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Garassino M, He Y, Ahn MJ, Orlov S, Potter V, Kato T, Laskin J, Voon P, Reungwetwattana T, Ramalingam S, Wu YL, Albayaty M, Cross S, Huang X, Kulkarni D, Cho B. EP08.02-108 Osimertinib Long-Term Tolerability in Patients with EGFRm NSCLC Enrolled in the AURA Program or FLAURA Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.791] [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: 11/26/2022]
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Ramsali MV, Puduchira KG, Maganti SP, Vankaylapatti SD, Pasupuleti S, Kulkarni D. Anesthetic management and outcomes of patients with Steven-Johnson Syndrome-A retrospective review study. J Anaesthesiol Clin Pharmacol 2021; 37:119-123. [PMID: 34103835 PMCID: PMC8174442 DOI: 10.4103/joacp.joacp_46_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Steven-Johnson Syndrome (SJS) is a rare and severe form of erythema exudative multiforme. Multisystem involvement in SJS and the suspicion of precipitation of the disease with exposure to anesthetic drugs makes anesthesia a challenging task. The concerns during anesthesia are the mucosal lesions and special care that is required to prevent injury to the oropharynx and larynx during airway management and also the drugs used for anesthesia. In the literature, very few isolated case reports or case series are available. Here, we have analyzed the cases of SJS coming for ophthalmic anesthesia, taking into consideration factors like mode of presentation, precipitating factors, associated diseases, types of anesthesia, anesthetic modifications, and various drugs used during anesthesia. Material and Methods: The electronic medical records of 497 cases of SJS who required interventions like ophthalmic examination or surgery (either under local or general anesthesia) over a period of 18 months were analyzed retrospectively. The records were reviewed to obtain the concerned details like anesthesia-inducing agents, muscle relaxants, inhalational agents, and analgesics. The problems concerned with monitoring and intubation were also noted. The data were analyzed and presented as frequency and percentage. Results: Patient age ranged between 9 months and 72 years. Many surgeries were conducted under general anesthesia (441) although a few required local (peribulbar block) anesthesia (56). The drugs administered for general anesthesia were sevoflurane, isoflurane, propofol, thiopentone, vecuronium, and atracurium and those administered for pain management were fentanyl, tramadol, butorphanol, and paracetamol. The patients who were sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were not administered the same. None of the patients reacted adversely to the different drugs used for anesthesia. Conclusion: Identifying the precipitating factors, understanding the pathophysiology and its implications for anesthesia will help in successfully managing anesthesia in the rare cases of SJS.
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Kulkarni D. Rectal prolapse in a young adult male patient and its unique aetiology. S Afr j sports med 2018. [DOI: 10.17159/5126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kumar S, Patki A, Padhy N, Moningi S, Kulkarni D, Ramchandran G. A comparison of the effect of 0.9% saline versus balanced salt solution (plasma-lyte a) on acid base equilibrium, serum osmolarity and serum electrolytes in supratentorial neurosurgical procedures requiring craniotomy. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646232] [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: 10/27/2022] Open
Affiliation(s)
- S. Kumar
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - A. Patki
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - N. Padhy
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - S. Moningi
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - D. Kulkarni
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G. Ramchandran
- Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
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Dixon JM, Renshaw L, Young O, Kulkarni D, Saleem T, Sarfaty M, Sreenivasan R, Kusnick C, Thomas J, Williams LJ. Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device. Eur J Surg Oncol 2016; 42:1834-1840. [PMID: 27591938 DOI: 10.1016/j.ejso.2016.07.141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 05/18/2016] [Revised: 07/04/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast conserving surgery (BCS) aims to remove a breast cancer completely and obtain clear margins. Complete excision is essential to reduce the risk of local recurrence. The ClearEdge™ (CE) imaging device examines margins of excised breast tissue intra-operatively. The aim of this study was to investigate the potential of the device in detecting margin involvement in patients having BCS. METHODS In Phase-1 58 patients underwent BCS and had 334 margins assessed by the device. In Phase-2 the device was used in 63 patients having BCS and 335 margins were assessed. Patients with margins considered close or involved by the CE device were re-excised. RESULTS The margin assessment accuracies in Phase-1 and Phase-2 compared to permanent section pathology were very similar: sensitivity (84.3% and 87.3%), specificity (81.9% and 75.6%), positive predictive value (67.2% and 63.6%), and negative predictive value (92.2% and 92.4%). The false positive rate (18.1% and 24.4%) and false negative rate (15.7% and 12.7%) were low in both phases. In Phase-2 re-excision rate was 37%, but in the 54 where the CE device was used appropriately the re-excision rate was 17%. Had all surgeons interpreted all images appropriately and re-excised margins detected as abnormal by the device in Phase-2 then the re-excision rate would have been 7%. CONCLUSION This study shows that the CE device has potential to reduce re-excision after BCS and further randomized studies of its value are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/complications
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/surgery
- Dielectric Spectroscopy/instrumentation
- Dielectric Spectroscopy/methods
- Female
- Humans
- Intraoperative Period
- Male
- Margins of Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasm, Residual
- Predictive Value of Tests
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Affiliation(s)
- J M Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK; University of Edinburgh, Medical School, Scotland, UK.
