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Biomedical subjects

P Madhavan

Publications and source records attributed to P Madhavan.

27 records · Page 2Linked to original sources
PubMed1995

Nonunion of intertrochanteric fractures of the femur. Treatment by modified medial displacement and valgus osteotomy.

Nonunion of intertrochanteric fractures is uncommon but its effects are disabling. We describe a modification of the medial displacement and valgus osteotomy of Dimon and Hughston (1967) which we used in seven fractures, six of which united within 16 weeks. Postoperatively, hip function was good. The method provides good initial stability, a source of cancellous bone graft, good postoperative hip abductor function and reliable healing of the nonunion without the need for intraoperative imaging.

Adult↗
PubMedDate not supplied

Modified medial displacement and valgus osteotomy for unstable intertrochanteric fractures.

We have described previously a modification of the medial displacement and valgus osteotomy of Dimon and Hughston to manage non-unions of intertrochanteric fractures. In this study, we have used the same modification to manage fresh, unstable intertrochanteric fractures. Eighty-seven patients underwent this procedure. Four died within 4 months. The remaining 83 patients were evaluated over a period ranging from 4 to 49 months. There was a low complication rate with this method. They included one perforation of the femoral head, one post operative infection that recurred as a deep infection, one partial superior migration of the implant, one varus fixation with noticeable shortening and two cases where the trochanteric wire had snapped. In the others, the hip movement, abductor function, functional recovery and rate of union (8-12 weeks) were good. The method permits early weight-bearing and avoids some of the problems seen with anatomical fixation of unstable fractures using the sliding screw plate. We feel that medial displacement and valgus osteotomy with an angled blade plate has a definite role in the treatment of unstable intertrochanteric fractures in some situations.

Aged↗
PubMedDate not supplied

Low dose intraarterial thrombolysis with tissue plasminogen activator: does it deliver as promised?

The widespread use of intraarterial thrombolytic therapy has been based on perceived benefits over operative treatment and the downgrading of the magnitude of subsequent surgery. Thirty-three patients who had thrombolysis for peripheral artery occlusion were retrospectively analyzed at St. James's Hospital from 1991 to 1997. One patient received streptokinase unsuccessfully. Five other patient's records were inadequate for analysis. Twenty-seven patient's notes were analyzed for risk, duration of occlusion, duration of treatment, dosage of tissue plasminogen activator (tPA) and conduits thrombolysed. There were 15 males and 12 females. The mean age was 62 years (range, 20-87). Fourteen were current or reformed smokers. Five were diabetic. Indications for treatment included acute graft occlusion (n=13), embolus (n=6), and primary and secondary arterial thrombosis (n=8). Duration of occlusion was less than 24 hours in seven, 1 to 7 days in ten, and more than 7 days in ten patients. Twelve (44.44%) patients had complete clot lysis, four (14.81%) had partial clearance, and 11 (40.74%) remained occluded. Eight (29.63%) had serious complications including one death. Eighteen (66.66%) patients needed further surgical intervention to maintain graft patency. Data were analyzed using the chi-square and pooled t test. No significant difference was observed in results from thrombolysis from different conduits, gender, etiology, or smoking history. Increased duration of tPA administration was associated with an increased risk of failure. Administration of total dosages greater than 60 mg was associated with a higher risk of failure. Diabetics had a poor outcome (p=0.0520). Only 44 % of patients successfully underwent lysis. A primary surgical option may be a more sensible course than lysis, given that the vast majority of patients ended up having surgery anyway.

Adult↗
PubMedDate not supplied

Unusual presentation of an appendiceal malignancy.

Primary malignant epithelial tumors of the appendix are uncommon. The most common presentation of appendiceal malignancy is right lower abdominal pain suggestive of acute appendicitis. Presentation caused by loco-regional spread with involvement of neighboring organs is rare. We present the case of a 48-year-old woman with an appendiceal malignancy who presented with symptoms and signs suggestive of complicated diverticular disease with an enterovaginal fistula. From a review of the literature, this is the first report of an appendiceal malignancy presenting in this manner.

Adenocarcinoma, Mucinous↗