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Biomedical subjects

G K Ninan

Publications and source records attributed to G K Ninan.

7 recordsLinked to original sources
PubMed2001

Acute appendicitis: the continuing role for active observation.

We present the results of a 6-year review of appendicitis. In the event of diagnostic doubt, a policy of active observation was instituted. This review endorses the validity of such a policy, indicating that it does not expose patients to increased morbidity. Data were collected prospectively over a 6-year period on 1,479 children admitted with suspected acute appendicitis (AA); 1,028 (69.5%) were discharged with a diagnosis of non-specific abdominal pain after a mean observation period of 2.5 days, whilst in the remaining 451 a clinical diagnosis of AA was confirmed. The male-to-female ratio was equal, with no difference in the mean age of males (11 years) or females (12 years); 95% of patients were over the age of 5 years. In 324 (72%) cases surgery was performed on the day of admission, whilst in the remaining 126 (28%) it was deferred for 1 to 6 days because the clinical diagnosis of AA remained doubtful. The mean hospital stay was 4 days (range 1-32). Analysis of the histological reports of all 451 cases confirmed a positive predictive value for clinical assessment alone of 97.9% and a normal appendicectomy rate of 2.6%. No mortality was observed; surgical morbidity was recorded at 6% with no correlation between postoperative morbidity and timing of surgery evident (Spearmans correlation coefficient = -0.079, p = 0.9). Active observation for suspected AA thus remains a valid technique for achieving an accurate diagnosis and successful outcome.

Acute Disease↗
PubMed2000

Serum cytokine profile in reflux nephropathy.

Cytokines are small regulatory peptides with diverse functions. They regulate the immune system and modulate the inflammatory response, both of which are implicated in vesico-ureteric reflux (VUR) and associated reflux nephropathy (RN). The cytokine profile in VUR and RN has yet to be fully investigated. Blood was obtained from three subject groups immediately after induction of anaesthesia: group A [subjects with VUR and established RN, (N=9)]; group B [VUR alone but no associated RN, (N=6)]; and group C [age- and sex-matched controls with no history of urinary sepsis, (N=14)]. Serum cytokine levels of tumour-necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), soluble TNF receptor-1 (sTNF-R1), and interleukin-8 (IL-8) were measured using standard ELISA technique. Serum levels of IL-6 were higher in group A subjects (1.798-4.638 pg/ml, median 3.253 pg/ml) than controls (1.531-2.078 pg/ml, median 1.798 pg/ml). There was no significant difference in levels in group B subjects (1.498-3. 048 pg/ml, median 1.948 pg/ml) and controls. These same relationships were observed for levels of TNF-alpha (group A: 8. 501-14.471 pg/ml, median 13.483 pg/ml; group B: 7.088-10.650 pg/ml, median 8.886 pg/ml; group C: 6.746-13.344 pg/ml, median 7.671 pg/ml) and sTNF-R1 (group A: 690.34-5780.74 pg/ml, median 1197.38 pg/ml; group B: 366.65-1401.62 pg/ml, median 592.82 pg/ml; C: 313.49-636.33 pg/ml, median 504.17 pg/ml). IL-8 was not significantly elevated in any of the study groups (A or B) compared with control group C (group A: 27.08-56.38 pg/ml, median 31.35 pg/ml; group B: 29.90-35. 87 pg/ml, median 31.35 pg/ml; group C: 25.05-30.22 pg/ml, median 29. 90 pg/ml). These results suggest there may be an immunological basis to RN.

Adolescent↗
PubMed1999

Urinary cytokines as markers of reflux nephropathy.

PURPOSE: We established whether the urinary cytokines interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha and soluble TNF receptor-1 have a role as noninvasive markers of renal damage in children with vesicoureteral reflux. MATERIALS AND METHODS: We performed an observational study in a surgical and urological unit at a pediatric teaching hospital. Urine cytokine levels of IL-6, TNF-alpha and soluble TNF receptor-1 were measured using a standard enzyme-linked immunosorbent assay technique in children stratified into group 1--11 with vesicoureteral reflux and reflux nephropathy, group 2--6 with vesicoureteral reflux only and no associated nephropathy, and group 3--15 age and sex matched controls. RESULTS: Urinary levels of the cytokines IL-6 and soluble TNF receptor-1 were significantly elevated in group 1 versus group 3 (0.048 to 13.25 pg./micromol. creatinine, mean 3.658 versus 0.027 to 0.677, mean 0.247 and 102.89 to 4,502.9 pg./micromol. creatinine, mean 1,395.3 versus 13.06 to 569.6, mean 145.357, respectively). Neither cytokine in group 2 (0.074 to 10.96 pg./micromol. creatinine, mean 2.94 and 51.52 to 1,115.48, mean 413.137, respectively) was elevated compared to that in group 3. TNF-alpha was not elevated in group 1 or 2 compared to that in group 3 (0.104 to 2.518 pg./micromol. creatinine, mean 0.56, 0.094 to 1.278, mean 0.334 and 0.065 to 0.694, mean 0.241, respectively). CONCLUSIONS: Measuring the urinary levels of the cytokines IL-6 and soluble TNF receptor-1 may be useful as a noninvasive marker of reflux associated renal damage. Further studies with larger patient groups are necessary to locate the source of production of the elevated urinary cytokines measured in our study.

