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Vijay Mittal

Publications and source records attributed to Vijay Mittal.

10 recordsLinked to original sources
PubMed2006

The effect of gradually increased blood flow on ischemia-reperfusion injury in rat kidney.

BACKGROUND: Gradually increased blood flow to the ischemic rat kidney was studied to assess the ability to diminish ischemia-reperfusion injury. METHODS: The left renal artery and vein were isolated in 25 rats. Microclamps were applied for 45 minutes and were released at once (group II) or gradually (group III). Renal arterial blood flow and K+ activity were measured. Bilateral kidneys were harvested for histopathology and for malonyldealdehyde and myeloperoxidase levels. RESULTS: Increased K+ activity returned to preischemic values faster in group III than in group II. No statistically significant difference existed in malonyldealdehyde and myeloperoxidase levels; histopathologic scoring showed less tissue damage in group III (P < .05). Contralateral kidney samples showed signs of ischemia in group II. CONCLUSIONS: Gradually increased blood flow to the ischemic kidney decreases ischemic changes. Ischemic insult to 1 kidney causes histopathologically detectable changes to the contralateral kidney, which can be diminished by gradual reperfusion.

Analysis of Variance↗
PubMed2006

Correlation between clinical and histological findings in parathyroid tumors suspicious for carcinoma.

Carcinoma of the parathyroid is a rare malignancy that can be cured surgically if the proper diagnosis and treatment is given initially. Arriving to the clinical suspicion of a malignancy preoperatively is by far the most important step for a good prognosis. Our goal is to review the correlation between clinical and final histopathological findings that can arouse the suspicion of such malignancy and their true predictive value in the diagnosis. All patients that underwent surgical removal of the parathyroid mass between March of 1992 and March of 2003 were reviewed retrospectively at Providence Hospital and Medical Centers. Among 168 patients who underwent parathyroid excision, 14 (8.3%) had hyperplasia of the parathyroid, 121 (72%) had benign adenoma, 25 (14.8%) had other benign lesions, and 8 (4.7%) patients had primary carcinoma of the parathyroid confirmed by pathology. Our mean serum calcium level was 11.57 mg/dL, which was lower than the mean level (12 mg/dL) for benign hyperparathyroidism. The mean tumor size was 2.18 cm, smaller than the proposed for malignant criteria, and none of the eight patients (0%) had any symptoms of hypercalcemia at the time of diagnosis. Seven of eight patients (87.5%) had frank signs of invasion together with other histological features, and two patients had associated papillary carcinoma of the thyroid. Five patients from our series did not meet clinical criteria for malignancy (tumor size > 3 cm, palpable mass, and serum calcium > 14 mg/dL), but had undisputable histological findings (high mitotic pattern, fibrous trabeculae, capsular invasion, vascular invasion, and nodular involvement). On the other hand, 17 patients with benign histology had tumors greater than 3 cm, and an additional 18 had palpable masses on physical examination. We believe that these patients need to be followed closely. The patients with diagnosis of parathyroid carcinoma, their kindred, and those with large adenomas may benefit from genetic screening for HRTP2 gene mutations in search of early detection of tumors suspicious for malignancy. This is based on the fact that we did not find correlation between the clinical presentation and the histological features in our patients with proven malignancy.

Adenoma↗
PubMed2005

Reinforcement of subcuticular continuous suture closure with surgical adhesive strips and gum mastic: Is there any additional strength provided?

BACKGROUND: This study aimed to compare the burst strength of suture closure versus the use of suture and strip together. METHODS: On cadavers, 50 skin incisions were closed as follows: group 1--subcuticular continuous suture; group 2--same suturing with placement of strips; group 3--same as group 2 except gum mastic was applied prior to strips; group 4--strips alone; and group 5--strips with gum mastic application. The separation forces were measured using a tensilometer. RESULTS: The mean separation forces were as follows: group 1, 14.17 kg; group 2, 14.37 kg; group 3, 15.39 kg; group 4, 1.52 kg; and group 5, 3.85 kg. There were no statistically significant differences between groups 1, 2, and 3. When compared with group 4, group 5 required markedly more force to separate the wound. CONCLUSIONS: Strip reinforcement with/without gum mastic did not provide any additional strength when sutures were used. Gum mastic increased the adherence of strips and this was important when strips were the only means of wound closure.

