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Biomedical subjects

Rajiv Gupta

Publications and source records attributed to Rajiv Gupta.

34 records · Page 2Linked to original sources
PubMed2003

Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial.

BACKGROUND AND AIM: Hepatorenal syndrome (HRS) occurs in about 18% of cirrhotic patients with ascites and is characterized by intense renal vasoconstriction, low glomerular filtration rate and preserved tubular function and normal renal histology. The aim of the present study was to examine the effects of terlipressin on renal function, systemic hemodynamics and clinical outcome in patients with HRS. METHODS: The study was a randomized controlled single-blind trial. We randomly assigned 24 consecutive patients with HRS to treatment with terlipressin 1 mg i.v. at 12-h intervals (group A; n = 12) or placebo at 12-h intervals (group B; n = 12). The end-point of the study was improvement in renal functions defined as reversal of HRS and survival at 15 days. RESULTS: The two groups were comparable at baseline. After treatment with terlipressin, urine output significantly (P < 0.05) increased progressively in group A (day 4, 960 +/- 40 mL/24 h; day 8, 1068 +/- 56 mL/24 h) compared with group B (day 4, 451 +/- 40 mL/24 h; day 8, 291 +/- 45 mL/24 h). Creatinine clearance improved (P < 0.05) in group A (day 4, 20.2 +/- 2.1 mL/min; day 8, 35 +/- 2.8 mL/min) compared with group B (day 4, 11.3 +/- 1.3 mL/min; day 8, 9.3 +/- 1.7 mL/min). Serum creatinine decreased in group A but not in group B (day 8, 1.6 +/- 0.01 compared with 3.9 +/- 0.26, P < 0.05). Mean arterial pressure increased significantly (P < 0.05) in group A. Terlipressin administration was associated with transient self-limiting side-effects including crampy abdominal pain in two patients and cardiac arrhythmias in three patients. Five of the 12 patients survived in group A compared with none in group B at day 15 (P < 0.05) and all survivors had reversal of HRS. CONCLUSION: In patients with HRS, terlipressin significantly improved renal functions and systemic hemodynamics, and showed a trend towards better clinical outcome. The drug merits further evaluation with different dosages and longer schedules.

Blood Pressure↗
PubMed2003

Panhemispheric infarction: a complication of cuffed catheter.

The need for reliable vascular access remains the Achilles heel of hemodialysis. Complications of vascular access are a leading cause of morbidity and mortality in patients who undergo hemodialysis, especially in those patients with end-stage renal disease. Among methods of vascular access, arteriovenous fistulae have the lowest rate of infection and should be the access of choice when vascular anatomy permits. Also, the incidence of staphylococcal infections in patients infected with human immunodeficiency virus is increasing. To emphasize the need to use arteriovenous fistula access for hemodialysis whenever possible, we report the case of a patient with end-stage renal disease and human immunodeficiency virus infection who died as a result of panhemispheric infarction and uncal herniation as a result of fulminant staphylococcal bacteremia caused by central venous catheter sepsis.

Adult↗
PubMed2003

Sepsis in a renal transplant recipient due to Citrobacter braakii.

Cellulitis is usually caused by organisms such as beta-hemolytic streptococci and Staphylococcus aureus. Citrobacter are gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. They are rarely implicated in skin or soft tissue infections. The genus Citrobacter has been respeciated according to genetic relatedness. Citrobacter braakii refers to the genomospecies 6 of the Citrobacter freundii complex. There are no detailed studies of infections caused by the newly formed specific genetic species. We report a case of C. braakii infection in a renal transplant patient receiving immunosuppressive therapy. The patient's lower extremity cellulitis did not respond to conventional antibiotic therapy. Blood cultures grew C. braakii. Sensitivity studies and treatment with appropriate antibiotics resulted in prompt recovery. Immunosuppressive therapy in renal transplant recipients predisposes to infection by unusual pathogens, and this should be suspected when lack of a clinical response to conventional antibiotics is observed. We believe this is the first reported case of C. braakii cellulitis and bacteremia in a renal transplant recipient.

Anti-Bacterial Agents↗
PubMed2002

Double-breasted repair of the posterior mitral valve leaflet.

The double-breasted repair of the posterior leaflet of the mitral valve is an alternative technique for correction of mitral regurgitation in selected patients. This new technique has the advantage of avoiding distortion of the posterior annulus and simplifies the repair, especially in complex posterior leaflet prolapse.

Cardiac Surgical Procedures↗
PubMed2002

Wegener's granulomatosis diagnosed by testicular biopsy.

