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Behers BJ, Melchor J, Behers BM, Meng Z, Swanson PJ, Paterson HI, Mendez Araque SJ, Davis JL, Gerhold CJ, Shah RS, Thompson AJ, Patel BS, Mouratidis RW, Sweeney MJ. Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements. Nutrients 2023; 15:4223. [PMID: 37836507 PMCID: PMC10574336 DOI: 10.3390/nu15194223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.
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Affiliation(s)
- Benjamin J. Behers
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Julian Melchor
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Brett M. Behers
- College of Medicine, University of South Florida, 560 Channel Side Drive MDD 54, Tampa, FL 33602, USA; (B.M.B.); (S.J.M.A.)
| | - Zhuo Meng
- Department of Statistics, Florida State University, 117 N Woodward Ave., Tallahassee, FL 32306, USA; (Z.M.); (P.J.S.)
| | - Palmer J. Swanson
- Department of Statistics, Florida State University, 117 N Woodward Ave., Tallahassee, FL 32306, USA; (Z.M.); (P.J.S.)
| | - Hunter I. Paterson
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Samuel J. Mendez Araque
- College of Medicine, University of South Florida, 560 Channel Side Drive MDD 54, Tampa, FL 33602, USA; (B.M.B.); (S.J.M.A.)
| | - Joshua L. Davis
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Cameron J. Gerhold
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Rushabh S. Shah
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Anthony J. Thompson
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Binit S. Patel
- Internal Medicine Residency, Florida State University, 1700 South Tamiami Trail, Sarasota, FL 34239, USA;
| | - Roxann W. Mouratidis
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
| | - Michael J. Sweeney
- College of Medicine, Florida State University, 1115 W Call Street, Tallahassee, FL 32304, USA; (J.M.); (H.I.P.); (J.L.D.); (C.J.G.); (R.S.S.); (A.J.T.); (R.W.M.); (M.J.S.)
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Pore JL, Gates JM, Orford R, Campbell CM, Clark RM, Crawford HL, Esker NE, Fallon P, Gooding JA, Kwarsick JT, Macchiavelli AO, Morse C, Rudolph D, Såmark-Roth A, Santamaria C, Shah RS, Stoyer MA. Identification of the New Isotope ^{244}Md. Phys Rev Lett 2020; 124:252502. [PMID: 32639781 DOI: 10.1103/physrevlett.124.252502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
In an experiment performed at Lawrence Berkeley National Laboratory's 88-inch cyclotron, the isotope ^{244}Md was produced in the ^{209}Bi(^{40}Ar,5n) reaction. Decay properties of ^{244}Md were measured at the focal plane of the Berkeley Gas-filled Separator, and the mass number assignment of A=244 was confirmed with the apparatus for the identification of nuclide A. The isotope ^{244}Md is reported to have one, possibly two, α-decaying states with α energies of 8.66(2) and 8.31(2) MeV and half-lives of 0.4_{-0.1}^{+0.4} and ∼6 s, respectively. Additionally, first evidence of the α decay of ^{236}Bk was observed and is reported.
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Affiliation(s)
- J L Pore
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - J M Gates
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - R Orford
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - C M Campbell
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - R M Clark
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - H L Crawford
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - N E Esker
- Department of Chemistry, San José State University, One Washington Square, San José, California 95192, USA
| | - P Fallon
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - J A Gooding
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
- Department of Physics, Lund University, SE-22100 Lund, Sweden
| | - J T Kwarsick
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - A O Macchiavelli
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - C Morse
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - D Rudolph
- Department of Chemistry, University of California Berkeley, Berkeley, California 94720, USA
| | - A Såmark-Roth
- Department of Chemistry, University of California Berkeley, Berkeley, California 94720, USA
| | - C Santamaria
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
| | - R S Shah
- Department of Physics, Lund University, SE-22100 Lund, Sweden
| | - M A Stoyer
- Nuclear Science Division, Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, California 94720, USA
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
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Rohrbach S, Shah RS, Tuttle T, Murphy JA. Berichtigung: Neutral Organic Super Electron Donors Made Catalytic. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201910425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Neutral organic super electron donors (SEDs) display impressive reducing power but, until now, it has not been possible to use them catalytically in radical chain reactions. This is because, following electron transfer, these donors form persistent radical cations that trap substrate-derived radicals. This paper unlocks a conceptually new approach to super electron donors that overcomes this issue, leading to the first catalytic neutral organic super electron donor.
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Affiliation(s)
- Simon Rohrbach
- Dept. of Pure and Applied Chemistry, University of Strathclyde, 295 Cathedral Street, Glasgow, G1 1XL, UK
| | - Rushabh S Shah
- GlaxoSmithKline Medicines Research Centre, Gunnels Wood Road, Stevenage, SG1 2NY, UK
| | - Tell Tuttle
- Dept. of Pure and Applied Chemistry, University of Strathclyde, 295 Cathedral Street, Glasgow, G1 1XL, UK
| | - John A Murphy
- Dept. of Pure and Applied Chemistry, University of Strathclyde, 295 Cathedral Street, Glasgow, G1 1XL, UK
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Rohrbach S, Shah RS, Tuttle T, Murphy JA. Neutral Organic Super Electron Donors Made Catalytic. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201905814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Simon Rohrbach
- Dept. of Pure and Applied ChemistryUniversity of Strathclyde 295 Cathedral Street Glasgow G1 1XL UK
| | - Rushabh S. Shah
- GlaxoSmithKline Medicines Research Centre Gunnels Wood Road Stevenage SG1 2NY UK
| | - Tell Tuttle
- Dept. of Pure and Applied ChemistryUniversity of Strathclyde 295 Cathedral Street Glasgow G1 1XL UK
| | - John A. Murphy
- Dept. of Pure and Applied ChemistryUniversity of Strathclyde 295 Cathedral Street Glasgow G1 1XL UK
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Davies SG, Fletcher AM, Shah RS, Roberts PM, Thomson JE. Asymmetric syntheses of nakinadine D, nakinadine E, and nakinadine F: confirmation of their relative (RS,SR)-configurations and proposal of their absolute (2S,3R)-configurations. J Org Chem 2015; 80:4017-29. [PMID: 25790266 DOI: 10.1021/acs.joc.5b00376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The syn- and anti-diastereoisomeric forms of the reported structures of the marine alkaloids nakinadines D-F have been synthesized, for the first time in all cases, via an approach involving asymmetric Mannich-type (imino-aldol) reactions of methyl phenylacetate with N-tert-butylsulfinyl imines as the key steps to control the stereochemistry. Comparison of the (1)H and (13)C NMR spectroscopic data reported for the natural materials with those acquired for these synthetic samples confirms the initially assigned relative (RS,SR)-configurations of these three alkaloids. In the absence of specific rotation (or other diagnostic) data for the natural materials, it is not possible to unambiguously assign their absolute configurations, although given the absolute (2S)-configurations assigned to nakinadines B and C, and the absolute (2S,3R)-configuration previously established for nakinadine A, the data herein uphold our proposal that nakinadines D-F share the absolute (2S,3R)-configuration.
