Search PubMed⌕ Search

Biomedical subjects

M C Misra

Publications and source records attributed to M C Misra.

At least 19 recordsLinked to original sources
PubMed2001

Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. A randomized trial.

OBJECTIVE: To evaluate the total cost of minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC) and perform a cost-effectiveness (CE) analysis. METHODS: One hundred adult subjects with painful gallstone disease were randomized: 59 cases for LC and 41 cases for MC. Patients with gallstones shown on ultrasound with normal common bile duct and no history of icterus were included after an informed consent. Cases with acute cholecystitis and raised alkaline phosphatase were excluded. LC was performed using CO2 insufflation and a Storz 2D video camera. MC was done by transverse rectus cutting incision. Outcome was coded as success or failure. Success was defined as operation without injury to bile duct, viscera or vessels, minimal pain and discomfort at 4 weeks, no wound infection up to 4 weeks, and resumption of work within 2 weeks of operation. The total cost of each case included cost of investigations, cost of disposable articles for operation, cost of drugs, cost of hospital stay, and cost of operation including anesthesia. LC and MC were done with reusable instruments. A "societal viewpoint" has been taken in the cost calculations. RESULTS: There were 50/59 successful outcomes in LC and 15/40 outcomes in MC group. Total cost for LC was 386,769 rupees (Rs) and for MC was Rs 205,041. CE in LC was Rs 7,735 and in MC was Rs 13,669. Incremental CE ratio comparing LC with MC was 3,028.33. CONCLUSION: LC is a more cost-effective method for treatment of gallstone disease.

Adult↗
PubMed2000

Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids.

BACKGROUND: Patients with acute bleeding from internal haemorrhoids often have to be referred by the general practitioner to the surgeon for definitive treatment with invasive outpatient procedures. At the initial consultation, patients frequently seek postponement of immediate surgery to a more convenient time. Effective and rapid non-invasive control of acute bleeding could be of practical use in scheduling surgery to a time convenient to both patient and surgeon. METHODS: In a 90-day randomized, double-blind study treatment with a micronized purified flavonoid fraction (MPFF) was compared with placebo, in 100 outpatients who presented for treatment of acute internal haemorrhoids of less than 3 days' duration. The primary endpoint was cessation of bleeding on the third day of treatment. RESULTS: Of 50 patients randomized to each group, acute bleeding ceased by the third day in 40 (80 per cent) who received MPFF compared with 19 (38 per cent) who had placebo (P < 0.01). Mean(s.d. ) duration of acute bleeding from onset to cessation of 4.9(1.6) days was 2.1 (95 per cent confidence interval 1.2-2.9) days less than that in patients receiving placebo (P < 0.01). Continued treatment in patients with no bleeding prevented a relapse in 30 of 47 patients, compared with 12 of 30 receiving placebo (P < 0.05). CONCLUSION: Patients with acute internal haemorrhoids treated with MPFF had rapid cessation of bleeding and a reduced risk of relapse. This could be of value in the more convenient timing of treatment with invasive outpatient procedures.

Acute Disease↗
PubMed1998

Plantaricin LP84, a broad spectrum heat-stable bacteriocin of Lactobacillus plantarum NCIM 2084 produced in a simple glucose broth medium.

Lactobacillus plantarum NCIM 2084 produced an antibacterial substance when grown at 40 degrees C for 36 h in a laboratory medium. The antibacterial substance was active against a wide range of bacteria comprising Gram positive and negative foodborne pathogenic and spoilage bacteria. However, related mesophilic lactobacilli were not inhibited, except for L. amylovorus DSM 20531. The antimicrobial activity was observed between late log and stationary growth phases. The antibacterial substance was partially purified through concentration under vacuum, followed by extraction with methanol and acetone (M-A extract). On fractionation of the M-A extract through Sephadex G-25, the activity was present in an eluant volume of 85 to 100 ml (peak I), indicating an apparent molecular mass of between 1 and 5 kDa and the purification attained was 80-fold. The antimicrobial principle was stable to heat (121 degrees C for 20 min) and catalase, but sensitive to trypsin and chymotrypsin, indicating it to be a bacteriocin. The M-A extract exhibited a bactericidal and lytic effect against Bacillus cereus F 4810 and Escherichia coli D 21. The ability of L. plantarum NCIM 2084 to produce an effective bacteriocin in a simple growth medium is of potential interest in its application as a biopreservative in traditional fermented foods.

