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Biomedical subjects

S Aggarwal

Publications and source records attributed to S Aggarwal.

At least 127 records · Page 7Linked to original sources
PubMed1991

Clinical evaluation of autotransfusion during liver transplantation.

The clinical suitability of intraoperative autotransfusion was evaluated in 25 patients undergoing orthotopic liver transplantation using a Cell Saver #4 (Haemonetics) with acid-citrate-dextrose anticoagulation. In the first 14 patients (phase 1), biochemical, hematologic, coagulation, and semiquantitative bacteriologic studies were performed from the collected blood, processed blood, and patients' blood before and after 500 mL of autotransfusion. The acid-citrate-dextrose solution produced adequate anticoagulation, and the system effectively removed most of the potassium, red blood cell fragments, plasma free hemoglobin, bilirubin, coagulation factors, platelets, and fibrin degradation products. Autotransfusion (500 mL) did not alter coagulation, electrolyte balance, and hematologic findings in recipients except for a clinically insignificant increase in plasma free hemoglobin. Seventeen of 56 samples of the collected blood or processed blood were positive for coagulase (-) Staphylococcus (occasional or rare), but blood cultures before and after autotransfusion were negative in all patients. In the next 11 patients (phase 2), a quantitative bacteriologic study was performed from the collected blood, processed blood, skin, bile duct stump, peritoneal cavity, and room air using a mock reservoir. The processed blood was not transfused. All blood cultures from the patients were sterile. However, coagulase (-) Staphylococcus or Bacillus sp was seen in two cultures from skin, three from the processed blood, and three from air, suggesting that room air and skin were the sources of contamination. When the patients of the two phases of study were compared, postoperative blood cultures were all sterile, and renal function was similar. Therefore, autotransfusion appears to be clinically acceptable during liver transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Pharmacokinetics and pharmacodynamics of doxacurium in normal patients and in those with hepatic or renal failure.

We determined the pharmacokinetics and duration of action of a bolus dose of doxacurium (15 micrograms/kg) in 27 patients anesthetized with isoflurane and nitrous oxide. Nine patients had normal renal and liver functions and were undergoing a variety of surgical procedures, nine were undergoing cadaveric kidney transplantation because of end-stage renal disease, and nine were undergoing cadaveric liver transplantation because of end-stage hepatocellular disease. Plasma concentrations of doxacurium were measured for 6 h after administration using a sensitive and specific capillary gas chromatographic assay. Plasma concentration versus time data were analyzed by a noncompartmental method based on statistical moments. Neuromuscular blockade was assessed by measuring the electromyographic evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. The degree of neuromuscular blockade after doxacurium administration was described as the percent of control of the first train-of-four response. The pharmacokinetic variables were (normal vs hepatic failure vs renal failure, respectively): volume of distribution at steady state (220 +/- 110 vs 290 +/- 60 vs 270 +/- 130 mL/kg [mean +/- SD]), plasma clearance (2.7 +/- 1.6 vs 2.3 +/- 0.4 vs 1.2 +/- 0.7 mL.kg-1.min-1), mean residence time (95.2 +/- 57 vs 129.4 +/- 30 vs 270 +/- 210 min), and elimination half-life (99 +/- 54 vs 115 +/- 31 vs 221 +/- 156 min). Plasma clearance and mean residence time differed significantly between patients with renal failure and control patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Management options in fulminant hepatic failure.

The diagnosis of FHF carries with it a high mortality rate. Though the early results of OLT for FHF are encouraging, some have called for caution as these results are in a select population and may be similar to the optimistic early reports of now-discredited therapies. However, OLT differs fundamentally from all other interventions and, as such, it is ethically unjustified to withhold potentially life-saving therapy from patients with a predicted mortality in excess of 60%. Therefore, patients with FHF should be transferred at an early stage to an experienced liver unit where the option of liver transplantation can be considered.

Acute Kidney Injury↗
PubMed1990

Bony ankylosis of the temporomandibular joint: a computed tomography study.

