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Biomedical subjects

K Srinivasan

Publications and source records attributed to K Srinivasan.

161 records · Page 9Linked to original sources
PubMedDate not supplied

Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch.

BACKGROUND: Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome. METHODS: A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid. RESULTS: Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. CONCLUSION: Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.

Adult↗
PubMedDate not supplied

Waist circumference correlates better with body mass index than waist-to-hip ratio in Asian Indians.

BACKGROUND: Waist circumference has been reported to be a better index of android (abdominal) obesity than waist-to-hip ratio. It is likely that the cut-off values that denote medical risk in the Caucasian population cannot be extrapolated to Asian Indians. METHODS: This was a hospital-based, cross-sectional study. Anthropometric measurements were taken in 285 subjects (207 men, mean age 37 years, range 18-76 years; and 78 women, mean age 31.5 years, range 18-69 years). The subjects comprised patients under psychiatric care as well as normal individuals. The correlation of waist circumference, hip circumference and waist-to-hip ratio with body mass Index was studied. The prevalence of abdominal obesity using waist circumference was compared to the prevalence of abdominal obesity using waist-to-hip ratio. (Both the standard and the new recommended cut-offs for Asians were used.) RESULTS: Waist circumference correlated better with body mass index than waist-to-hip ratio (in men r = 0.821 and 0.341, and in women r = 0.729 and 0.113; p < or = 0.01 ). Forty-seven per cent of overweight men and 73% of overweight women had abdominal obesity as defined by the standard waist circumference cut-offs compared to none of the men and 47% of overweight women using the waist-to-hip ratio. CONCLUSION: Waist circumference correlates better with body mass index than waist-to-hip ratio. The prevalence of abdominal obesity using waist circumference is higher than that with waist-to-hip ratio. This is especially so in Asian Indians as the new recommendations of both body mass index and waist circumference cut-offs to detect subjects at medical risk are lower in them than in Caucasians.

Adolescent↗
PubMedDate not supplied

Complete axillary conversion after neoadjuvant chemotherapy in locally advanced breast cancer: a step towards conserving axilla?

OBJECTIVES: This study was designed to assess the clinical, sonographic and histopathological response of axillary lymph node metastasis to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIAL AND METHODS: Forty patients with locally advanced breast cancer (LABC) with clinically palpable or sonographically detectable axillary nodes were studied. FNAC of the primary tumor and axillary nodes was done and patients were started on neoadjuvant chemotherapy. Axillary nodes were assessed clinically and sonographically for response after 3 cycles of chemotherapy. All patients underwent total mastectomy with axillary clearance and the lymph nodes in the specimen were examined for metastasis. RESULTS: 47% patients had complete clinical nodal response, while 19% showed complete sonographic response. Complete pathological nodal response was documented in 22% of patients. Ultrasonography was found to be more sensitive than clinical examination in assessing complete nodal response. 10% of the patients had complete pathological response of both primary tumor and axillary nodes. There was significant correlation between pathological response of primary tumor and lymph nodes (P=0.004). Patients with complete sonographic or clinical response were found to have no or minimal residual disease in axilla and hence axillary dissection may be avoided in them.

Analysis of Variance↗
PubMedDate not supplied

Anterior or posterior gastro-jejunostomy with truncal vagotomy for duodenal ulcer--are they functionally different?

Truncal vagotomy with gastrojejunostomy (GJ) is the standard treatment for chronic cicatrizing duodenal ulcer with gastric outlet obstruction. We tried to determine if a significant functional difference exists in the early and late outcomes following anterior and posterior types of GJ to treat this condition. The case records of 106 patients who underwent truncal vagotomy and GJ at our institute from 1 January 1995 to 31 December 1999 were studied retrospectively. Patients were followed up with a personal interview. Perioperative and long-term parameters were compared in the anterior and posterior G.I. groups. Sixty-five patients (61.32%) were followed up; 31 in the anterior group and 34 in the posterior group. The median follow-up was 5 years (range 2.5-7.5 years). Except for a significant difference in length of afferent loop (p < 0.0001), there were no significant differences in the duration of hospital stay, nasogastric aspirates on postoperative days 1, 2, 3 and 4 and the day the nasogastric tube was removed. Early postoperative complications were uncommon and not different in the two groups and long-term outcomes were similar. The Anterior GJ, being technically easier and needing less operative time, may be advocated in all cases of chronic duodenal ulcer, with gastric outlet obstruction requiring truncal vagotomy and drainage.

Duodenal Ulcer↗
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Postoperative intussusception in the adult: a case report.

We report the case of a 40-year-old man who presented with a history of sudden onset abdominal pain and obstipation of 1 day's duration. During laparatomy, a 5mm perforation was seen in the anterior wall of the first part of the duodenum, which was closed by a Graham patch and the abdomen was closed after peritoneal lavage. Postoperatively, the patient's condition worsened and he was posted for a laparatomy with a diagnosis of postoperative obstruction. During the laparatomy, an ileocolic was seen which could be easily reduced. After the second surgery, the patient made an uneventful recover.

