Biomedical subjects
Publications and source records attributed to M N Mathur.
The radial artery is usually harvested as a pedicle with surrounding veins, perivascular fat, and areolar tissue. We describe an alternative technique of skeletonization of the radial artery and its potential advantages over the pedicled technique.
BACKGROUND: Fecal incontinence from single anal sphincter defects are surgically remedial and commonly the result of obstetric injuries. Overlapping anal sphincter repair has previously been associated in small series with good results in 69 to 97 percent of patients. OBJECTIVES: The aims of this study were to assess the results of overlapping anal sphincter repair in one institution and to assess the effects of age, presence of a neuropathy, and addition of a temporary colostomy on the success of surgery. METHODS: A study of 57 overlapping anal sphincter repairs in 56 (54 females) patients at the Royal Prince Alfred Hospital during a six-year period was performed. All patients were investigated preoperatively with endoanal ultrasound and concentric needle electromyography. Patients have been assessed prospectively since 1994 with a questionnaire, including a four-point Likert scale of continence level, the St. Mark's incontinence scoring system (range, 0-13), the Pescatori incontinence scoring system (range, 0-6), and patient assessment of success or failure of the overlapping anal sphincter repair. A colostomy was selectively formed in conjunction with an overlapping anal sphincter repair in 21 patients (8 preoperatively, 13 simultaneously), and 18 patients had a concomitant neuropathy (3 unilateral, 15 bilateral). RESULTS: After a median follow-up of 18 months, median continence scores overall had improved from St. Mark's incontinence scoring 13 to 3 (P < 0.0001) and Pescatori incontinence scoring 6 to 2 (P < 0.0001). Forty-nine of 57 (86 percent) repairs have been successful, and 8 are considered to be failures. Twenty-one of 27 (78 percent) repairs in patients younger than 40 years of age were successful, as were 28 of 30 (93 percent) repairs in patients older than 40 years of age (P = 0.10). Four of 18 (22 percent) repairs associated with a neuropathy failed compared with 4 of 39 (10 percent) without a neuropathy (P = 0.21). Improved or normal continence was achieved in 17 of 21 (81 percent) patients with a stoma and overlapping anal sphincter repair and in 32 of 36 (89 percent) patients with an overlapping anal sphincter repair alone (P = 0.32). The presence of a stoma did not improve the rate of wound healing by primary intention (62 percent for stoma vs. 64 percent for overlapping anal sphincter repair alone; P = 0.55). CONCLUSIONS: Single anal sphincter defects can be successfully treated with an overlapping anal sphincter repair. There is no improvement in primary healing with selective stoma formation. Age of the patient and presence of a neuropathy should not detract from proceeding with overlapping anal sphincter repair when singular anal sphincter defects are detected on endoanal ultrasound in muscle that is still active.
The validity of a Hindi version of the Diagnostic Interview for Genetic Studies (DIGS) was investigated. The original English version was initially translated into Hindi. The Hindi version was then back-translated and compared with the original. Next, a group of psychiatric inpatients and outpatients were interviewed using the Hindi version. The resultant diagnoses were compared with those obtained for the same patients using a Hindi version of the Present State Examination (PSE), and the clinical diagnoses given by the treating psychiatrists. The DIGS diagnoses were significantly correlated with both the PSE diagnoses (Cohen's kappa = 0.80) and the clinical diagnoses (kappa = 0.56). Interrater reliability between three interviewers for diagnoses obtained using the Hindi version of the DIGS varied (kappa = 0.45-1.00). Possible causes for this variability are discussed. The Hindi version of the DIGS fulfills the need for a current comprehensive interview schedule not only for psychiatric genetic research in India, but also for nongenetic research.
Aeromonas hydrophilia, a Gram-negative facultative anaerobe, is a rare cause of cellulitis. We review the literature and report a case of Aeromonas hydrophilia cellulitis which failed to respond to the conventional management of surgical debridement and antibiotics. Hyperbaric oxygen therapy was used successfully to control the infection. As far as we are aware this is the first case in world literature of Aeromonas hydrophilia cellulitis treated with hyperbaric oxygen.
This study is a retrospective case series analysis of all 82 road deaths occurring in the Orana Area Health Service (OAHS) over the 2 year period 1989-90. The OAHS services a population of 112,800 in an area of 199,077 km2 in north-west New South Wales. The aim of the study was to document timing, place and cause of deaths, severity of injuries, pre-hospital management of victims, and a TRISS analysis of outcome. This was done using ambulance, hospital, police and autopsy reports. Seventy-two (88%) of the victims were motor vehicle occupants, five (6%) were motorcyclists and four (5%) were pedestrians. The median ambulance response time to the scene of the accident was 17 min (range 2-103 min). All deaths occurred within 24 h of injury with 65 (79%) of the victims being dead at the scene, nine (11%) dying en-route and eight (10%) reaching hospital alive. A TRISS analysis was performed on 51 deaths and 8% (4/51) of these had a greater than 50% probability of survival. Of the victims that had inevitable deaths according to TRISS, 11% (5/47) may have survived if pre-hospital care arrived sooner. Reduction in the rural road toll is achievable through preventative measures and strategies to improve access to care and administration of pre-hospital care.
Long-term venous access using Hickman catheters and implantable subcutaneous ports is a well established technique. These devices have customarily been inserted via the internal jugular, subclavian or cephalic veins. On occasions, these routes may be unavailable. This article reviews the outcome of 53 prolonged venous access catheters (39 Hickmans and 14 catheters attached to implantable ports) inserted percutaneously via the external iliac vein into 37 patients over a period of 5.7 years. The indications for insertion were chemotherapy (40%), total parenteral nutrition (36%), intravenous antibiotics (13%), poor venous access (7%) and bone marrow transplantation (4%). The main reasons for use of the external iliac vein were thrombosis of the subclavian veins or superior vena cava and subclavian central line sepsis. The only complication of insertion was one inadvertent puncture of the external iliac artery. Twenty-seven catheters (51%) remained complication free and functioning for the time for which they were required. Four catheters (7%) are still functioning in situ having been present for 1-5 years. Sixteen catheters (30%) became infected, with a 17% incidence of septicaemia. Venous thrombosis was associated with three catheters (6%). Catheters remained in situ for a median period of 30 days (range 5-569 days). The authors conclude that long-term venous access using percutaneous external iliac vein insertion is a useful technique when other routes are unavailable, but there is a relatively high incidence of catheter-related sepsis.
The multiple naevoid basal cell carcinoma syndrome (Gorlin's syndrome) is an inherited multisystem disorder which affects not only the skin, but also the skeletal system and a variety of other tissues and organs. This is a report of the case of a 29 year old woman who presented with multiple advanced basal cell carcinomas. On the basis of a literature review, guidelines for management are suggested and the importance of early diagnosis and regular follow-up is emphasized.
Although metastatic melanoma is renowned for its propensity to spread to a wide range of sites, symptomatic metastases within the biliary tree are very rare. A patient with a past history of melanoma who presented with obstructive jaundice and in whom computerized tomography (CT) scanning revealed a spherical filling defect 1 cm in diameter at the lower end of the common bile duct is reported. The obstructing lesion was thought likely to be a gallstone. However, on surgical exploration it was found to be a polypoid melanoma metastasis, freely mobile within the lumen of the lower duct but attached to its wall by a thin stalk. There was no evidence of metastatic melanoma elsewhere in the abdomen. The tumour was removed without difficulty, completely relieving the obstructive jaundice. The patient remains well 14 months later, with no evidence of recurrent visceral melanoma.
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