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Biomedical subjects

N Kohli

Publications and source records attributed to N Kohli.

At least 37 records · Page 2Linked to original sources
PubMed1999

The anatomic and functional outcomes of defect-specific rectocele repairs.

OBJECTIVE: This study was undertaken to evaluate the anatomic, functional, and quality-of-life effects of site-specific posterior colporrhaphy in the surgical management of rectocele. STUDY DESIGN: In a retrospective observational study 125 patients were studied who had undergone site-specific posterior colporrhaphy between 1995 and 1996, either alone or in conjunction with other pelvic procedures. Physical examination was performed >/=6 months after the operation to assess the anatomic success of the repair. Standardized questionnaires were used to assess quality of life, sexual function, and bowel function. RESULTS: Surgical correction was found at follow-up examination to have been achieved in 82% of eligible patients (73/89). All daily aspects of living improved significantly (P <.05), including ability to do housework (56% improvement or cure), travel (58% improvement or cure), and social activities (60% improvement or cure). Emotional well-being also significantly improved after the operation, as measured by thoughts of embarrassment (57% improvement or cure) or frustration (71% improvement or cure). Sexual function was not affected; however, reports of dyspareunia significantly (P <.04) improved or were cured after the operation in 73% of patients (19/26), worsened in 19% of patients (5/26), and arose de novo in 3 patients. Results showed no other significant differences in vaginal dryness, orgasm ability, sexual desire, sexual frequency, or sexual satisfaction. Bowel symptoms were assessed subjectively and were noted to have significantly improved (P <.008) after the operation. The following improvement or cure rates were obtained: stooling difficulties, 55%; pelvic pain or pressure, 73%; vaginal mass, 74%; and splinting, 65%. CONCLUSION: This study indicates that defect-specific posterior colporrhaphy is equal to or superior to traditional posterior colporrhaphy. This type of repair provides durable anatomic support and is successful in restoring bowel function. It does not detrimentally affect sexual function, may aid in the resumption of sexual activity, and significantly improves quality of life and social aspects of daily living.

Adult↗
PubMed1999

Computed tomography comparison of bony pelvis dimensions between women with and without genital prolapse.

OBJECTIVE: To compare bony pelvis dimensions between white women with and without genital prolapse using computed tomography (CT) pelvimetry. METHODS: Thirty-four multiparous white women with vaginal prolapse beyond the hymen and 34 matched white controls with no signs or symptoms of pelvic support defects underwent CT pelvimetry. The anteroposterior and transverse diameters of the pelvic inlet, the interspinous diameter of the midpelvis, and the intertuberous diameter of the pelvic outlet were measured. Post hoc power analysis showed that 22 women were needed in each group to detect a 10% difference in the pelvic dimensions between groups, with an alpha error of 1% and a beta error of 10%, resulting in a 90% power. RESULTS: Mean (+/- standard deviation [SD]) age of the subjects was 63.4+/-8.3 years, compared with 62.9+/-7.8 years for controls. Mean parity of the subjects was 3.3+/-1.7, compared with 3.6+/-1.7 for controls. Mean (+/- SD) anteroposterior (12.5+/-1.3 versus 12.8+/-1.0 cm), interspinous (11.5+/-0.8 versus 11.2+/-0.9 cm), and intertuberous (10.0+/-1.0 versus 9.8+/-0.8 cm) diameters were not significantly different between study groups. Mean transverse diameter of the pelvic inlet was significantly greater in women with prolapse than those without prolapse (12.9+/-0.7 versus 12.4+/-0.6 cm, P = .006). CONCLUSION: Women with advanced vaginal prolapse have larger transverse inlet diameters than do women with normal pelvic support.

Female↗
PubMed1999

GABA-transaminase antisense oligodeoxynucleotide modulates cocaine- and pentylenetetrazol-induced seizures in mice.