Bacteriocins↗
PubMed1998

Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma.

BACKGROUND: Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer. METHODS: The study is a retrospective analysis of all patients having PD for ampullary carcinoma in one surgical unit at All India Institute of Medical Sciences over 18 years, with PG being the only drainage procedure for the pancreatic stump. RESULTS: Among 125 patients having PD for ampullary carcinoma, overall morbidity rate was 28%, mortality rate was 4.8%, with no cases of leakage from the pancreaticogastrostomy. CONCLUSIONS: In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.

Adult↗
PubMed1996

Male breast cancer: a retrospective study from a regional cancer center in northern India.

Over a 7-year period from 1987 to 1993, 41 male breast cancer patients were seen in the breast cancer clinic of the Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences (AIIMS). Their mean age was 54.2 years; and duration of symptoms ranged from 1 to 84 months with a mean of 15.1 months. Breast lump was the commonest presenting symptom. Fine needle aspiration cytology (FNAC) was the commonest diagnostic procedure. The TNM stage distribution was stage I, 5; stage II, 13; stage III, 17; and stage IV, 6. Radical mastectomy (25/36) was the commonest surgical procedure. Locoregional radiotherapy was given in 15 patients. Thirty patients received systemic adjuvant therapy (chemotherapy or tamoxifen, or a combination of the two). Local or distant recurrence occurred in 8 patients (8/31, 28.3%). Actuarial overall and disease-free survival was 100% and 80.1% at 2 years and 91.7% and 66.7% at 4 years, respectively. On univariate analysis, axillary lymph node status and age were found to affect disease-free survival significantly. Advanced stage of disease at presentation is common in Indian patients and will continue to influence treatment policies. Neoadjuvant chemotherapy needs to be evaluated for locally advanced tumors to improve outcome. Multicentric studies are necessary to define the relative roles of tamoxifen and chemotherapy for adjuvant treatment.

Adult↗
PubMed1996

Laparoscopic hernia repair--what are the results?

The two widely practised laparoscopic groin hernia repairs are: a) trans-abdominal preperitoneal (TAPP) and b) trans-extraperitoneal preperitoneal (TEPP) approaches. Early results are encouraging with both the techniques being associated with low recurrence rates (0% to 2%) comparable to the best, reported for standard open repair (Shouldice and Lichtenstein's). Other complications are higher in the beginning following laparoscopic hernia repair compared to the conventional method. These complications are related to the learning curve and expected to come down significantly with increasing experience of surgeons. Laparoscopic repair of recurrent groin hernia appears to be considerably superior to the conventional technique. The recurrence rates following conventional repair of recurrent groin hernias are between 1.5% and 35% (Table I) compared to none for laparoscopic repair of recurrent inguinal hernias. The disadvantages of laparoscopic repair include greater technical difficulty, higher incidence of serious complications and increased cost. Sutured open repair is associated with high postoperative discomfort, greater difficulty of repairing recurrent hernia with higher societal cost (due to prolonged time-off from work for 12% to 57% of patients operated for various open technique-Table II). The techniques of laparoscopic hernia repairs are nearly standardised today. Laparoscopic surgeons have an obligation to offer the new alternative and to ensure that it is safely used. Laparoscopic repair is another technique used for the repair of inguinal hernias, which is going to stay as a safe and effective alternative to open repair as the learning curve is over. There is an urgent need to have well-designed prospective randomised trials in the near future.

Hernia, Inguinal↗
PubMed1995

Omental rhabdomyosarcoma presenting with pyrexia.

