Biomedical subjects

Balakrishnan Mahesh

Publications and source records attributed to Balakrishnan Mahesh.

11 recordsLinked to original sources

PubMed2006

Recurrent localized fibrous tumor of the pleura.

Localized fibrous tumors of the pleura are rare. They are often asymptomatic and may have symptoms based on size, bronchial invasion, or hormone production, or a combination of these. Complete resection offers the best chance of cure. However, recurrence is reported in a significant number of patients and can often be treated by repeated resection, albeit with increasing difficulty. We present a case in which delayed recurrence occurred after excision of such a tumor. This required a chest-wall resection and reconstruction after which a second recurrence occurred. Further thoracotomy including a latissimus dorsi free flap procedure was needed for a third-time recurrence.

Diaphragm↗

PubMed2006

Value of wedge resection for lung cancer in poor cardiopulmonary status patients.

The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.96 years) with baseline poor cardiopulmonary status underwent wide-margin wedge resection of preoperatively diagnosed primary lung cancer. All patients suffered from chronic obstructive pulmonary disease and 9 (37.5%) also had symptomatic ischemic heart disease. Eight patients were in New York Heart Association class III and 12 were in class IV. There were no post-operative deaths. Complications included chest infection in 3, surgical emphysema with prolonged air leak in 1, and atrial fibrillation in 6. Overall 7-year survival was 23.3%. Three patients with ischemic heart disease suffered late non-cancer-related death due to myocardial infarction at 48, 60, and 60 months postoperatively. Cancer-free 5-year survival was 54.3%, with 7/24 (29%) late recurrences. Our study suggests that wide-margin wedge resection is a valuable surgical option for primary lung cancer in patients with poor cardiopulmonary status.

Aged↗

PubMed2005

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. Medical treatment is effective in a few instances of endocarditis involving the leaflets alone in bioprostheses. However, accurate diagnosis, better myocardial protection, and improved surgical strategies have led to better survival in patients undergoing surgery after failed conservative therapy. This comprehensive review addresses various issues involved in the management of this complication.

Anti-Bacterial Agents↗

PubMed2004

Value of wide-margin wedge resection for solitary pulmonary nodule: a single center experience.

OBJECTIVE: Despite refinements of the diagnostic procedures, often surgery remains the only option to ascertain the histopathological nature of solitary pulmonary nodules (SPN). Aim of the present study was to ascertain the value of wide-margin wedge resection (WMWR) with curative intent in a consecutive cohort of patients afflicted by SPN. METHODS: From January 1995 to January 2002, 129 patients (74 male, mean age 60.5+/-14.4 years) underwent WMWR of a SPN. In-hospital outcome was prospectively collected and retrospectively analyzed. Incidence of malignancy was obtained by histology. Patients found to be afflicted by primary lung cancer (PLC) were sub-grouped according to their preoperative cardiopulmonary status (CPS). In-hospital and mid-term clinical outcome of all the patients is presented. RESULTS: There were 3 (2.3%) in-hospital deaths. Distribution of histology included 61 (47.3%) PLC (41 poor CPS), 20 (15.5%) secondary lung cancer (SLC), and 48 (37.2%) miscellaneous benign lesions. Twenty patients with PLC were fit and underwent completion lobectomy within 2 weeks following WMWR. Hospital length of stay was longer in patients with PLC as compared to patients with SLC (P=0.04). There were 17/61 (27%) recurrences in the PLC group. Of these, 2 occurred in fit patients undergone previous WMWR-lobectomy, and 15 in patients with poor baseline CPS. All these patients were referred for adjuvant therapy. Overall 5-year survival of the PLC group was 66% (61.1% for those with poor CPS and 82.5% for those with good CPR (P=NS). Seven out of 20 (35%) patients with SLC had late recurrent disease, leading to 1 re-operation. The overall 5-year survival in this group was 58.8%. There was only 1 non-related late death in the benign group. CONCLUSIONS: The WMWR resection of a primarily malignant SPN determines a valuable 5-year survival but a relatively high incidence of late recurrence. WMWR is a safe and effective surgical option for patients presenting with poor cardiopulmonary reserve.

