Biomedical subjects

S Elangovan

Publications and source records attributed to S Elangovan.

28 records · Page 2Linked to original sources

PubMedDate not supplied

Safety and efficacy of enalapril in multivalvular heart disease with significant mitral stenosis--SCOPE-MS.

Angiotensin-converting enzyme inhibitors (ACEI) are often used in preventing and treating heart failure due to regurgitant valve disease. The majority of patients with symptomatic rheumatic heart disease (RHD) have significant mitral stenosis (MS) and are denied ACEI therapy, because of the fear of hypotension in the presence of fixed obstruction. The authors assessed the safety and efficacy of ACEI in 109 consecutive patients with RHD and with significant mitral stenosis (mitral valve orifice, MVO < 1.5 cm2)and with NYHA class III or IV heart failure symptoms. Mean age was 33.1+/-12 years, systolic blood pressure (BP) was 111+/-10, and diastolic BP was 73+/-8 mm Hg. MS was significant in 100 patients with mitral regurgitation in 46, aortic regurgitation in 19, and pulmonary hypertension in 60 patients. After initial stabilization, enalapril 2.5 mg bid was started in hospital and titrated up to 10 mg bid over 2 weeks. NYHA status, Borg score, and 6-minute walk test were assessed at baseline, and at 1, 2, and 4 weeks. Seventy-nine of the 100 patients who completed the study had severe MS (MVO < 1.0 cm2). Enalapril was well tolerated by all study patients without hypotension or worsening of symptoms. NYHA class (3.2+/-0.5 baseline vs 2.3+/-0.5 at 4 weeks, p < 0.01) Borg Dyspnea Index (7.6+/-1.3 vs 5.6+/-1.3, p < 0.01), and 6-minute walk distance (226+/-106 vs 299+/-127 m, p < 0.01) improved significantly with enalapril. Patients with associated regurgitant lesions showed more improvement in exercise capacity (120+/-93 vs 39+/-56 m, p < 0.001). Enalapril was well tolerated in patients with RHD with moderate and severe MS. Irrespective of the valve pathology, enalapril improved functional status and exercise capacity with maximum benefit in patients with concomitant regurgitant valvular heart disease.

Adult↗

PubMedDate not supplied

Patterns and predictors of prehypertension among "healthy'' urban adults in India.

Cardiovascular disease is still on the increase in India owing to changing socioeconomic factors and unhealthy lifestyles. Better understanding of the role of hypertension (HTN) has led to new Joint National Committee (JNC-7) guidelines for its diagnosis and management. The authors aimed to evaluate the predictors and correlates of prehypertension (PreHTN) among adults in urban India. Study design is a cross-sectional survey among 2,007 adults in Chennai in July 2003; 1,505 men and 502 women over the age of 18 years were studied. Demographic data collected by direct interview were the following: age, smoking, alcohol intake, type of work, exercise patterns, and monthly income. Anthropometric data of height, weight, and waist and hip dimensions were measured. Blood pressure (BP) was recorded thrice, with at least 15 minutes between readings 2 and 3. The mean of readings 2 and 3 was taken for the study. Of the 2,007 people studied, 951 (47.4%) had PreHTN and 696 (34.7%) had HTN. PreHTN was found in 46.6% of the men and 49.8% of the women. PreHTN was prevalent in 47.4% of adults, and another 34.7% had hypertension (Stage I, 20%, and Stage II, 14.7%). In urban India less than 18% of adults have normal BP of less than 120/80. Multiple logistic regression analysis after age and sex correction identified obesity, diet, family history and middle-income group as correlating with PreHTN. The factors that predict HTN were age, sex, smoking, alcohol intake, sedentary lifestyle, and type of work.

Adult↗

PubMedDate not supplied

Bone changes in leprosy patients with disabilities/deformities (a clinico-radiological correlation).

