Elephantiasis nostras: complication of third degree acid burn.
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Burns, Chemical↗
Biomedical subjects
S Maheshwari
Publications and source records attributed to S Maheshwari.
Parachute tricuspid valve.
Parachute abnormality of mitral valve frequently occurs with left sided obstructive lesions though occasionally may occur as an isolated lesion. Symptoms depend upon the severity of stenosis and associated lesions. Parachute abnormality of the tricuspid valve has rarely been reported and its association with left to right shunts has not been described so far.
Adult↗
Case report: Aneurysmal bone cyst of the ethmoid bone.
Aneurysmal bone cysts (ABCs) are benign, slow growing expansile lesions usually found in long bones or vertebrae. Plain radiography reveals expansion of bone and cortical thinning. MRI may assist in diagnosis by virtue of its ability to demonstrate blood-fluid levels, which is a characteristic finding in these lesions. Very few cases of ABC of the paranasal sinuses have been reported in the literature. We present MRI findings of ABC of the ethmoid sinus in a 19-year-old male.
Adult↗
Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up.
OBJECTIVES: The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA). BACKGROUND: Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA). METHODS: Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation < 20 mm Hg. RESULTS: Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 +/- 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm Hg to 4 +/- 6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm Hg to 13 +/- 11 mm Hg at follow-up (p < 0.001). CONCLUSIONS: Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.
Adolescent↗
Coronary risk and dyslipidemia in type 2 diabetic patients.
OBJECTIVES: A prospective study was carried out to find out the percentage of dyslipidemia in type 2 diabetics, to study the pattern of dyslipidemia, categorize the levels of LDL, HDL and triglycerides into higher, borderline and lower risk of developing coronary heart disease in type 2 diabetics and to compare the lipid profile with non-diabetics. MATERIAL AND METHODS: Five hundred patients of type 2 diabetes mellitus and 150 age, sex and BMI matched non-diabetic healthy individuals were studied. The labelling of dyslipidemia and the categorization of risk for developing coronary heart disease (CHD) was done according to the guidelines of American Diabetes Association (ADA, 1998). RESULTS: Dyslpidemia was present in 89% of diabetic patients with LDL hyperlipoproteinemia (LDL > 100 mg%) in 76%, HDL dyslipidemia (HDL < 35 mg%) in 58%, hypertriglyceridemia (TG > 200 mg%) in 22% patients. On analysing CHD risk based on lipid profile, it was revealed that in LDL moiety 48% fell in higher risk of CHD (LDL > 130 mg%), 28% in borderline risk (LDL 100-130 mg%) and 24% (LDL < 100 mg%) in lower risk. For HDL 18.5% fell in higher risk (HDL < 35 mg%) and TG only 0.5% fell in higher risk (TG > 400 mg%). The lipid profile was significantly altered in diabetic patients as compared to non diabetics. CONCLUSIONS: The major concern which our study highlights is the high percentage of LDL dyslipidemia majority of whom fell in higher risk of developing CHD. Triglyceride and HDL levels were of lesser significance when newer ADA (1998) criteria for dyslipidemia were applied.
Adult↗
Early treatment of skeletal Class III: a case report.
Skeletal class III malocclusion is a growth related facial deformity which increases if left untreated. Skeletal class III malocclusion should be corrected as soon one recognises the initial signs. Mixed dentition period is the time of greatest opportunity for occlusal guidance and growth modulation. A case of skeletal class III malocclusion in mixed dentition is presented, which was treated with a Delaire face mask therapy to modulate the craniofacial growth and to achieve a balanced profile.
Age Factors↗
Pulmonary thrombosis, homocysteinemia, and reperfusion edema in an adolescent.
Deep vein thrombosis, pulmonary embolism, and pulmonary thrombosis in situ are rare in childhood and adolescence [1,2]. Unfortunately, these diagnoses may be unsuspected in a pediatric patient with dyspnea and chest pain. This article illustrates the diagnostic and therapeutic challenges that arose from unrecognized chronic thrombotic disease in an adolescent.
Adolescent↗
Balloon angioplasty of postsurgical recoarctation in infants: the risk of restenosis and long-term follow-up.
OBJECTIVES: This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for postsurgical recoarctation in infants. BACKGROUND: Balloon angioplasty is a well-accepted modality for the treatment of recoarctation. However, infants remain a group of concern because of their size, risk for complications and the potential for restenosis with growth. Age <12 months has been determined to be a risk factor for the development of recoarctation after angioplasty for native coarctation. Although studies on postsurgical coarctation have found no relationship between age at angioplasty and the development of recoarctation, few studies specifically addressing infants have been performed. METHODS: Clinical, echocardiographic, hemodynamic and angiographic data on 22 consecutive children <1 year of age who underwent BA between 1986 and 1996 were reviewed. RESULTS: A successful result, defined as a postprocedure gradient of < or =20 mm Hg, was achieved in 20 of 22 (91%) infants with a reduction in the systolic peak pressure gradient from 48 +/- 27 to 9 +/- 10 mm Hg (p < 0.001) and an increase in coarctation diameter from 2.7 +/- 1.1 to 5.2 +/- 1.5 mm (p < 0.001). At long-term follow-up of a median of 56 months (0.6 to 12 years), the restenosis rate after an initial optimal result was 16% (3 of 19). Five (24%) infants required reintervention (2 initially unsuccessful; 3 recoarctation), with a success rate of 95% after two procedures. Suboptimal long-term outcome correlated with a lower infant weight. CONCLUSIONS: Balloon angioplasty can be safely performed in infants, with good long-term results. The risk of restenosis is low and can be successfully managed with repeat angioplasty.