Adult↗
PubMed2004

Residents' working hours in a consortium-wide surgical education program.

Traditional work schedules of surgical residents have been cited as a factor that negatively influences education and the quality of patient care. Demands by federal and state legislators as well as the general public have forced a re-evaluation of the issue. Long working hours and resulting sleep deprivation affect the lives of residents profoundly, but the question remains does it lower the quality of medical care? The justification for the long hours is that they are vital to medical education, but residents are so drained by their schedules that they are rarely in the best state of mind to learn from their experiences. Under the scrutiny of the Resident Review Committee (RRC), many programs and institutions have been cited in the recent past in violation of resident working hour requirements. As a result, many institutions have implemented reforms, thereby reducing the number of citations they received. In spite of having the highest number of citations, the field of general surgery has failed to show any improvement. The Oakland Health Education Programme Center for Medical Education (OHEP), a consortium of 16 teaching hospitals in the State of Michigan, set out to review the components of general surgery residency training in order to be able to make recommendations that might assist program directors in making appropriate changes where necessary to enhance resident education and the quality of patient care as well as to meet the personal demands of residents. Questionnaires on residents' attitudes concerning their working hours and possible reforms were sent to all general surgery residency programs in the OHEP consortium. The questionnaire consisted of 25 questions divided into three major sections: the first section encompassed demographic information including current work hours and on-call schedules. The second section consisted of questions relating to attitudes toward work hours and the options for change. The third section consisted of questions that viewed the perceived effects of limited work hours. From the seven participating hospitals with surgery residency programs in OHEP, 92 residents responded to our survey. The majority of residents were in the first 3 years of postgraduate training. The mean age of residents was 30 years old. Sixty-four per cent of respondents were male, and 18 per cent were female. Residents reported an average of 56 with a range of 0 to 110 hours on call. Variations in the number of hours had to do with the various rotations residents were on, in that during certain elective rotations, residents were not assigned to any call. The on-call schedule varied; alternate nights were reported by 11 per cent, every third night by 33 per cent, and every fourth night or more by 53 per cent. The majority of surgical residents did express the need for reform and did not feel that reforms would affect the quality of resident education. However, residents did not want to lengthen residency training beyond the 5 years. The results of our study indicates that the majority of residents in general surgery programs in Michigan perceive a need for reform of work schedules. Surgical educators may have underestimated this need in the past. Most residents thought that long hours impaired their educational experience and at times compromised their clinical care.

Attitude of Health Personnel↗
PubMed2003

The stress cascade and schizophrenia: etiology and onset.

Psychosocial stress is included in most etiologic models of schizophrenia, frequently as a precipitating factor for psychosis in vulnerable individuals. Nonetheless, the stress-diathesis model has not been tested prospectively in prodromal patients as a predictor of psychosis. The biological effects of stress are mediated by the hypothalamic-pituitary-adrenal (HPA) axis, which governs the release of steroids, including cortisol. The past few decades have witnessed an increased understanding of the neural effects of stress and cortisol, including both normal and abnormal diatheses. As few biological markers have been evaluated as risk factors for psychosis in prodromal patients, the HPA axis and its interaction with intervening life events are apt candidates for study. In this article, we review the HPA axis and its neural effects, present a model for how stress might precipitate psychosis in vulnerable individuals, review the empirical evidence of a link between stress and schizophrenia symptoms, and propose a research design and appropriate statistical models to test the stress-diathesis model for psychosis onset in prodromal patients.

Animals↗
PubMed2003

Gastrointestinal complications after ruptured aortic aneurysm repair.