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Affiliation(s)
- Stephen G Davies
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Mansfield Road, Oxford OX1 3TA, U.K
| | - Ai M Fletcher
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Mansfield Road, Oxford OX1 3TA, U.K
| | - Rushabh S Shah
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Mansfield Road, Oxford OX1 3TA, U.K
| | - Paul M Roberts
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Mansfield Road, Oxford OX1 3TA, U.K
| | - James E Thomson
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Mansfield Road, Oxford OX1 3TA, U.K
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Joshi NM, Shah RS. Gastric trichobezoar in a 6-year old girl. APSP J Case Rep 2015; 6:8. [PMID: 25628997 PMCID: PMC4288839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/07/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- NM Joshi
- Department of General Surgery, P.D. Hinduja Hospital and MRC. VS Marg, Mahim, Mumbai – 400020.
| | - RS Shah
- Department of Paediatric Surgery, P.D. Hinduja Hospital and MRC. VS Marg, Mahim, Mumbai – 400020.
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Abstract
BACKGROUND Fentanyl, a synthetic opioid, is a popular choice amongst anaesthesiologists in the operating room. Pre induction intravenous fentanyl bolus is associated with coughing in 28-65% of patients. Fentanyl induced cough is not always benign and can be remarkably troublesome at the most critical moment of anaesthesia when airway reflex is lost. OBJECTIVES To study the effect of pre emptive use of minimal dose fentanyl through the peripheral venous cannulae on the incidence of cough by a larger bolus of intravenous fentanyl. METHODS One hundred and fifty patients aged 18-75 years undergoing elective surgical procedures were randomized into three groups of 50 each. The first group received 0.5 ml saline 0.9% intravenously one minute prior to the administration of fentanyl 150 μg (3 ml); the second group received pre emptive fentanyl 25 μg (0.5 ml) prior to the administration of fentanyl 125 μg (2.5 ml); and the third group received preemptive fentanyl 25 μg (0.5 ml), followed by the administration of fentanyl 150 μg (3 ml). Based on the number of coughs observed, cough severity was graded as mild (1-2), moderate (3-5), or severe (>5). RESULTS The incidence of fentanyl induced cough was significantly lower in both pre emptive group 4 (8%) for 125 μg fentanyl and 7 (14%) for 150 μg than in the saline group 15 (30%). CONCLUSION Pre-emptive use of minimal dose fentanyl 25 μg administered one minute before a larger bolus dose of fentanyl (125 or 150 μg) can effectively suppress cough.
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Affiliation(s)
- S K Shrestha
- Department of Anesthesia, Kathmandu University School of Medical Science, Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel Kavre, Nepal
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Davies SG, Fletcher AM, Roberts PM, Shah RS, Thompson AL, Thomson JE. (-)-(2S,3R,Z)-Nakinadine A: first asymmetric synthesis and absolute configuration assignment. Org Lett 2014; 16:1354-7. [PMID: 24564566 DOI: 10.1021/ol500096r] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mannich-type reaction of methyl phenylacetate with the N-tert-butylsulfinyl imine derived from (R)-tert-butylsulfinamide and (Z)-14-(pyridin-3'-yl)tetradec-11-enal has been used as the key step in the first asymmetric synthesis of (-)-nakinadine A. Both the 2,3-syn- and 2,3-anti-diastereoisomers were prepared; comparison of spectroscopic and specific rotation data facilitated assignment of the absolute (2S,3R,Z)-configuration within the natural product. (-)-(2S,3R,Z)-Nakinadine A was prepared in 10 steps from 11-bromoundecan-1-ol, in 10% overall yield, 97:3 dr [(Z):(E) ratio], and >98% ee.
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Affiliation(s)
- Stephen G Davies
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford , Mansfield Road, Oxford OX1 3TA, U.K
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Singh J, Shah RS, Vaidya N, Mahato PK, Shrestha S, Shrestha BL. Comparison of ketamine, fentanyl and clonidine as an adjuvant during bupivacaine caudal anaesthesia in paediatric patients. Kathmandu Univ Med J (KUMJ) 2013; 10:25-9. [PMID: 23434957 DOI: 10.3126/kumj.v10i3.8013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. OBJECTIVES To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. METHODS Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. RESULTS The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. CONCLUSION We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for subumbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects.
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Affiliation(s)
- J Singh
- Department of Anesthesia, Kathmandu University School of Medical Science, Dhulikhel Kavre, Nepal.
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Bhandarkar DS, Shah RS, Katara AN, Shankar M, Chandiramani VA, Udwadia TE. Laparoscopic biopsy in patients with abdominal lymphadenopathy. J Minim Access Surg 2011; 3:14-8. [PMID: 20668613 PMCID: PMC2910374 DOI: 10.4103/0972-9941.30681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 12/10/2006] [Indexed: 11/17/2022] Open
Abstract
Background: Abdominal lymphadenopathy (AL) - a common clinical scenario faced by clinicians - often poses a diagnostic challenge. In the absence of palpable peripheral nodes, tissue has to be obtained from the abdominal nodes by image-guided biopsy or surgery. In this context a laparoscopic biopsy avoids the morbidity of a laparotomy. Aim: This retrospective analysis of prospectively collected data represents our experience with laparoscopic biopsy of abdominal lymph nodes. Materials and Methods: Between October 2000 and November 2005, 28 patients with AL underwent laparoscopic biopsy. Pre-operative radiological imaging studies had identified a nodal mass in 20, a solitary node in 1, a cold abscess in 1 and a mesenteric cystic lesion in 1 patient. In five patients with chronic right lower abdominal pain and normal ultra-sonographic findings mesenteric nodes were identified and biopsied during diagnostic laparoscopy. Results: The sites of biopsied lymph nodes included para-aortic (10), mesenteric (8), external iliac (3), left gastric (2), obturator (1), aorto-caval (1) and porta hepatis (1). One patient with enlarged peripancreatic nodes mass and another with a mesenteric cystic mass had cold abscesses drained in addition to biopsy. There were no perioperative complications and the median postoperative stay was 2 days (range 1-4 days). Histopathology revealed tuberculosis in 23 patients, reactive adenitis in 2, lymphoma in 1 metastatic carcinoma in 1, and a retroperitoneal sarcoma in 1. Conclusions: In patients with AL, laparoscopy provides a safe and effective means of obtaining biopsy. It is of particular value in patients in whom (a) the nodes are small or present in locations unsuitable for image-guided biopsy, (b) adequate tissue cannot be obtained by image-guided biopsy or (c) previously undiagnosed lymphadenopathy is encountered during diagnostic laparoscopy.