| | - L Renshaw
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - O Young
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - D Kulkarni
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - T Saleem
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | | | - J Thomas
- Pathology Department, Western General Hospital, Edinburgh, Scotland, UK
| | - L J Williams
- University of Edinburgh, Medical School, Scotland, UK
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Barber M, Williams L, Anderson E, Neades G, Raine C, Young O, Kulkarni D, Young I, Dixon J. Outcome of the use of acellular-dermal matrix to assist implant-based breast reconstruction in a single centre. Eur J Surg Oncol 2015; 41:100-5. [DOI: 10.1016/j.ejso.2014.08.475] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/04/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022] Open
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Thosani N, Quesada A, Kulkarni D, Wolf DS. The many faces of gastrointestinal T-cell lymphoma manifest simultaneously in the same patient. Endoscopy 2013; 45 Suppl 2 UCTN:E31-2. [PMID: 23526503 DOI: 10.1055/s-0032-1325856] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- N Thosani
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, Texas, USA.
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Akolekar D, Kulkarni D, Barber M. 166 Radial Scar and Its Association with Malignancy: Retrospective Audit. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70234-4] [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: 10/28/2022]
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Sekhar Majumdar SM, Rajani B, Kulkarni D, Subrahmanya M. Numerical Simulation of Incompressible Turbulent Flow using Linear Eddy Viscosity-based Turbulence Models. DEFENCE SCI J 2010. [DOI: 10.14429/dsj.60.603] [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: 11/13/2022]
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Gurjar SV, Kulkarni D, Khawaja HT. Outpatient general surgical follow-up: are we using this resource effectively? Int J Surg 2008; 7:62-5. [PMID: 19095510 DOI: 10.1016/j.ijsu.2008.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Raised patient expectations and the 2-week rule for the investigation of suspected malignancy have led to heightened demands on surgical outpatient clinics. In this context, the utility of benign post-operative or investigative follow-ups requires justification. METHODS The surgical outpatient clinic workload of four substantive general surgeons at a typical DGH was analysed over a 4-week period. All notes were examined to identify referral source, management plan and whether that clinic attendance was justified. RESULTS Twenty three clinics (410 patients) were examined over the period of this study. Three hundred and twenty one patient episodes were examined; 52 episodes did not occur due to patient non-attendance and 37 episodes were not accounted for ('missing/incomplete data'). Thirty three percent of the patients underwent consultant review whilst 57% were reviewed by middle grade surgeons and 9% by SHO/ST2 doctors. Forty eight percent of the consultations were new referrals: 37% of these patients were added to the elective surgical waiting list. One hundred and sixty eight follow-up consultations occurred, which included cancer patients (6%), review patients (12%), patients attending for investigative results (13%) and benign post-operative follow-ups (22%). Forty six of the 69 (66%) post-operative follow-ups were deemed unnecessary as patients were being seen after benign procedures (hernia repair, anorectal surgery or laparoscopic cholecystectomy). CONCLUSION Over 50% attendances (21/41) for 'normal' results could have been avoided by the use of a directed informative letter. Outpatient clinics are an important resource whose usage must be optimised.