Adolescent↗
PubMed1995

Subureteric Teflon injection (STING). Results of a European survey.

Subureteric Teflon injection (STING) has been successfully used by several investigators for treating vesicoureteric reflux (VUR) in children. This multicentre European survey reviews the results of STING in 6,216 ureters. Twenty-two paediatric surgeons/urologists from 18 centres in Europe answered an enquiry regarding their experience with STING in the treatment of VUR. 6,216 refluxing ureters were injected with Polytef paste in 4,166 children during 1984-1990. There were 975 boys and 3,191 girls. Their ages ranged from 2 months to 14 years (mean 5.1 years). The reflux was grade I in 4.4% of ureters, grade II in 36.1%, grade III in 40.2%, and grades IV and V in 19.3% of ureters. All patients were followed up for periods ranging from 3 months to 81/2 years and 90% were followed up for more than 2 years. 76.3% of all ureters stopped refluxing after a single injection of Teflon paste, cure rate increased to 84.9% after a second injection. A further 10.2% of refluxing ureters showed significant improvement in the grade of reflux after a single injection and needed no further treatment. 1.3% of ureters were cured after a third or fourth injection. Failure to correct or improve VUR was seen in 224 ureters (3.6%), necessitating reimplantation. Twenty ureters (0.32%) developed vesicoureteric junction obstruction following STING and these were reimplanted without difficulty. Results of this multicentre survey confirm that STING is an effective day care procedure for treatment of all grades of VUR. 95% of all ureters were cured or showed significant improvement after two injections of Teflon paste.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Endoscopic correction of vesico-ureteric reflux in duplex systems.

Between May 1984 and April 1990, 37 children with vesico-ureteric reflux (VUR) in 43 duplex systems were treated by endoscopic subureteric Teflon injection (STING). There were 32 girls and 5 boys; the duplex systems were complete in 27 refluxing units and incomplete in 16 refluxing units. All patients had high-grade reflux. In incomplete duplicated systems, VUR was corrected in 14 (87.5%) after a single injection of polytef paste and 2 patients required 2 injections to correct VUR. Of the 27 refluxing units with complete ureteral duplication, reflux was corrected in 16 (59%) units after a single injection of polytef paste, and 3 (11%) units showed improvement of VUR to grade I or II after 1 injection; no further treatment was given. 7 units with complete ureteral duplication required 2-4 injections for correction of VUR. STING failed to correct VUR in 1 duplex system which required a re-implantation. In 93% of refluxing units where VUR was corrected by a single injection, the quantity of polytef paste used was less than 0.3 ml. 36 (97%) of patients were discharged home on the day of the procedure. All patients were followed up for 2-8 years. Of the corrected ureters, there were no recurrences in the incomplete duplicated ureters. 3 of the completely duplicated ureters showed recurrence of reflux at follow-up micturating cystography.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Delayed primary anastomosis for esophageal atresia: 18 months' to 11 years' follow-up.

In 1977 we started treating babies with isolated esophageal atresia by delayed primary anastomosis and in 1981 reported our early experience in five cases treated between 1977 and 1979. Since 1979, 11 further consecutive cases have been managed by initial gastrostomy followed by delayed primary esophageal anastomosis. Their mean gestation was 35 weeks (range, 28 to 40 weeks) and mean birth weight was 2,040 g (range, 1,140 to 2,720 g). The esophageal gap between the two ends when assessed initially at fluoroscopy ranged from 2.2 to 4.5 cm (mean, 3.2 cm). Age at delayed primary anastomosis ranged from 6 to 20 weeks. Anastomotic leak occurred in three babies in the immediate postoperative period and all were successfully managed conservatively. Eight of the 11 patients developed anastomotic strictures; seven cases required 1 to 5 esophageal dilatations. One patient who did not respond to multiple esophageal dilatations required resection of an esophageal stricture. One patient died at 15 months of age of unrelated causes. The 10 surviving patients have been followed-up from 18 months to 11 years. At follow-up, seven patients were eating normally. Three patients had swallowing difficulties and all three were found to have esophageal strictures on barium swallow, two of them also had gross esophageal reflux and hiatus hernia. The height and weight in the 10 patients varied from 3rd centile to 75th centile. Delayed primary anastomosis is feasible in cases of isolated esophageal atresia and the patient's own esophagus is the best. A more aggressive approach should be applied to gastroesophageal reflux in these patients.

Anastomosis, Surgical↗