Angioplasty, Balloon↗
Insulin secretory response in healthy adult offspring of hypertensive parents.
OBJECTIVES: The present study was done to observe the insulin secretory response in healthy adult offspring of normotensive and hypertensive parents as the etiology of essential hypertension is largely treated as unknown. METHODS: The insulin secretary response was observed in 20 healthy adult offspring of normotensive parents (Group I) and 25 healthy adult offspring of hypertensive parents (Group II). The mean serum insulin levels were assessed at fasting, 30, 60, 90 and 120 minutes after 75 grams of oral glucose load in both groups. RESULTS: The mean serum insulin levels in fasting state was higher in group II (32.40 +/- 18.59) than group I (17.90 +/- 11.98) (p < 0.01). After 30 minutes mean serum insulin levels were higher in group II than group I (88.00 +/- 56.04, 40.5 +/- 15.15 respectively, p < 0.001). There was no statistically significant difference after 60, 90 and 120 minutes of oral glucose load (p > 0.05). CONCLUSIONS: Our observations suggest that the insulin secretory response in fasting and 30 minutes after oral glucose load was earliest metabolic abnormality in subjects at high risk for developing hypertension i.e. offspring of hypertensive parents.
Adult↗
Role of losartan therapy in the management of diabetic hypertension.
The management of diabetic hypertension requires meticulous selection of agents in the antihypertension armamentorium. There may be several associated factors to be considered while treating a hypertensive diabetic. These include hyperglycemia, dyslipidemia, proteinuria, left ventricular hypertrophy and heart failure to name a few. Losartan is the first of a new class of agents in the list of antihypertensive drugs. By its selective angiotension II receptor (subtype AT1) blocking action it is postulated to bring about a more complete inhibition of the renin-angiotensin system. Thus, it might produce all the benefits of angiotensin converting enzyme (ACE) inhibitor therapy with the freedom from cough so commonly seen with the use of ACE inhibitors. This review attempts to analyze the possible benefits of losartan therapy in diabetes.
Diabetes Complications↗
Serum insulin assay: an important therapeutic tool in management of freshly diagnosed type 2 diabetes mellitus.
OBJECTIVES: The study was performed to see that, whether metabolic control and response to treatment in freshly diagnosed patients of type 2 diabetes mellitus is affected by primary pathology (hyperinsulinemia/inappropriate insulin secretion). METHODS: One hundred and eight freshly diagnosed patients of type 2 diabetes mellitus with age range from 30-65 years were followed for a period of three months. The blood glucose, serum triglyceride, and serum insulin levels were determined in each patient. Patients were found to have either higher or normal to low serum insulin values at fasting, and accordingly patients were distributed into two groups; group one (normal to low initial fasting serum insulin level i.e. < or = 30 microU/ml) and group two (high fasting serum insulin level i.e. > or = 30 microU/ml). Each group was further divided into two subgroups A and B. Subgroup A was treated with glipizide and B with metformin. RESULTS: Diabetic patients who had fasting hyperinsulinemia (n = 53, 100%) had blood pressure > or = 140/90 at the time of presentation. Patients who had fasting serum insulin within normal range only 30% (n = 17) had hypertension. Patients of group one had good recovery from hyperglycemia and reduction in triglyceride values when treated with sulphonylurea (subgroup A) as compared to patients treated with biguanide (subgroup B). On the contrary patients of group two showed poor glycemic control, increase in blood pressure and rise in serum triglyceride titre when treated with sulphonylurea (subgroup A) while in the same group biguanide effectively produced euglycemia with normalization of blood pressure and decrease in triglyceride levels (subgroup B). CONCLUSION: Assessment of initial serum insulin levels is helpful guide to decide about the type of oral hypoglycemic agent to be used in freshly diagnosed patients to type 2 diabetes mellitus.
Adult↗
Effect of antioxidant therapy on serum superoxide dismutase activity in patients with type-2 diabetes mellitus.
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Antioxidants↗
Maxillary expansion--an interceptive modality in mixed dentition.
Maxillary expansion is a very useful procedure for arch length augmentation, posterior crossbite treatment and removing cross arch interferences. Removable appliances are in the realm of a pedodontist and general dentist. However, one should be aware of the problems arising at an early age of the child, should be able to properly diagnose the condition and if required, a timely referral to a specialist is also expected.
