred in 65 of 70 surviving patients (92.9%). Nonclinical ventricular tachycardia occurred in another four patients. All nine patients with postoperative ventricular tachycardia responded to drugs. The major factors predictive of hospital mortality were prolonged cardiopulmonary bypass (greater than 150 minutes), preoperative ejection fraction less than 31%, and incomplete preoperative mapping. Hospital mortality in patients with an ejection fraction below 31% was significantly associated with a history of amiodarone usage. At 3 years of follow-up, freedom from sudden cardiac death was 95.7%, and 86.7% of patients were free of ventricular tachycardia on no antiarrhythmic drugs. These results suggest that direct ventricular tachycardia operations are an effective form of therapy for patients with sustained monomorphic ventricular tachycardia.

Adult↗
PubMed1990

Surgical epicardial ablation of left ventricular pathway using sling exposure.

We report our experience with 43 consecutive patients with left free wall pathways operated on since December 1988 using a modified direct epicardial approach through a medial sternotomy, without the adjunct of normothermic cardiopulmonary bypass. The left atrioventricular sulcus is exposed by dislocating the heart cephalad and to the right using a sling made of a large sponge passed around the ventricle through the transverse sinus. While the arterial pressure is monitored, the heart is positioned to obtain adequate exposure without compromising the ventricular function. The left atrioventricular junction is exposed using a direct approach. The epicardium is incised along the ventricular edge and a plane of dissection is identified and opened using blunt dissection over the ventricular wall. The entire left atrioventricular junction can be exposed. After dissection, electrophysiological testing is repeated to assess accessory pathway conduction. Epicardial cryoablation was used when accessory pathway conduction was not present (42 patients). Transmural cryoablation was used under normothermic cardiopulmonary bypass when accessory pathway conduction persisted after dissection (subendocardial pathway). In all, cardiopulmonary bypass was not used in 41 patients. There was one early relapse that required transmural cryoablation. There were no complications.

Adult↗
PubMed1989

Results of direct surgical ablation of ventricular tachycardia not due to ischemic heart disease.

Surgical treatment of sustained ventricular tachycardia due to nonischemic causes is uncommon. Nonischemic ventricular tachycardia was treated in 14 patients by map-directed surgical ablation of an arrhythmogenic site. There were 9 male and 5 female patients. The mean age was 33 +/- 13.4 years (range, 15 to 57 years). The etiology was idiopathic in 4 patients, cardiomyopathy in 3, acute myocarditis in 1, arrhythmogenic right ventricular dysplasia in 2, tumor in 1, postoperative Tetralogy of Fallot in 2, and acute bacterial endocarditis in 1. Pre- and/or intraoperative electrophysiologic mapping was achieved in 13 of 14 patients. A variety of operations were performed without death. Two late deaths have occurred, neither of them, however, from arrhythmias. After operation two patients had recurrent arrhythmias. Surgery for nonischemic ventricular tachycardia is safe and effective and should be considered early in the course of these mostly young patients.

Adolescent↗
PubMedDate not supplied

Neonatal morbidity in a hospital at Shimla.

During the study period there were 2063 live births. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p < 0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p < 0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p < 0.001)]. Hyperbilirubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p < 0.001] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.

Asphyxia Neonatorum↗
PubMedDate not supplied

Neonatal mortality rate: relationship to birth weight and gestational age.

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p < 0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p < 0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.

Birth Weight↗
PubMedDate not supplied

Effect of starvation and insulin-induced hypoglycemia on oxidative stress scavenger system and electron transport chain complexes from rat brain, liver, and kidney.

Considerable evidence suggests that oxidative stress plays an important role in tissue damage associated with hypoglycemia and other metabolic disorders. The altered brain neurotransmitters metabolism, cerebral electrolyte contents, and impaired blood-brain barrier function may contribute to CNS dysfunction in hypoglycemia. The present study elucidates the effect of starvation and insulin-induced hypoglycemia on the free radical scavanger system--reduced glutathione (GSH) content, glutathione S-transferase (GST), glutathione peroxidase (GPx), glutathione reductase (GR), gamma-glutamyl transpeptidase (gamma-GTP), gamma-glutamyl cystein synthetase (gamma-GCS), catalase and superoxide dismutase (SOD), and mitochondrial electron transport chain (ETC) complexes I-IV from three different regions of rat brain, namely cerebral hemispheres (CH), cerebellum (CB), and brainstem (BS). Peripheral organs, such as liver and kidney, were also studied. Significant changes in these enzymic activities were observed. The analysis of such alterations is important in ultimately determining the basis of neuronal dysfunction during metabolic stress conditions, such as hypoglycemia, and also defining the nature of these changes may help to develop therapeutic means to cure metabolically stressed tissues.

