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S Madan

Publications and source records attributed to S Madan.

At least 19 recordsLinked to original sources
PubMed2005

Evaluation of the efficacy of mifepristone/misoprostol and methotrexate/misoprostol for medical abortion.

BACKGROUND: Unsafe abortion is a major cause of mortality among women in India accounting for 12% of all maternal deaths. In developing countries, annually, up to 200,000 women die of complications after illegal abortion. Medical abortion is potentially a simple and a safe method for use in developing countries. We conducted a prospective controlled trial to compare the efficacy of low-lose mifepristone and methotrexate for medical abortion. OBJECTIVE: To find out the efficacy of low-dose mifepristone and methotrexate for inducing abortion. METHOD: In this prospective clinical study, 100 women opted for a medical method of abortion. Out of these, 50 patients were given 50 mg/m2 of methotrexate intramuscularly followed by 800 micro gm of intravaginal misoprostol, and 50 patients were given 200 mg of mifepristone orally followed by 800 micro gm of intravaginal misoprostol. MAIN OUTCOME MEASURES: Complete abortion was the principal outcome measure. Secondary outcome measures were side effects and acceptability data. RESULTS: The rate of expulsion by first week after initiation of treatment was 58% in methotrexate and 98% in mifepristone group (P <0.001). CONCLUSION: Low-dose mifepristone and intravaginal misoprostol is safe, effective, and well tolerated as compared to methotrexate and misoprostol.

Abortifacient Agents↗
PubMed2003

Use of ThinPrep monolayer technique and cytospin preparation in urine cytology: a comparative analysis.

We compared the ThinPrep (TP) technique to the cytospin (CS) preparation in the cytological diagnosis of urine by processing 79 specimens by these two techniques. Ten cases were positive for malignancy (six high grade (HG)/carcinoma in situ; four low grade (LG) transitional cell carcinomas (TCC)). Forty-eight cases were within normal limits (59%) and 21 cases had atypical cytological features (19%). The TP technique was better in terms of a cleaner background with fewer obscuring inflammatory cells and blood and with a more even distribution of cells. In general, the cytomorphology was comparable in both techniques. However, in cases with malignancy, CS was relatively superior in the cytomorphologic details; in TP, the diagnostic cells were mostly dispersed as single cells with loss of architectural features and were difficult to find. Artifactual empty spaces and air-drying were more frequently present in TP. In cases contaminated with squamous cells, the urothelial cells were difficult to find in TP. Screening time was comparable for both techniques. In conclusion, to avoid false-negative diagnosis, CS would be complementary to the TP technique in malignant cases and, in particular, those with low cellularity.

Artifacts↗
PubMed2003

The Marchetti-Vicenzi nail. A DGH experience.

From July 1993 to September 1997, 28 nailings were done on 26 patients using the Marchetti-Vicenzi flexible nail. The minimum length of follow-up was 1 year. All the patients were examined clinically and radiographically. All the 19 tibiae united. Of the nine femur fractures, one required exchange nailing. Complications were delayed union, mal-union, shortening and infection. The complication rate was 3/19 for the tibia and 2/19 for the femur. The mean operative time and the mean fluoroscopy time for the tibia nailings was 36 and 0.22 min and for the femur nailings was 39 and 0.20 min, respectively. This was much lower than that for Russell-Taylor nails.

Adolescent↗
PubMed2002

Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis.