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Affiliation(s)
- S V Gurjar
- Medway Maritime Hospital, Gillingham, Kent, UK.
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Hirshfield KM, Kulkarni D, Kostialik J. A polymorphism in the 3′UTR region of E-cadherin associates with recurrence of breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22101] [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: 11/20/2022] Open
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Hoque H, Ahmad N, Sran H, Patel S, Gurjar S, Kulkarni D. Invasive lobular cancer and re-do surgery – extent of the problem! EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70603-7] [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: 10/22/2022] Open
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Kulkarni D, Beechey-Newman N, Kothari A, Hamed H, D'Arrigo C, Ryder K, Fentiman I. The epidemiology of HER-2 positive tumours. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80102-3] [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: 11/26/2022] Open
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Reyes R, Kulkarni D, Khan M, Aps J, Goligher J, Gotlieb M. Imprint cytology of core needle biopsy specimens in a one-stop breast clinic: an accurate, reliable and useful method of evaluating breast lesions. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80069-8] [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: 10/24/2022] Open
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Kulkarni D, Beechey-Newman N, Hamed H, Kothari A, Ryder K, Fentiman I. Occult primary breast cancer. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80107-2] [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: 11/28/2022] Open
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Abstract
This study was designed to assess the efficacy and long-term outcome of fistulectomy and saucerization for treatment of mammary duct fistulae. Mammary fistula is a chronic condition that represents the final step in what has been termed "mammary duct associated inflammatory disease sequence." The treatment is primarily surgical and may include healing by secondary intention or primary closure with or without antibiotics. Reported series are small and often include variable surgical strategies applied without consistency. A consecutive series of 53 patients who had 59 mammary duct fistulae were treated by fistulectomy with saucerization. The median age was 32 years. Wounds were allowed to heal by secondary intention and antibiotics were not used. We reviewed the case records to establish the incidence of recurrent fistula and the time to complete healing. The long-term cosmetic outcome was determined by a postal survey. After a median follow-up of 6 years there had been no relapse in 92%. There was significant delay in healing in six cases (range: 10 to 30 weeks). Thirty-eight patients (83%) gave a definite history of regularly smoking between 10 and 20 cigarettes a day. Two thirds of the patients were either pleased or satisfied with the final cosmetic result of the surgery, but more than 90% said that it left them with some distortion of the nipple. Fistulectomy and saucerization achieves long-term cure in the majority of patients with mammary duct fistula, but it results in some degree of distortion of the nipple. The strong relationship between smoking and the occurrence of mammary duct fistulae is again demonstrated.
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Affiliation(s)
- N Beechey-Newman
- Hedley Atkins Breast Unit, Guy's Hospital London SE1 9RT, London, United Kingdom.
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Beechey-Newman N, Kulkarni D, Kothari A, D'Arrlgo C, Culora G, Hamed H, Fentiman I. Breast duct microendoscopy in nipple discharge: microbrush improves cytology. Surg Endosc 2005; 19:1648-51. [PMID: 16222469 DOI: 10.1007/s00464-005-0124-7] [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: 03/24/2005] [Accepted: 05/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast duct microendoscopy is a new technique that allows direct visualization of the mammary ductal epithelia and has the potential to provide greater accuracy in the diagnosis of benign and malignant breast conditions. We have already established the feasibility of BDME on mastectomy specimens and in patients both under general and local anesthesia. It was the aim of this study to investigate the use of BDME in patients with pathological nipple discharge and to explore the feasibility of using an endoluminal microbrush to take cytology samples from specific lesions. MATERIALS AND METHODS Breast duct microendoscopy was offered to all patients undergoing surgery for nipple discharge. Surgery included microdochectomy (younger women) and total duct excision (especially in postmenopausal women). The microbrush was used to collect samples whenever an endoluminal papilloma was seen on endoscopy. The results of microbrush cytology samples were compared to ductal lavage samples. RESULTS Fifty consecutive patients undergoing microdochectomy or total duct excision for nipple discharge had breast microendoscopy (28 general, and 22 under local anesthesia). Thirty-one patients had microdochectomy and nineteen had total duct excision. Visualiza- tion of discharging ducts was accomplished in 100% cases. Endoluminal abnormalities were seen in 33 (66%) patients and dilated ducts were seen in 17 patients. Among the 33 patients, 15 had single papilloma, 3 multiple papilloma and 15 inflammation (erythema, fronds, adhesions). Seven out of eight patients with an intraductal papillorna who had microbrush cytology showed papillary cells whereas only 2 out of 11 patients who had ductal lavage were positive for papillary cells. Thus the sensitivity of the brush cytology technique for the diagnosis of papilloma was 87.5% and the sensitivity of ductal lavage 18% (p = 0.0055). CONCLUSION Breast duct microendoscopy is an effective way of establishing the etiology of nipple discharge. The microbrush increases the sensitivity of cytology significantly.
