Management of late failures of femoro-popliteal and femoro-distal bypasses.
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Blood Vessel Prosthesis↗
Biomedical subjects
S K Gupta
Publications and source records attributed to S K Gupta.
Serum leucine aminopeptidase profile in cancers of gastro-intestinal tract with special reference to hepatic metastasis.
Serum leucine aminopeptidase (LAP) was estimated in 30 cases of gastro-intestinal cancers, and compared with 50 age and sex matched controls. Highly significant increase of serum LAP was seen in 7 patients with hepatic metastasis (p less than 0.001) from adenocarcinoma of stomach, colon and rectum. The enzyme values showed a highly significant increase in carcinoma of colon, when compared with different anatomical sites of the gastro-intestinal tract (p less than 0.001). However, in adenocarcinoma of stomach and rectum, significantly increased level of serum LAP was observed (p less than 0.01) which contrasted sharply with the normal enzyme values in squamous cell carcinoma of oesophagus and anal canal.
Female↗
Pupillary dilatation during cataract surgery--relative efficacy of indomethacin and flurbiprofen.
In a prospective, randomized, double-blind trial, we evaluated the relative efficacy of indomethacin and flurbiprofen when used as adjuvants to routinely used mydriatics for maintenance of pupillary dilatation in patients with heavily pigmented iris undergoing extracapsular cataract extraction. The drugs were administered orally as well as topically according to a fixed regimen. The pupillary diameters, measured with calipers at various surgical steps, were significantly larger at every step in the study groups in which either of the adjuvants had been used than they were in the control group (P less than .001). Flurbiprofen tended to help maintain a larger pupillary diameter in the later stages of surgery than indomethacin, but this difference was not statistically significant. We conclude that it is important to use prostaglandin synthetase inhibitors as adjuvants to routine mydriatics, and that flurbiprofen may be somewhat more effective than indomethacin in this capacity.
Cataract Extraction↗
Ocular atopy and mycotic keratitis.
In a retrospective analysis, we studied the association between ocular atopy and keratomycosis. Forty-one (26.3%) of 156 patients with fungal corneal ulcers were found to have preexisting allergic conjunctivitis. All patients had been using a combination of antibiotics and corticosteroids before developing the corneal ulcer. Fungus isolation on Sabouraud's agar medium was obtained in 74.8% (31/42) ulcers. The most common fungi isolated were Fusarium (32.3%) and Aspergillus (29%). One percent silver sulfadiazine was used as an antifungal agent in these patients. Overall efficacy of this drug was found to be 77.8%, with Fusarium being the most sensitive (87.5%).
Adolescent↗
Comparison of central nervous system and peripheral pharmacodynamics to atropine pharmacokinetics.
Two experiments were designed to examine the pharmacokinetic-pharmacodynamic relationship for the central nervous system and peripheral effects of atropine. According to a random Latin square design, healthy young male volunteers were given i.m. injections containing single doses of placebo or 0.5, 1.0, 2.0 or 4.0 mg of atropine. The central nervous system tests included wheel tracking, a coordination task, and digit symbol substitution, a memory-psychomotor speed task; the physiological variable was heart rate. The pharmacokinetics of atropine were best described by a two-compartment model with very rapid first order absorption. Changes in plasma atropine levels and heart rate closely overlapped for all four doses throughout most of the time course. In contrast, the differential time course of changes in atropine levels and behavioral impairment indicates that pharmacokinetics is not the primary rate-limiting mechanism for the central nervous system effects of atropine. Alternative explanations are discussed, including differential atropine effects on peripheral M2 receptors mediating a heart rate effect and on CNS M1 receptors mediating the memory-psychomotor effect.
Adult↗
Remote distal arteriovenous fistula to improve infrapopliteal bypass patency.
The results of the use of prosthetic materials for femorocrural bypass surgery have been less than optimal. The creation of a distal anastomotic arteriovenous fistula to augment blood flow and velocity through the graft is well known. However, it may create turbulence at the anastomosis and steal blood flow away from the distal artery. A canine model was developed to evaluate the effect of fistula size on graft/arterial hemodynamics. In 16 patients we have constructed a distal arteriovenous fistula, which is remote from the distal anastomosis, and we studied the effect of such fistulas on bypass patency and distal arterial hemodynamics. Patients selected for this procedure had multiple previously failed reconstructions and limb-threatening ischemia and did not have usable autogenous vein. Femorotibial bypass graft reconstructions were performed with polytetrafluoroethylene followed by the creation of a side-to-side arteriovenous fistula 5 to 15 cm below the distal anastomosis in the same artery and accompanying veins. We have achieved a 1-year patency of 67% with a 75% limb salvage rate. We also serially measured blood flow and velocity within the bypass, the arteriovenous fistula, and the distal outflow vessel using duplex scanning after surgery. Mean estimated blood flow through the bypass during the immediate postoperative period was 264 ml/min, the arteriovenous fistula was 157 ml/min, and the distal artery was 19 ml/min. Unlike an arteriovenous fistula created at the distal anastomosis, a remote distal arteriovenous fistula not only increases graft blood flow but also augments native arterial blood flow between the distal anastomosis and fistula and thus may improve distal limb perfusion.