STUDY DESIGN: This retrospective study analyzed the outcome of 44 patients who had decompression, pedicle screw-rod fixation, and fusion for Grades 1 and 2 spondylolytic spondylolisthesis. OBJECTIVE: To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion and posterolateral fusion for low grades of isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: It has been suggested that stabilization with instrumented fusion is somewhat unpredictable due to lack of anterior support. Does circumferential fusion using posterior lumbar interbody fusion circumvent all the problems, and is it better than posterolateral fusion clinically? METHODS: A single surgeon treated 21 patients with instrumented posterolateral fusion and 23 patients with instrumented circumferential fusion, (i.e., posterior lumbar interbody fusion, and posterolateral fusion. These two groups were compared for clinical outcome, fusion rate, and correction of slippage. RESULTS: The minimum follow-up period for the patients was 2.1 years. The clinical satisfactory outcome on the Oswestry index was 81% for posterolateral fusion and 69% for posterior lumbar interbody fusion. The subjective outcome was 86% and 65%, respectively, for the two groups (P > 0.05). However, a consideration of subjective scores showed that three patients (14.3%) in posterolateral fusion group and eight patients (34.8%) in posterior lumbar interbody fusion group had an unsatisfactory outcome (P = 0.0135), which was very significant. There were two nonunions in the posterolateral fusion group and none in the posterior lumbar interbody fusion group (P > 0.05). The correction of slippage and the loss of correction at the last follow-up assessment was better in the posterior lumbar interbody fusion group, although this was not statistically significant (P > 0.05). Radicular symptoms and neurologic improvement were statistically similar between the two groups. CONCLUSIONS: Posterolateral fusion has a better clinical outcome in low grades of isthmic spondylolisthesis, although posterior lumbar interbody fusion is more predictable in maintaining correction and achieving union. Careful patient selection is needed for each operation, and adjacent level disc degeneration may influence the procedure offered to the patient.

Adult↗
PubMed2002

Wroblewski wedge augmentation for recurrent posterior dislocation of the Charnley total hip replacement.

We analysed 68 cases of acetabular augmentation using the Wroblewski wedge for recurrent posterior dislocation of Charnley total hip replacements inserted through a posterior approach. The follow-up was done by postal questionnaire in living patients or by thorough search of case notes in the dead. All hips were followed up either until death or a minimum of 2 years. The average follow-up for the surviving successful group was 35.3 months. Out of 68 hips, 52 (76%) had no further dislocation at a mean follow-up of 35.3 months (range, 24-95 months). An additional 4 hips became stable after one closed reduction for a re-dislocation. After a second augmentation, 5 more hips were stabilised. Wroblewski wedge augmentation is a simple and effective procedure and should be considered before embarking on major revisions in recurrent posterior dislocations in the elderly with no obvious cause for instability.

Acetabulum↗
PubMed2001

[Primary pulmonary hypertension: new treatment options].

Primary pulmonary hypertension (PPH) is a rare, progressive and life-threatening pulmonary vascular disease of unknown aetiology, which results in elevated pulmonary vascular resistance, pulmonary hypertension and eventually right ventricle failure. PPH occurs in all age groups, but most frequently in women aged 20-30 years old. The mean survival after the onset of symptoms is 2-3 years. Although the disease remains incurable at present, major advances in treatment options have been made during the last 10 years. This had led to a considerable improvement in extended survival and the quality of life in a substantial number of PPH patients. At present the most important treatment options include anticoagulants, calcium channel antagonists, chronic prostacyclin therapy (cost of this only reimbursed by health insurers in the Netherlands since 1999) and if needs be lung or heart-lung transplantation. Chronic continuous intravenous administration of epoprostenol is burdensome for the patient and requires adequate patient selection and a well-developed intramural and extramural infrastructure.

Adult↗
PubMed2001

Containment and stabilization of bone graft in anterior lumbar interbody fusion: the role of the Hartshill Horseshoe cage.

The Hartshill Horseshoe cage is a titanium implant that is inserted after removal of the disc in anterior lumbar interbody fusion. The authors use corticocancellous iliac crest graft, which is contained within the confines of the implant. The cage and the motion segment are stabilized by inserting screws into the adjacent vertebral bodies through holes in the implant. Between 1995 and 1997, 27 patients had this implant inserted. Minimum follow-up was 2.1 years (mean: 2.9 years). Patients were assessed using the Oswestry disability index, a core set of six questions, a pain drawing, and psychometrically using the Zung Depression Scale and the Modified Somatic Perception Questionnaire. The patients' subjective assessment was also obtained. Twenty-one patients (77.8%) improved significantly on the Oswestry disability index and 22 patients (81.5%) improved by subjective assessment using the "core set" of six questions. There was no evidence of pseudarthrosis, loosening, or osteolysis around the implant or the screws. The cage prevents graft extrusion, collapse, or sinkage through the endplates. The normal lumbar lordosis is restored and, by restoring normal intervertebral disc space height, the Horseshoe opens up the neural foraminae. This cage stabilizes the motion segments and secures the graft, preventing micromotion at the graft vertebral body interface and providing a conducive environment for fusion.