One hundred and ten leprosy patients (96 males and 14 females, mean age 45.3 years) with disabilities/deformities were examined radiologically to evaluate bone changes and correlating them with clinical parameters. Most patients (98) had paucibacillary leprosy. The mean duration of leprosy was 7.4 years and that of deformity was 4.1 years. Ten patients presented with reaction. Seventy-five (68.2%) patients had received a full course of antileprosy treatment. The overall prevalence of bone changes was 87.3% (96 patients); specific, non-specific, osteoporotic and facial changes were seen in 44.5%, 75.5%, 38.2% and 9.1% of the patients respectively. Among the specific bone changes, primary periosteitis (28.2%) and "bone cysts" (22.7%) were the more common findings. Among the non-specific bone changes, terminal phalangeal absorption (48.2%), soft tissue changes (44.5%) and concentric absorption (32.7%) were more common. Specific bone changes showed a significant (P < 0.05) increase with lack of or incomplete antileprosy treatment. Non-specific bone changes showed significant correlation (P < 0.05) with increasing duration of disease, lack of or partial treatment and rising disability index. Osteoporotic changes showed a significant relationship with rising disability index.

Adolescent↗

PubMedDate not supplied

Role of operative flexible choledochoscopy in calculous biliary tract disease.

BACKGROUND: In India, no study is available regarding the use of operative choledochoscopy in the management of choledocholithiasis. ERCP facilities are not always available at many centres and usually require the expertise of a medical gastroenterologist. In contrast, operative choledochoscopy is a simpler procedure that can easily be learned and practised by many surgeons at the time of CBD exploration. AIMS: To study the role of the flexible choledochoscopy in the diagnosis and management of calculous biliary tract disorders. METHODS: Twenty four patients with choledocholithiasis underwent flexible choledochoscopy. Stones were removed either with Desjardin's forceps or by choledochoscopic instrumentation. Postoperative T-tube cholangiography was done to detect any retained stones. RESULTS: Flexible choledochoscopy was performed in a total of 24 patients. Choledochoscopy was done through a choledochotomy in 23 and through the cystic duct in one patient. The choledochoscope was used following conventional CBD exploration in 18 of the 23 patients. Complete clearance of stones was confirmed by choledochoscopy in 12 of the 18 patients and additional stones were seen in the remaining 6 patients. Fogarty balloon catheter and Dormia forceps were used to extract these stones. A CBD stricture was seen in 4 of these 18 patients and choledochoscopic biopsy was done in one of them. In 5 of the 23 patients, the choedochoscope was used as the initial exploring instrument. Impacted CBD stones were detected in 3 of the 5 patients, external compression of the CBD due to periampullary carcinoma in one and stones in both the ampulla and common hepatic duct in the last patient. Postoperative T-tube cholangiography was done in 10 patients and did not reveal any retained stones. Drainage procedures were carried out in 13 patients: 11 had choledochoduodenostomy and 2 had transduodenal sphincteroplasty. Choledochoscopy was a direct aid in choosing the operative procedure in 21 patients. CONCLUSIONS: Flexible choledochoscopy is the most effective method of CBD exploration and is essential in all patients with choledocholithiasis. No additional morbidity or mortality is caused by this procedure.

Endoscopy↗

PubMedDate not supplied

5-fluorouracil-Induced cardiotoxicity.

Cardiotoxicity due to antineoplastic agents such as doxorubicin, daunorubicin, cyclophosphamide, vincristin, vinblastin, cisplatin and busulfan is well known. However, 5-fluorouracil-induced cardiotoxicity is yet to be widely recognized by cardiologists. We report a patient who developed 5-fluorouracil-induced cardiotoxicity syndrome.

Adult↗

PubMedDate not supplied

Complete axillary conversion after neoadjuvant chemotherapy in locally advanced breast cancer: a step towards conserving axilla?

OBJECTIVES: This study was designed to assess the clinical, sonographic and histopathological response of axillary lymph node metastasis to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIAL AND METHODS: Forty patients with locally advanced breast cancer (LABC) with clinically palpable or sonographically detectable axillary nodes were studied. FNAC of the primary tumor and axillary nodes was done and patients were started on neoadjuvant chemotherapy. Axillary nodes were assessed clinically and sonographically for response after 3 cycles of chemotherapy. All patients underwent total mastectomy with axillary clearance and the lymph nodes in the specimen were examined for metastasis. RESULTS: 47% patients had complete clinical nodal response, while 19% showed complete sonographic response. Complete pathological nodal response was documented in 22% of patients. Ultrasonography was found to be more sensitive than clinical examination in assessing complete nodal response. 10% of the patients had complete pathological response of both primary tumor and axillary nodes. There was significant correlation between pathological response of primary tumor and lymph nodes (P=0.004). Patients with complete sonographic or clinical response were found to have no or minimal residual disease in axilla and hence axillary dissection may be avoided in them.

