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Biomedical subjects

G Ravichandran

Publications and source records attributed to G Ravichandran.

At least 19 recordsLinked to original sources
PubMed2006

Modified Girdlestones-Taylor procedure for claw toes in spinal cord injury.

STUDY DESIGN: A combination of review of case notes and outpatient follow-up. OBJECTIVE: To evaluate the effectiveness of the modified Girdlestones-Taylor procedure in patients with spinal cord injury (SCI). SETTING: Princess Royal Spinal Injuries Centre (PRSIC), Northern General Hospital, Sheffield, UK. METHODS: Nine patients with claw toe deformities to 27 toes were treated at the PRSIC from 1996 to 2005. After examination of their medical records, their toes were assessed for pain, residual deformity and stiffness. They were also asked to grade their satisfaction with the surgical outcome. The results were tabulated. RESULTS: The average age of our series of patients was 43.3 years. The mean time from injury to surgery was 20.4 years and the mean time from surgery to last follow-up was 37.3 months. All our patients had good to excellent results, with over 70% of the toes having excellent results. CONCLUSION: The modified Girdlestones-Taylor procedure for claw toe correction appears to be a safe and effective treatment for patients with SCI.

Adult↗
PubMed2006

Comprehensive findings on clinical, bacteriological, histopathological and therapeutic aspects of cutaneous tuberculosis.

OBJECTIVE: To define the bacteriological and histological correlates of the three predominant clinical forms of cutaneous tuberculosis and to evaluate the efficacy of a 9-month daily regimen containing rifampicin and isoniazid. METHODS: In the dermatological clinics of two major teaching hospitals in Chennai, 213 patients with suspected clinical manifestations of cutaneous tuberculosis underwent examination and a skin biopsy for bacteriological and histological tests. They were treated with a daily regimen of rifampicin and isoniazid for 9 months and follow-up for 3 years. RESULTS: Bacteriological and/or histological confirmation of tuberculosis was obtained in 88% of the cases. Lupus vulgaris lesions were seen mainly in the extremities and verrucosa cutis occurred predominantly on the sole and foot, while the cervical and axillary regions were the commonest sites for scrofuloderma. Ninety-two per cent of the patients showed resolution of the lesions within the first 6 months of chemotherapy; 1% failed to respond to this regimen. There was no relapse in any of the cases during the follow-up period of 3 years. CONCLUSIONS: Clinical findings were adequate to identify major forms of cutaneous tuberculosis as evidenced by bacteriological and histopathological examination. A daily regimen of rifampicin and isoniazid for 9 months was effective in treating cutaneous tuberculosis.

Adult↗
PubMed2002

A comparison of heparin/warfarin and enoxaparin thromboprophylaxis in spinal cord injury: the Sheffield experience.

OBJECTIVES: To compare the safety and effectiveness of two different thromboprophylactic protocols in the management of patients with spinal cord injury - one using heparin/warfarin and the other using enoxaparin. STUDY DESIGN: Retrospective. SETTING: Princess Royal Spinal Injuries Unit, Sheffield, UK. METHODS: Retrospective review of two cohorts of patients with acute spinal injury admitted to a supra-regional spinal injuries centre and treated with different pharmacological agents. One group received heparin/warfarin in combination with antiembolism stockings and mechanical measures for thromboprophylaxis whereas the second group received enoxaparin in combination with the other measures. Patients who developed clinical symptoms suggestive of deep vein thrombosis or pulmonary embolism were investigated as appropriate. RESULTS: Four of the 101 patients on heparin/warfarin developed symptoms of venous thromboembolism compared to 13 of the 72 who were on enoxaparin. Of the 13, three had been on 40 mg of enoxaparin daily and 10 on 20 mg enoxaparin daily. Six patients on enoxaparin and one patient on warfarin developed thromboembolic complications after they had been mobilised and the anticoagulant discontinued. Eight patients on warfarin prophylaxis and three patients on enoxaparin developed haemorrhagic complications necessitating cessation of therapy. CONCLUSION: This study suggests that the traditional protocol of warfarin/heparin for thromboprophylaxis in spinal cord injury patients remains a safer option than enoxaparin.

