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Biomedical subjects

V S Iyer

Publications and source records attributed to V S Iyer.

13 recordsLinked to original sources
PubMed2004

Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids.

PURPOSE: Rubber band ligation therapy for symptomatic hemorrhoidal disease has been used for many years and is a well-accepted treatment modality, but information on long-term outcome is limited. Our goals were to determine safety and long-term efficacy of this treatment. METHODS: A retrospective chart review of patients undergoing rubber band ligatures for symptomatic internal hemorrhoids in a single practice was conducted. Information on presenting symptoms, number of bands applied, response to therapy, complications encountered, length of follow-up, interval to recurrent symptoms when applicable, and subsequent therapy were documented. Supplemental information was obtained from telephone follow-up. Outcome was categorized as success or failure, in which success was defined as: permanent relief of symptoms for follow-up period; marked improvement in symptomatology with rare manifestation of bleeding (< or = 1/month); symptom relief for a limited period of time (> or = 100 days), and failure was defined as: modest improvement (decreased but not relief of symptoms); or no improvement in symptoms. RESULTS: A total of 805 patients underwent 2,114 rubber band ligatures. Most common presenting symptoms were bleeding in 731 patients (90.8 percent) and prolapsing in 382 patients (47.5 percent). The median number of bands placed was two (range, 1-17). The median time between bandings was 4.7 (range, 1.1-35.6) weeks. Median follow-up time was 1,204 (range, 14-9,571) days. Excluding 104 patients lost to follow-up (never returned after initial treatment), success was obtained in 70.5 percent (494/701) and failure in 29.5 percent (207/701) of patients. Success rates were similar for all degrees of hemorrhoids. Hemorrhoidal disease requiring the placement of four or more bands was associated with a trend in higher failure rates and greater need for subsequent hemorrhoidectomy. Complications per treatment series included bleeding (2.8 percent), thrombosed external hemorrhoids (1.5 percent), and bacteremia (0.09 percent). Higher bleeding rates were encountered with the use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin. Time to recurrence was less with subsequent treatment courses. Treatment of recurrent symptoms with rubber band ligation resulted in success rates of 73.6, 61.4, and 65 percent for first, second, and third recurrences respectively. This resulted in a cumulative success rate of 80.2 percent for this method of treatment. CONCLUSIONS: Rubber band ligatures are safe and effective therapy for symptomatic internal hemorrhoids. It can be used to treat all degrees of hemorrhoids with similar effectiveness. The likelihood of success is lower if more than four bands are needed to eliminate symptoms. The use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin is associated with higher bleeding rates. Rubber band ligatures for recurrence of symptoms is effective; however, time to recurrence is less with subsequent treatments.

Adult↗
PubMed1994

Factors influencing mortality and myocardial infarction after coronary artery bypass grafting.

Although the mortality for coronary artery bypass graft surgery has declined, some categories of patients are still recognized as being at greater risk. Because the mortality, even for most patients with risk factors, is less than 10%, evaluating this risk and any improvement arising from changing techniques requires thousands of cases. The need for these large patient numbers makes the evaluation of changes difficult. Even when other risk factors are accounted for in the mortality estimate, the patient's age remains an important factor, although there is no obvious reason why this should be so. Similarly, female sex is well recognized as a risk factor. However, the tendency for women to have a smaller body surface area and corresponding smaller arterial diameters may be the explanation. Perfusion time appears to have a strong influence on mortality after it exceeds about 90 minutes, and a similar influence on myocardial infarction also appears to be present. The increased risk of myocardial infarction with unstable angina may relate to disruption of the normal endothelial vasodilatation caused by nitric oxide.

Age Factors↗
PubMed1993

Mortality and myocardial infarction after coronary artery surgery. A review of 12,003 patients.

OBJECTIVE: To review the results of uncomplicated coronary artery bypass graft surgery and to identify factors which influence operative mortality (OM) and postoperative myocardial infarction (PMI). DESIGN: An analysis of the outcome in patients having coronary artery bypass graft surgery for the first time from 1978 to 1990 inclusive. SETTING: The Cardiothoracic Surgery Unit at the Royal Adelaide Hospital. PARTICIPANTS: Twelve thousand and twenty-two patients had coronary artery bypass graft surgery only. Complete data were available for 12,003 patients. RESULTS: There was an overall mortality rate of 0.99% and a postoperative myocardial infarction rate of 1.34%. Older patients and women had a higher operative mortality rate. Both unstable angina and poor ventricular function increased the mortality rate. The only significant operative factor was the perfusion time. There was a more than 16-fold increase in mortality in patients who had an average bypass time (48 minutes) compared with those whose bypass time was 100 minutes or more (0.63% v. 10.3%). The PMI rate changed over the study period, and was also influenced by the presence of unstable angina and the duration of bypass: unstable angina doubled the rate from 0.86% to 1.91%, and with an average bypass time the PMI rate was 0.56% whereas with a bypass time of 100 minutes or more the rate increased to 7.7%. CONCLUSIONS: The outcome after coronary artery bypass graft surgery is strongly dependent on the perfusion time and the presence of unstable angina. Older patients and women are more likely to die during the operation.

Adult↗
PubMed1986

Nifedipine for postoperative blood pressure control following coronary artery vein grafts.

The drug control of raised blood pressure following coronary artery bypass grafting was studied in 20 patients during the early postoperative period. On a random basis, 10 patients were given intranasal nifedipine and 10 other patients received intranasal saline. If the systolic pressure was raised, it was treated by an infusion of sodium nitroprusside. The systolic pressure abated in those treated with nifedipine so that 7 of the 10 did not require any other treatment in the first hour. The reduction in pressure was accomplished without an increase in heart rate. The requirement for sodium nitroprusside to control the pressure was much less in the first hour postoperatively in the nifedipine treated group and at 4 hours, the effect of nifedipine was still apparent. This study demonstrates that intranasal nifedipine is an effective adjunct for controlling raised blood pressure in the early postoperative period.

Blood Pressure↗
PubMed1982

Fresh autologous blood transfusion and platelet counts after cardiopulmonary bypass surgery.

The effect of fresh autologous blood transfusion on platelet count and blood requirement in the early postoperative period is examined in a control group and in patients receiving early and late autologous replacement. Withdrawal of blood in the autologous groups appeared to enhance platelet numbers as the autologous groups had higher mean platelet counts than the control group immediately after bypass, in spite of having lower mean haematocrit. After bypass all groups showed a progressive rise in platelet count with time. A substantial part of the rise was explained by haemoconcentration resulting from fluid shifts but there was also an increase in the total circulating platelet numbers. There was no difference in postoperative blood loss between the three groups. Autologous blood replacement hastens the postoperative rise in platelet count but does not alter the postoperative blood loss.

Blood Transfusion, Autologous↗