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Biomedical subjects

R Madan

Publications and source records attributed to R Madan.

35 records · Page 2Linked to original sources
PubMed2000

Giant cell arteritis. Episodes of syncope add complexity to an unusual presentation.

GCA presents in various forms, creating a diagnostic conundrum for the treating physician. Evaluation requires extensive medical examination, testing, and imaging to rule out other conditions. Compared with the process of diagnosing GCA, treating it is relatively straightforward. Most patients show significant improvement with corticosteroid therapy. Our patient presented with syncope, which also has numerous causes. Detailed testing confirmed a positional trigger for her syncope in the absence of hemodynamic disturbances. She responded promptly to corticosteroid therapy. We speculate that flow-limiting stenosis in the vertebrobasilar system may have caused her symptoms.

Aged↗
PubMed1999

Comparison of anti-emetic effects of ondansetron, metoclopromide or a combination of both in children undergoing surgery for strabismus.

This prospective, randomized and double-blinded study was designed to evaluate the anti-emetic efficacy of a combination of ondansetron and metoclopramide in 100 ASA physical status I and II children of either sex and 1-15 years of age undergoing elective surgery for strabismus. A standardized anaesthetic technique and post-operative analgesia were used for all the children. Children were divided into four groups. They received saline, metoclopromide 250 micrograms kg-1, ondansetron 150 micrograms kg-1 or a combination of metoclopramide 150 micrograms kg-1 and ondansetron 100 micrograms kg-1 intravenously immediately after the insertion of an intravenous cannulae. There were no differences between the groups in their age, gender, weight, duration of surgery, number of muscles subjected to surgery or intravenous fluids received. In the first 24 post-operative hours, 18 (72%) patients in the placebo group, 15 (60%) patients in the metoclopramide group, 10 (40%) patients in the ondansetron group and 11 (44%) patients in the combination group had nausea or vomiting. The overall incidence of post-operative nausea and vomiting was significantly (P < 0.05) lower in the combination group and in the ondansetron group compared with the placebo group. Nine (36%) patients in both the placebo and the metoclopramide groups and one (4%) patient in the ondansetron group required rescue anti-emetic treatment. None of the patients in the combination group required rescue anti-emetic and this was significantly less (P < 0.01) when compared with the placebo and the metoclopramide groups. Recovery and sedation scores were comparable in all the four groups. A combination of metoclopramide 150 micrograms kg-1 and ondansetron 100 micrograms kg-1 administered prior to surgery was not found to be more effective than ondansetron 150 micrograms kg-1 alone for the prophylaxis of nausea and vomiting following surgical repair of strabismus in paediatric patients.

Adolescent↗
PubMed1997

The anaesthetist and the antiphospholipid syndrome.

Antiphospholipid syndrome is a paradoxical disease state with in vitro prolongation of activated partial thromboplastin time and a strong predilection for in vivo thrombosis. The syndrome can be associated with systemic lupus erythematosus or lupus-like diseases or may be primary, presenting with thrombotic phenomena in young patients with no risk factors for thrombosis. We present two cases seen in two different settings in the hospital.

Adult↗
PubMed1994

Anaesthesia and the Sturge-Weber syndrome.

We report a series of 13 patients with Sturge-Weber syndrome anaesthetised on 17 occasions. Anaesthesia management varied depending on the clinical manifestations which ranged from localized, superficial skin lesions to extensive systemic involvement. These patients tolerate anaesthesia well but anaesthetic management includes evaluation for associated anomalies. Difficulty with intubation may occur due to angiomas of the mouth and upper airway. Anaesthesia should be planned to avoid trauma to the haemangiomata and increases in intraocular and intracranial pressure.

Adolescent↗
PubMed1993

Environmental release of chemicals and reproductive ecology.

Reproductive ecology is defined as "the study of causes and mechanisms of the effects of environmental risk factors on reproductive health and the methods of their prevention and management." Major areas of concern, within the purview of this paper, relate to adverse pregnancy outcomes, effects on target tissues in the male and the female, and alterations in the control and regulatory mechanisms of reproductive processes. Teratogenic potential of chemicals, released as a result of accidents and catastrophes, is of critical significance. Congenital Minamata disease is due to transplacental fetal toxicity caused by accidental ingestion of methyl mercury. Generalized disorders of ectodermal tissue following prenatal exposure to polychlorinated biphenyls have been reported in Taiwan and Japan. The Bhopal gas disaster, a catastrophic industrial accident, was due to a leak of toxic gas, methyl isocyanate (MIC), in the pesticide manufacturing process. The outcome of pregnancy was studied in female survivors of MIC exposure. The spontaneous abortion rate was nearly four times more common in the affected areas as compared to the control area (24.2% versus 5.6%; p < 0.0001). Furthermore, while stillbirth rate was found to be similar in the affected and control areas, the perinatal and neonatal mortality rates were observed to be higher in the affected area. The rate of congenital malformations in the affected and control areas did not show any significant difference. Chromosomal aberrations and sister chromatid exchange (SCE) frequencies were investigated in human survivors of exposure. The observed SCE frequencies in control and exposed groups indicated that mutagenesis has been induced. Strategies for the management, prediction, and preventability of such disasters are outlined.

Abortion, Spontaneous↗
PubMed1990

Goldenhar's syndrome: an analysis of anaesthetic management. A retrospective study of seventeen cases.

Seventeen patients with Goldenhar's syndrome who had surgery 28 times are presented. Various authors have reported problems in the anaesthetic management of these patients, but we encountered significant difficulties in only one. Three anaesthetic techniques were used. A thorough pre-operative assessment with back-up facilities for difficult intubation are important. Additional cardiorespiratory and craniovertebral anomalies may necessitate modifications in the basic techniques.

Anesthesia↗
PubMed1986

Immunologic tools to decipher efficacy of BCG immunotherapy in advanced breast cancer: a one year follow up study.

We report the clinical outcome of conventional therapy and BCG immunisation therapy for 40 patients with advanced breast carcinoma. The clinical outcome was better for the 20 patients receiving BCG immunisation therapy. All patients were assessed for cell mediated immunologic competence before starting treatment and after completion of treatment. Thereafter they were followed for one year. Those patients who showed good local response to BCG vaccination before starting therapy had better prognosis, and those for whom anergy to PPD and DNCB could be reversed by BCG immunotherapy showed clinical improvement. Another interesting finding was that IgA was the predominating immunoglobulin located in normal breast tissue and benign breast tumours while IgG was deposited in most of the malignant breast tumour. This indicated that malignant tumours of the breast jeopardise the secretory immune system of the mammary gland.

B-Lymphocytes↗
PubMedDate not supplied

Diazepam induced delirium.

In Ophthalmic practice diazepam is often used a a premedicant. We report a case where administration of diazepam led to a state of acute delirium because of which surgery had to be postponed. The possible mechanisms for this reaction and the treatment is discussed. This side effect of diazepam should be kept in mind while dealing with delirium in the geriatric age group.

Aged↗