Animals↗
Sarcoidosis in India: a review of 125 biopsy-proven cases from eastern India.
One hundred and twenty-five cases of biopsy proven sarcoidosis have been found during a prospective study since 1972 in Calcutta, Eastern India. The presentation, clinical course and radiological features are considerably different from those seen in the West. Elderly males over 40 years are more prone. Low grade fever, cough, dyspnoea, arthralgia are common symptoms while hepatosplenomegaly, hypercalcaemia, hypercalciuria and hyperglobulinaemia are frequent signs. Nearly 60% are MT negative (up to 100 TU). Serum angiotensin converting enzyme and high lymphocyte count in bronchoalveolar lavage fluid are usual findings in active disease. Chest X-ray usually shows mottled opacities or fibrosis in 60% cases. Clinico-radiological dissociation (i.e. remarkable dissociation between the alarming-looking chest X-ray and scanty physical signs and symptoms in chest) was a very remarkable feature in this series. Treatment with oral steroid or steroid aerosol with oxyphenbutazone and chloroquine give equally good results initially. However, most cases tend to relapse inspite of adequate initial treatment. The pattern of the disease is similar almost all over India with minor regional differences like more erythema nodosum and eye involvement in Chandigarh in the extreme north (which could also have been due to case selection). The pattern from Northern India (Delhi) and Western India is nearly similar to our figures.
Adolescent↗
Unsuspected inflow disease in candidates for axillofemoral bypass operations: a prospective study.
Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.
Adult↗
In situ or reversed vein bypass for lower limb revascularization?
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Arterial Occlusive Diseases↗
Significance and management of inflow gradients unexpectedly generated after femorofemoral, femoropopliteal, and femoroinfrapopliteal bypass grafting.
With multilevel arteriosclerosis, some patients undergoing infrainguinal bypass grafting will develop femoral/brachial pressure gradients only after the bypass is performed. We therefore evaluated arteriographically alternate inflow sites and measured the femoral/brachial pressure gradients before and after placement of 87 femorofemoral and 510 femoropopliteal/infrapopliteal bypasses. No prebypass femoral/brachial pressure gradients were present with and without intraarterial papaverine. However, femoral/branchial pressure gradients greater than or equal to 15 mm Hg were observed after the bypass placement in 16 femorofemoral patients and 43 femoropopliteal/infrapopliteal patients. Gradients averaged 28 +/- 8 (SD) (range, 15 to 50) mm Hg. The post femorofemoral bypass gradients were treated by immediate supplementary inflow extension to the aorta (three patients) or an axillary artery (three patients); by postoperative iliac percutaneous transluminal angioplasty (four patients) or by no treatment (six patients with femoral/brachial pressure gradients of 15 to 35 [23 +/- 5] mm Hg). The 43 postfemoropopliteal/infrapopliteal bypass gradients were treated by immediate supplementary inflow extension to the contralateral femoral artery (15 patients), the aorta (8 patients), or an axillary artery (3 patients); by postoperative iliac percutaneous transluminal angioplasty (5 patients) or by no treatment (12 patients with femoral/brachial pressure gradients of 15 to 30 [21 +/- 4] mm Hg). No thrombosis occurred in the 10 femorofemoral bypasses with postbypass femoral/brachial pressure gradients that were treated. One of the six femorofemoral patients with untreated gradients required a subsequent aortic extension, and one thrombosed after 2 years. Of the 12 untreated patients with femoropopliteal/infrapopliteal bypasses one graft occluded early, and two late failures occurred 12 and 18 months later.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Characteristics of monoclonal antibodies reactive with human sperm and seminal plasma.
The characteristics of monoclonal antibodies developed against human spermatozoa are described. Out of 10 monoclonal antibodies 9 did not react in ELISA with human RBC, WBC, platelets, Raji cells nor mouse sperm. Four monoclonal antibodies reacted with monkey sperm and all 10 reacted with human seminal plasma. Monoclonal antibodies showed differential reactivity with pre- and post-capacitated sperm. Four monoclonal antibodies were able to agglutinate sperm whereas none of these were positive in sperm-immobilization assay. Interestingly, two monoclonal antibodies (MA-46 and MA-50) were able to block the attachment of pre-capacitated sperm to zona denuded hamster oocytes. MA-46 and MA-50 recognized in immunoblot spermatozoa antigens having apparent molecular weights of 14 and 20 K Da and greater than 200 K Da respectively. The monoclonal antibodies reported in this study will be useful in further delineating the spermatozoa antigens involved in regulation of fertility.