Adult↗
PubMed2001

ECT for a patient with a metallic skull plate.

Electroconvulsive Therapy (ECT) is a safe and effective treatment for a variety of psychiatric conditions. The American Psychiatric Association Task Force Report identifies no absolute contraindications to ECT; however, it lists several relative contraindications. The presence of a metallic skull plate is not addressed, nor has it been previously documented in the literature. As a result, there may be reluctance among some psychiatrists to perform ECT under such circumstances. This article reviews the literature for ECT done in the presence of skull defects and intracranial metallic bodies. A case report of ECT being performed on an elderly patient with a metallic skull plate is presented. In the presence of a skull defect, it is advisable to place electrodes equidistant from the defect to reduce the risk of damage. The case report presented adds to the literature to show that ECT may safely be performed in the presence of a metallic skull plate.

Aged↗
PubMed2001

Fine-needle aspiration biopsy of vertebral and intervertebral disc lesions: specimen adequacy, diagnostic utility, and pitfalls.

BACKGROUND AND OBJECTIVES: Fine-needle aspiration biopsy (FNAB) is used extensively in the clinical workup of radiologically detected bony lesions. The aims of this study were to evaluate the diagnostic utility of FNAB of such radiologically detected vertebral and intervertebral disc lesions in patients with and without a known primary malignancy, to establish criteria for specimen adequacy, and to evaluate the diagnostic pitfalls. DESIGN: The cytologic material obtained by FNAB performed under computed tomographic guidance of 78 cases comprising 66 vertebral and 12 intervertebral disc lesions was reviewed and analyzed. The initial cytologic diagnosis was compared with the diagnosis after review in all 78 cases. RESULTS: Thirty-five cases (45%) were positive for malignancy, 1 case (1.3%) was suspicious for malignancy, 9 (11.5%) consisted of normal cellular elements with no evidence of malignancy, 21 (27%) were unsatisfactory/inadequate for diagnosis, and 12 (15.2%) were benign nonneoplastic lesions. Nonneoplastic lesions diagnosed included fracture callus, discitis/osteomyelitis, degenerative disc disease, and Paget disease. In 11 cases, FNAB gave the initial diagnosis of malignancy (8 occult carcinomas and 3 plasmacytomas). In 23 out of 36 cases with a clinical history of a known primary tumor, FNAB established the diagnosis of metastases, and in 1 case, a second primary was detected. CONCLUSIONS: Fine-needle aspiration biopsy of radiologically suspected vertebral and intervertebral disc lesions in patients with a history of a known malignancy is useful to confirm the presence of metastases. In cases without any history of malignancy, FNAB can provide additional clues to aid in the subsequent workup and treatment of cases diagnosed with an unsuspected malignancy and other nonneoplastic lesions. Through assessment of the specimen adequacy, correct interpretation of the cytologic material available, and correlating with the clinical and radiologic findings, a definitive diagnosis can be made in most cases.

Adult↗
PubMed2000

Ketorolac entrapped in polymeric micelles: preparation, characterisation and ocular anti-inflammatory studies.