Bony ankylosis of the temporomandibular joint is a disabling disease that almost invariably manifests itself in the first two decades of life. CT of the temporomandibular joints was performed in 50 patients--axial CT in 2 and coronal CT in 48--of whom 43 (86%) had received trauma to the joints. New bone of variable form and thickness was observed in 64 joints (the involvement was bilateral in 14 patients). These joints were classified into one of two categories: type I, medially angulated condyle with deformed articular fossa and a mild-to-moderate amount of new bone formation; and type II, no recognizable condyle or fossa but instead a large mass of new bone. Type I was etiology-specific and seen only when trauma was the antecedent, whereas type II was a sequelae of either insult. A pseudofracture in the new bone was seen in 49 (77%) joints. Six joints showed subtle deformities but no new bone. Since coronal CT fully characterizes the lesion at acceptable radiation exposure levels, it appears to be valuable in the preoperative workup of these patients.

Adolescent↗
PubMed1990

Phycomycosis infection in acute leukaemia.

Fungal infections are increasingly being reported in patients with acute leukaemia on intensive induction chemotherapy protocols. The common fungi seen are candida, aspergillus and mucormycosis. We have seen 3 cases of mucormycosis over the last 4 years. All 3 patients had acute leukaemia-two had acute lymphoblastic and one acute myeloid leukaemia. All patients were in neutropenic phase after induction chemotherapy. Features suggestive of fungal infection were fever and development or progression of pulmonary infiltrates despite antibiotic therapy. Repeated body fluid cultures were negative in two patients. In the first patient, the diagnosis was confirmed after biopsy of a palatal mass; he was treated successfully with amphotericin-B. In two patients the diagnosis was confirmed at autopsy. A high degree of suspicion in febrile, neutropenic cancer patients on chemotherapy and early administration of amphotericin-B may improve the outcome. With dissemination, the prognosis is poor.

Adolescent↗
PubMed1990

Posterior fossa epidermoid in a member of a kindred with von Hippel-Lindau disease.

The authors describe the case of a middle-aged member of a kindred with von Hippel-Lindau disease in whom a posterior fossa epidermoid developed. The epidermoid was initially thought to be a hemangioblastoma, a tumor to which those who have von Hippel-Lindau disease are predisposed. Radiologic investigations, especially magnetic resonance imaging, were useful in demonstrating the extra-axial nature of the tumor and also in characterizing it as an epidermoid.

Brain Diseases↗
PubMed1990

Immunization coverage evaluation surveys in rural Narela zone and city zone areas of Delhi.

A major purpose of the immunization coverage evaluation surveys to document the vaccination status of children aged 1-2 years was to determine the true picture of the immunization status of the target population and to identify areas which need strengthening. Immunization coverage evaluation surveys were carried out for a 2.4 lakh rural and 2.2 lakh urban population of Delhi by the cluster sampling method. A total of 210 and 212 children, respectively aged 12 to 23 months, were included in the study in 30 randomly selected clusters in each zone. The percentage of children immunized with DPT3/OPV3/BCG was 70.0 and 73.1 in the rural and city zones, respectively while those immunized with DPT3/OPV3/BCG/Measles was only 30.0 and 37.3% in the two zones. Dropout rate for DPT and OPV, I to III was 16-18%. The drop out rate between DPT and OPV II and III was higher than that between DPT and OPV II and II. Percentage of non-immunized children was significantly higher in rural (8.0%) as compared to urban areas (2.3%). Maximum immunizations were done by the Health Centres. Done on a periodic basis, a coverage evaluation survey will show whether or not vaccination coverage objectives have been met.

Child, Preschool↗
PubMed1989

Angiographic abnormalities of the morphologically left ventricle in the presence of Ebstein's malformation.

Cineangiography of the morphologically left ventricle was performed in 10 patients with Ebstein's malformation. The angiographic findings included left ventricular contour abnormalities (8), mitral valve prolapse (7) and global hypokinesia (5). Left ventricular abnormalities were present whether the left ventricle was normally placed or in mirror-image position in congenitally corrected transposition. Abnormalities of the morphologically left ventricle in Ebstein's malformation have received little attention in the past. Frequent occurrence of these abnormalities should make careful evaluation of the morphologically left ventricle mandatory in all patients with Ebstein's malformation.

Adolescent↗