Urogenital involvement, other than the kidneys, is extremely rare in Wegener's granulomatosis (WG) and occurs in less than 1% of the cases. When encountered it is confined to prostate, bladder, urethra, cervix, and vagina. Granulomatous infiltration of the testis from WG has not been cited in the medical literature. We report a case of WG in a Hispanic male who presented with sensorineural hearing loss and hemoptysis. He had a pulmonary lesion and a painless right testicular mass, which was found to have necrotizing granulomas on excisional biopsy. This may be the first reported case of WG diagnosed by testicular biopsy as testicular involvement is rare in WG. We believe that the actual incidence of testicular involvement in WG may be higher as genital examination may be ignored during routine physical examinations.

Biopsy↗
PubMed2002

Listeria monocytogenes-induced monomicrobial non-neutrocytic bacterascites.

Spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis of the liver. The organisms most commonly involved in this infection are gram-negative bacteria like Escherichia coli and Klebsiella pneumoniae, and gram-positive bacteria like Streptococcus pneumoniae and Staphylococcus aureus. Listeria monocytogenes is an uncommon gram-positive bacillus implicated in infections in neonates, pregnant females, the elderly, and immunocompromised patients. Listeria monocytogene-induced SBP is rare, with less than 40 cases reported in the medical literature. Monobacterial non-neutrocytic bacterascites (MNB) is a variant of SBP, where the ascitic fluid culture is positive but the ascitic neutrophil count is less than 250/mm3. Forty percent of these patients will subsequently have SBP. Only 2 cases of MNB from L monocytogenes have previously been reported. We report a case of MNB in a patient with cirrhosis whose ascitic neutrophil count was 164/mm', but Gram stain and microbiologic culture showed the growth of L monocytogenes.

Humans↗
PubMedDate not supplied

High-resolution computed tomography of temporal bone: Part III: Axial postoperative anatomy.

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200-mu isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this and the subsequent part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same axial (article III) and coronal (article IV) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.

Humans↗
PubMedDate not supplied

High-resolution computed tomography of temporal bone: Part IV: Coronal postoperative anatomy.

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200 micro isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this, the fourth part, and the third part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same coronal (article IV) and axial (article III) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.

Cochlear Implantation↗
PubMedDate not supplied

High-resolution flat-panel volume-CT of temporal bone--part 1: axial preoperative anatomy.

The purpose of this four-part series is to show the high-resolution axial and coronal anatomy of the temporal bone from a flat-panel detector-based volume CT (parts 1 and 2); these imaging planes are then used to outline the effect of different surgical procedures commonly applied to the temporal bone (parts 3 and 4). The structures that are removed or altered in 11 different surgical procedures are color-coded and inscribed in axial and coronal sections. Clinically important imaging features and complications following these surgeries will also be discussed. In these high-resolution images, many structures that are below the resolution limit of conventional CT can be seen and localized. It is hoped that one would be able to picture these structures and surgeries, in the mind's eye, even when they fall below the resolution limit using a conventional CT scanner. This article (part 1) focuses on the preoperative axial anatomy.

Humans↗
PubMedDate not supplied

High-resolution computed tomography of temporal bone: Part II: coronal preoperative anatomy.

The purpose of this 4-part series is to demonstrate the high-resolution axial and coronal anatomy of temporal bone from a flat-panel detector-based volume computed tomography (CT) scanner (parts I and II); these imaging planes are then used to outline the effect of different surgical procedures commonly applied to the temporal bone (parts III and IV). The structures that are removed and/or altered in 11 different surgical procedures are color coded and inscribed in axial and coronal sections. Clinically important imaging features and complications after these operations are also discussed. In these high-resolution images, many structures that are below the resolution limit of conventional CT can be seen and localized. It is hoped that this exposition enables one to visualize these structures and surgeries in the mind's eye, even when they fall below the resolution limit using a conventional CT scanner. This article (part II) focuses on the preoperative coronal anatomy.

Cadaver↗
PubMedDate not supplied

Inherently 3-dimensional method for measurement of computed tomographic resolution anisotropy.

OBJECTIVE: Current techniques to measure computed tomography (CT) spatial resolution use separate methods for in-plane and out-of-plane directions. The growing use of near-isotropic voxel size necessitates a new single method that inherently measures resolution in any direction. METHOD: We introduce a method using a set of numerous glass microspheres suspended in a small volume from which a mean sphere image is constructed. Projecting asymptotes after imaging different microsphere sets with decreasing diameters provides an inherently 3-dimensional measure of spatial resolution and anisotropy. We apply the method to both a flat-panel and multidetector CT scanner. RESULTS: The full-width at half-maximum from line profiles through mean sphere in transverse directions corresponds to known microsphere diameters. Increased longitudinal full-width at half-maximum corresponds to known anisotropy, which is larger for a multidetector CT scanner than for a flat-panel CT scanner. CONCLUSIONS: A new single method to measure CT resolution is inherently isotropic.

Anisotropy↗