Aged↗

PubMed2004

Splenic infarct: a rare cause of spontaneous rupture leading to massive haemoperitoneum.

A 76-year-old woman presented to the accident and emergency department with an acute surgical abdomen. She did not have any significant medical history or history of trauma. Examination findings revealed generalized peritonitis. Preliminary investigations were unhelpful in revealing a cause. On urgent exploratory laparotomy, a ruptured spleen was found and splenectomy performed. The hollow viscera were normal. The gross and microscopic appearances were suggestive of splenic rupture occurring through areas of infarction. We proceed to analyse the causes of spontaneous rupture of the spleen in our discussion of this case.

Abdomen, Acute↗

PubMed2003

Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes.

OBJECTIVE: We sought to compare early and midterm clinical outcomes in patients receiving a right internal thoracic artery or a radial artery as the second arterial conduit for myocardial revascularization. METHODS: Data prospectively collected for all patients who underwent coronary artery bypass surgery between April 1996 and May 2001 and who received both a left internal thoracic artery graft and either a right internal thoracic artery (n = 336) or a radial artery graft (n = 325) were analyzed. Patients in the radial artery group were older, with a greater body mass index, poorer ejection fraction, greater prevalence of diabetes, and higher New York Heart Association class than those in the right internal thoracic artery group. RESULTS: Odds ratios for perioperative myocardial infarction, atrial fibrillation, postoperative transfusion, and intensive care unit stay all showed a statistically significant benefit in the radial artery group compared with results in the right internal thoracic artery group (P <or=.05). Survival estimates at 18 months for patients who received right internal thoracic artery and radial artery grafts were 98.4% and 99.7%, respectively (hazard ratio, 0.25; 95% confidence interval, 0.06-1.10; P =.07). Estimates for survival free from any cardiac-related event or death in the right internal thoracic artery and radial artery groups were 92.3% and 97.8%, respectively (hazard ratio, 0.37; 95% confidence interval, 0.16-0.84; P =.02). A multivariate Cox regression model showed a stronger protective effect of a radial artery graft (hazard ratio, 0.25; 95% confidence interval, 0.12-0.51; P <.0001). CONCLUSION: Early and midterm outcomes of myocardial revascularization with 2 arterial grafts are better if the radial artery is used for the second graft rather than the right internal thoracic artery, assuming that the left internal thoracic artery is used for the first arterial graft.

Aged↗

PubMed2003

Pulmonary sclerosing hemangiomas: new approach in patients with low cancer risk.

Three cases of sclerosing hemangioma managed differently are described. Thoracic surgeons should raise their awareness of this benign slow-growing tumor in the differential diagnosis of solitary pulmonary nodule. Radiographic evidence of expansion of such a lesion is not conclusive for malignancy, and should not affect its biological behavior. Intraoperative frozen-section histology may prevent unnecessary resection of lung tissue. Extracapsular enucleation is the treatment of choice for sclerosing hemangiomas.

Adult↗

PubMed2002

The evolution of training in off-pump coronary surgery in a single institution.

BACKGROUND: This study analyses the development of off-pump coronary artery bypass (OPCAB) surgery training at a single institution, and compares the early and midterm clinical outcomes of OPCAB and conventional coronary artery bypass grafting (CABG) procedures performed by trainees with or without direct consultant cardiothoracic surgeon supervision. METHODS: Analysis was undertaken on data prospectively recorded on a computer database (Patient Analysis and Tracking System). Of the 2,422 CABG operations performed between January 1999 and December 2001, 969 (40%) were carried out by trainees either off pump (422) or on pump (547). RESULTS: Although the total number of CABG operations performed by trainees remained constant, there was a significant increase in the number of OPCAB operations during the study period compared with conventional CABG, as well as an increase in the average number of grafts per patient in the OPCAB group (both p < 0.05). Furthermore, a significant trend towards using two or more arterial conduits in the OPCAB group was observed in the study period. The number of OPCAB operations performed by trainees as independent operators without direct consultant supervision also increased significantly (p < 0.05). Early and midterm clinical outcomes were similar between patients operated by trainees on pump or off pump as independent operators versus under direct consultant supervision. CONCLUSIONS: The significant increase in OPCAB operations performed by trainees as independent operators or under direct consultant supervision, as well as the increase in the number of grafts per patient and arterial conduits used for myocardial revascularization, demonstrate a progression of training in beating heart surgery for cardiothoracic trainees. Improvements in the techniques have made it safe to teach trainees off-pump multivessel coronary artery revascularization.