A 45-year-old man was admitted with pyrexia and intermittently palpable lump in the left lumbar region. Laparotomy revealed a primary omental tumor which on histological examination showed alveolar rhabdomyosarcoma of the omentum. Following surgery the fever subsided. Presentation of omental rhabdomyosarcoma with fever has not been reported earlier.

Fever↗
PubMed1995

Post-mastectomy seroma: a new look into the aetiology of an old problem.

Postmastectomy seroma (PMS) remains an unresolved quandary as the risk factors for its formation have still not been identified. Sixty-four consecutive female patients undergoing Halsted mastectomy were prospectively studied for this purpose. The risk factors that were studied included age and weight, diabetes, hypertension, tumour (size and location) and nodal (positive or negative) status and the use of perioperative blood transfusion. Additionally, the effect of PMS on total hospital drainage (THD), post-operative hospital stay and other wound-related complications were assessed. The incidence of PMS in this study was 28%, and those patients with PMS were designated as group A while the remaining patients were designated as group B. Group A patients were significantly older (P < 0.02) and heavier (P < 0.05) than group B patients; also, there were significantly (P < 0.0001) greater number of hypertensive patients in group A than in group B. In terms of other risk factors the two groups were statistically similar. Group A patients had significantly greater (P < 0.01) amount of THD than group B patients. Although no septic complications were observed as a result of seroma, its presence significantly (P < 0.0001) lengthened the post-operative hospital stay in group A patients. It is concluded that (1) PMS is a common problem, (2) its occurrence significantly increases the post-operative hospital stay, and (3) hypertension is perhaps the most important risk factor for its causation. Hypertension contributes to seroma formation, probably by way of prolonged oozing from the large mastectomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Aneurysm of the inferior thyroid artery.

A case of aneurysm of the inferior thyroid artery is presented. It is usually not possible to diagnose the exact site of origin clinically. Digital subtraction angiography can determine the precise site and type of aneurysm. In view of the high incidence of complications, early surgical treatment is recommended.

Adult↗
PubMed1994

Primary pelvic hydatid cyst presenting with obstructive uropathy and renal failure.

Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually). A case of primary pelvic hydatid cyst presenting with obstructive uropathy leading to chronic renal failure is presented. A combination of preoperative albendazole therapy of 1.2 g/day for 8-12 weeks and surgical excision were effective in alleviating the symptoms and improving the renal function.

Adult↗
PubMed1993

Role of enteral hyperalimentation in patients of carcinoma oesophagus.

The nutritional status of 24 patients of carcinoma oesophagus was assessed before and after central hyperalimentation with a liquid blenderized diet containing 3000-3500 cal and 100-120 g protein. The overall prevalence of malnutrition was found to be 70.8 per cent before the initiation of therapy. Of the various parameters used for assessment of nutritional status weight loss was the most common finding (91.6%) followed by alteration in midarm circumference, haemoglobin, triceps skin fold thickness, midarm muscle circumference and serum albumin. Enteral hyperalimentation for 10 days improved nutritional status by inducing significant gain in body weight (74.1%), triceps skin fold thickness (50%), midarm circumference (58%), midarm muscle circumference (62.5%) and serum albumin levels (91.6%). There was no significant change in haemoglobin levels.

Adolescent↗
PubMed1992

Evaluation of post-operative stay after inpatient major surgery--a prospective study.

The present study was carried out at a single surgical unit of AIIMS, to evaluate the risk and benefit of short post-operative stay in adult population after inpatient surgery under general anaesthesia for various intra-abdominal, Genitourinary, breast and thyroid disorders including emergency procedures. The age of the patients ranged from 17-71 years. Patients with minor surgical procedures were excluded from the study. A total number of 138 patients were included in the study comprising of Test group. The patients were discharged within 5 days of the operative procedure. There was no major morbidity or mortality related to early discharge. The mean duration of postoperative length of hospital stay was 5.25 days in test group of patients as compared to 10.20 in control group of patients. In conclusion therefore, short hospitals stay following major procedures is safe and effective in reducing the cost of hospital care to the patient and hospital both.

Adult↗