Epidural fentanyl for cesarean section in postpartal cardiomyopathy.
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Adult↗
Biomedical subjects
S Krishnamurthy
Publications and source records attributed to S Krishnamurthy.
Primary peritoneal mesothelioma.
A patient with primary peritoneal mesothelioma who had occupational exposure to asbestos 30 years ago is reported. The disease was progressive and the patient died 12 months after the diagnosis.
Asbestos↗
Technetium-99m-iminodiacetic acid organic anions: review of biokinetics and clinical application in hepatology.
Technetium-99m-labeled iminodiacetic acid analogs are a new class of organic anions, taken up and secreted by hepatocyte into hepatic bile by a carrier-mediated organic anion pathway. They provide a new dimension in the assessment of pathophysiology and morphology of the hepatobiliary system. The amount of uptake and the rapidity of its elimination from the liver is dependent upon the structural configuration of the agent as well as the functional integrity of the hepatocyte and the patency of the biliary system. The clinical areas for application are wide and include most of the hepatobiliary diseases. Technetium-99m-iminodiacetic acid, an agent well suited for both planar and single photon tomographic scintigraphy, is ideal for early diagnosis prior to anatomical changes in the hepatobiliary system. The data collection directly from the liver provides quantitation of both regional and global liver diseases. The count-based method for measuring gallbladder emptying overcomes the theoretical disadvantages of geometric tests. Biokinetics and current clinical application of six of the 99mTc-iminodiacetic acid agents are reviewed, and the potential future clinical and research areas of application are indicated.
Anions↗
Influence of far-ultraviolet radiation on the permeability of the outer membrane of Escherichia coli.
Far-ultraviolet radiation (254 nm) at a dose of 10, 20, and 30 J/m2 was found to disrupt the outer membrane permeability barrier of Escherichia coli to various antibiotics, dyes, and detergents. The degree of sensitization to these agents was proportional to the radiation dose. The irradiated cells showed a significant increase in the sensitivity of hydrophilic antibiotics (ampicillin, carbenicillin, penicillin), whereas much less sensitization was found towards hydrophobic probes (kanamycin, erythromycin, rifamycin SV, crystal violet, phenol, novobiocin) and detergents (dodecyl sulfate, bile salt, Triton X-100). The biochemical data and ultrastructural analysis of the outer membrane by freeze-etching have shown that the increase in phospholipid:protein ratio after irradiation had changed the architecture of the outer membrane from a highly asymmetric bilayer structure with densely packed lipopolysaccharide--protein particles on the outer half, to one predominantly exhibiting smooth phospholipid bilayer characteristics. The structure, composition, and barrier function of the outer membrane were restored to normal within 3 h of postirradiation incubation in nonproliferative medium. During this period, the acquisition of resistance towards a hydrophilic antibiotic (ampicillin) was faster than that for a hydrophobic agent (phenol).
Anti-Bacterial Agents↗
Megacolon in myotonic dystrophy caused by a degenerative neuropathy of the myenteric plexus.
A 32-yr-old man with myotonic dystrophy had a left hemicolectomy performed because of a megacolon. The colonic mucosa, smooth muscle, and connective tissue appeared normal by hematoxylin and eosin and trichrome stains and transmission electron microscopy. In contrast, the myenteric plexus had markedly fewer neurons than normal on the hematoxylin and eosin stains. Silver staining of the plexus revealed degeneration and decreased numbers of argyrophilic neurons, which were smaller and had fewer processes and a more uneven staining quality than controls. Many axons were fragmented, and increased numbers of glial cell nuclei were present in the plexus. Degenerative changes in the neurons were present in a patchy distribution on transmission electron microscopy. Immunohistochemistry revealed a decrease of the substance P- and enkephalin-immunoreactive fibers in the muscularis externa. This suggests that colonic motor dysfunction associated with myotonic dystrophy may be caused by a visceral neuropathy that involves the substance P- and enkephalin-immunoreactive fibers of the smooth muscle.
Adult↗
Scintigraphic criteria for the diagnosis of obstructive hepatobiliary diseases with Tc-99m IDA.