Abdominal Pain↗
PubMedDate not supplied

Clinical examination of pregnant women by paramedical and medical personnel: an assessment of consistency of findings in a field study.

BACKGROUND: As a part of a project to improve the maternal and child health services in 4 primary health centres (PHCs) in Bellary and Raichur districts of Karnataka, we assessed the consistency in recording symptoms, signs and some clinical observations of pregnant women by three examiners-the junior health assistant, medical officer of the PHC and a private medical practitioner. METHODS: One hundred seventy-four pregnant women were examined independently by the three examiners on the same day for 4 symptoms reported by the women themselves, 4 signs assessed by the examining person and 9 simple clinical observations. Agreement rates in each examiner pair for each parameter were assessed. RESULTS: We found poor rates of agreement in assesment of various parameters by each observer pair. The disagreement rates were lower between the two doctors compared with those between the junior health assistant and each doctor. CONCLUSION: The agreement rates between various healthcare personnel in assessing pregnant women are low. There is a need for measures to correct this situation.

Clinical Competence↗
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A study of stress and autonomic nervous function in first year undergraduate medical students.

Psychological stress is a risk factor for hypertension and coronary artery disease. The purpose of this study was to assess the impact of real life stressor, that of stress among first year medical students on cardiac autonomic regulation. Stress levels in 36 non-smoking, healthy first year medical students of either gender were assessed on a self-rating scale. Cardiac autonomic regulation was tested using both conventional tests and spectral analysis of heart rate variability (HRV). Nine subjects who obtained scores on the stress scale in the upper quartile were classified as the "stress" group and the rest constituted the "no stress" group (n = 27). There were no significant differences between the two groups on any of the conventional tests of autonomic nervous activity. The low frequency power in normalized units and low frequency high frequency ratio of heart rate variability in supine posture was significantly higher in the "stress" group compared to the "no stress" group. The low frequency power in normalized units was significantly positively correlated with total stress score. The changes were suggestive of a tilt in the resting cardiac autonomic balance towards increased sympathetic activity.

Adult↗
PubMedDate not supplied

Noncovalent binding of 3'-methyl-N,N-dimethyl-4-aminoazobenzene and its metabolites to liver cytosolic proteins and its role in their nuclear translocation.

When liver cytosol prepared from rats administered [14C]3'-methyl-N,N-dimethyl-4-aminoazobenzene was subjected to Sephadex gel chromatography, four peaks (I-IV) of radioactivity containing proteins and one peak (V) of radioactivity devoid of protein were obtained. Forty to fifty-five per cent of the radioactivity in the protein peaks was butanol-extractable. When the protein peaks were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis, over 90% of the radioactivity was separated from the proteins, indicating lack of covalent binding. Several differences in the metabolite patterns were seen when the butanol-extractable metabolites from the five chromatographic peaks were analyzed by TLC. When pooled fractions of the peaks were incubated with isolated rat liver nuclei, only radioactivity associated with peak II was translocated into the nucleus. Translocation was time- and temperature-dependent and was maximal at 40 min at 37 degrees C. Only 10 to 12% of the radioactivity associated with peak II could be translocated even in the presence of an excess of nuclei, indicating that specific protein metabolite adduct(s) present in this fraction is/are translocated. Five per cent of translocated radioactivity was irreversibly bound to DNA, 3% to RNA, 67% to non-histone proteins, and 7.5% to histones; the remaining was not associated with any of these macromolecules.

Animals↗
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From one generation to the next: changes in fertility, family size preferences, and family planning in an Indian state between 1951 and 1975.

Over the last 25 years modernization in Karnataka, India, resulted in a large reduction in infant and child mortality, substantial increases in literacy, and initiation of an intensive family planning program. The drop in the birth rate during this period, however, was much less than would be anticipated under such circumstances. Two surveys carried out in 1951--52 and 1975 provide data on current and cumulative fertility, family size preferences, and knowledge and use of family planning. A comparison of these data leads to the conclusion that the level of family planning activities was not high enough to counteract the increase in the fertility of married women that was a consequence of modernization.

Adolescent↗
PubMedDate not supplied

Partial cholecystectomy in elective and emergency gall bladder surgery in the high risk patients--a viable and safe option in the era of laparoscopic surgery.

Partial cholecystectomy was performed in this Institute in fifteen patients in the last 8 years. Three were performed in cirrhotic patients with bleeding diathesis. The other indications were obscure anatomy, intraperitoneal adhesions, Mirizzi syndrome and poor general condition of the patient. None of these had any major morbidity in the immediate postoperative period. Partial cholecystectomy is a safe and viable option in a difficult situation.

Acute Disease↗
PubMedDate not supplied

Truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer in India.