Gastrointestinal complications after ruptured aortic abdominal aneurysm (AAA) repair are not well defined and are limited to descriptions of ischemic colitis. We sought to delineate risk factors predicting gastrointestinal complications after ruptured AAA repair. Data from 100 consecutive patients after ruptured AAA repair between July 1980 and June 2000 were gathered for multiple preoperative, intraoperative, and postoperative factors. These variables were analyzed relative to postoperative gastrointestinal complications and resulting mortality. Overall mortality was 48 per cent. Gastrointestinal complications were encountered 29 times in 27 patients of 100 total patients (27%). Complications included prolonged adynamic ileus (three), acute pancreatitis (four) and cholecystitis (two), perforated duodenal ulcer (one), bowel obstruction (three), antibiotic-associated colitis (six), ischemic colitis (three), bowel infarction (four), and liver failure (three). Comparison of patients with and without gastrointestinal complications showed no predictive preoperative or intraoperative variables. Gastrointestinal complications are common in ruptured aortic aneurysm repair and carry increased mortality and morbidity. Surgeons must maintain a high level of suspicion to anticipate possible gastrointestinal complications.

Aged↗
PubMed2002

Carotid artery restenosis: an ongoing disease process.

Recurrence of carotid artery stenosis after primary endarterectomy is a well-known entity. The treatment and optimal management of the disease process, however, is a matter of ongoing debate. We retrospectively reviewed carotid endarterectomies for recurrent disease performed at a community hospital over the past 21 years to evaluate the outcome of surgical intervention. Eighty-two recurrences occurred in 1648 carotid endarterectomies. Females had a slightly higher recurrence rate as compared with males, and the majority of patients had risk factors in the form of hypertension, peripheral vascular disease, or cigarette smoking. All endarterectomies were repaired with a patch angioplasty by either a vein or a prosthetic graft. One patient died secondary to complications of coronary artery disease. None of the patients developed any postoperative neurological event or permanent nerve damage. A subgroup of 11 patients with recurrent carotid artery stenosis with contralateral occlusion underwent 14 endarterectomies with no neurological complications. In conclusion occlusive carotid disease is an ongoing phenomenon, and continued surveillance is recommended. Surgical treatment of recurrent disease is a safe option. Endarterectomies for recurrent carotid disease in the presence of contralateral occlusion can be performed safely.

Age Distribution↗
PubMed2002

Outcome analysis of pancreaticoduodenectomy at a community hospital.

There is an ongoing debate about the proposed regionalization of pancreaticoduodenectomies. The purpose of our study is to demonstrate that good outcomes can be achieved in a well-managed low-volume community hospital. We retrospectively analyzed pathologic findings, morbidity, mortality, and one-year survival in 32 patients who underwent pancreaticoduodenectomy at Providence Hospital over a 10-year period and compared these results with data collected at Johns Hopkins, and the Mayo Clinic. The patients had a mean age of 68.5 +/- 2.96 years; 56.3 per cent were female and 71.9 per cent were white. Overall in our series 90.6 per cent of specimens were found to be malignant, which is statistically higher than the 68 per cent at Johns Hopkins (P = 0.013) and not significantly different from Mayo Clinic (76%). The 30-day mortality rate at Providence Hospital was 3.1 per cent, which is not statistically different from Johns Hopkins (1.3%) and Mayo Clinic (3.6%). One-year survival rate at Providence Hospital was 59.4 per cent, which is significantly different from 79 per cent at Johns Hopkins (P = 0.016). The one-year survival rate at Providence Hospital is higher than an approximately 50 per cent average reported nationally. The postoperative complication rate was 62.5 per cent; the most common complication was delayed early gastric emptying (28.1%). A statistical difference in morbidity exists between Providence Hospital and Johns Hopkins (P = 0.027) but not between Providence Hospital and Mayo Clinic (46%). The higher rate of malignant disease treated in the population at Providence Hospital may contribute to a higher complication rate and lower one-year survival rate than the reported rates at Johns Hopkins because of the poorer health of cancer patients. However, statistical analysis of mortality rates for pancreaticoduodenectomy at Providence Hospital show no difference from mortality rates at Johns Hopkins and Mayo Clinic. Therefore in low-volume community hospitals pancreaticoduodenectomy can be performed safely as evidenced by a comparable low mortality rate and a high one-year survival rate.

Aged↗