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Affiliation(s)
- D S Bhandarkar
- Department of Minimal Access Surgery, P. D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, India
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Gouda BP, Kochar RT, Shah RS. Retained portion of the appendix following laparosocpic appendicectomy causing peritonitis and ileus. J Minim Access Surg 2011; 7:154-5. [PMID: 21523241 PMCID: PMC3078481 DOI: 10.4103/0972-9941.78353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 09/25/2010] [Indexed: 11/04/2022] Open
Abstract
We describe a patient who developed peritonitis and paralytic ileus due to a retained portion of the inflammed appendix following laparoscopic appendicectomy (LA). The details of the presentation and management are discussed along with a brief review of the unusual complications LA.
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Affiliation(s)
- B P Gouda
- Department of Surgery, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai-400007, India
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Shweihat YR, Shah RS, Joshi M, Kennedy MP, Samant RS. ENDOBRONCHIAL ULTRASOUND TRANSBRONCHIAL NEEDLE ASPIRATION IN A GEOGRAPHICAL REGION WITH ENDEMIC HISTOPLASMOSIS INFECTION. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p13004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Desai Meena P, Khatkhatay MI, Bhanu Prakash KV, Savardekar LS, Shah RS, Ansari Z. Hormonal profiles and biochemical indices of bone turnover in Indian women. Osteoporos Int 2007; 18:923-9. [PMID: 17225188 DOI: 10.1007/s00198-006-0318-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED The study establishes Indian referent database for bone turnover markers. The levels of markers decreased across the four quartiles of BMD showing a negative correlation with BMD. The study depicts that levels of hormones and bone turnover makers can aid in identifying women at risk for osteoporosis. INTRODUCTION Biochemical markers of bone turnover reflect changes in bone metabolism earlier and aid in the management of osteoporosis. Since a referent database for Indian women is lacking, the study was initiated to establish the same and suggest that hormonal profiles and markers of bone turnover can aid in identifying women at risk for osteoporosis. METHODS Osteocalcin (OC), bone specific alkaline phosphatase ((BSAP), C-terminal crosslinking telopeptide of type-I collagen (CTX-I), deoxypyridinoline (DPD), follicle-stimulating hormone (FSH) and estrone glucuronide (E(1)G) were measured in 365 Indian women (20-70 years) and correlated with BMD measurements by dual energy absorptiometry (DXA) using one way analysis of variance (ANOVA). RESULTS The mean levels of bone resorption markers; CTX-I and DPD increased significantly across the age showing a negative correlation with BMD. The increase in levels of CTX-I and DPD was significantly higher (p < 0.0001) as compared to the femoral and spinal BMD, which dropped only 30-36%. The levels of bone turnover markers and FSH decreased across the four quartiles of spinal and femoral BMD showing a negative correlation whereas E(1)G levels increased across the four quartiles. CONCLUSION The bone turnover markers were comparatively low in cohort of Indian women studied.
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Affiliation(s)
- P Desai Meena
- Department of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health, Parel, Mumbai, India.
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Katara AN, Bhandarkar DS, Shah RS, Udwadia TE. Breakage of fascial closure device during laparoscopic surgery. J Minim Access Surg 2005; 1:79-81. [PMID: 21206652 PMCID: PMC3004111 DOI: 10.4103/0972-9941.16533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 05/19/2005] [Indexed: 11/04/2022] Open
Abstract
Breakage of instruments during laparoscopic surgery is rare. However, when it does occur, locating and retrieving the broken part of the instrument can be cumbersome. Moreover, inability to do so may carry serious medicolegal implications. We report a patient in whom the tip of a fascial closure device broke during laparoscopic surgery. This was located by intraoperative fluoroscopy and retrieved from the extraperitoneal plane via a small incision. The paper discusses the probable factors responsible for breakage of the fascial closure device in our patient and reviews the previously reported cases of the rare complication of breakage of instruments during laparoscopic surgery.
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Affiliation(s)
- A N Katara
- Department of Minimal Access Surgery, P. D. Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India
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Bhandarkar DS, Shah RS. Laparoscopic choledochoduodenostomy for retained bile duct stone. J Postgrad Med 2005; 51:156-7. [PMID: 16006721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
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Maheshwari PN, Bhandarkar DS, Andankar MG, Shah RS. Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi in pelvic ectopic kidneys. Surg Endosc 2004; 18:1151. [PMID: 15054649 DOI: 10.1007/s00464-003-4518-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Accepted: 09/29/2003] [Indexed: 10/26/2022]
Abstract
Although percutaneous nephrolithotomy is a well-established endourological modality for the management of calculi in the normally placed kidney, it is not easy to apply in the management of calculi in pelvic ectopic kidneys. We report the cases of three patients who were found to have large calculi in pelvic ectopic kidneys and subsequently underwent laparoscopically guided transperitoneal percutaneous nephrolithotomy, all with successful outcome. In all patients, complete stone clearance was achieved in a single operation with no intraoperative or postoperative morbidity. They remain asymptomatic and recurrence-free at a follow-up ranging from 2 to 38 months. Laparoscopic guidance allows the transperitoneal route to be used safely for percutaneous nephrolithotomy in patients with calculi in pelvic ectopic kidneys. We believe it to be a feasible, safe, and valid minimally invasive management option for this uncommon but challenging urological condition.
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Affiliation(s)
- P N Maheshwari
- Department of Urology, R. G. Stone Urological Research Institute, 14-A Road, Khar (West), 400 052, Mumbai, India.
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Bhandarkar DS, Katara AN, Shah RS. Intrahepatic subcapsular hematoma complicating laparoscopic cholecystectomy. Surg Endosc 2004; 18:868-70. [PMID: 14973675 DOI: 10.1007/s00464-003-4540-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
A 64-year-old woman underwent endoscopic retrograde cholangiopancreatography for bile duct stones, followed 2 days later by an uneventful laparoscopic cholecystectomy. She presented after 10 days with upper abdominal discomfort, nausea, and pyrexia. Investigations revealed a decrease in hemoglobin, and computed tomography identified a large intrahepatic subcapsular hematoma in segments V and VI. There was no intraabdominal collection and the rest of the viscera were normal. The collection was drained percutaneously under ultrasound guidance and a wide-bore catheter placed. She was treated with intravenous antibiotics and the catheter was removed 14 days later upon cessation of drainage. Serial ultrasonographic examinations showed a reduction in the size of the hematoma and complete resolution at 4 months. She remained well and asymptomatic at follow-up 16 months later. We report this case due to its rarity and review the previously documented cases of this complication.
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Affiliation(s)
- D S Bhandarkar
- Department of Minimal Access Surgery, P. D. Hinduja National Hospital & Medical Research Centre, Veer Savrakar Marg, Mahim, 400 016 Mumbai, India.
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Abstract
Oculocutaneous albinism represents a group of inherited skin disorders characterized by a generalized reduction of cutaneous, ocular and pilar pigmentation from the time of birth. Oculocutaneous albinism types 1 and 2 are the most common, but several other types have been described. A defect in the melanin synthesis pathway, resulting in reduced formation of melanin, is responsible for oculocutaneous albinism. Aetiology, clinical manifestations, diagnosis and management are discussed.
