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Biomedical subjects

N Ananthakrishnan

Publications and source records attributed to N Ananthakrishnan.

At least 19 recordsLinked to original sources
PubMed1998

Predicting regional lymph node metastasis in carcinoma of the penis: a comparison between fine-needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy.

OBJECTIVE: To evaluate the accuracy of clinical examination and fine-needle aspiration cytology (FNAC) in detecting groin metastases in patients with carcinoma of the penis, and to assess the positive and negative predictive value (PPV, NPV) of a preliminary sentinel lymph-node biopsy (SNB) and biopsy of the most medial of the horizontal group of inguinal lymph nodes (MIN) in selecting patients for an ilio-inguinal block dissection. PATIENTS AND METHODS: The study comprised 28 patients (56 groins) with Stage I (one), Stage II (11) and Stage III (16) carcinoma of the penis. All patients underwent a detailed clinical examination followed by FNAC of the palpable inguinal nodes, and were subsequently submitted for block dissection. The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases. RESULTS: The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both MIN and SN were 100%. The sensitivity and NPV of MIN were higher than for SN, although not significantly so. CONCLUSION: Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection. FNAC is accurate and specific when nodes are palpable; in those with impalpable nodes a preliminary MIN biopsy followed by SNB if the MIN biopsy is negative will accurately select all patients with metastases in the groin nodes. This can be performed by examining frozen sections of the lymph nodes; if positive, block dissection can be carried out at the same time.

Adult↗
PubMed1995

Tropical vaginal hydroceles: are they all filarial in origin?

Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.

Adult↗
PubMed1994

Can regional lymph node involvement be predicted in patients with carcinoma of the penis?

OBJECTIVE: To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre-operatively by clinical and histological parameters. PATIENTS AND METHODS: Seventy-eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes. RESULTS: The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases. CONCLUSIONS: In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow-up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow-up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.

Amputation, Surgical↗
PubMed1993

Mid-colon oesophagocoloplasty for corrosive oesophageal strictures.

Corrosive strictures of the oesophagus are common and being long and dense frequently require surgical replacement of the oesophagus. Presently available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of ischaemic necrosis of the colon, cervical salivary fistula or oesophagocolic stenosis. A method of mid-colon oesophagocoloplasty using an isoperistaltic colonic segment from the mid-ascending to the mid-descending colon is reported. The procedure was carried out in 33 patients. The conduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck and abdominal dissection, near-total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of ileocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon available for anastomosis. A wide side to side oesophagocolic anastomosis in the neck, resection and discarding of the bulky terminal ileocaecal segment after completion of the cervical anastomosis, closure of the terminal end of the colon and its placement adjacent to the hypopharynx and end to side cologastric anastomosis complete the procedure. There was no mortality and there was no instance of colonic necrosis. The procedure restored an ability to eat normal food in 93.9% of patients compared to only 39.2% of patients with bougienage.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

Accuracy of fine needle aspiration cytology of abdominal masses without radiological guidance.

This study was undertaken to evaluate the accuracy of FNAC of abdominal masses without the help of radiological guidance and to determine factors which affect the outcome of the procedure. Five hundred consecutive patients were studied. FNAC was reported by a single cytopathologist without knowledge of subsequent histology. In calculating indices of accuracy of FNAC only those patients in whom both FNAC and histology reports were available (N = 383) were considered. The overall incidence of unsatisfactory specimens was 5.6%. Consistency of the mass did not affect accuracy of FNAC. However, age (below 12 years) plane of the swelling, mobility of mass and size of the swelling, all significantly affected the adequacy of cytological yield. The overall true positive rate was 100.0% and there were no false positives. The true negative rate was 40.2% and false negative rate was 70.9%. The high false negative rates in hepatic and pancreatic lesions can be reduced by imaging techniques. Luminal organs had poor accuracy rates. The overall accuracy rate was 73.5%, comparable to that reported in literature. A positive diagnosis of malignancy had a 100% predictive value. Overall, it appears that nonguided FNAC is as accurate as guided FNAC except for very small lesions or discrete lesions such as hepatic secondaries where guidance may be useful.

Abdominal Neoplasms↗
PubMed1993

Is ulcer recurrence after simple closure of perforated duodenal ulcer predictable?

OBJECTIVE: To study whether factors such as age, duration of pre-perforation symptoms, size of perforation and operative evidence of chronicity could predict recurrence of ulcer after simple closure of perforated duodenal ulcers, thus enabling patients at high risk of recurrence to be subjected to definitive surgery instead of simple closure of perforation. DESIGN: Retrospective. One hundred and fifty-two patients who had undergone simple closure of duodenal ulcer perforation in the last 10 years were included in the study. SETTING: A postgraduate research and teaching institution. PATIENTS AND MEASUREMENTS: Patients were subjected to a personal interview and Visick grading of symptoms 1-10 years after simple closure of duodenal ulcer perforation. Ninety of them underwent esophagogastroduodenoscopic evaluation. RESULTS: Symptomatic ulcer recurrence rate was 23.1% by Visick grading and 42.2% on endoscopy. Ulcer symptom recurrence rate had no correlation with patient's age, duration of pre-perforation symptoms, or size of perforation, but correlated significantly with operative evidence of chronicity (p < 0.001). However, 7 of 35 symptomatic recurrences would have been missed by the use of this criterion alone. Endoscopic evidence of recurrence also correlated only with operative evidence of chronicity. False positives and false negatives with Visick grading showed that this symptomatic evaluation was unsatisfactory even for selecting patients for further endoscopic workup. CONCLUSION: Though not infallible, evidence of chronicity of ulcer at laparotomy may be a useful predictor of recurrence of ulcer after simple closure of perforated duodenal ulcer.