Child↗
Blinded evaluation of reverse transcriptase-polymerase chain reaction prostate-specific antigen peripheral blood assay for molecular staging of prostate cancer.
OBJECTIVES: The reverse transcriptase-polymerase chain reaction (RT-PCR)-prostate-specific antigen (PSA) assay to detect presumed occult micrometastatic prostate cancer has been controversial, and this molecular staging has been thought to be clinically useful by some groups but not others. METHODS: We used a sensitive nested RT-PCR assay with specific primers derived from the PSA sequence and a very stringent two-step PCR protocol with denaturing temperature of 94 degrees C annealing and extension temperature of 68 degrees C. This method enabled us to detect PSA-expressing LNCaP prostate cancer (PC) cells as low as one cell of 10 million lymphocytes (1/10(7)). Ninety-six patients with PC were studied, including 85 before radical prostatectomy (RP), and 22 controls, including healthy men and women and men with benign prostatic hyperplasia. RESULTS: In 85 patients undergoing RP, a minimum of two independent RT-PCR-PSA assays detected circulating prostate cells preoperatively in 27 patients (31.8%). Of 12 patients with locally advanced or advanced stage cancer, RT-PCR-PSA was positive in 5 (41.7%); of the 22 controls, no patient was RT-PCR-PSA positive. In 10 randomly selected cases, the RT-PCR product was confirmed as PSA by DNA sequencing. Of the 27 patients undergoing RP who were RT-PCR positive, 11 (40.7%) had non-organ-confined disease (pT3a or greater), and of the 58 patients who were RT-PCR negative, 32 (55.2%) had non-organ-confined disease. Patients with RT-PCR positive results also had lower margin positivity (9 of 27, 33.3%) than did patients with RT-PCR negative results (21 of 58, 36.2%). Finally, at a mean follow-up of 25.7 months, 5 (18.5%) of 27 RT-PCR positive patients had recurrence (PSA) compared with 14 (24.1%) of 58 RT-PCR negative patients. CONCLUSIONS: On the basis of this blinded study, RT-PCR for PSA-expressing cells in 85 patients before RP is not related to clinical stage, age, race, grade, Gleason sum, serum PSA or prostatic acid phosphatase, tumor volume, or tumor multifocality. RT-PCR positivity did not predict pathologic stage or early PSA recurrence. A standardized RT-PCR assay needs to be developed to account for interlaboratory discrepancies.
Aged↗
Fungal diseases of the paranasal sinuses.
Fungal diseases of the paranasal sinuses can be categorized into the invasive and noninvasive varieties. The invasive form has been classified as acute fulminant fungal sinusitis, granulomatous invasive fungal sinusitis, and chronic invasive fungal sinusitis. The noninvasive form can be classified as the fungus ball and the allergic fungal sinusitis. The following review discusses the various types of fungal sinusitis with a special emphasis on the CT and MR imaging features.
Acute Disease↗
Recent advances in interventional pediatric cardiovascular disease.
Transcatheter therapy in children with congenital or acquired heart disease is a challenging, innovative, and constantly evolving field. In this article we review the various "nonsurgical" techniques that are currently available, with a discussion of their applications and an update on the recent advances in the field of interventional cardiology.
Angioplasty, Balloon↗
Transcatheter closure of an anomalous venous connection by a novel method.
Left superior vena cavae draining to the left atrium have traditionally been treated with surgical ligation. Advances in cardiac catheterization have made transcatheter closure a viable alternative to surgery. We report on an innovative method using a Greenfield filter and Gianturco coils for closure of a persistent left superior vena cava.
Abnormalities, Multiple↗
Beta-amyloid augments platelet aggregation: reduced activity of familial angiopathy-associated mutants.
The beta-amyloid (A beta) peptide is present both in serum and in platelets, however it is unclear whether A beta plays a role in platelet function. We have now investigated the effects of soluble A beta on platelet function and have found that low levels (0.1-1 nM) of soluble A beta augment ADP-dependent platelet aggregation and translocation of focal adhesion kinase to the platelet cytoskeleton. Addition of A beta to gel-filtered platelets along with concentrations of adenosine diphosphate (ADP) producing submaximal aggregation responses increased the aggregation response by over 2-fold depending on the ADP:A beta ratios. The structure activity requirements for A beta activity showed intriguing constraints. Only full length A beta has significant activity. Truncated A beta peptides, such as A beta(1-16) or A beta(25-35), or reverse A beta(40-1) all show little or no activity. We also examined the activity of mutant A beta peptides, corresponding with the APP(692A-G) and APP(693E-Q) (at A beta21 and A beta22, respectively) which are found in familial Alzheimer's disease and hereditary cerebral hemorrhagic amyloidosis, Dutch type (HCHWA-D), and found that these peptides showed little or no activity. These results suggest that A beta interacts with platelets in a highly specific manner and may play a role in regulating platelet function.
Adenosine Diphosphate↗