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Affiliation(s)
- J F Okulicz
- Department of Dermatology and Paediatrics, New Jersey Medical School, Newark, New Jersey 07103-2714, USA
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Mariasegaram M, Pullenayegum S, Jahabar Ali M, Shah RS, Penedo MCT, Wernery U, Sasse J. Isolation and characterization of eight microsatellite markers in Camelus dromedarius and cross-species amplification in C. bactrianus and Lama pacos. Anim Genet 2002; 33:385-7. [PMID: 12354152 DOI: 10.1046/j.1365-2052.2002.00896_6.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Mariasegaram
- Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
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Shah RS, Blakely ML, Lobe TE. The role of laparoscopy in the management of common bile duct obstruction in children. Surg Endosc 2001; 15:1353-5. [PMID: 11727149 DOI: 10.1007/s004640000320] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/1999] [Accepted: 02/25/2000] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic common bile duct exploration is commonplace in adults; however, this procedure is not often performed in children. The goal of this study was to evaluate the results of laparoscopic common bile duct exploration in children. METHODS Of 50 patients undergoing laparoscopic cholecystectomy, six patients (12%) had obstructing lesions of the common bile duct (CBD). Five children underwent laparoscopic common bile duct exploration, and one child had a preoperative endoscopic sphincterotomy and stone removal. RESULTS The mean age at laparoscopic CBD exploration was 11.6 years (range, 5-16). The obstructing lesion was visualized by intraoperative cholangiography in all five patients. The mean operative time for laparoscopic cholecystectomy along with CBD exploration was 215 min (range, 160-282). The transcystic laparoscopic CBD exploration was performed using a 7-Fr, multichannel rigid, or 10-Fr flexible fiberoptic cystoscope. The stones were either pushed into the duodenum with the scope or extracted through the cystic duct using a 3-Fr Segura basket. In one patient, a candidial ball disintegrated during an attempt to remove it with the basket. A repeat cholangiogram at the end of each procedure showed an anatomically normal CBD with free flow of contrast into the duodenum. All patients enjoyed a quick recovery. They were started on a regular diet on the same day of surgery and discharged on the 1st or 2nd postoperative day. One patient with sickle cell disease developed a pulmonary infarction and required 5 additional days of hospitalization. One patient developed recurrent choledocholithiasis 6 months after laparoscopic exploration and was treated successfully with endoscopic sphincterotomy and stone extraction. CONCLUSIONS Laparoscopic CBD exploration can be performed safely at the time of the cholecystectomy in children. Endoscopic sphincterotomy before cholecystectomy is not necessary. We recommend laparoscopic CBD exploration for obstructing lesions of the CBD. Endoscopic sphincterotomy should be reserved for recurrent lesions of the CBD after laparoscopic cholecystectomy.
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Affiliation(s)
- R S Shah
- Section of Pediatric Surgery, University of Tennessee, Memphis, 77 Washington Ave., Suite 220, Memphis, TN 38105, USA
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Moorchung N, Shah RS, Tiwari RK. KIKUCHIS DISEASE. Med J Armed Forces India 2001; 57:241-2. [PMID: 27365609 DOI: 10.1016/s0377-1237(01)80054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- N Moorchung
- Graded Specialist (Pathology), Military Hospital, Saugor
| | - R S Shah
- Senior Advisor (Pathology), Command Hospital (Central Command), Lucknow
| | - R K Tiwari
- Classified Specialist (Surgery), Military Hospital, Saugor
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Palayekar VV, Joshi JV, Hazari KT, Shah RS, Chitlange SM. Comparison of four nonculture diagnostic tests for Chlamydia trachomatis infection. J Assoc Physicians India 2000; 48:481-3. [PMID: 11273137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Chlamydia trachomatis (CT) is one of the commonest sexually transmitted diseases leading to urethritis, epididymitis, prostatitis in men and urethritis, cervicitis, endometritis and pelvic inflammatory disease, sometimes complicated by infertility and ectopic gestation in women. Since culture of fastidious bacteria in a monocellular medium is not available in most laboratories we compared direct immunofluorescence antigen detecting test (DFA) with three other nonculture tests-antigen detecting enzyme immunoassay (EIA), Papanicolaou staining (Pap) and Geimsa stain for endocervical swabs from women in reproductive age group. METHODS Three hundred and fifty seven women between 16 and 41 years of age and attending family welfare clinics of IRR were evaluated for the presence pap smears. In 100 cases DFA staining was compared with Geimsa staining. RESULTS DFA test was positive in 60/357 (16.8%), EIA in 29 (8.1%) of cases and Pap smear in 37 (10%) cases. In the second group DFA was positive in 17 (17%) and Geimsa in 10 (10%) cases. CONCLUSION Amongst the four tests DFA showed maximum sensitivity. ELISA is less expensive but has lower sensitivity. Pap stain also has less sensitivity and good specificity, the quality of smear is likely to affect the diagnosis. Though Geimsa stain is cheapest, for chlamydial cervicitis in our experience it was not as sensitive as DFA. Thus each laboratory must decide the method depending on its resources.
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Affiliation(s)
- V V Palayekar
- Department of Contraceptive Research, Institute for Research in Reproduction (ICMR), Jehangir Merwanji Street, Parel, Mumbai-400 012
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Abstract
Lactoferrin, an iron-binding protein, has been proposed to act as an anti-infective agent and has been used as a diagnostic marker in several inflammatory disorders. A sensitive enzyme-linked immunosorbent assay developed earlier was used for lactoferrin estimation in cervical mucus. A brief study was undertaken to observe if lactoferrin is detectable in cervical mucus and to correlate its level with reproductive tract infection, if present. One hundred and twelve cervical mucus samples were collected from healthy as well as infected females. Some of these females were using CuT-200 intrauterine copper devices for contraception. Women were at different phases of their menstrual cycle. The presence of detectable amount of lactoferrin in cervical mucus was confirmed. The average level of lactoferrin in cases either with clinical symptoms of cervicitis or with proven infection by PAP smear was significantly (t=7.6, P<0.01) higher than the normal controls. CuT users have higher (P<0.01) mean level of lactoferrin than corresponding non-users.
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Affiliation(s)
- J Mania-Pramanik
- Institute for Research in Reproduction, (Indian Council of Medical Research), Jehangir Merwanji Street, Parel, 400012 Mumbai
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Abstract
PURPOSE To examine parental demographic characteristics by adult (> or = 20 years at baby's conception) and teenage (< 20 years at baby's conception) paternity in births to very young adolescents (< 15 years at baby's conception). METHODS This was a population-based, retrospective cohort analysis of all 12,317 very young adolescent mothers residing in California with a first singleton live birth during 1993-1995. Risks for adult, compared to teenage, paternity were evaluated using multivariate logistic regression. RESULTS Adult fathers, responsible for 26.7% of births to very young adolescents, were a mean of 8.8 years older than the mother. The risk factors for adult compared to adolescent paternity were as follows: father's educational attainment of at least 3 years below that considered adequate for his age [adjusted odds ratio (AOR) = 8.34], father's (AOR = 2.46) or mother's (AOR = 1.36) educational attainment 1-2 years below that considered adequate for their age, mother's birthplace outside the United States (AOR = 3.12), and father's Hispanic ethnicity (AOR = 1.60) or African-American race (AOR = 1.50). CONCLUSIONS Adult fathers were responsible for over one quarter of the births in our study. Adolescent pregnancy prevention focusing on younger adolescents must programmatically address adult paternity. Variations in adult paternity patterns across cultural groups suggest that we need further study of the role that cultural beliefs and practices play in very young adolescent pregnancy.
