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Biomedical subjects

S Ramesh

Publications and source records attributed to S Ramesh.

At least 19 recordsLinked to original sources
PubMed1997

Open trial of intravenous immune serum globulin for chronic sinusitis in children.

BACKGROUND: Chronic sinusitis in children is a complex clinical problem. Some patients do not improve with medical therapy and some fail surgery as well. OBJECTIVE: A therapeutic trial of intravenous immune serum globulin (IVIG) was given to children whose sinus disease was recalcitrant to the usual therapeutic modalities. The objective of IVIG administration was to modulate the inflammatory process contributing to the chronicity of the sinusitis. METHODS: Six patients were given a 12-month trial of monthly (400 mg/kg) IVIG infusions. Entry criteria included persistence of sinusitis after 3 months of full course antibiotics, or two episodes of sinusitis within a 3-month period while on prophylactic antibiotics. All patients had abnormal sinus CT (computerized tomography) scans at entry. Three of the six patients remained symptomatic despite prior sinus surgery. Patients with primary immune deficiencies were excluded. Each patient served as his own control based on their previous 12-month history and clinical course. Four of the 6 patients were atopic as demonstrated by prick skin testing; however, all patients had nasal eosinophilia. RESULTS: Full course antibiotic use decreased in five of the six patients (183 to 84 days); correspondingly, the episodes of sinusitis decreased (average 9 to 4 per year). In addition, sinus CT scans showed significant improvement. CONCLUSION: This preliminary open-trial of IVIG suggests its usefulness as adjunct therapy to medical management in selected patients with chronic sinus disease. The mechanism(s) by which IVIG may be helpful is probably not based on the concept of replacement therapy, but more likely as an immune or inflammatory modulating agent.

Anti-Bacterial Agents↗
PubMed1997

A traumatic deterioration in general surgeons access to emergency theatre.

An audit has been carried out of general surgical emergency theatre usage before and after the allocation of some of the emergency theatre time for trauma lists. The median delay between decision to operate and operation starting rose from 1 hour 15 minutes to 2 hours 30 minutes. There was a fall in the number of operations carried out during the day (p < 0.001) and a corresponding increase in the number of procedures performed after midnight (p < 0.005). Emergency theatre usage provides advantages to patient and surgeon alike. However, by its nature it will not be fully occupied all of the time. There is always likely to be a temptation to use some of the "free time' for non-emergency cases. This results in the advantages of the emergency theatre being lost.

Abscess↗
PubMed1995

Theatre delay for general surgical emergencies: a prospective audit.

A prospective audit of emergency theatre use for general surgery has been undertaken. Two month periods were studied before and after the introduction of a fully staffed 24-hour emergency theatre. Data were collected using a proforma documenting the time of the decision to operate, the actual time of the operation and the reason for and duration of any delay. After the introduction of the facility the proportion of procedures performed after midnight fell from 29 cases (21.3 per cent) to 7 (6.3 per cent) (p < 0.05). Emergency operating between 0900-1700 hrs increased from 40 cases (29.4 per cent) to 71 (61.3 per cent) (p < 0.05). There was no significant difference in the causes of delay between the two groups, the commonest being queuing for theatre. However, the length of the delay was significantly reduced. That for an appendicectomy was reduced from a median of 4 hrs 40 mins (range 30 mins-18 hrs 45 mins) to 1 hr 29 mins (0-6 hrs 30 mins) (p < 0.01) and for drainage of abscess from 5 hrs 56 mins (15 mins-20 hrs 30 mins) to 1 hr 51 mins (0-4 hrs 30 mins) (p < 0.01). There was no significant difference in the seniority of the surgeon making the decision to operate. In the first part of the audit we identified problems with regard to delay which were addressed by the introduction of the emergency theatre. The audit cycle has been successfully closed improving the care of general surgical emergencies requiring urgent or emergency operations.

Emergencies↗
PubMed1995

Extrarenal Wilms' tumour--a case report and review of literature.

Extra renal Wilm's tumour (EWT) is an exceedingly rare entity and needs to fulfill certain criteria. Of the 48 cases reported, only about 36 have been found to be convincingly proved. We present one more well proven case of EWT and have extensively reviewed the literature. The diagnostic, staging and management guidelines are discussed. Amongst the reported cases, the behaviour of the tumour appears to parallel that of similarly staged "intra renal" Wilm's tumour. Hence the staging and the management protocols of "intra renal" Wilm's tumour can well be applied to tumour of extra renal location albeit with some modifications.

