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Biomedical subjects

S Talwar

Publications and source records attributed to S Talwar.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Tuberculous perforations of the small intestine.

The hospital records of 58 patients operated on for tuberculous perforations of the small intestines at our hospital between 1987 and 1996 were reviewed. Clinical features were non-specific in the majority of the patients. Pneumoperitoneum on abdominal radiographs was present in only 28 (48.3%) patients. Forty-five (77.6%) were operated on within 36 hours of perforation. Surgical management consisted of resection and end-to-end anastomosis (n = 45); oval excision of the perforation and transverse anastomosis reinforced with an omental patch (n = 7); ileo-transverse colostomy (n = 5); and peritoneal drainage only (n = 1). There were 17 deaths (29.3%). Adverse prognostic factors were operation beyond 36 hours (p < 0.01), multiple perforations (p < 0.001), and faecal fistula formation (p < 0.01). Mortality was least with early resection and end-to-end anastomosis of the perforated bowel segment. We conclude that a high index of suspicion is essential for early diagnosis and optimal treatment of patients with tuberculous intestinal perforations.

Adolescent↗
PubMedDate not supplied

Post-infarction ischaemic mitral regurgitation: what determines the outcome.

Ischaemic mitral regurgitation is an important determinant of survival in patients with coronary artery disease. A retrospective analysis was performed to evaluate the overall outcome and its determinants in patients with ischaemic mitral regurgitation. Over a period of 10 years, 72 patients underwent operations for mitral regurgitation of ischaemic origin. Age ranged from 37 to 68 years (mean 54.6 +/- 10.4 years), and 62 (86.1%) were male. Thirteen (18%) patients had acute and 59 (82%) had chronic ischaemic mitral regurgitation. Twenty-one patients were in New York Heart Association class II, 32 in class III and 19 in class IV. Moderate to severe left ventricular dysfunction was present in 42 patients. Valve prolapse was present in 35 (48.6%) patients and restricted leaflet motion secondary to myocardial dysfunction was present in 37 (51.4%) patients. All the patients were operated using standard cardiopulmonary bypass technique. Mitral valve was replaced in 33 patients and repaired in 39. Repair included a combination of techniques: chordal transposition (n = 2), chordal shortening (n = 18), leaflet resection (n = 2), posterior collar annuloplasty (n = 35) and annuloplasty with flexible Duran's ring (n = 3). Operative mortality was 18.1 percent (13/72). Low cardiac output was the cause of death in the majority (n = 10). Acute presentation and presence of restricted leaflet motion were the significant predictors of early mortality. Follow-up ranged from 3 to 84 months (mean 41.6 +/- 10.2 months). Late mortality was 46.2 percent. Actuarial survival in operative survivors at five years was 44.4 +/- 8.8 percent. To conclude, ischaemic mitral regurgitation carries a poor early and late outcome, with left ventricular dysfunction and presence of restricted leaflet motion being important contributors to it. In addition, acute presentation also reflects greater early mortality.

Adult↗
PubMedDate not supplied

Omentopexy for limb salvage in Buerger's disease: indications, technique and results.

Buerger's disease is a limb-threatening condition occurring in the young and productive age group and its management has always been a challenging problem. A large number of medical and surgical options have been suggested, but the quest for an ideal solution to this problem continues. Omentopexy for Buerger's disease is an attractive option, which is rapidly gaining popularity. We discuss the historical aspects, technical considerations and results of omental transfer for this limb-threatening condition. In doing so, the relevant literature on the subject has been extensively reviewed. In all published series, there has been marked improvement in intermittent claudication and rest pain. Ischaemic ulcers have healed and the progression of gangrene has stopped. If carried out with the complete understanding of the anatomy of the omental vascular arcade, the results of omentopexy are gratifying, thus avoiding amputation and conserving the limb.

Arm↗
PubMedDate not supplied

Choice of incision in surgical management of small bowel perforations in enteric fever.

Fifty six patients with typhoid enteric perforation who underwent operative treatment were randomly assigned to 2 groups. Twenty seven patients in group A underwent laparotomy via the Rutherford-Morrison incision while 29 patients in group B underwent the same procedure via a right paramedian incision. Surgical treatment consisted of two layer closure of the perforation with peritoneal lavage and tube drainage in all cases. Mean operating time in group A and group B was 45 +/- 10 minutes and 73 +/- 6 minutes respectively (p < 0.001). Postoperative wound dehiscence in group A and group B was observed in 2 and 11 cases respectively (p < 0.001). Incisional hernia developed in 8 patients in group B and none in group A (p < 0.01). Two patients in group A and 10 in group B developed adhesion-obstruction (p < 0.05). Differences in wound sepsis, pelvic abscess and mortality were not significant. Mean hospital stay in groups A and B was 12.4 days and 16.8 days respectively (p < 0.001). We conclude that in the presence of a confirmed preoperative diagnosis of typhoid enteric perforation, laparotomy via the Rutherford-Morrison incision may significantly reduce postoperative wound complications and morbidity without significantly altering the overall outcome.

Female↗