Animals↗
Necessity of adjuvants for inducing effective antibody response to zona pellucida antigens.
Rhesus monkeys evoked a vigorous antibody response to a single heteroimmunization dose of zona pellucida antigens, when these were administered along with complete Freund's adjuvant. The antisera recognized all the three major porcine zona glycoprotein families and the animals were rendered amenorrheic after such immunization. Monkeys immunized with zona without adjuvant, however, failed to show any anti-zona antibody response and had normal menstrual cycles. Zona pellucida glycoproteins are thus not effective immunogens unless administered along with a powerful adjuvant.
Adjuvants, Immunologic↗
Role of culture for mycobacteria in fine-needle aspiration diagnosis of tuberculous lymphadenitis.
A total of 390 cases of tuberculous lymphadenitis was subjected to fine-needle aspiration cytology; 100 of the aspirates were subjected to culture for mycobacteria. The overall acid-fast bacilli (AFB) positivity in smears was 23.58%, with a maximum positivity of 32.94% in smears with both necrosis and granuloma. The overall rate of isolation of mycobacteria on culture was 35%. Mycobacteria were more frequently isolated from caseating lesions (40%) than noncaseating lesions (9%). Caseating lesions with granuloma had the highest AFB (smear and/or culture) positivity at 52%. Mycobacterium avium infection was diagnosed by culture in one case.
Biopsy, Needle↗
Role of fine-needle aspiration cytology in childhood malignancies.
During the last 4 yr, fine-needle aspiration cytology (FNAC) has been employed in 1,474 patients in 0-15-yr age group at our institute. Of these, 245 patients were found to have malignant disease, including primitive neuroectodermal tumors, hepatoblastoma, nephroblastoma, sarcoma, and epithelial malignancies. Four metastases from medulloblastoma and two each from astrocytoma and meningioma were confirmed without open biopsy. FNAC interpretation was easy when cytologic findings were correlated with relevant clinical and radiologic data.
Adolescent↗
Fine-needle aspiration cytology of sacrococcygeal chordoma.
The fine-needle aspiration cytology (FNAC) of four cases of chordoma that were diagnosed preoperatively is presented. One of the cases showed anaplastic components along with the classical features of chordoma; this is probably the second case diagnosed with these features on FNAC. The cytologic features of classical chordoma include conspicuous extracellular matrix in the background. Polygonal cells, dissociated and in small groups, were identified in all cases. Physaliphorous cells were also prominently found in these cases. In addition, the case with anaplastic features showed very bizarre cells with profound multinucleation and the presence of intranuclear cytoplasmic inclusions. The diagnosis of chordoma was possible because of a high index of suspicion on clinical grounds and the use of special staining for confirmation.
Aged↗
Resting gated pool ejection fraction: a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting.
Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.
Adult↗
Pharmacokinetics of cyclosporin: influence of rate-duration profile of an intravenous infusion in renal transplant patients.
1. The pharmacokinetics of cyclosporin were studied in six renal transplant patients, following intravenous administration of 5 mg kg-1 infused over 3, 6 and 24 h. 2. Plasma, separated at 37 degrees C, was analysed for cyclosporin by h.p.l.c. 3. The data were described by a biexponential disposition model. 4. None of the disposition parameters (clearance, initial volume of distribution, half-lives) changed with the duration of infusion.
Adult↗
Cimetidine-nicoumalone interaction in man: stereochemical considerations.
1. The cimetidine-nicoumalone interaction was studied in five subjects who received a single 10 mg oral dose of racemic nicoumalone alone and 3 days into an oral regimen of cimetidine of 200 mg three times daily and 400 mg at night. 2. The concentrations of R(+)- and S(-)-nicoumalone in plasma were measured using a stereospecific h.p.l.c assay; augmentation of prothrombin time was used as a measure of response. 3. Cimetidine increased the rate (but not extent) of absorption of both R(+)- and S(-)-nicoumalone, and reduced the clearance of R(+)-nicoumalone but not that of the S(-)-enantiomer. 4. Cimetidine increased the anticoagulant response produced by nicoumalone in some but not all subjects, despite a consistent effect on the pharmacokinetics of the oral anti-coagulant. 5. Cimetidine appears to produce its effect by stereoselectively inhibiting the elimination of R(+)-nicoumalone.
Acenocoumarol↗