Acute Disease↗
PubMed2001

Observations of transient high temperature vortical microstructures in solids during adiabatic shear banding.

By using a unique infrared high-speed camera especially constructed for recording highly transient temperature fields at the microscale, we are able to reveal the spatial and temporal microstructure within dynamically growing shear bands in metals. It is found that this structure is highly nonuniform and possesses a transient, short range periodicity in the direction of shear band growth in the form of an array of intense "hot spots" reminiscent of the well-known, shear-induced hydrodynamic instabilities in fluids. This is contrary to the prevailing classical view that describes the deformations and the temperatures within shear bands as being essentially one-dimensional fields. These observations are also reminiscent of the nonuniform structure of localized shear regions believed to exist, at an entirely different length scale, in the earth's lower crust and upper mantle.

Journal Article↗
PubMed2001

Neuropathic lumbar spondylolisthesis--a rare trigger for posture induced autonomic dysreflexia.

STUDY DESIGN: Case report. OBJECTIVES: Description of a rare trigger for autonomic dysreflexia. SETTING: Princess Royal Spinal Injuries Unit, Sheffield. METHODS AND RESULTS: A case of Charcot's spine (neuropathic spinal arthropathy) in a woman with a traumatic T5 paraplegia is described. She developed symptoms of autonomic dysreflexia, brought on by changes in posture. The postural variation was attributable to a freely mobile neuropathic spondylolisthesis at the L4/5 level. A laminectomy performed for the implantation of a sacral anterior root stimulator was identified as a causative factor in the development of the neuropathic joint. Surgical stabilisation and fusion resulted in amelioration of her symptoms. CONCLUSION: Neuropathic spine is a rare cause of autonomic dysreflexia that should be considered when other more common factors have been excluded. The development of Charcot's spine in the spinal cord injured population is facilitated by surgical procedures involving the vertebrae.

Autonomic Dysreflexia↗
PubMed2001

The biopsychosocial model and spinal cord injury.

OBJECTIVE: To highlight the importance of taking the psychological, social and biological aspects into consideration when dealing with somatic complaints of spinal cord injured patients. SETTING: Supra-regional Spinal Injury Unit in the UK. STUDY DESIGN: Case study series. MATERIAL AND METHODS: The somatic complaints of four patients with spinal cord injury were assessed and their relationship to psychological and social issues were correlated. Two patients suffered unexplained pain, another excessive spasm uncontrolled with intrathecal Baclofen pump and the fourth with several pressure sores, constipation and other physical problems. The impact of psychosocial issues on the somatic complaints were analysed. RESULTS: In all four patients the resolution of their psychosocial issues resulted in significant gains vis-à-vis their somatic complaints. CONCLUSION: Psychological and social issues of spinal injury patients could have a serious impact on the resolution of somatic complaints. It is important to take these into consideration in their treatment.

Adaptation, Physiological↗
PubMed2001

Efficacy and safety of butenafine in superficial dermatophytoses (tinea pedis, tinea cruris, tinea corporis).

Superficial dermatophytoses of skin are very common infections seen in clinical practice. Besides topical imidazoles, triazoles and allylamines, topical butenafine (a benzylamine derivative) is a novel agent with broad antifungal activity. One hundred and eleven patients with tinea infections were enrolled in this multicentric, randomised, single-blind non-comparative study, which involved application of butenafine (1%) cream in tinea pedis (4 weeks) and tinea cruris and tinea corporis (2 weeks) cases. The results showed that butenafine causes rapid resolution of signs and symptoms (erythema itching, burning, crusting, scaling, etc), with good patient and physician acceptability of treatment. The broader spectrum fungicidal activity and better drug retention in superficial skin layers may be responsible for this beneficial effect.