The mechanism of action of many anticonvulsive agents is to increase the function of the GABAergic system. Inhibition of GABA-Transaminase (GABA-T), the degradative enzyme for GABA, increases GABA levels in the brain. In this study, antisense oligodeoxynucleotides (ASO) targeted at the start codon region of GABA-Transaminase mRNA were used to modify seizure activity. Mice were treated, by intracerebroventricular injection, with antisense oligos or appropriate controls. At various times after treatment, the animals were challenged with cocaine (70 mg/kg, i.p.) and observed for seizure activity. At 15 hours after treatment, 1.152 and 1.44 nmol antisense oligo blocked cocaine-induced seizures. There was no effect of antisense oligo 8 or 36 hours after treatment. In addition, treatment with 7.2 nmol antisense oligo prevented pentylenetetrazol-induced seizures. These data demonstrate the modulation of seizure threshold using antisense oligodeoxynucleotides to GABA-T.

4-Aminobutyrate Transaminase↗
PubMed1999

A diagnostic rule for tuberculous meningitis.

Diagnostic confusion often exists between tuberculous meningitis and other meningoencephalitides. Newer diagnostic tests are unlikely to be available in many countries for some time. This study examines which clinical features and simple laboratory tests can differentiate tuberculous meningitis from other infections. Two hundred and thirty two children (110 tuberculous meningitis, 94 non-tuberculous meningitis, 28 indeterminate) with suspected meningitis and cerebrospinal fluid (CSF) pleocytosis were enrolled. Tuberculous meningitis was defined as positive CSF mycobacterial culture or acid fast bacilli stain, or basal enhancement or tuberculoma on computed tomography (CT) scan with clinical response to antituberculous treatment. Non-tuberculous meningitis was defined as positive CSF bacterial culture or Gram stain, or clinical response without antituberculous treatment. Thirty clinical/laboratory features of patients with tuberculous meningitis and non-tuberculous meningitis were compared by univariate and multiple logistic regression analysis. Five features were independently predictive of the diagnosis of tuberculous meningitis (p < 0.007): prodromal stage >/= 7 days, optic atrophy on fundal examination, focal deficit, abnormal movements, and CSF leucocytes < 50% polymorphs. When validated on another set of 128 patients, if at least one feature was present, sensitivity was 98.4% and, if three or more were present, specificity was 98.3%. This simple rule would be useful to physicians working in regions where tuberculosis is prevalent.

Child↗
PubMed1998

Vaginal paravaginal repair in the surgical treatment of anterior vaginal wall prolapse.

Objective: To describe our technique and report our clinical experience with the vaginal paravaginal repair in the surgical treatment of displacement cystocele.Methods: Forty-five patients with bilateral paravaginal support defects underwent vaginal paravaginal repair during a 2-year period at our institution. The technique of vaginal paravaginal repair will be illustrated through the use of anatomic photographs taken at the time of surgery. Demographic data were collected for each patient. Preoperative evaluation, intraoperative parameters, and postoperative course were reviewed.Results: The technique of vaginal paravaginal repair was standardized with transvaginal entrance into the retropubic space bilaterally. The paravaginal defects were identified and repaired using permanent suture in a 3-point closure incorporating the pubocervical fascia, arcus tendineous, and vaginal wall. Concurrent repairs were performed as appropriate.Mean age of the patients was 65.9 +/- 2 years (range 35-76). Thirty-eight patients had advanced prolapse of the anterior vaginal wall beyond the introitus, and 21 patients had coexisting stress incontinence. Postoperatively, the length of stay was 2.6 +/- 1.1 days (range 1-6) and urethral catheterization was required for a median 7 days. Intraoperative complications included 1 case of bilateral ureteral obstruction, and postoperative morbidity included 1 retropubic hematoma requiring re-exploration, 2 vaginal abscesses, and 2 postoperative transfusions.Conclusion: The vaginal paravaginal repair is a safe and effective technique in the surgical correction of vaginal wall prolapse due to a displacement cystocele. The vaginal approach provides adequate exposure to the relevant anatomy and good clinical results.