Anesthesia, General↗

PubMed2002

Pedicled intercostal muscle flap: a simple technique of closing pancreatico-pleural fistula from a thoracic approach.

A simple technique to close a pancreatico-pleural fistula in the course of thoracotomy and decortication for multiloculated empyema complicating acute haemorrhagic pancreatitis is described. Friable diaphragmatic tissue around the fistula made direct closure not a suitable option. The intercostal muscle flap of the thoracotomy space was mobilized on the anterior intercostal artery, tagged around the fistula into healthy diaphragmatic tissue. This simple technique was successful in closing the fistula and helping control the sepsis.

Acute Disease↗

PubMed2002

Failure of low molecular-weight heparin in the prevention of prosthetic mitral valve thrombosis during pregnancy: case report and a review of options for anticoagulation.

All mechanical heart valves are thrombogenic and may be associated with thromboembolic complications if anticoagulation is inadequate. This risk is increased in pregnancy due to a hypercoagulable state. The ideal anticoagulation regimen in pregnant patients with prosthetic heart valves is uncertain. Oral dicoumarol anticoagulants, subcutaneous low molecular-weight heparin, subcutaneous high-dose heparin and continuous high-dose intravenous heparin each have their own merits and demerits. A case is presented of a pregnant patient who had prosthetic valve thrombosis while receiving low molecular-weight heparin and who required re-do prosthetic mitral valve replacement. An analysis is also included of the options available for anticoagulating this difficult patient group.

Adult↗

PubMedDate not supplied

Colour duplex ultrasound-guided sclerotherapy: a new approach to the management of patients with peripheral vascular malformations.

INTRODUCTION: Colour duplex ultrasound (CDU)-guided sclerotherapy is a valuable modality for treating peripheral vascular malformations (PVMs). PATIENTS AND METHODS: Between April 1996 and October 1998, 75 patients (age 5-65 years) with PVMs were subjected to CDU. Sclerotherapy was subsequently performed on 40 patients, without sedation, using 3% sodium tetradecyl sulfate, with mean follow-up of 4 years. RESULTS: CDU of the 33 high-flow lesions (HFLs) revealed direct arteriovenous (AV) communicating channels with very high forward diastolic flow in seven lesions (arteriovenous fistulas, AVFs), but not in the other 25 lesions (non-AVF). One was a mixed lesion picked up by CDU. Sixteen HFLs were subjected to sclerotherapy; 13 (81.25%) regressed. CDU of the 42 low-flow lesions (LFLs) helped categorize them into Type 1, where no supplying arteries could be seen (12 lesions), and Type 2, where supplying arteries were seen (30 lesions). Type 2 lesions could be further subcategorized based on the spectral trace of their supplying arteries: Type 2a, high-resistance flow (25 lesions); and Type 2b, low-resistance flow with a small forward diastolic flow (5 lesions). Twenty-four LFLs were subjected to sclerotherapy; 20 (83.3%) regressed. CONCLUSION: CDU findings correlated well with the clinical appearances of PVMs, and helped to further subcategorize these lesions based on flow. Significant differences in the Doppler flowmetry parameters of the supplying arteries seen in the HFLs and LFLs have enabled us to suggest values for differentiating between them. CDU was also found to be valuable in the follow-up of these lesions.

Abnormalities, Multiple↗