Polymeric micelles made of copolymer of N-isopropylacrylamide (NIPAAM), vinyl pyrrolidone (VP) and acrylic acid (AA) having cross-linkage with N,N'-methylene bis-acrylamide (MBA) were used as host carrier in which up to 30%w/w ketorolac (free acid) was entrapped to make the formulation. The lyophilised powder was used for physical characterisation. The drug entrapment was found to be about 80% and the formulation was stable for 8-10 days at room temperature. The smaller the amount of ketorolac dissolved into the micelles, the longer was the formulation shelf life. The size of the particles as measured by dynamic light scattering was found to be around 35 nm diameter at 25 degrees C. TEM picture showed spherical particles. The structure of the polymer and its morphology were characterised by FTIR, NMR and XRD measurements. IR data indicated weak interaction between polymer and ketorolac in the encapsulated system. NMR spectra indicated rigid polymer backbone with intermittent iso-propyl group in the chain. XRD spectra showed significant loss of crystallinity of the drug while being entrapped in the polymeric micelles. The release of drug in aqueous buffer (pH 7.2) from the polymeric micelles at 25 degrees C were 20 and 60% after 2 and 8 h respectively and is temperature and pH dependent. In vitro corneal permeation studies through excised rabbit cornea indicated two fold increase in ocular availability with no corneal damage compared to an aqueous suspension containing same amount of drug as in nanoparticles. The formulation showed significant inhibition of lid closure up to 3 h and PMN migration up to 5 h compared to the suspension containing non-entrapped drug, which did not show any significant effect.

Acrylamides↗
PubMed2000

Recurrent intrapelvic cyst complicating metal-on-metal cemented total hip arthroplasty.

Spontaneous intrapelvic masses causing vascular compression raise the suspicion of a neoplasm or infection. We present a patient who developed a recurrent intrapelvic cyst 14 years after a McKee-Farrar total hip arthroplasty which presented as acute onset of lower limb swelling, threatening the vascularity of the limb. This cyst recurred three times, and the patient finally needed revision total hip arthroplasty. The most probable cause of the recurrence was the cement and metal wear debris. Such cysts have been described in the literature, but to the best of our knowledge, this is the only report that describes it complicating a metal-on-metal prosthesis.

Aged↗
PubMed2000

Lateral epicondylalgia: treatment by manipulation under anaesthetic and steroid injection and operative release.

A retrospective study of 112 cases of lateral epicondylalgia treated between April 1995 and April 1998 was conducted. The treatment modalities included manipulation under anaesthetic and operative release. A questionnaire was used to assess the outcome. The patients who were unresponsive to conservative treatment either had manipulation under anaesthetic and a steroid injection or had an operative release. Those who had manipulation under anaesthetic and injection had 33.3% satisfactory outcome for pain and function at 17.2 months mean follow-up. Among those who had operative release, 69% had satisfactory outcome for pain and function at 17.2 months mean follow-up. The results of manipulation under anaesthetic and steroid injection are not good enough for this treatment to be recommended in the management of tennis elbow. It is more effective to treat the patients unresponsive to conservative treatment with open release.

Adult↗
PubMed1996

Splenic lymphocytes with circulating villous lymphocytes--a case report.

A 25 years old male presented with hepatomegaly splenomegaly and fever. He was diagnosed as splenic lymphoma with circulating villous lymphocytes (SLVL) on morphology, cytochemistry and immunocytochemistry performed on peripheral blood and bone marrow smears. Case is being presented because of rarity and unusual presentation at young age.

Adult↗
PubMed1994

Desmoplastic fibroma. A rare oral tumor in children.

A report on confirmed cases of desmoplastic fibroma in a 30-month-old male and a nine-year-old male, both of which responded well to surgical therapy and neither of which has shown signs of recurrence. A 10-year clinical and radiographic follow-up is included.

Child↗
PubMed1994

Novel method of treating large cysts of jaws in children.

The odontogenic keratocyst is remarkable because of its aggressive behavior and high recurrence rate. Managing these cysts is the clinician's primary problem. An innovative technique for treating children that minimizes postoperative complications and maximizes results is described here.

Adolescent↗
PubMed1993

Characterization of three overlapping deletions causing X-linked lymphoproliferative disease.

Blot hybridization was used to find DNA sequences missing in a male who lacked two-thirds of Xq25. The probes were used to discover two additional males with deletions resulting in X-linked lymphoproliferative disease (XLP). All three deletions have a region in common, and DXS739 is within this candidate region. The new deletions were also detectable using chromosome banding, and the smallest removes only one-third of Xq25. XLP is the only consequence of the deletions.

Adult↗