Journal Article↗
PubMed1998

Site-specific fascial defects in the diagnosis and surgical management of enterocele.

OBJECTIVE: The aim of this study was to assess the surgical feasibility and clinical outcomes of a vaginal enterocele repair that was based on the theory of site-specific defects in the vaginal fascia. STUDY DESIGN: Seventeen patients during a 2-year period with a diagnosis of enterocele and vaginal vault descensus with or without coexisting rectocele underwent surgical correction with a site-specific fascial defect repair. An enterocele was defined as vaginal wall prolapse seen during the operation in which the peritoneum was found to be in direct contact with the vaginal epithelium, with no intervening fascia. Patients were examined at 4 weeks after the operation and then at 6-month intervals, with site-specific analysis of pelvic prolapse at the vaginal apex and posterior vaginal segment. RESULTS: Identification and site-specific fascial defect repair of the enterocele were successfully performed in all 17 cases. All patients also underwent a uterosacral ligament vaginal vault suspension, and 15 patients (88%) underwent concurrent posterior colporrhaphy. There were no intraoperative complications. At a mean follow-up of 6.3 months (range 1-17 months), 2 patients (12%) had mild, asymptomatic vaginal vault descensus but no patients (0/17) had evidence of a recurrent enterocele or rectocele. CONCLUSION: Enterocele correction through a fascial defect repair is easily performed through the vaginal route and is associated with excellent surgical outcomes on short-term follow-up.

Adult↗
PubMed1998

Teaching the pelvic organ prolapse quantitation system.

OBJECTIVE: The objective of this study was to determine the ease with which the new Pelvic Organ Prolapse Quantitation system could be learned by residents and medical students. STUDY DESIGN: Standardized multiple-choice tests were administered to 51 obstetric and gynecology residents and medical students from 4 community-based and university-based programs. Parallel pretests and posttests were administered in conjunction with a 17-minute video demonstration of the Pelvic Organ Prolapse Quantitation system and with the addition of a visual memory aid. The posttest was repeated 3 months after the video presentation. RESULTS: The use of a 17-minute video significantly enhanced participants' ability to interpret examination findings when expressed in the terminology of the system (mean improvement in scores 33%, P <.0001). Posttest scores were similar regardless of the type of program or exposure to urogynecology faculty. These scores were maintained at the 3-month retesting. CONCLUSION: The Pelvic Organ Prolapse Quantitation system can be effectively taught by means of a public-domain video presentation.

Audiovisual Aids↗
PubMed1998

Mesh erosion after abdominal sacrocolpopexy.

OBJECTIVE: To report our experience with erosion of permanent suture or mesh material after abdominal sacrocolpopexy. METHODS: A retrospective chart review was performed to identify patients who underwent sacrocolpopexy by the same surgeon over 8 years. Demographic data, operative notes, hospital records, and office charts were reviewed after sacrocolpopexy. Patients with erosion of either suture or mesh were treated initially with conservative therapy followed by surgical intervention as required. RESULTS: Fifty-seven patients underwent sacrocolpopexy using synthetic mesh during the study period. The mean (range) postoperative follow-up was 19.9 (1.3-50) months. Seven patients (12%) had erosions after abdominal sacrocolpopexy with two suture erosions and five mesh erosions. Patients with suture erosion were asymptomatic compared with patients with mesh erosion, who presented with vaginal bleeding or discharge. The mean (+/-standard deviation) time to erosion was 14.0+/-7.7 (range 4-24) months. Both patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh. CONCLUSION: Mesh erosion can follow abdominal sacrocolpopexy over a long time, and usually presents as vaginal bleeding or discharge. Although patients with suture erosion can be managed successfully with conservative treatment, patients with mesh erosion require surgical intervention. Transvaginal removal of the mesh with vaginal advancement appears to be an effective treatment in patients failing conservative management.

