Biomedical subjects
Publications and source records attributed to D Pai.
Incontinentia pigmenti or Bloch-Sulzberger syndrome, is a rare X linked dominant disorder with characteristic skin, hair, eye, dental and neurological abnormalities commonly affecting females. This article reports the clinical features and management of a 11 year old girl diagnosed with Incontinentia pigmenti.
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PURPOSE: This study was performed to assess the accuracy of high-resolution sonography in measuring penile carcinoma. METHODS: Sonography was performed using a 7.5-MHz linear-array transducer in 59 patients with penile carcinoma. The sonographic measurement of tumor extent was compared with clinical and pathologic measurements. The tumor extent measured by gross pathologic evaluation on cut sections of the fresh penectomy specimen was used as the definitive standard. The echogenicity of the tumor was compared with that of the surrounding normal penile tissue to classify the tumor as hyperechoic, hypoechoic, or of mixed echogenicity (containing both hyperechoic and hypoechoic elements). We evaluated the relationship between the echogenicity of the tumor and both tumor morphology (exophytic or infiltrative) and tumor grade as determined on pathologic examination. RESULTS: The overall mean difference +/- standard deviation in the tumor extent between clinical and gross pathologic evaluation was 3.9 +/- 5.3 mm (range, 1-9 mm), whereas the overall mean difference between sonographic and gross pathologic evaluation was 1.2 +/- 1.7 mm (range, 1-7 mm). As determined with reference to the gross pathologic extent, the error in measuring the extent on clinical examination was significantly greater than the error on sonography (p < 0.001). Lesions involving the glans alone were more often underestimated by clinical examination than were lesions involving the shaft (with or without glanular involvement). The error in measuring the extent of tumor by sonography was not related to the site of the tumor. The tumor was hyperechoic in 21 cases (36%), hypoechoic in 28 cases (47%), and of mixed echogenicity in 10 cases (17%). There was no significant association between echogenicity and tumor morphology or grade. CONCLUSIONS: Sonography gives a more accurate estimate of penile tumor extent than does physical examination. Routine use of sonography for such measurements should enable preservation of more of the penis.
OBJECTIVE: To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. PATIENTS AND METHODS: Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test. RESULTS: Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. CONCLUSIONS: Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.
BACKGROUND: Duodenal ulcer perforation is a common emergency in south India, with about 100-120 cases being treated at Jawaharalal Institute of Post Graduate Medical Education and Research each year. The routine to date has been to leave two tube drains: one in the Morrison's pouch and one in the pelvis after omental patch closure. This study was conducted to test the efficacy and safety of drain usage routinely after duodenal ulcer perforation closure with Roscoe Graham omental patch technique. METHODS: In this prospective controlled study, 44 patients formed the test group (without drains) and 75 patients formed the control group (with abdominal drainage). Only patients of perforated duodenal ulcer closed with Roscoe Graham omental patch technique were included in the study. The incidence of postoperative fever, wound infection, time for return of bowel function and duration of hospital stay were noted. Details of drainage noted were the mean amount of daily drainage, mean time of drain removal and occurrence of drain-related complications. Peritoneal fluid, wound discharges, drain tips and drain wounds were cultured. Abdominal ultrasound was performed in all patients in the second postoperative week or if earlier indicated to detect intra-abdominal collections. RESULTS: It was found that there was no difference in incidence or duration of postoperative pyrexia, return of bowel function or postoperative hospital stay between the two groups. Routine use of drains was not effective in preventing postoperative fluid collection nor in decreasing the incidence of intra-abdominal abscesses. The migration of bacteria from the exterior to the peritoneal cavity via the drain was also demonstrated. Drains were found to cause morbidity including intestinal obstruction. CONCLUSION: The routine use of drains was found to be neither safe nor effective in patients of perforated duodenal ulcer treated by omental patch closure.