Administration, Topical↗
PubMed2000

Evaluation of safety and efficacy of ketoconazole 2% and zinc pyrithione 1% shampoo in patients with moderate to severe dandruff--a postmarketing study.

A postmarketing study was conducted on 236 patients from 23 centres suffering from moderate to severe dandruff with a combination of ketoconazole and zinc pyrithione (1%) for a duration of 4 weeks with 2 weeks further follow-up. Scoring of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at each week up to 6 weeks. The results indicate that there was a consistent improvement in dandruff scores over the treatment period and a reduction of > 90% was seen for all areas of scalp individually as well as collectively as compared to baseline. The treatment also showed significant improvement in other signs and symptoms such as erythema and itching, with a highly favourable adverse event profile. The overall assessment for global improvement by investigators showed good-excellent results with high acceptability amongst the patient population for the treatment. A combination shampoo of ketoconazole (2%) and zinc pyrithione (1%) offers a safe and effective option in the treatment of dandruff.

Adolescent↗
PubMed1995

Intrathecal baclofen--a multicentre clinical comparison of the Medtronics Programmable, Cordis Secor and Constant Infusion Infusaid drug delivery systems.

A retrospective review was carried out of 34 consecutive traumatic spinal cord damaged patients who have had the Medtronics Programmable, Cordis Secor or Constant Infusion Infusaid intrathecal baclofen drug delivery systems inserted between July 1987 and 1992. The results indicate that whilst this treatment has many benefits there is a significant risk of complications, some potentially fatal. It should only be provided by a skilled and experienced team. The Medtronics Programmable pump is an excellent pump. It is of particular benefit where the therapeutic window is small or fine-tuning required. The Constant Infusion Infusaid is adequate if less precise control and continuous infusion is sufficient. It is of particular benefit in financially disadvantaged countries. The Cordis Secor device is helpful when unpredictable intermittent relief of spasticity is required but is otherwise limited by its complication rate.

Adolescent↗
PubMed1987

Transrectal ultrasonography compared with voiding cystourethrography after spinal cord injury.

Transrectal ultrasonography was compared with voiding cystourethrography (VCU) in 27 patients after spinal cord injury. Both techniques gave clear images of the bladder and posterior urethra. Ureteric reflux, intraprostatic reflux and anterior urethral diverticula were seen only on VCU. Ultrasonography showed soft tissue detail and muscle contraction not seen on VCU. Other advantages of ultrasonography included the lack of radiation hazard, allowing prolonged observation; no contrast medium was required and this eliminated the need for catheterisation.

Humans↗
PubMed1983

The accuracy of a hand-held real time ultrasound scanner for estimating bladder volume.

In a prospective study using a portable real time ultrasound scanner, 82 estimations of the bladder volume were made in male patients with neurogenic bladder and these were compared in each case with the measured volume of urine obtained by catheterisation performed immediately after estimation. A further 25 estimations/measurements were made in patients in whom the bladder volume was less than 150 ml. Both studies showed that the scanner offered a reproducible and safe alternative to catheterisation for estimating bladder volumes. The accuracy is sufficient for most clinical purposes.

Humans↗
PubMed1982

Missed injuries of the spinal cord.

Damage to the spinal cord had not been recognised initially in 15 patients out of a consecutive series of 353 admitted over a decade to the National Spinal Injuries Centre with paralysis due to trauma to the cord. In some patients the missed diagnosis led to mismanagement and a greater neurological deficit. Missed injuries of the spinal cord are seen in patients with multiple injuries and head injuries and in those without any paralysis. Various radiological errors contribute to the failure to recognise the vertebral injury. In addition to causing severe disability to the victim these missed and mismanaged injuries of the spinal cord cost the National Health Service large sums in compensation. A careful evaluation of the history of each accident, with greater awareness of the potential of certain types of accidents to cause spinal cord injury, should reduce the incidence of missed injuries of the spinal cord.

Accidents↗