Analysis of Variance↗

PubMedDate not supplied

Left ventricular hydatid cyst with myocardial infarction in a patient with severe rheumatic mitral stenosis.

Cardiac echinococcosis is rare, and the most serious of all hydatid infestations. We report a case of 30-year-old female who had a hydatid cyst, myocardial infarction and severe rheumatic mitral stenosis. Following mitral valvotomy, the hydatid cyst and the left ventricular aneurysm were totally excised under cardiopulmonary bypass. The patient was discharged on the post-operative day 15 with the advice to continue albendazole for 5 years.

Adult↗

PubMedDate not supplied

Clinical and laboratory findings in acute appendicitis in the elderly.

BACKGROUND: Early diagnosis and surgery are important factors by which the morbidity and mortality of acute appendicitis in elderly patients can be lowered. This study was conducted to determine clinical and laboratory results that are commonly associated with acute appendicitis in elderly patients. METHODS: A retrospective chart review was conducted of patients aged 60 years or older who underwent appendectomy or laparotomy for suspected acute appendicitis during a 5-year period in a metropolitan county. Acute appendicitis was confirmed by the pathology report. RESULTS: Elevated band cells and right lower quadrant pain were predictors of acute appendicitis in clinically suspected cases. Band cells greater than 6 percent had an excellent positive predictive value, as all patients with elevated band cells had acute appendicitis. With increasing white cell count and temperature, specificity increased, sensitivity decreased, and the positive predictive value remained high. CONCLUSIONS: It is essential to have a high degree of suspicion to recognize acute appendicitis in an afebrile elderly patient who has abdominal pain, a mildly elevated white cell count, and band cells in the upper limits of normal.

Acute Disease↗

PubMedDate not supplied

Improving pneumococcal vaccination rates in an elderly population by patient education in an outpatient clinic.

BACKGROUND: Invasive pneumococcal disease is a major cause of morbidity and mortality in elderly patients. This study investigated the impact of a patient education intervention on the pneumococcal vaccination rate in elders. METHODS: Charts of all patients aged 65 years or older who visited a university ambulatory care clinic during a 3-month period were reviewed for pneumococcal vaccination status before the patients' arrival for an office visit. Those who did not have the vaccination were provided patient education in the waiting room. Data were collected on age, sex, race, and immunization status. The reasons for refusing the vaccination before or during this intervention also were obtained. The charts of patients who consented were flagged for the attending physician to order the vaccination if appropriate. RESULTS: Charts of 535 patients were reviewed for pneumococcal vaccination status. Of these patients, 291 had had a pneumococcal vaccination before the study. The cumulative vaccination rate increased significantly from 54 percent to 79 percent after the study intervention. The rate of pneumococcal vaccination was significantly lower among African-Americans than whites both before and after the patient education intervention. CONCLUSION: This study reports a substantial impact of patient education on improving pneumococcal vaccination rates in an elderly population. Most elders accept vaccination, and it can be delivered effectively without an additional visit.

Black or African American↗

PubMedDate not supplied

Incidence of acute appendicitis confirmed by histopathologic diagnosis.

The annual incidence of acute appendicitis by gender, age, and race in Sedgwick County, Kansas was lower than values reported in most other communities. However, the trends of peak incidence during the second decade, male predominance among all races, and the highest incidence in Caucasians also were noted in the current study. The rates of perforation and gangrenous appendicitis were significantly higher in the elderly. No association was noted between the presence of fecalith and acute appendicitis or perforation. A better understanding of the etiology of acute appendicitis may explain the trends and differences in the incidence of acute appendicitis observed.

Acute Disease↗