Animals↗
PubMedDate not supplied

Biochemical and molecular markers in renal cell carcinoma: an update and future prospects.

Cancer is a big problem in the developed world as well as in developing countries. Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. RCC is more common in men than in women (2:1), and it most often occurs in patients between the ages of 50-70 years. In all cancers the cancerous cells release particular kind of proteins (called tumour markers) and blood tests are used to detect the presence of these markers. These tumour markers nowadays are an area of interest for oncologists who search for a possible solution in the detection and treatment of RCC. Different kinds of biochemical and molecular markers such as ferritin, MN/CA9, apoptotic index, p53, IL-2, gamma-enolase, CD44, CD95, chromosome instability and loss of heterozygosity have been tested in RCC, but so far no marker fulfils one or the other criteria to be considered as an ideal marker for RCC. This review gives basic and updated information about the different kinds of biomarkers studied in RCC and about the role implementation of genomics and proteomics in RCC.

Adult↗
PubMedDate not supplied

Jejunal serosal onlay flap for repair of large common bile duct defect in Mirizzi's syndrome.

Reconstruction of the common bile duct (CBD) has been performed using a variety of materials, ranging from synthetic i.e. teflon, to autogenous tissues such as veins, arteries, appendix, ureter, gallbladder, duodenum, etc. The onlay jejunal serosal patch has been commonly used to cover defects because of duodenal ulcer perforations and injuries. To the best of our knowledge, the use of this technique for choledochoplasty in Mirrizi syndrome has not been reported. We present a case of Mirrizi syndrome type III, in whom nearly three fourths of the CBD was eaten away by a large gallstone and the repair was done using an onlay serosal patch of the jejunum.

Cholestasis, Extrahepatic↗
PubMedDate not supplied

Mechanical bowel obstruction: the Chandigarh experience.

Intestinal obstruction is a fairly common surgical emergency in India, but there is little data available regarding the spectrum of intestinal obstruction in India, or its related complications. This paper represents a retrospective review of 97 patients who underwent surgery for intestinal obstruction at Government Medical College and Hospital, Chandigarh, India, over four years (1997-2000). The case files of all these patients were reviewed and analysed for patient particulars, pre-operative clinical examination and investigations, intraoperative findings, final diagnosis, post-operative morbidity, and mortality. The mean age of our patients was 39.46 years, with an overall male to female ratio of 2.46:1. Most of the patients were in the age group of 17 to 60 years (62.89%). A total of 107 causes for the obstruction could be identified at surgery, with intra-abdominal adhesions and bands (27.10%) being the commonest followed by obstructed herniae (22.43%). Strangulation was present in 21 patients at the time of surgery. This group of patients had a significantly higher post-operative morbidity than patients with simple obstruction, although no statistically significant difference was seen in between the mortality rates in these two groups.

Adult↗
PubMedDate not supplied

Spleen preserving distal pancreatectomy for blunt abdominal trauma--a case report.

The case of a 22-year-old male who underwent spleen preserving distal pancreatectomy (SPDP) for pancreatic trauma is briefly reported. SPDP was performed by preserving the splenic vessels to maintain a reliable splenic blood flow post-operatively. Although technically demanding, this procedure can be performed safely and easily in the emergency, and avoids splenectomy-related problems in the post-operative period.

Abdominal Injuries↗
PubMedDate not supplied

Pancreas-sparing duodenectomy for trauma.

The application of pancreas sparing duodenectomy (PSD) in extensive duodenal trauma has not been fully explored. We report 3 caes of duodenal trauma in whom PSD was performed successfully and with good results.

Abdominal Injuries↗