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Rajiv Goel

Publications and source records attributed to Rajiv Goel.

At least 37 records · Page 2Linked to original sources
PubMed2005

Physiological matrix metalloproteinase concentrations in serum during childhood and adolescence, using Luminex Multiplex technology.

Matrix metalloproteinases are a family of zinc-dependent proteinases which are involved in the breakdown and remodeling of extracellular matrix. As children grow and adolescents reach pubescence, their bodies undergo changes that require age-related morphogenesis of the extracellular matrix, possibly requiring unique patterns of matrix metalloproteinase (MMP) expression during periods of rapid tissue growth (i.e., childhood) or accelerated tissue remodeling and expansion (i.e., adolescence). Therefore, we have characterized age-specific and gender-specific differences in circulating concentrations of MMPs (specifically MMP-1, -2, -3, -8 and -9) in 189 serum samples obtained from healthy subjects, aged 2-18 years. MMP concentrations were measured using Fluorokine MultiAnalyte Profiling kits and a Luminex Bioanalyzer, as well as by commercial ELISA. Serum levels of MMP-1, -2, -3, -8, and -9 in healthy pediatric subjects represent log-normal distributions. MMP-2 was significantly negatively correlated with age (r=-0.29; p<0.001), while MMP-3 was significantly positively correlated with age (r=0.38; p<0.001). Although plasma, not serum, is considered the appropriate blood sample for measurement of MMP-8 and -9, serum levels of MMP-8 and -9 were also found to be highly positively correlated with each other (r=0.76; p<0.01). MMP results obtained by Fluorokin MultiAnalyte Profiling methods correlated well with conventional ELISA methods and use of this technology provided several advantages over ELISA.

Adolescent↗
PubMed2005

Severe obesity in children and adolescents: implications for treatment.

The prevalence of clinically severe obesity in adults has been rising rapidly. We completed a needs assessment that examined the prevalence of severe obesity in a tertiary pediatric weight management clinic. The Arkansas Children's Hospital (ACH) Fitness Clinic, a specialty clinic treating overweight children and adolescents, is offered in partnership with the University of Arkansas for Medical Sciences Child and Adolescent Bariatrics Center. Our hypothesis is that the ACH Fitness Clinic has a large proportion of severely overweight children and that these patients are in need of more aggressive adjuvant therapies to improve their health status. The study reported here is part of an ongoing feasibility study regarding the need for pharmacologic and surgical options for Fitness patients who are morbidly overweight and are not responding well to a behavior treatment program alone. Of the 701 overweight (BMI >95th percentile for age and gender) children and adolescents seen in Fitness Clinic over a 29-month period, 72% had a Body Mass Index (BMI) >35, which is considered severe obesity in adults.

Adolescent↗
PubMed2004

Radical cystectomy in septuagenarian patients with bladder cancer.

INTRODUCTION: Clinical results of radical cystectomy performed on elderly bladder cancer patients over 70 years old were assessed to determine whether age is one of the critical points for the application of this type of surgery. MATERIALS: From January 1992 to December 2002, 41 radical cystectomy performed in septuagenarian population were compared with 197 performed in patients less than 70 years of age. RESULTS: The early and late complication rate for septuagenarians was 29.7% and 12%, compared with 26.9% and 9.6% for patients younger than 70 years respectively. The overall mortality rate for septuagenarians was 4.9%, compared with 8.6% for patients younger than 70 years. There was no significant difference between the two groups with regard to pathologic stage or length of hospital stay. The 5-year overall survival rate for septuagenarians was 53% compared with 59% for patients younger than 70 years. CONCLUSIONS: When indicated after adequate preoperative assessment and optimization of the patient, radical cystectomy is a safe procedure in the septuagenarians and patient should not be denied surgery dependent on chronologic age.

Aged↗
PubMed2004

Complication of percutaneous suprapubic cystostomy.

A patient with urethral stricture presented to us with acute retention. Sequential dilatation over a guidewire was done and a suprapubic catheter was placed percutaneously. Guide wire broke during the procedure, which came to our notice on micturating urethrogram. Laser core through for the stricture and endoscopic removal of the guidewire were done.

Cystostomy↗
PubMed2004

Renal sinus hemangioma simulating renal mass: a diagnostic challenge.

A 47-year-old female presenting with right flank pain and renal mass on ultrasonography was evaluated for renal malignancy. Based on the CT findings and blood aspiration on repeated fine needle aspiration biopsy the patient underwent radical nephrectomy. Histopathology revealed renal sinus hemangioma with normal kidney, perirenal fat and the hilar structures.

