Biomedical subjects
Publications and source records attributed to A S Kumar.
This study was conducted on 83 patients who underwent an uncomplicated transurethral resection of the prostate for carcinoma or benign hyperplasia. In all cases the urethral catheter was removed within 24 h of surgery. Only 2 patients failed to void because of clot retention. The total hospital stay was 3 days in 67 patients. There were no significant complications due to early removal of the catheter.
There has never, to our knowledge, been a report of aortic valve replacement via a right thoracotomy. However, we recently used this approach in 2 young women with severe aortic stenosis. Exposure of the aortic valve was excellent, and we encountered neither technical difficulties nor sequelae related to the right thoracotomy. We believe that right thoracotomy provides adequate access for safe aortic valve replacement and yields cosmetically more appealing results than does median sternotomy.
From September 1991 through August 1992, 38 patients (34 female and 4 male) underwent mitral valve surgery through a limited right anterior thoracotomy. The ascending aorta was easily cannulated for arterial return in all patients. Although there was no operative mortality, 8 patients required reoperation for bleeding, usually associated with the site of chest-wall puncture for the left atrial pressure line and epicardial pacing wires, a problem that we were able to correct. Right lower lobe collapse occurred in 2 patients, but the lungs were fully expanded in all patients before hospital discharge. We believe that a return to this older surgical approach is particularly suited to young patients and provides the important advantages over median sternotomy of superior mitral valve exposure and a cosmetically acceptable scar.
We have used a strategy based on the polymerase chain reaction (PCR) to amplify and construct full-length sucrose synthase (SS) cDNA of sugarcane. Two SS-specific internal primers were synthesized based on their complementarity to published consensus sequences of the SS gene of maize and wheat. Amplification of full-length cDNA was achieved by an anchored PCR method utilizing primers which extend to 5' and 3' ends of specific cDNA. In the first step, a homopolymeric oligo(dC) tail was added to the 3' end of single-stranded cDNAs. The two SS cDNAs were amplified, one with a 5' end (SSp1) and the other with a 3' end (SSp2) using one internal SS primer and the other anchored end primer. Finally, overlapping fragments were identified by restriction mapping, and the non-overlapping fragments were excised and religated to reconstruct full-length cDNA. Partial sequences of the reconstructed cDNAs (SS-5' and SS-3') were compared with the published SS sequences to confirm that the amplified DNA was a copy of the SS transcript.
One hundred fifty consecutive patients (71 female, 79 male) underwent mitral valve reconstruction from February of 1987 through February of 1991 for mitral regurgitation, with or without mitral stenosis. Of these patients, 134 had rheumatic mitral disease and required 1 or more procedures for correction. One hundred twenty-eight patients were age 30 or under. A posterior semicircular annuloplasty was performed, with the repair buttressed by a collar of Teflon felt; in addition, commissurotomy, papillary muscle splitting, chordal shortening, chordal and papillary fenestration, and closure of acquired clefts were performed as needed. Pre- and postoperative assessment of mitral regurgitation was carried out with the aid of echocardiography. Operative mortality was 3.3% (5 patients), and late mortality was 1.3% (2 patients). There were 3 episodes of thromboembolism at follow-up (mean time of occurrence, 16 months).
From February of 1987 through February of 1991, 25 patients with rheumatic mitral disease underwent cusp-level shortening of the chordae of the anterior mitral leaflet as part of the valvular reconstruction procedure at our institutions. All patients had moderate or severe mitral regurgitation, with prolapse of the anterior mitral leaflet. Seventeen patients also had mitral stenosis. Postoperative echocardiograms, both transthoracic and transesophageal, showed correction of leaflet prolapse and mitral regurgitation. This preliminary report suggests that the technique satisfactorily corrects mitral regurgitation in patients with elongated and thickened chordae characteristic of rheumatic mitral disease.
Fifty left atrial appendages collected fresh during closed mitral valvotomy in patients with chronic rheumatic heart disease, were analysed to determine the frequency of Aschoff nodules and characteristics of mononuclear inflammatory infiltration. Fifty-six percent of specimens demonstrated Aschoff nodules with no clinical or laboratory evidence of acute rheumatic activity in the patients undergoing surgery. Endomyocardial infiltration contained predominantly T cells and occasionally B cells. The relative proportions of T helper-inducer, T suppressor-cytotoxic lymphocytes and macrophages were 45.1 +/- 7.6, 23.5 +/- 4.8 and 29.3 +/- 9.6%, respectively. Frequent presence of Aschoff nodules and heavy mononuclear infiltrates in chronic rheumatic heart disease suggests a possibility of subclinical ongoing carditis.
The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.
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A case of chronic rheumatic heart disease with quadrivalvular involvement is presented. Pulmonary valve involvement was diagnosed only at surgery. The rarity of this disorder and problems regarding diagnosis and management are highlighted.
An unusual case of fibrosarcoma of the right ventricle is described in a 25-year-old man. The diagnosis of a right ventricular tumour was made on the basis of echocardiographic and radionuclide studies and was confirmed by angiocardiography. The surgical management and postoperative course are described together with a brief review of the literature.
Two patients in whom a massive bolus of air was introduced into the arterial circuit and ascending aorta during valve replacement and in whom the recovery was complete are presented. The technical details of the management of this serious accident are described.
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3 cases of contact leukoderma due to 'Bindi' and footwear occurring together in the same patients are reported. In 2 patients depigmentation occurred at the patch test sites with 'Bindi', most probably due to the adhesive in it.
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