Abdomen↗
PubMed1997

Percutaneous suprapubic teloscopy: a minimally invasive cystoscopic technique.

We describe a percutaneous approach to suprapubic teloscopy that may be used to assess bladder-ureteral integrity during laparoscopic surgery. After access is gained to the hollow of the bladder using a percutaneous suprapubic catheter introducer, a telescope is inserted via the access sheath, and bladder integrity and ureteral patency are confirmed. We describe this technique as a viable alternative to traditional cystoscopy at laparoscopic surgery.

Catheterization↗
PubMed1997

Comparative morbidity and charges associated with route of hysterectomy and concomitant Burch colposuspension.

OBJECTIVE: To compare the surgical morbidity, postoperative course, and hospital charges of Burch colposuspension performed in conjunction with abdominal versus vaginal hysterectomy. METHODS: Power analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a beta error of 20% and an alpha error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight, and operative and total hospital charges were obtained for each group. RESULTS: There was no statistically significant difference in demographics, surgical history, postoperative hemoglobin and hematocrit decrease, postoperative complications (10 versus 23%), operative charges ($4417 +/- 1200 versus $4731 +/- 1453), mean uterine weight (113.5 +/- 45 versus 125.8 +/- 45 g), and operative times (3.0 +/- 0.8 versus 2.9 +/- 0.7 hours) between the vaginal and abdominal groups, respectively. A post hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for postoperative complication rates. The abdominal group had significantly longer hospital stays (3.1 +/- 1.0 versus 2.6 +/- 0.7 days) and higher charges ($7337 +/- 1828 versus $6342 +/- 1123) than the vaginal group. CONCLUSION: When hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate.

Adult↗
PubMed1997

Open compared with laparoscopic approach to Burch colposuspension: a cost analysis.

OBJECTIVE: To compare postoperative course and hospital charges of an open versus laparoscopic approach to Burch colposuspension for the treatment of genuine stress urinary incontinence. METHODS: A retrospective chart review was performed to identify all patients undergoing open or laparoscopic Burch colposuspension by the same surgeon over a 2-year period. Patients undergoing additional surgical procedures at the time of colposuspension were excluded from the study. Twenty-one patients underwent open Burch colposuspension and 17 patients underwent laparoscopic colposuspension. Demographic data including age, parity, height, and weight were collected for each group. Both groups also were compared with regard to operative time, operating room charges, estimated blood loss, intraoperative complications, change in postoperative hematocrit, time required to resume normal voiding, length of hospital stay, and total hospital charges. RESULTS: The laparoscopic colposuspension group had significantly longer operative times (110 versus 66 minutes, P < .01) and increased operating room charges ($3479 versus $2138, P < .001). There was no statistical difference in estimated blood loss or change in postoperative hematocrit between the two groups. No major intraoperative complications occurred in either group. Mean length of hospital stay was 1.3 days for the laparoscopic group and 2.1 days for the open group (P < .005). However, total hospital charges for the laparoscopic group were significantly higher ($4960 versus $4079, P < .01). CONCLUSION: Laparoscopic colposuspension has been described as a minimally invasive, cost-effective technique for the surgical correction of stress urinary incontinence. Although the laparoscopic approach was found to be associated with a reduction in length of hospital stay, it had significantly higher total hospital charges than the traditional open approach because of expenses associated with increased operative time and use of laparoscopic equipment.

Adult↗
PubMed1997

Clinical correlates of CT abnormality in generalized childhood epilepsy in India.