Adult↗
PubMed1991

Coexisting tuberculosis and carcinoma of the colon.

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 +/- 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P less than 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 +/- 11 years vs 34 +/- 10 years, P less than 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.

Adenocarcinoma↗
PubMed1990

Problems and limitations with fine needle aspiration cytology of solitary thyroid nodules.

Fine needle aspiration cytology (FNAC) is a widely employed tool in the investigative work-up of patients with single thyroid nodules. Although its advantages are well documented, the limitations and problems in interpretation of FNAC in this condition are not well known. Experience with FNAC in 150 patients with solitary thyroid nodules is presented, highlighting the pitfalls of this technique. There was an inadequate specimen rate of 22.7% which declined with increasing experience. Follicular carcinomas could not be differentiated from follicular adenomas by cytology. Difficulties may arise in the detection of papillary carcinomas due to occult lesions, mixed papillary and follicular carcinomas or due to associated thyroid pathology. False positivity is, however, much rarer and is generally due to cellular adenomatous goitres with marked papillary activity. In view of these cytologic limitations, care must be exercised by the treating physician in interpreting cytological results.

Adenoma↗
PubMed1989

A new technique for chronic venous ulcers of the lower limb: modified Felder-Rob procedure.

Subfascial ligation of perforating veins is a commonly performed operative procedure for chronic venous ulcers of the leg. The most widely adopted incision currently used is the posterior midline approach described by Felder. This, however, is associated with significant morbidity due to necrosis of skin overlying the tendo Achillis with consequent exposure-induced necrosis and contracture of the tendon. A new incision based on anatomical studies is described. The procedure was adopted in 45 limbs with chronic venous ulcers. The incision is associated with very minimal morbidity and has given excellent results in the form of a major necrosis rate of only 4.4% (none of which involved the skin over the tendo Achillis or the tendon itself) and an ulcer recurrence rate of 4.4% during the period of follow-up of 2-8 years.

Achilles Tendon↗
PubMed1989

Jejunogastric intussusception: therapeutic options.

Acute jejunogastric intussusception is a rare complication of gastric surgery. It presents considerable difficulties in diagnosis unless the index of suspicion is high. Four cases of acute retrograde jejunogastric intussusception are reported. They were managed surgically after diagnosis had been confirmed by upper gastrointestinal contrast studies. In situ resection of the distal portion of gangrenous intussusceptum was performed in one case, while the intussusception could be reduced manually in the other three cases. The importance of early diagnosis in preventing avoidable morbidity and mortality has been stressed. In situ resection is recommended as the method of choice for the management of irreducible, gangrenous intussusception.

Adult↗
PubMed1989

An evaluation of the relative utility of different criteria of positivity in assessing the response to insulin induced hypoglycemic stimulation of the vagus as test for completeness of vagotomy.

This study evaluates the relative merits of the five most commonly used criteria for interpreting the results of the insulin test for completeness of vagotomy. One hundred and eighty tests were performed in normal controls and in patients with duodenal ulcer studied both preoperatively and after truncal vagotomy and drainage. It was found that Hollander's original criteria especially the response in the first post insulin hour was more useful than other criteria. Further use of multiple criteria instead of one alone, has a greater predictive value than mere statement of a positive or negative Hollander response.

Blood Glucose↗
PubMed1988

Retroperitoneal colopexy for adult rectal procidentia. A new procedure.

Nonresective fixation procedures are superior to resections in the management of rectal procidentia. A new operative procedure of retroperitoneal fixation of the redundant rectum and sigmoid after mobilization of the rectum up to the pelvic floor is described. The procedure was performed in 32 patients. In a follow-up ranging up to 11 years, only one recurrence of mucosal prolapse was seen. Rectal, bladder, and sexual functions were normal. There was a low wound infection rate and no mortality. The procedure appears superior to conventional operations for rectal procidentia and, at the same time, avoids usage of prosthetic materials for fixation with their known risk of complications.

Adolescent↗
PubMed1988

Cicatrical gastric stenosis caused by corrosive ingestion.

Sixteen patients with gastric cicatrization due to ingestion of corrosive agents were treated over a 7 year period at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry. Fifteen patients developed gastric outlet obstruction due to ingestion of corrosives, while another had midgastric stenosis due to formalin intake. An associated oesophageal stricture was present in 62.5% of the cases. Partial gastrectomy was found to be the most satisfactory procedure and carried out in 60% of the cases. Pyloroplasty done in one patient was found inadequate within 1 year of surgery. Gastrojejunostomy carried out in two patients was associated with prolonged hospitalization due to malfunction of the anastomotic site.

Acids↗
PubMed1988

Corrosive oesophagitis: an analysis of 50 cases.

A total of 50 consecutive patients who were treated in JIPMER Hospital between 1970 and 1981 for corrosive injuries of the oesophagus and stomach were analysed. There were 23 males and 27 females. All but seven presented with dysphagia due to an established stricture. In addition seven of them had associated stricture of the stomach. They were treated with either repeated dilatations or, in selected cases, oesophageal replacement. Perforation of the oesophagus is an important complication associated with oesophageal dilatation indicating the need for oesophageal replacement in multiple or long dense strictures. Results are quite satisfactory with both modalities of treatment. However, oesophageal replacement surgery, performed properly in selected cases, offers a permanent solution to these unfortunate victims.

Adolescent↗