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Affiliation(s)
- D J Taylor
- Maternal and Child Health Branch, California Department of Health Services, Sacramento, USA
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Abstract
PURPOSE Nineteen children had early thoracoscopic intervention for empyema between 1992 and 1997 at the LeBonheur Children's Medical Center. The authors have evaluated the results of this treatment. METHODS Thoracoscopic intervention was performed at the fibrinopurulent state of empyema. An irrigating laparoendoscope was inserted, loculi were disrupted, debris was evacuated, and a chest tube was passed through the port site. RESULTS The patients were aged between 11 months and 16 years (mean, 6.5 years). The etiology of the empyema was parapneumonic in 17, and there was one case each of perforated appendicitis and mediastinal histoplasmosis. They underwent thoracoscopy at a mean of 4.6 days after hospital admission (range, 1 to 12 days). Chest tubes were removed at 1 to 5 days (mean, 2.9 days) after operation, and resolution of fever occurred at 1 to 9 days (mean, 3.8 days) postoperatively. Patients were discharged home between 4 and 10 days (mean, 6.1 days) postoperatively, and the mean hospital stay was 10.3 days (range, 5 to 21). There were no complications. The surgical technique was simple and well tolerated, requiring few disposable items, and the mean operating time was 77 minutes. CONCLUSIONS Thoracoscopy eliminated the morbidity of thoracotomy and the discomfort and expense of prolonged chest tube drainage. Thoracoscopy may be used as early first-line therapy in a majority of pediatric patients with fibrinopurulent empyema.
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Affiliation(s)
- C M Merry
- Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA
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Bufo AJ, Shah RS, Li MH, Cyr NA, Hollabaugh RS, Hixson SD, Schropp KP, Lasater OE, Joyner RE, Lobe TE. Interval appendectomy for perforated appendicitis in children. J Laparoendosc Adv Surg Tech A 1998; 8:209-14. [PMID: 9755912 DOI: 10.1089/lap.1998.8.209] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.
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Affiliation(s)
- A J Bufo
- Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA
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Abstract
OBJECTIVE To compute ratios of severe pregnancy complications (the number of hospitalizations for pregnancy complications per 100 deliveries) and to examine factors associated with their prevalence. METHODS Using population-based California hospital discharge data to estimate hospitalization ratios of pregnancy complications during 1987-1992, we defined cases by preselected pregnancy complication codes from the International Classification of Diseases, Ninth Revision, Clinical Modification, excluding induced abortions and delivery-associated complications. All hospital deliveries of liveborn or stillborn infants were included in our denominator. We examined ratios by age, race-ethnicity, payment source, total hospitalization charges, and length of hospital stay. RESULTS There were 833,264 hospitalizations for pregnancy complications in California (25 complications per 100 deliveries), which included admissions for preterm labor (33%), genitourinary infection (16%), and pregnancy-induced hypertension (15%). Age-specific ratios were highest for women 14 years old and younger (38 per 100 deliveries) and lowest for women 25-29 years old (23 per 100 deliveries). Ratios of complications varied by race-ethnicity; black women had the highest (42 per 100 deliveries), and Asian-Pacific Islander women had the lowest (21 per 100 deliveries). Ratios were unaffected by payment source. In 1987, Medicaid charges were $118 million for 33% of the number of total hospitalizations for complications. In 1992, such Medicaid hospitalizations accounted for $356 million (49%) of the $734 million in total charges and for 183,295 (45%) of the 409,000 total hospital days. CONCLUSION Our results showed disparities in ratios of severe complications of pregnancy by age and race-ethnicity as well as a shift of financial burden to Medicaid. These findings suggest that such complications may be reduced by identifying risk factors and targeting high-risk groups.
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Affiliation(s)
- C L Scott
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Affiliation(s)
- C F Lanzieri
- Department of Radiology, University Hospitals of Cleveland, OH 44106, USA
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Affiliation(s)
- C F Lanzieri
- Department of Radiology, University Hospitals of Cleveland, OH 44106, USA
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Lanzieri CF, Bangert BA, Tarr RW, Shah RW, Shah RS, Lewin JS, Gilkeson RC. Neuroradiology case of the day. Multiple cerebral abscesses associated with isolated pulmonary arteriovenous malformation. AJR Am J Roentgenol 1997; 169:296, 299-302. [PMID: 9207557 DOI: 10.2214/ajr.169.1.9207557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C F Lanzieri
- Department of Radiology, University Hospitals of Cleveland, OH 44106, USA
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Lanzieri CF, Bangert BA, Tarr RW, Shah RS, Lewin JS, Gilkeson RC. Neuroradiology case of the day. Dysembryoplastic neuroepithelial tumor. AJR Am J Roentgenol 1997; 169:293, 297-8. [PMID: 9207553 DOI: 10.2214/ajr.169.1.9207553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C F Lanzieri
- Department of Radiology, University Hospitals of Cleveland, OH 44106, USA
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Farris GM, Robinson SN, Gaido KW, Wong BA, Wong VA, Hahn WP, Shah RS. Benzene-induced hematotoxicity and bone marrow compensation in B6C3F1 mice. Fundam Appl Toxicol 1997; 36:119-29. [PMID: 9143481 DOI: 10.1006/faat.1997.2293] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Long-term inhalation exposure of benzene has been shown to cause hematotoxicity and an increased incidence of acute myelogenous leukemia in humans. The progression of benzene-induced hematotoxicity and the features of the toxicity that may play a major role in the leukemogenesis are not known. We report the hematological consequences of benzene inhalation in B6C3F1 mice exposed to 1, 5, 10, 100, and 200 ppm benzene for 6 hr/day, 5 days/week for 1, 2, 4, or 8 weeks and a recovery group. There were no significant effects on hematopoietic parameters from exposure to 10 ppm benzene or less. Exposure of mice to 100 and 200 ppm benzene reduced the number of total bone marrow cells, progenitor cells, differentiating hematopoietic cells, and most blood parameters. Replication of primitive progenitor cells in the bone marrow was increased during the exposure period as a compensation for the cytotoxicity induced by 100 and 200 ppm benzene. In mice exposed to 200 ppm benzene, the primitive progenitor cells maintained an increased percentage of cells in S-phase through 25 days of recovery compared with controls. The increased replication of primitive progenitor cells in concert with the reported genotoxicity induced by benzene provides the components necessary for producing an increased incidence of lymphoma in mice. Furthermore, we propose this mode of action as a biologically plausible mechanism for benzene-induced leukemia in humans exposed to high concentrations of benzene.