Diagnosis, Differential↗
PubMed2004

Characteristics of children with asthma who are enrolled in a Head Start program.

BACKGROUND: Asthma is an increasing public health concern that disproportionally affects children. In 1998, the Centers for Disease Control identified children aged 0 to 4 years as the "driving force" behind climbing rates of asthma-related emergency department visits and hospitalizations. Despite the significant asthma burden in preschool children, few studies characterize this population. OBJECTIVE: This study identifies and characterizes children at risk for asthma who are enrolled in a local Head Start program. METHODS: Caregivers of 368 children aged 3 to 5 years who were identified by using an asthma survey were recruited. Data were collected on demographics, health care use and access, medication use, symptoms, and trigger exposure. Exposure to tobacco smoke was determined by urinary cotinine and allergen sensitization by skin prick test. RESULTS: At baseline, 64% of the children had more than 1 emergency department visit for asthma in their lifetime, whereas 31% had more than 1 visit in the previous 6 months. Caretakers reported smoking in 37% of households with cotinine exceeding 20 ng/mg in 27% of the sample. Twenty-one percent reported symptoms consistent with intermittent asthma, and 79% reported symptoms consistent with persistent asthma. Forty-five percent of the children reported nighttime symptoms more than 1 night per week. Seventy-one percent had positive test results for more than 1 allergen, and 42% had positive test results for more than 3 allergens. Only 32% of children with persistent asthma had both rescue and controller medications. CONCLUSION: Children with asthma enrolled in a Head Start program have significant environmental tobacco smoke exposure, are highly atopic and symptomatic, and do not receive appropriate medication treatment. Overall, children in the study had poor asthma control. This high-risk group could benefit from case management programs.

Black or African American↗
PubMed2004

Squamous cell carcinoma of the renal pelvis manifesting after percutaneous nephrolithotomy for long standing calculus.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm and is usually associated with long standing stone disease. The disease is aggressive in nature and usually has a poor prognosis. We report a case of renal lithiasis who underwent successful percutaneous nephrolithotomy (PCNL) for renal pelvic calculus, and eight months later presented with a large invasive squamous cell carcinoma in the same location.

Carcinoma, Squamous Cell↗
PubMed2004

Should retroperitoneoscopic nephrectomy be the standard of care for benign nonfunctioning kidneys? An outcome analysis based on experience with 449 cases in a 5-year period.

PURPOSE: Laparoscopic nephrectomy has become a routine procedure at specialized centers with the advantages of less postoperative pain, minimal scars, rapid recovery and short convalescence. We report our experience with the establishment of retroperitoneoscopic nephrectomy as the standard of care for benign nonfunctioning kidneys. MATERIALS AND METHODS: We retrospectively compared the records of patients who underwent simple nephrectomy retroperitoneoscopically or by open surgery from January 1998 to October 2003 at our center. RESULTS: A total of 351 simple nephrectomies were done retroperitoneoscopically, while 83 were done as an open procedure. Mean operative time was significantly longer in the retroperitoneoscopic group. However, mean blood loss, complication rate, hospital stay and convalescence were significantly less in the retroperitoneoscopic group. CONCLUSIONS: Retroperitoneoscopic nephrectomy has become a standardized procedure. It should be offered as the primary treatment modality to patients with benign renal disease scheduled for elective nephrectomy except in those in whom it is contraindicated.

Blood Loss, Surgical↗
PubMed2004

Upper pole access for complex lower pole renal calculi.

OBJECTIVES: To assess the efficacy of superior pole access for complex lower pole calyceal calculi. PATIENTS AND METHODS: In all, 102 patients with complex inferior calyceal calculi were included in a prospective unrandomized study. Complex inferior calyceal calculi were defined as multiple calculi in two or more inferior calyces of the lower polar group, with each calyx draining through a separate infundibulum and at an acute angle to each other. In 33 patients (32%; group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access was obtained through a superior calyceal puncture. The stone-free rates, decrease in haemoglobin, operative duration, requirement for additional tracts and second procedures in the two groups were compared. RESULTS: Stone clearance rates and blood loss values were better in group 2, although they were not significantly different. The mean operative duration, number of tracts required and the re-look procedure rate was significantly less in group 2. Two patients (3%) in group 2 had hydrothorax related to supracostal puncture and required chest tube insertion. CONCLUSIONS: Superior calyceal puncture (supracostal or infracostal) affords optimum access to complex inferior calyceal stones, providing faster and better clearance with a single puncture, and less requirement for second-look procedures.

