Tornwaldt's cysts are sometimes a bit of a headache.
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Adult↗
Biomedical subjects
R Pathi
Publications and source records attributed to R Pathi.
Isolated spinal cord lipoma.
A case of isolated intradural spinal cord lipoma is presented. Most isolated spinal cord lipomas are intradural extramedullary, and the most common location is subpial. True intramedullary lipomas are very rare. Patient history is usually of months to years of local back pain, with recent escalation of pain and development of neurological symptoms. MRI examination shows a well circumscribed lesion of high signal on both T1 and T2 weighted images, and suppression on fat saturation sequence. Subtotal resection is the surgical aim. This improves pain but neurological symptoms rarely improve, usually are unchanged, and occasionally are worse.
Adult↗
Predictors of prolonged dysphagia following acute stroke.
Dysphagia following acute stroke frequently necessitates prolonged enteral feeding. There is evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. The aim of this study was to identify predictors of prolonged dysphagia. The subjects were 149 consecutive patients admitted with acute stroke. Clinical findings and imaging results were prospectively collected, and subsequent progress recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (< or =14 days); or prolonged dysphagia (>14 days). Validity of the water swallow test as a predictor of aspiration pneumonia was confirmed. Significant associations for prolonged dysphagia were seen with stroke severity, dysphasia and lesions of the frontal and insular cortex on brain imaging. These results indicate that it may be possible to predict patients who will develop prolonged significant dysphagia following acute stroke thereby facilitating referral for insertion of PEG at an earlier time point.
Acute Disease↗
Evaluation of the effectiveness of digital radiography in emergency situations.
The time differences between digital and conventional radiography for emergency patients were investigated, and clinician satisfaction with the two modalities was compared. Time-motion data was collected daily over 5 weeks for a digital group and a conventional X-ray group. For standardization purposes, only emergency patients requiring chest X-rays were selected for the study. Data were collected from 30 patients in each of the two groups in the time-motion study, and 31 out of 50 Emergency and Intensive Care clinicians responded to the questionnaire. Results were analysed by percentage, and chi2 analysis was used where appropriate. The time for availability of images to requesting clinicians was 70% less for digital images compared to conventional radiography. The overall satisfaction between digital and conventional radiography was very similar, but most clinicians expressed an opinion that digital radiography offered significant image modification advantages.
Emergency Medical Services↗
Bleomycin upregulates gene expression of angiotensin-converting enzyme via mitogen-activated protein kinase and early growth response 1 transcription factor.
Pulmonary fibrosis is a progressive disorder characterized by the loss of alveolar architecture through epithelial and endothelial cell apoptosis and fibroblast proliferation. Recent studies showed that angiotensin-converting enzyme (ACE) activity is increased in fibrotic tissues, and ACE inhibitors administered in vivo ameliorate fibrosis, suggesting that ACE may play a critical role. However, the regulation of ACE expression is not well understood. In the present study, we demonstrate that bleomycin, a chemotherapeutic agent which induces pulmonary fibrosis in animals and humans, increases gene expression of ACE. Treatment of primary bovine pulmonary artery endothelial cells with 0.1 to 1.0 microg/ml bleomycin increased ACE enzymatic activity and ACE mRNA, as monitored by hippuryl-L-histidyl-L-leucine assay and competitive quantitative reverse transcriptase polymerase chain reaction (RT-PCR), respectively. Luciferase reporter constructs showed that upregulation of ACE transcription by bleomycin is mediated through element(s) in the 97-bp ACE promoter. Bleomycin activated p42/p44 mitogen-activated protein kinase (MAPK) and induced nuclear translocation and activation of the early growth response (Egr)-1 transcription factor, a factor previously shown to positively regulate ACE expression. The MAPK kinase1/2 (MEK1/2) inhibitor U0126 blocked MAPK and Egr-1 activation by bleomycin, suggesting that Egr-1 activation is MAPK dependent. These data provide the first evidence that bleomycin activates ACE gene expression through the MAPK pathway and Egr-1.
Animals↗