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Affiliation(s)
- G M Farris
- Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina 27709-2137, USA
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Shah RS, Chen MK, Lobe TE, Bufo AJ, Gross E, Whitington GL. Laparoscopic common duct exploration in a child with recurrent pancreatitis due to a primary fungus ball in the terminal common bile duct. J Laparoendosc Adv Surg Tech A 1997; 7:63-7. [PMID: 9453867 DOI: 10.1089/lap.1997.7.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report on a case of a fungus ball obstructing the distal common bile duct and causing recurrent pancreatitis in an otherwise healthy 3-year-old boy. Laparoscopic exploration of the common bile duct was performed using a 10 french rigid fiberoptic cystoscope and a Dormia basket. This is the first example of a primary fungus ball in common bile duct presenting as a pancreatitis and treated laparoscopically.
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Affiliation(s)
- R S Shah
- Section of Pediatric Surgery, LeBonheur Children's Medical Center, The University of Tennessee, Memphis 38105, USA
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Farris GM, Wong VA, Wong BA, Janszen DB, Shah RS. Benzene-induced micronuclei in erythrocytes: an inhalation concentration-response study in B6C3F1 mice. Mutagenesis 1996; 11:455-62. [PMID: 8921506 DOI: 10.1093/mutage/11.5.455] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
High concentrations (300-1000 p.p.m.) of benzene have been shown to induce an increase in the frequency of micronucleated erythrocytes in mice. This study investigated the mutagenicity of benzene at lower concentrations, including the current limit for occupational exposure, 1 p.p.m. The frequencies of micronucleated polychromatic erythrocytes (MPCE) in the bone marrow and blood and micronucleated normochromatic erythrocytes (MNCE) in the blood of male B6C3F1 mice were measured following inhalation of benzene at 0, 1, 10, 100 or 200 p.p.m. during an 8 week exposure period. Only 100 and 200 p.p.m. benzene induced a statistically significant increased frequency of micronucleated erythrocytes in the bone marrow and blood. The frequency of MPCE plateaued at week 2 with 43/1000 (100 p.p.m.) and 86/1000 (200 p.p.m.) in the bone marrow as compared with 10/1000 for controls. The frequency of MNCE in the blood progressively increased to 13.4/1000 (100 p.p.m.) and 32.5/1000 (200 p.p.m.) at week 8 as compared with 1.8/1000 for controls. Cytotoxicity of replicating and maturing erythrocytes by 100 and 200 p.p.m. benzene delayed the accumulation of MNCE in the blood. There was not a statistically significant increase in the frequency of micronucleated erythrocytes, as an indicator of mutagenicity, with inhalation of 1 or 10 p.p.m. benzene over an 8 week period. A quadratic curve fit the bone marrow MPCE data of mice exposed to up to 200 p.p.m. benzene with a high correlation (R2 = 0.94) and could not be rejected based on lack of fit.
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Affiliation(s)
- G M Farris
- Chemical Industry Institute of Toxicology, Research Iriangle Park, NC 27709-2137, USA
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Palayekar V, Joshi JV, Hazari KT, Shah RS, Chitlange SM. Chlamydia trachomatis detected in cervical smears from Copper-T users by DFA test. Adv Contracept 1996; 12:145-52. [PMID: 8863910 DOI: 10.1007/bf01849636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was carried out to determine the prevalence of Chlamydia trachomatis (CT) antigen in endocervical smears from women using the Copper-T200 (Cu-T) intrauterine device and comparing them with nonusers. METHODS The direct fluorescent antibody (DFA) test was used to detect the CT antigen (CT Ag). RESULTS A total of 422 women between 17 and 42 years of age was evaluated. Out of these 71 (16.8%) were positive for CT Ag. Among Cu-T users (n = 222), 14.0% were positive. The duration of Cu-T use varied from 6 to 80 months. Among nonusers (n = 200), the DFA test was positive in 20.0% (p = 0.11, NS). However, as a whole, symptoms related to genital tract infection were significantly more common in Copper-T users than in nonusers (p < 0.02) and signs were relatively more common in Cu-T users but not significantly so (p = 0.16). Similarly, as a group, symptoms as well as signs were significantly more common in all DFA-positive cases than in all negative cases (p < 0.02). Among Cu-T users, symptoms were relatively more common, and signs were significantly more common, in women positive for CT Ag than in the negative cases (p < 0.04). There were two cases of mild pelvic inflammatory disease (PID) diagnosed clinically, one in a Copper-T user, and the other a nonuser, both being positive by the DFA test. CONCLUSION There was no correlation between the duration of Copper-T use and percent positivity for CT Ag. Although milder genital tract symptoms and signs were more common in women with chlamydial cervicitis, clinically PID appears to be uncommon (0.5%). PID in this study was not related to Copper-T use but related to chlamydial cervicitis in this group of women with low risk sexual behavior.
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Affiliation(s)
- V Palayekar
- Institute for Research in Reproduction (ICMR), Parel, Bombay, India
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Miller RT, Shah RS, Cattley RC, Popp JA. The peroxisome proliferations WY-14,643 and methylclofenapate induce hepatocyte ploidy alterations and ploidy-specific DNA synthesis in F344 rats. Toxicol Appl Pharmacol 1996; 138:317-23. [PMID: 8658533 DOI: 10.1006/taap.1996.0130] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
WY-14,643 (WY) and methylclofenapate (MCP) are peroxisome proliferators (PP) and hepatocarcinogens in rats. MCP causes hepatic polyploidization and preferentially induces replicative DNA synthesis in binucleate tetraploid hepatocytes (2 X 2N) in young Alpk:AP rats. To compare the effect of WY and MCP on hepatocyte ploidy and ploidy-specific DNA synthesis, male F344 rats were fed WY (0.1% in diet) or gavaged with MCP (25 mg/kg/day in corn oil) for 2, 5, or 10 days. Four rats per treatment group (including corn oil and diet control groups) were euthanized and the livers perfused at each time point. To identify cells undergoing DNA synthesis, all animals received BrdU by continuous infusion for 2 or 5 days prior to euthanasia. Hepatocyte ploidy and DNA synthesis were determined using one- or two-parameter flow cytometry. Averages +/- SEM for adult male F344 rats as a percentage of total hepatocytes for each ploidy subclass are 2N = 3.4 +/- 0.7%, 4N = 69.9 +/- 1.9%, 2 X 2N = 14.4 +/- 2.4%, 8N = 2.2 +/- 0.4%, and 2 X 4N = 9.6 +/- 0.9%. Significant alterations were not induced in the proportions of 2 X 2N or 4N ploidy subclasses by WY or MCP at any time point. However, WY caused increases in 8N hepatocytes at 2, 5, and 10 days (2 days, 5.2% vs 2.2% for controls; 5 days, 7.0% vs 3.1% for controls; 10 days, 6.4% vs 3.6% for controls) as did MCP at 5 and 10 days (5 days, 6.3% vs 2.5% for controls; 10 days, 5.3% vs 2.9% for controls). In addition, a majority of BrdU-containing hepatocytes were 4N following 5 and 10 days of WY and MCP [34.3% (WY) and 16.8% (MCP) vs 1.8% and 1.1% for controls, respectively, for 2 X 2N (5 days) as a percentage of total hepatocytes]. Hepatocytes with intermediary DNA content (between tetraploid and octaploid) from MCP- and WY-treated rats were predominantly mononuclear, the percentage of binucleate hepatocytes being similar to or less than the percentage of binucleate cells within the total tetraploid hepatocyte population. These data suggest that polyploidization is induced by PP and induction of S-phase by WY and MCP occurs primarily in 4N hepatocytes in mature F344 rats and not within 2 X 2N hepatocytes. Identification of a ploidy subpopulation at risk for tumor development in rodents is essential for clarifying the role of cell replication in risk assessment studies of PP.