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Affiliation(s)
- N Beechey-Newman
- Department of Academic Oncology, Breast Unit, 3rd Floor, Thomas Guy House, Guy's Hospital, London, SE1 9RT, United Kingdom
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Affiliation(s)
- D Kulkarni
- Tyrone county Hospital, Omagh, Northern Ireland.
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Kulkarni D, Miller GAB. Multiple primary neoplasms developing in a case of prostate cancer. Ulster Med J 2003; 72:55-7. [PMID: 12868707 PMCID: PMC2475399] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D Kulkarni
- Tyrone County Hospital, Hospital Road, Omagh, Co. Tyrone, BT79 0AP
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Kulkarni D, Kulkarni H, Kulkarni V, Deshpande AA, Kandi JS. Persistent hyperplastic primary vitreous--a case report. INDIAN J PATHOL MICR 2001; 44:497-8. [PMID: 12035380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- D Kulkarni
- Department of Pathology, MGM's Medical College, Samarth Nagar, Aurangabad
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Bindu S, Mulay S, Kulkarni D. Cherubism: a differential diagnosis of multinucleate giant cell lesions of jaw. INDIAN J PATHOL MICR 2001; 44:489-90. [PMID: 12035376] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- S Bindu
- Department of Pathology, MGM's Medical College, Aurangabad
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Dwivedi AK, Kulkarni D, Singh S. Sensitive high-performance liquid chromatographic assay method for the determination of picroside I in plasma. J Chromatogr B Biomed Sci Appl 1997; 698:317-20. [PMID: 9367223 DOI: 10.1016/s0378-4347(97)00272-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Picroliv is a new hepatoprotective agent, being developed at the Central Drug Research Institute (CDRI, Lucknow, India). Picroside I is a major active constituent of picroliv. A sensitive high-performance liquid chromatographic assay method in plasma has been developed and validated for the determination of picroside I in plasma. The method consists of extraction of the drug, after protein precipitation with methanol, from rabbit plasma samples. Separation was achieved using a C18 endcapped reversed-phase column coupled with a photodiode array detector and acetonitrile-0.1 M acetic acid (25:75) as mobile phase. The lower limit of quantification in plasma is 50 ng/ml. The standard curve was linear over the range of 50-500 ng/ml in rabbit plasma. The analytical recovery of picroside I added to plasma was >80%. The reproducibility was determined by the inter- and intra-assay precision which were <15%.
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Affiliation(s)
- A K Dwivedi
- Pharmaceutics Division, Central Drug Research Institute, Lucknow, India
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Holla RK, Sequeira RP, Kulkarni D. Cyclosporine and wound healing: differential effects on tensile strength, granuloma weight, wound contraction and epithelization period in rats. Indian J Exp Biol 1988; 26:869-73. [PMID: 3248846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kumar A, Rao M, Kulkarni D. Zinc incorporation reverses suppressant effect of ibuprofen on wound healing. Indian J Exp Biol 1988; 26:483-5. [PMID: 3263950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kelly VC, Kulkarni D. Experiences with fetal monitoring in a community hospital. Obstet Gynecol 1973; 41:818-24. [PMID: 4708480] [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: 01/11/2023]
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