Abdominal Neoplasms↗
PubMed1994

The role of methotrexate in the management of steroid-dependent asthma.

Severe asthma often requires high-dose corticosteroid therapy. However, steroid therapy is fraught with many side effects. There are conflicting reports in the literature regarding the role of methotrexate in reducing the steroid requirements of these patients. This study examined the role of low-dose methotrexate in the management of steroid-dependent asthma. Eleven subjects with stable steroid-dependent asthma were enrolled in a placebo-controlled double-blind crossover trial. Patients received methotrexate, 15 mg/wk, or placebo each for two 12-week periods. There was significant improvement of pulmonary function and reduction of prednisone requirement in both placebo and methotrexate treatment periods. However, methotrexate was not superior to placebo. Only 3 of 11 patients responded to methotrexate. Although low-dose methotrexate therapy may have a role in a small select group of steroid-dependent asthmatics, it provided no additional benefit overall.

Adolescent↗
PubMed1993

Early discharge from hospital after open appendicectomy.

A prospective study of 200 consecutive open emergency appendicectomies was carried out. All patients were informed before operation that they would be discharged the following day if possible. The operation was performed through a standard muscle-splitting incision. At the end of the operation the wound was infiltrated with bupivacaine and a diclofenac suppository was given. There were 29 normal, 129 acutely inflamed, six gangrenous and 36 perforated appendices. In all, 147 patients (73.5 per cent) were discharged home within 24 h and reviewed 2 weeks later. Twelve patients had seen their general practitioner, mainly for wound problems (eight) or pain (two). Two others required readmission. Thirty-four patients (23.1 per cent) required no postoperative analgesia; 104 (70.7 per cent) required paracetamol or co-proxamol for < or = 3 days and nine (6.1 per cent) for > 3 days. No patient had a problem directly related to early discharge from hospital. Fifty-three patients (26.5 per cent) were not discharged home early due to peritonitis (36), social reasons (seven), nausea (seven), associated caecal volvulus (one) and pregnancy (two). Early discharge from hospital within 24 h after emergency appendicectomy is safe and has good patient acceptability.

Adolescent↗
PubMed1993

Popliteal aneurysm: morphology and management.

Since January 1988, 32 patients have presented with 44 popliteal aneurysms (22 thrombosed, 22 non-thrombosed). Patients with thrombosed aneurysms were older (median age 72 versus 66 years), and more likely to have bilateral lesions (P < 0.02) and serious associated cardiovascular disease (P < 0.02). Nineteen aneurysms thrombosed acutely; 12 were treated with intra-arterial thrombolysis, which was at least partially successful in seven. All 12 were subsequently bypassed, as were the other seven which were associated with such severe ischaemia that they required urgent operation. One patient died and two others required major amputation. Other complications included foot-drop (two patients), renal failure (one) and wound infection (two). Two grafts thrombosed and required re-exploration. Elective bypass was carried out in 11 patients without acutely thrombosed aneurysms; there were no significant postoperative problems. Distortion within the aneurysm (P < 0.01), large size (P < 0.01) and distortion of the popliteal artery above or below the lesion (P < 0.02) were all associated with thrombosis. Stenosis within the aneurysm was more likely in patients with multiple lesions (P < 0.01) and distortion with larger aneurysms (P < 0.01). After correcting for distortion, none of the other variables was independently significant. The combination of distortion and diameter > 3 cm was present in 13 of 15 thrombosed aneurysms. Morbidity is high following acute thrombosis of popliteal aneurysm. Distortion of the aneurysm appears to be a more sensitive predictor of thrombosis than size alone. The combination of distortion with a diameter > 3 cm may help to define popliteal aneurysms that should be bypassed electively.

Aged↗
PubMed1991

Galactosemia.

Explore the source record for details and available documents.

Breast Feeding↗
PubMed1986

Pycnodysostosis with visceral manifestation and rickets.

Pycnodysostosis is a rare bone disease. Visceral manifestations associated with anemia and/or rickets have been reported in pycnodysostosis. Five children with typical findings of pycnodysostosis with hepatosplenomegaly, anemia with rickets, one with visceromegaly and anemia, and another with rickets alone are reported here. These findings strongly suggest that extramedullary erythropoiesis does occur in pycnodysostosis.

Anemia↗