The purpose of this study is to define the scintigraphic parameters that reliably predict the presence of obstructive hepatobiliary diseases. Gallbladder and intestinal visualization times noted during cholescintigraphy with Tc-99m IDA were compared to functional and morphologic parameters for their ability to accurately diagnose biliary diseases. One hundred and twenty-five normal subjects and 127 patients with five different types of hepatobiliary diseases were studied. Bile pooling in segmental ducts with minimal prolongation of excretion t-1/2 was the feature most commonly seen in partial common bile duct obstruction, and biliary nonvisualization with marked prolongation of excretion t-1/2 was the primary feature of total obstruction. Sclerosing cholangitis showed band constrictions and beading along bile ducts with regional variation in excretion t-1/2, and primary biliary cirrhosis demonstrated normal bile ducts with uniform prolongation of excretion t-1/2. Patients with cholelithiasis showed normal image patterns of the major ducts. Intestinal visualization by 60 minutes was only 46% sensitive and 77% specific with an overall accuracy of 74% in the detection of biliary obstruction. Delayed gallbladder visualization and reduction in ejection fraction were sensitive but nonspecific indicators of biliary disease. We conclude that Tc-99m-IDA imaging is an accurate test for the diagnosis of obstructive hepatobiliary disease provided both quantitative functional and qualitative morphologic parameters are analyzed. Intestinal nonvisualization at 60 minutes alone is not reliable as a sole parameter for the detection of partial biliary obstruction.
Adult↗
Primary biliary cirrhosis: Tc-99m IDA planar and SPECT scanning.
The authors studied ten patients with primary biliary cirrhosis using planar and single photon emission computed tomography (SPECT); results were compared with those from 13 healthy subjects. Patients with primary biliary cirrhosis had six- to tenfold prolongation of mean halflife (t 1/2) hepatic excretion of technetium-99m iminodiacetic acid (IDA) compared with mean t 1/2 excretion in healthy subjects. All patients with primary biliary cirrhosis had diffuse, uniform hepatic isotope retention and normal major bile ducts on planar and SPECT scans. The gallbladder was seen within 60 minutes in nine of nine patients who had intact gallbladders. The mean gallbladder volume was normal, but gallbladder ejection fractions and ejection rates were reduced in patients with primary biliary cirrhosis compared with those of healthy subjects. In contrast with previous studies of patients with sclerosing cholangitis and common bile duct obstruction, patients with primary biliary cirrhosis had different findings on scintiscans. In the early evaluation of patients with cholestasis, Tc-99m IDA hepatobiliary scintigraphy may be useful in the selection of the most appropriate invasive diagnostic test to enable a definitive diagnosis.
Adult↗
Non Hodgkin's lymphoma of stomach in a case of Hodgkin's disease.
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Adult↗
Nuclear hepatology: where is it heading now?
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Humans↗
Metacarpophalangeal joint motion and the role of the collateral ligaments.
A three stage study of the metacarpophalangeal joint was performed. First, a triaxial goniometer was designed which allowed direct measurement of joint motion in living and cadaveric hands. Then, based on the above data, a computer simulated model of the joint was developed. This permitted an analysis of the orientation of the joint for any given point in the axis of motion, the effects of the collateral ligaments and their contribution to joint motion and stability. Finally the metacarpal head was analysed using a shadow profilometer and anatomical dissections. From 0 degree to 70 degrees, the metacarpal head demonstrated a curved configuration. At approximately 70 degrees, the metacarpal head assumed a bicondylar shape which produced a bony block to lateral deviation. Dissection of the collateral ligaments demonstrated that they ran diagonally from the metacarpal head to the proximal phalanx. We conclude that the metacarpophalangeal joint has an instant axis. From 0 degree to 70 degrees of flexion, in any given hand, the angle of lateral deviation is constant. Beyond 70 degrees there is a marked decrease in lateral deviation. The joint has two degrees of freedom and the collateral ligament is taut in all positions.
Female↗
Thermal effects of polymerization of methyl-methacrylate on small tubular bones.
This study was designed to investigate the thermal effects of polymerization on small tubular bones. The results demonstrated only a slight increase in temperature during cement-curing in the medullary canals of these bones. The maximum rise (11.7 degrees C) was within the levels of tolerance for living bone cells. It was demonstrated that the small volumes of methyl-methacrylate cool more rapidly, hence further decreasing the deleterious effects of heat. The histological studies showed no recognisable adverse reaction to the thermal effects of methyl-methacrylate polymerization on small tubular bones or on the overlying tissue.
Animals↗
Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients.
We obtained follow-up information on 13 patients who underwent subtotal colectomy for severe idiopathic constipation 19-45 months previously. Stool frequency increased from one bowel movement per 11.5 days before colectomy to 5.3 bowel movements per day after colectomy. Nine patients have required readmissions for abdominal pain and four have required further surgery for symptoms of small bowel obstruction. Ten patients consider that their quality of life is improved, although five have variable amounts of fecal incontinence. Preoperative studies did not predict the three patients who failed to improve. Subtotal colectomy palliates constipation in most patients with severe idiopathic constipation but patients should be cautioned that not all improve and some are left with significant abdominal pain, obstructive symptoms, diarrhea, and fecal incontinence.
Adult↗
Diagnosis of sclerosing cholangitis with technetium 99m-labeled iminodiacetic acid planar and single photon emission computed tomographic scintigraphy.