BACKGROUND: Insufficient information is available on long term results of truncal vagotomy and gastrojejunostomy since most previous series have relied on functional grading using the Visick scale which possibly both overdiagnoses and underdiagnoses complications. We used endoscopy to assess the results following truncal vagotomy and gastrojejunostomy as well as functional grading and compared them with published results of highly selective vagotomy. METHODS: Two hundred patients were reviewed (5-11 years after truncal vagotomy and gastrojejunostomy) by clinical examination and endoscopy. Completeness of vagotomy was assessed by estimation of the postprandial alkaline tide in the urine and gall bladder using ultrasonography. RESULTS: The ulcer recurrence rate was 15 (7%). Nine (60%) of the recurrent ulcers were asymptomatic and detected only on endoscopy. In all patients with recurrence, the urinary alkaline tide estimation revealed an incomplete vagotomy. Dumping was present in 12%, it was troublesome in 4%, occasional episodes of post-vagotomy diarrhoea in 6% (all in Visick grades I or II) and bile vomiting in 17% (affecting the lifestyle in only 5%). Recurrence and other complications were not related to the experience of the operating surgeon or the type of gastroenterostomy. There was no mortality. Overall, satisfactory long term functional results (Visick grades I and II) were found in 8% of patients. CONCLUSIONS: Truncal vagotomy and gastrojejunostomy still remains the best option in the surgical management of chronic duodenal ulcer. Long term results are good with a relatively low incidence of troublesome complications.

Adolescent↗
PubMedDate not supplied

Blood utilization in elective surgery--requirements, ordering and transfusion practices.

BACKGROUND: Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve, ageing of the blood unit and wastage of blood bank resources. We evaluated the preoperative blood-ordering and transfusion practices for common elective general surgical procedures at a major Indian hospital. The principal aim of this study was to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory. METHODS: Six hundred and eighty patients undergoing 21 different surgical procedures between April 1993 and March 1995 were studied. Blood-ordering and transfusion details were noted and the data used to calculate cross-matched to transfused ratio (C/T ratio), transfusion probability (%T) and transfusion index (Ti). The maximum surgical blood-order schedule was calculated using Mead's criterion. RESULTS: There was gross over-ordering of blood in 10 out of the 21 procedures studied. Three hundred and seventy (40%) of the cross-matches performed were unnecessary. Sixty per cent of the patients studied had blood loss of less than 10% of the total blood volume and 90% of the cross-matches performed for this group were unnecessary. Based on these data, the maximum surgical blood-order schedule was calculated for 11 common surgical procedures. CONCLUSION: This study shows that blood was over-ordered in 10 out of the 21 procedures studied. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution to preoperative over-ordering of blood.

Blood Transfusion↗
PubMedDate not supplied

A trial of various regimens of antibiotics in acute appendicitis.

A three year prospective randomised study was undertaken to study the efficacy of three regimens of antimicrobial drug combinations in reducing postoperative wound sepsis in acute appendicitis. Group A--Metronidazole and gentamicin; Group B--Metronidazole and ciprofloxacin; Group C--Metronidazole and cefotaxime. Randomization was done by drawing from a set of sealed envelopes. Antibiotics were started preoperatively once a presumptive diagnosis of appendicitis was made, provided there was no history of prior antibiotic usage. For simple appendicitis (normal or inflamed) two more doses were given postoperatively. For complicated appendicitis, duration of antibiotic treatment was four days postoperatively. All antibiotics were given intravenously to avoid variations in bioavailability. Wound was inspected daily till discharge and at 30 days post operatively or earlier if the patient had symptoms of wound infection. A total of 128 patients completed the study. Eighty nine were simple appendicitis while the rest were complicated. Twenty one developed wound infection. Out of 21, 13 occurred in group A, 5 in group B and 3 in group C. Individually, the difference in infection rates between group A and group C patients with simple appendicitis was statistically significant. Infection rates in all other groups were not statistically different. Cefotaxime and metronidazole combination had the lowest wound infection rate. Hence it is recommended for antibiotic prophylaxis.

Acute Disease↗
PubMedDate not supplied

Gastrojejunocolic fistula following surgery for peptic ulcer.

This article aims to emphasize that gastrojejunocolic fistula following peptic ulcer surgery, though uncommon in the post vagotomy era, still continues to occur. We stress the changing trends in its epidemiology, aetiopathogenesis and treatment. The case records of 12 patients with gastrojejunocolic fistula (seen over a 15 year period) were reviewed. Details regarding clinical presentation, investigations and treatment were analyzed and the results compared with previous published series. All the 12 patients in this study had a short loop posterior retrocolic gastrojejunostomy as part of the primary peptic ulcer surgery. Diarrhoea and profound weight loss was present in all of them. Incompleteness of vagotomy was proved in all the six patients investigated for the same. The fistula was demonstrated in all of them on barium enema, while it was seen on upper GI endoscopy in 4. Eight patients were treated by a one stage resection and repair of fistula. A three stage procedure was performed in two.

Adult↗