The CT scan gives valuable insight into the aetiology of epilepsy. Studies done so far in India suggest that the causes are quite different from the West. CT scan has become available in larger cities in India, but is expensive. Information about clinical features that may 'predict' a CT abnormality would be useful to clinicians. The object was to determine which, if any, of 10 clinical features predict a CT abnormality in patients presenting with generalized epilepsy. Consecutive children with generalized epilepsy were enrolled prospectively and clinical features charted. Predetermined clinical variables were compared in those with and without CT abnormality. The setting was a pediatric in-patients and out-patients of a teaching hospital in northern India. One-hundred-and-sixty-two out of 178 consecutive children (age 1 month to 12 years) presenting with generalized epilepsy; ten clinical features viz seizure type, age at onset, number of seizures, duration of epilepsy, family/antecedent history, mental/neurological deficit, abnormal EEG and evidence of tuberculosis, were studied. Univariate analysis taking (1) CT abnormality/no abnormality and (2) ring/disc enhancing lesion/no such lesion on CT as outcomes. An abnormal CT scan was found in 79 (49 percent) patients. There were two high yield groups: (1) younger children with neurological/mental deficits; (2) older children without deficits. When these two groups were combined, odds ratio for CT abnormality was 3.06 (1.4-6.7). The commonest CT abnormality was a ring/disc like enhancing lesion seen in 32 patients. Higher age at onset (> 4 years), absence of mental/neurological deficits, generalized tonic-clonic type of seizures and fewer episodes of seizures at presentation were significantly associated with this finding. In addition to existing indications for CT scan, these results can guide physicians when referring patients for this investigation.

Brain↗
PubMed1996

Pyometra following Le Fort colpocleisis.

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.

Aged↗
PubMed1996

Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension.

OBJECTIVE: Our purpose was to compare the recurrent cystocele rate after anterior colporrhaphy versus anterior colporrhaphy performed in conjunction with transvaginal needle bladder neck suspension. STUDY DESIGN: A retrospective chart review of all patients undergoing anterior colporrhaphy with and without needle bladder neck suspension over a 3-year period was conducted. Preoperatively all patients had symptomatic anterior vaginal wall relaxation. Patients undergoing concomitant needle suspension procedures had genuine stress incontinence. Twenty-seven patients underwent anterior colporrhaphy alone, and 40 patients underwent anterior colporrhaphy with needle suspension. Demographic data including age, parity, menopausal status, and use of estrogen replacement was collected for each group. The recurrence rate of anterior vaginal wall relaxation was determined for each group by reviewing standardized postoperative office notes. RESULTS: There was no significant difference in the duration of follow-up between the two groups (13.2 months in the anterior repair group vs 13 months in the anterior repair-needle suspension group). However, a significant difference in recurrent cystocele rates was found between the two groups (7% [2/ 27] in the anterior repair group compared with 33% [13/40] in the anterior repair-needle suspension group, p < 0.01). CONCLUSION: The incidence of recurrent cystocele is significantly higher after anterior colporrhaphy with concomitant needle bladder neck suspension compared with anterior colporrhaphy alone. This difference may be related to the vaginal retropubic dissection at the time of transvaginal needle bladder neck suspension resulting in an iatrogenic paravaginal defect or denervation of the anterior vaginal wall.

Adult↗
PubMed1996

Value of CT scan in the diagnosis of meningitis.

OBJECTIVE: To study the diagnostic test characteristics of computed tomography (CT scan) in differentiating tuberculous (TBM) and pyogenic (PM) meningitis. DESIGN: Prospective diagnostic test evaluation. SETTING: Teaching hospital. METHODS: Children beyond 1 month of age admitted with meningitis were enrolled prospectively and CT scan done. Results of CT scan were compared with predefined gold standards for the diagnosis of either TBM or PM. RESULTS: CT scan was performed in 154 patients with meningitis. Of these 94 were TBM, 52 had PM and 8 were indeterminate and excluded from analysis. Basal enhancement, ventriculomegaly, tuberculoma and infarction were all significantly more common in the TBM group, while subdural collections were seen more in the PM group. The highest sensitivity (89.2%) and specificity (100%) for diagnosis of TBM were found for basal enhancement or tuberculoma or both. CONCLUSIONS: CT scan can be used to effectively distinguish TBM and PM.

Cerebral Infarction↗