A prospective study was conducted at JIPMER, Pondicherry from September 1993 to June 1995. Fifty cases of inguinal herniorrhaphy were done under local anaesthesia (LA) and 60 cases under spinal anaesthesia (SA). The aim was to assess the safety and efficacy of inguinal herniorrhaphy under LA. The parameters studied were: (i) Efficacy of the anaesthesia, (ii) safety and postoperative course, and (iii) patient satisfaction. The LA group patients had better postoperative analgesia and earlier return to ambulation. They did not suffer the postspinal complications of headache and urinary retention. However, intra-operative discomfort was significantly more in this group compared to the SA group.
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Isolated complete transection of the common bile duct due to blunt abdominal trauma is rare. We report such a case following an assault.
Spontaneous appendicocutaneous fistula is a rare complication of appendicitis. We report a case of appendicular carcinoid who presented with appendicocutaneous fistula.
Perforation of the gastrointestinal tract is rare in HIV infection and occurs most often in the colon and small intestine. Gastric perforation in HIV-positive patients has not been reported so far. We report an HIV-positive patient who developed gastric perforation.
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Two hundred and forty eight cases of proved typhoid ileal perforation were admitted and treated in three phases in the department of surgery during 1966-1998. Of these, 71% patients belonged to second and third decades of life. Male female ratio was 4:1. Abdominal pain (100%) fever (95%) and constipation (87%) were the main presenting symptoms. Abdominal guarding and rigidity (84%) were the principal physical signs. Plain radiograph of abdomen showed evidence of pneumoperitoneum in 57% of cases. The Widal test was positive for S. typhi in 74% of cases. Blood and bone marrow culture were positive for S. typhi in 9% and 30% respectively. Histology of the excised edges of perforation confirmed typhoid pathology in 62% of specimens. Many of the patients were treated conservatively in the first phase. In phase two and three vigorous resuscitation and early surgery was resorted to. Simple closure in two layers and wedge resection were the treatment of choice in most of the cases. Bypass, ileostomy and resection were done on few occasions. Chloramphenicol was the only drug used in the first phase. Other broad spectrum antibiotics were added to chloramphenicol with metranidazole in the second phase. Ciprofloxacin and metronidazole were the drugs of choice in the third phase. The mortality rate showed a dramatic improvement from 47.2% (first phase) to 17.7% (second phase) and as low as 7% in the last phase. The lag period (advent of symptoms to time of admission to hospital) showed definite correlation with mortality. Septicemia, wound infection, dehiscence, enterocutaneous fistula were the principal postoperative complications.
BACKGROUND: Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome. METHODS: A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid. RESULTS: Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. CONCLUSION: Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.
Two hundred and twelve cases of ileal perforation due to different causes (excluding typhoid) were treated in 3 phases in the Department of Surgery, JIPMER Hospital, Pondicherry, during the periods 1966-78 (phase I), 1981-88 (phase II) and 1990-1998 (Phase III). Forty per cent of the patients were in the second and third decades of life. Male-to-female ratio was 2.2:1. The majority of the perforations (52.8%) were due to non-specific causes. Trauma (19.3%) and mechanical factors (12.7%) were the other principal aetiologies. Pain abdomen (92.3%), constipation (63.6%) and fever (44.3%) were the principal presenting features. Abdominal guarding and rigidity (89%) were the main physical signs. Pneumoperitoneum was present in 66.8% of cases on plain X-ray abdomen. Widal and blood culture for Salmonella typhi were negative in all. Laparotomy was done in most of the cases after adequate resuscitation. Simple closure of the perforation, wedge resection and resection anastomosis were the different procedures of management. Histology of the margin of perforation/excised gut gave added evidence of a non-typhoid etiology. Broad-spectrum antibiotics in different combinations with metronidazole were administered postoperatively. Mortality was 28.2% in Phase I, and 9.4% and 11.9% in phases II and III respectively. The lag period (advent of symptoms and hospitalization) showed definite relationship with mortality and morbidity. Wound infection, wound dehiscence, enterocutaneous fistula and septicaemia were the principal postoperative complications.