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Affiliation(s)
- R T Miller
- Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina 27709, USA
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40
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Abstract
Teratoma affecting the large bowel is extremely rare. Thus far, only two cases have been reported in the English-language literature. Herein the authors describe what they believe is the third such case.
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Affiliation(s)
- R S Shah
- Department of Pediatric Surgery, Grant Medical College, Bombay, India
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Chitlange SM, Shah RS, Hazari KT, Anandkumar TC, Puri CP. Ultrasonographic monitoring of ovarian follicles in women using norethisterone for contraception. Int J Gynaecol Obstet 1996; 53:31-4. [PMID: 8737301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of intranasal and oral norethisterone (NET) on ovarian folliculogenesis. METHODS Sixteen healthy, sterilized women with regular menstrual cycles were recruited to the study. NET 300 micrograms per day was administered orally (n = 8) or intranasally (n = 8) for two consecutive menstrual cycles. Serial pelvic ultrasonography was performed to monitor ovarian follicular growth. RESULTS Ultrasonographic evidence of normal follicular growth and ovulation was observed in 10 cycles whilst 22 cycles were anovulatory. Formation of follicular cysts was seen in 14 cycles, 13 of which were anovulatory and in one ovulation was observed in the opposite ovary. The size of the cysts varied between 27 and 44 mm. The cysts disappeared when NET treatment was discontinued. A positive correlation between cyst size and estradiol levels was observed with intranasal NET in 50% of cyst cycles. In three cycles, although normal follicular growth and endocrine profile were observed, the follicles failed to rupture. These were classified as luteinized unruptured follicles. Immature follicles < 10 mm were seen in six cycles. CONCLUSION The study showed that NET administered either orally or intranasally evidently disturbs normal follicular growth and rupture.
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Affiliation(s)
- S M Chitlange
- Institute for Research in Reproduction (ICMR), Bombay, India
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42
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Shah RS, Kulkarni VR. Penile revascularization: an overview. Ann Acad Med Singap 1995; 24:749-54. [PMID: 8579325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Penile revascularization offers the possibility to restoring natural erections in selected cases of vasculogenic impotence. Men who have an isolated block in the internal pudendal artery may be cured by anastomosis of the inferior epigastric artery to the dorsal penile artery. In men with congenital arterial dysplasia or cavernosal arterial disease, the corpora can be revascularized by the arterialization of the deep dorsal vein. In the Virag-type procedures, the epigastric artery is anastomosed to the deep dorsal vein at the base of the penis; blood flows retrograde through the veins and enters the corpora through the connecting posterior emissary veins. A new procedure that permits antegrade arterialization of the dorsal vein has been developed (Parulkar-Shah ADVA procedure). In this, the distal (glanular) half of the dorsal vein is completely mobilised, divided near the glans and then flipped back to lie upon the symphysis pubis where it is anastomosed end-to-end to the inferior epigastric artery. This procedure works on the same principle as the Virag procedure but has the advantage that the flow of blood is in the direction of the venous valves; hence the valves do not have to be ruptured. Venogenic impotence can be treated by dorsal vein arterialization in combination with venous ligation.
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Affiliation(s)
- R S Shah
- Department of Urology and Andrology, Bhatia General Hospital, Bombay, India
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Panda BN, Shah RS, Nair R. TUBERCULOSIS OF BRAIN: PRESENTING WITH RECURRENT STROKE AND INTRACRANIAL HAEMORRHAGE: A Case Report. Med J Armed Forces India 1995; 51:139-141. [PMID: 28769272 PMCID: PMC5529886 DOI: 10.1016/s0377-1237(17)30950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B N Panda
- Classified Specialist (Medicine and Chest Disease), Military Hospital (CTC), Pune 411 040
| | - R S Shah
- Classified Specialist (Pathology), Military Hospital, Ahmedabad
| | - Rrk Nair
- Classified Specialist (Pathology), 150 Base Hospital, C/O 56 APO
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Abstract
To examine differences in perinatal health among nine Asian ethnic subgroups, a descriptive epidemiological study was conducted using linked birth/infant death certificates for 1982 to 1987. When compared with Whites, Asians had a lower proportion of young mothers, unmarried mothers, and women who received first trimester prenatal care; a higher proportion of foreign-born mothers; and a different birthweight distribution. A great deal of heterogeneity was found in risk factors and infant mortality rates among the various Asian ethnic subgroups. Paradoxically, although Asian ethnic subgroups had a higher perinatal risk profile, they had more favorable birth outcomes than did Whites.
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Affiliation(s)
- H W Morrow
- Maternal and Child Health Branch, California Department of Health Services, Sacramento 95814
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Joshi JV, Palayekar S, Hazari KT, Shah RS, Chitlange SM. The prevalence of Chlamydia trachomatis in young women. Natl Med J India 1994; 7:57-9. [PMID: 8019395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chlamydia trachomatis infection is common in women with pelvic inflammatory disease, infertility and ectopic gestation. In this study we examined the prevalence of this infection in young women undergoing routine gynaecological checks. METHODS Three hundred and five women aged between 19 and 41 were included in our study. Endocervical smears were collected by speculum examination, air-dried, acetone-fixed and stained for chlamydial antigen using fluorescein-labelled monoclonal antibody. RESULTS Ninety-five per cent of the women were asymptomatic. Only 5% had mild symptoms such as white discharge, abdominal pain or profuse periods; 34% gave a history of white discharge only. Chlamydial antigen was detected in cervical smears from 47 (15%) women. Of these, 9 (19%) had symptoms at examination and 20 (43%) had symptoms within 2 months. On gynaecological examination 25 women (53%) had minor signs such as erosion or cervicitis and only 1 (2%) had uterine tenderness suggestive of mild pelvic inflammatory disease. CONCLUSIONS It is important to diagnose chlamydial infection early because in its later stages it is associated with an ascending infection and serious complications. Young, relatively asymptomatic women should be screened for the presence of this organism.