The purpose of this study was to determine whether 99mTc-iminodiacetic acid planar biliary scintigraphy combined with single photon emission computed tomography could detect sclerosing cholangitis and provide additional information regarding the extent and severity of disease. Thirteen patients with sclerosing cholangitis and 13 normal control subjects were studied. Scintigraphic results were also compared with previously reported studies of patients with isolated common bile duct obstruction and with primary biliary cirrhosis. The planar scintigraphy in patients with sclerosing cholangitis showed beading or bandlike constrictions of the biliary tract corresponding to lesions seen on cholangiography, and the image pattern was distinctly different from images obtained from patients with isolated common bile duct obstruction or primary biliary cirrhosis. The single photon emission computed tomography images of the liver in patients with sclerosing cholangitis demonstrated multiple focal areas of 99mTc-iminodiacetic acid retention, representing bile stasis in intrahepatic bile ducts. Compared to controls, the mean hepatic clearance half-time of 99mTc-iminodiacetic acid was markedly delayed in patients with sclerosing cholangitis (6-10 times normal). Individual patients with sclerosing cholangitis had wider variation in isotope clearance half-time from three regions of the liver than patients with isolated common bile duct obstruction, consistent with regional difference in disease severity and variable impairment of bile flow. In 4 patients with sclerosing cholangitis with incomplete filling of the right and left hepatic ducts at cholangiography, planar and single photon emission computed tomographic scintigraphy provided evidence of significant intrahepatic sclerosing cholangitis. In conclusion, combined 99mTc-iminodiacetic acid planar and single photon emission computed tomographic scintigraphy is a sensitive noninvasive test for the diagnosis of sclerosing cholangitis and reliably differentiates sclerosing cholangitis from isolated common bile duct obstruction or primary biliary cirrhosis. Measurement of isotope clearance half-time provides quantitative physiologic data that may be useful in the longitudinal follow-up of patients with sclerosing cholangitis.
Adult↗
Pathology of neuromuscular disorders of the small intestine and colon.
A variety of pathological abnormalities of the smooth muscle and myenteric plexus result in clinical syndromes of disordered small intestinal and colonic motility. These pathological abnormalities have been noted by conventional light microscopy and by utilization of Smith's technique for visualizing the myenteric plexus with silver. We have classified the neuromuscular disorders into two major categories, i.e., those affecting the myenteric plexus and those affecting the smooth muscle. The classification is further developed based on the variety of clinicopathological features of the various disorders. Although we can now identify the underlying pathology of these motor disorders and thus understand these illnesses better than we did a decade ago, we have much more to learn. With the great strides being made to understand the normal structure, function, and development of the myenteric plexus and smooth muscle, there is hope that we will be able to learn much more about the etiology and pathogenesis of these neuromuscular disorders in the decade to come.
Colon↗
Salivary gland cancer in Alaskan natives, 1966-1980.
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Adult↗
Bactericidal effects of the neodymium:YAG laser: in vitro study.
The effects of laser energy on three bacterial strains, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were studied utilizing the neodymium:YAG laser. Cell suspensions of each strain were divided into four groups. In group I, suspensions from each strain were exposed to laser energy densities of 555-3,333 J/cm2. In groups II and III, two artificial dyes, congo red or methylene blue, were added to the suspensions prior to lasing. In group IVa, no laser energy was used, and group IVb was used to measure the bactericidal thermal effects of the laser. It was concluded that: Low dosages of laser energy exceeding 1,667 J/cm2 resulted in a 2 to 8 log decline in the number of viable bacterial colonies in vitro. Compared to the other two bacterial strains, P aeruginosa was the most sensitive to YAG laser irradiation. Addition of methylene blue, a dark-colored dye, enhanced the bactericidal effects of the YAG laser as indicated by the significantly reduced viability of P aeruginosa after irradiation with 2,222 J/cm2.
Catechols↗
An inflammatory axonopathy of the myenteric plexus producing a rapidly progressive intestinal pseudoobstruction.
A previously well 39-yr-old man presented with a 4-wk history of abdominal pain, nausea, vomiting, and weight loss. An upper gastrointestinal examination showed retained food in the stomach and duodenal dilatation. A radioisotope meal showed little gastric emptying; esophageal manometry was normal. Because of persistent symptoms, a duodenojejunostomy was done. However, the patient remained symptomatic and after an episode of profuse vomiting, aspirated and died 10 wk after initial presentation. At autopsy, no tumor was found. Hematoxylin and eosin stains throughout the gastrointestinal tract showed many lymphocytes and plasma cells within the myenteric plexus. Silver stains showed the argyrophilic and argyrophobic neurons to be normal, but axons showed beading, fragmentation, and dropout in all areas. We therefore concluded the following: intestinal pseudoobstruction can be caused by an inflammatory neuropathy of the myenteric plexus, not associated with a distant carcinoma, and this process produced an axonopathy while sparing neuron bodies.
Adult↗