Female↗
PubMed2004

Hemostasis in tubeless PNL: point of technique.

INTRODUCTION: Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. MATERIALS AND METHODS: Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. RESULTS: No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. CONCLUSIONS: Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL.

Adult↗
PubMed2003

Spontaneous perirenal hematoma during coronary angiography.

We report a case of spontaneous perirenal hematoma that developed acutely during an elective coronary angiography in a 65-year-old man with suspected coronary artery disease, probably related to the use of heparin during angiography. The patient did not have any systemic vasculitides and was not receiving antiplatelet or anticoagulant agents prior to the angiography. Serial follow-up high resolution CT scans with 2 mm cuts in the renal areas showed resolution of the hematoma but no underlying mass lesion or any other abnormality.

Aged↗
PubMed2003

An unusual complication of urethral stent.

A 62-year-old man with recurrent urethral stricture and an indwelling urethral stent presented to us with symptoms of difficult voiding. Retrograde urethrogram confirmed narrowing of the lumen of the urethra and a visual internal urethrotomy was done. However, during the urethrotomy, dense fibrosis around the stent was encountered making the incision difficult and leading to breakage of the blade of the urethrotome.

Equipment Failure↗
PubMed2003

Cooled lignocaine gel: does it reduce urethral discomfort during instillation?

INTRODUCTION: Topical urethral analgesia with 2% lignocaine gel for office procedures is an accepted practice in contemporary urology. However, instillation of 2% lignocaine gel into the urethra is associated with discomfort in some patients. MATERIAL AND METHODS: Forty consenting men reporting for cystoscopy under local anesthesia were randomized to receive 10 ml of 2% lignocaine hydrochloride gel at 4 degrees C and 22 degrees C. After instillation of the gel the patients were immediately asked to score the pain using a nongraphical visual analogue scale. RESULTS: The pain scores were analyzed using the paired Student's t-test. There was significant reduction in pain scores in the group receiving gel at 4 degrees C compared with the group at 22 degrees C (P < 0.05). CONCLUSION: Refrigerating the gel to 4 degrees C can significantly reduce the initial discomfort associated with instillation of 2% lignocaine hydrochloride into the male urethra.

Administration, Topical↗
PubMed2003

Pseudohypospadias with bilateral vesicoureteric reflux: consequences of inappropriate management of stricture urethra.

A 17-year-old male boy presented with clinical features of pseudohypospadias (small penile stump with absent distal penile urethra) associated with very small capacity bladder and bilateral grade IV vesicoureteric reflux following suprapubic urinary diversion for multiple urethro-cutaneous fistula and periurethral abscess which developed as a consequence of inappropriate initial management of urethral trauma. This case highlights the importance of the initial management of urethral trauma and the management of its rare complication.

Abscess↗
PubMed2003

Cost-effective laparoscopic pyeloplasty: single center experience.

OBJECTIVE: Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. METHODS: Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8-51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal (n = 12) and retroperitoneal (n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases. RESULTS: Laparoscopic Anderson-Hynes pyeloplasty was performed in 16, Foley Y-V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson-Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2-24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. CONCLUSION: Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner.

Adolescent↗
PubMed2003

Minimally invasive retroperitoneoscopic ureterolithotomy.

PURPOSE: We assessed the efficacy of modified technique of retroperitoneal ureterolithotomy for managing ureteral stones. MATERIALS AND METHODS: Between December 1999 and March 2002, 31 patients underwent retroperitoneal ureterolithotomy. In most cases only 3 ports (a 10 mm., 2 5 mm. and in a few 2, 3 mm.) were used without any ureteral stent or catheter. The stone was removed from the primary port site, while visualizing retrieval through the 3/5 mm. port using fine laparoscope. Ureterotomy closure was performed by intracorporeal interrupted sutures of 4-zero polyglactin. RESULTS: The 20 males and 11 females had a mean age of 38.5 years. Mean operative time was 67 minutes and mean hospital stay was 2.4 days. The mean analgesic requirement was 42.2 mg. meperidine. Mean followup was 8 months. There were no significant postoperative complications except persistent urine leakage in 2 patients 48 hours after surgery. An internal stent was placed and leakage subsided without any consequences. CONCLUSIONS: The modified, minimally invasive technique of retroperitoneal ureterolithotomy is highly effective and efficient without an associated increase in the complication rate.

Adult↗