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Affiliation(s)
- J V Joshi
- Institute for Research in Reproduction (ICMR), Maharashtra, India
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Abstract
The use of oral and intravenous cyclosporin represents a significant advance in the therapy of refractory inflammatory bowel diseases (IBD). However, oral administration of cyclosporin is fraught with improper delivery of cyclosporin to the colon for its topical action. Because of unpredictable metabolism by cytochrome P-450 IIIA, the targeted blood level for systemic effect is not reached at low doses. Furthermore, the doses that have been used for therapy of IBD have been shown to induce several adverse side effects. Thus, an alternate method of delivering cyclosporin to the colon is desirable. In this study, the effect of intracolonically administered cyclosporin was tested for its efficacy to heal mucosal erosions in dextran sulfate sodium (DSS)-induced colitis in mice. Both acute and chronic colitis was induced by feeding female Swiss-Webster mice with 5% DSS (30,000-40,000 mol wt) for five or seven days, respectively. Therapy was advocated prophylactically, prophylaxis plus therapy and therapeutically during the acute and chronic phase of the disease and therapeutically during the chronic phase of the disease. Intracolonic cyclosporin given prophylactically showed adverse effects by increasing the damage to the colonic mucosa. However, intracolonic cyclosporin given therapeutically in 2.5, 5, and 10 mg/kg after the induction of colitis resulted in dramatic responses in terms of reducing the disease activity and histologic scores, corroborated by complete histological resolution compared to oral cyclosporin given at identical doses. Intracolonic cyclosporin (5 mg/kg) was also very effective in reducing the chronic inflammation. The results of this study highlight the application of this animal model for therapeutic research. Furthermore, cyclosporin administered as an enema provides a new stratagem for the therapy of IBD because of its rapid onset of action at very low doses without the risk inherent in oral or systemic administration.
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Affiliation(s)
- S N Murthy
- Krancer Center for Inflammatory Bowel Disease Research, Department of Medicine, Hahnemann University, Philadelphia, Pennsylvania
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Cooper HS, Murthy SN, Shah RS, Sedergran DJ. Clinicopathologic study of dextran sulfate sodium experimental murine colitis. J Transl Med 1993; 69:238-49. [PMID: 8350599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We undertook this study in order to fully characterize the clinical and histopathology features of the dextran sulfate sodium (DSS) model of experimental murine colitis and to discover the earliest histopathologic changes that lead to colitis. EXPERIMENTAL DESIGN Acute colitis was induced in Swiss-Webster mice by 7 days of oral DSS with animals sacrificed daily. Chronic colitis was induced by: (a) 7 days of oral DSS followed by 7 days of H2O (for 1, 2, and 3 cycles) and (b) 7 days of oral DSS followed by 14 and 21 days of H2O. In each experimental group, the entire colons were examined histologically and correlated with clinical symptoms. RESULTS Acute clinical symptoms (diarrhea and/or grossly bloody stool) were associated with the presence of erosions and inflammation. More importantly, the earliest histologic changes which predated clinical colitis was loss of the basal one-third of the crypt (day 3), which progressed with time to loss of the entire crypt resulting in erosions on day 5. The earliest changes were very focal and not associated with inflammation. Inflammation was a secondary phenomena and only became significant after erosions appeared. Animals treated with only 7 days of DSS followed by 14 and 21 days of H2O developed a chronic colitis with the following histologic features: areas of activity (erosions and inflammation), inactivity, crypt distortion, florid epithelial proliferation and possible dysplasia. These changes were similar to animals given 3 cycles of DSS. The clinical disease activity index correlated significantly with pathologic changes in both the acute and chronic phases of the disease. CONCLUSIONS The mechanism of DSS colitis is presently unknown. However, the finding of crypt loss without proceeding or accompanying inflammation suggests that the initial insult is at the level of the epithelial cell with inflammation being a secondary phenomena. This may be a good model to study how early mucosal changes lead to inflammation and the biology of the colonic enterocyte. Chronic colitis induced after only 7 days of DSS may serve as a useful model to study the effects of pharmacologic agents in human inflammatory disease and mechanisms of perpetuation of inflammation. Finally, we believe that this model has the potential to study the dysplasia cancer sequence in inflammatory disease.
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Affiliation(s)
- H S Cooper
- Department of Pathology and Laboratory Medicine, Hahnemann University, Philadelphia, Pennsylvania
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Shah RS, Patel MP, Pikale HS, Kulkarni BK, Borwankar SS. Benign neonatal pneumoperitoneum--an enigma. J Postgrad Med 1992; 38:84-5. [PMID: 1432837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A case of neonatal pneumoperitoneum in absence of a bowel perforation or intrathoracic pathology has been reported. The cause of such a rare manifestation remains to be established.
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Affiliation(s)
- R S Shah
- Dept of Paediatric Surgery, KEM Hospital, Parel, Bombay, Maharashtra
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Shah RS, Pikale HS, Birmole BJ, Kulkarni BK, Borwankar SS. Adenocarcinoma of the colon in a child. J Postgrad Med 1992; 38:81-3. [PMID: 1432836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A rare case of a 10 year old boy presenting with history of lower GI bleeding for one year and acute intestinal obstruction was diagnosed as adenocarcinoma of the colon on exploration. One year follow-up after radical colectomy did not show any recurrence.
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Affiliation(s)
- R S Shah
- Dept of Paediatric Surgery, KEM Hospital, Parel, Bombay, Maharashtra
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50
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Abstract
Substance P has been implicated as a neuronal mediator of inflammation in various inflammatory conditions. However, the exact role played by substance P in inflammatory bowel diseases or in experimental colonic vasculitis has not been clearly understood. In this study, we examined the effect of close superior mesenteric artery injection of substance P under prevailing inflammatory conditions induced by intravenous human albumin antialbumin immune complex followed by intracolonic perfusion of 2.5% formaldehyde in rats or intracolonic perfusion of 5% alcohol alone. The immune complex- and formaldehyde-treated rats showed severe microvascular changes such as microvascular plugging by red blood cells, endothelial breakage and extravasation of plasma proteins and red blood cells. The bolus injection of 10(-8) M substance P reduced extravasation of Evans blue dye by 50% and the tissue wet to dry ratio by 20% in immune complex- and formaldehyde-perfused rats. Myeloperoxidase activity was not changed. Substance P also significantly inhibited (44%) the extravasation in alcohol-perfused rats. Pretreatment of immune complex- and formaldehyde-treated rats with substance P antagonist reversed the effect of substance P. These findings suggest that the most immediate effect of substance P may be vasodilation and clearing of vascular plugs induced by immune complex and formaldehyde. This effect of substance P differs from its chronic effect, which causes vasodilation and extravasation.
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Affiliation(s)
- S N Murthy
- Krancer Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Philadelphia, PA 19102-1192
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