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Biomedical subjects

K S Neelakandhan

Publications and source records attributed to K S Neelakandhan.

At least 19 recordsLinked to original sources
PubMed2001

Fate of hypertension after repair of coarctation of the aorta in adults.

BACKGROUND: Unrepaired aortic coarctation is known to have a detrimental effect on survival. The benefit of coarctation repair on systolic hypertension in adults has been questioned. This retrospective study was conducted to evaluate the impact of repair of aortic coarctation on systolic hypertension in adults. METHODS: Repair of aortic coarctation was performed in 84 patients aged 16-54 (mean 29) years. All patients were hypertensive before surgical intervention (mean systolic blood pressure 162 mmHg; mean diastolic blood pressure 93 mmHg). All patients underwent echocardiography and/or cardiac catheterization. The peak mean systolic gradient across the coarctation was 60 mmHg. The patients were followed after coarctation repair for between 1 and 12 (mean 5.2) years. RESULTS: There was significant regression of hypertension (P < 0.001) in all patients. Thirty-five patients (42 per cent) did not need any antihypertensive medication 3 months after surgery. The prevalence of hypertension at the last follow-up (after mean 5.2 years) was 31 per cent. CONCLUSION: Surgical repair of coarctation of the aorta in adults leads to regression of systolic hypertension and a decreased requirement for antihypertensive medication.

Adolescent↗
PubMed1999

Aortic arch aneurysms.

Aneurysms involving the aortic arch are formidable surgical challenges. Though the first successful surgery was performed more than 40 years ago, the risk of surgical treatment remained prohibitively high until recently. Intra-operative protection of the brain from ischaemic injury was the main concern. Deep hypothermic circulatory arrest with retrograde cerebral perfusion technique has considerably reduced the risk of surgery to acceptable levels.

Aortic Aneurysm, Thoracic↗
PubMed1996

Response to thymectomy in South Indian patients with myasthenia gravis.

AIMS: The rate of remission among patients with myasthenia gravis (MG) following thymectomy and the predictors of the outcome have revealed vast variation in studies from different geographic regions raising suspicion about the influence of ethnic factors. MATERIAL & METHODS: We retrospectively evaluated the outcome of 71 South Indian MG patients who were thymectomized between 1987 through 1993 and analyzed the relationship between clinical and histopathological features and postthymectomy outcome. RESULTS: The clinical severity of the disease did not differ between the 29 patients with and 42 patients without a thymoma. Seventynine percent of our patients responded favourably to thymectomy; without additional immunosupression therapy, 52% achieved a near-complete remission. An younger age and milder disease correlated with a good outcome. Patients with thymoma responded as favourably as those without a thymoma. CONCLUSIONS: The postthymectomy response of South Indian MG patients in general did not differ from that of Western and Oriental patients.

Adolescent↗
PubMed1996

Right atrial lipoma. Case report.

The authors report the successful excision of a right atrial lipoma in an adult male. The rarity of this lesion, clues to diagnosis and its management are discussed.

Adult↗
PubMed1996

Extracranial carotid artery aneurysms.

This article reviews the etiology, clinical manifestations, operative techniques, and results of management of fourteen cases of extracranial carotid artery aneurysms, operated upon in our institution between September 1990 and August 1994. Except for one, they were elective operations. Aneurysmectomy with restoration of continuity by direct anastomosis was done in four cases, an autogenous saphenous vein graft was performed in one, and prosthetic grafts (Dacron) in three. Local conditions precluded restoration of arterial continuity in two cases. Two patients underwent exclusion and bypass graft, and one underwent exclusion only. Ligation was resorted to in one patient, who was subjected to emergency surgery due to rupture of the aneurysm. A temporary, intra-operative, extraluminal carotid artery shunt was used in only one patient, as all the others had angiographic evidence of satisfactory cerebral cross-circulation. Two patients developed transient, neurological deficits in the post-operative period. There was no mortality. We conclude that aneurysms of the extracranial carotid arteries can be operated on with minimal morbidity and no mortality. Operative management is the treatment of choice because of their potential neurological complications, if left untreated.

Adult↗
PubMed1994

Natural history of aortoarteritis: an angiographic study in 26 survivors.

The natural history of aortoarteritis was angiographically studied in 26 surviving patients (19 female; 7 male). The interval between the initial and current angiographic study was 38-228 months (mean -84.46 months). All patients underwent panaortography during both studies and one patient also underwent pulmonary angiography. The lesions were extensive involving the ascending, arch and the descending thoracic and/or the abdominal aorta (Type III) in 15 patients; localized to the arch alone (Type I) in five patients and to the descending thoracic and/or abdominal aorta in five patients (Type II). Pulmonary angiography in the solitary patient with clinical features of pulmonary hypertension showed occlusion of the lower lobe branch of the right pulmonary artery. The lesions were occlusive in 19 patients, aneurysmal in one patient and mixed in six patients. While four patients developed fresh lesions in the follow-up period, two showed progression of existing lesions and one revealed partial thrombosis of an aneurysm. Persistently elevated erythrocytic sedimentation rate (> 40 mm) was identified as a reliable indicator for activity of inflammatory process and disease progression. The stable nature of the lesions in 20 out of 26 patients in this study indicates a non-progressive course in the healed stage of aortoarteritis and suggests a conservative approach to the management of this disease in all patients except those with severe, life-threatening manifestations.

Adolescent↗
PubMed1994

Abdominal aortic aneurysm repair in a patient with bilateral autotransplanted kidneys.

The case is presented of a 38-year-old male who presented with a large 10 cm x 8 cm pulsatile swelling in his abdomen. Thirteen years before, internal iliac arteries had been used to treat long segment occlusions and diseased state of both renal arteries. At the same time both kidneys had been transplanted to the iliac fossae. Digital subtraction angiography revealed a huge abdominal aortic aneurysm. Both kidneys were fully functional. As the renal transplants had been done extraperitoneally an easy transperitoneal approach was now possible. The maximum diameter of the aneurysm was 12 cm. An inclusion graft repair was carried out using a 16-mm woven Dacron graft. In the light of the favourable circumstances it was decided not to take any special protective measures against renal ischemia apart from keeping the aortic cross-clamp time short. The patient could be discharged with patent and normally functioning kidneys 10 days after surgery.

Adult↗
PubMed1994

Self-expandable stents for tracheal stenosis: experience in two patients.

Two patients with cervical tracheal stenosis, following prolonged ventilatory support, underwent balloon dilatation and expandable stainless steel stent placement across the stenoses. Following the successful release of the stent, there was gradual widening of the stenosed trachea in one patient, while in the other re-stenosis occurred due to columns of tracheal tissue projecting between the limbs of the stent. In the chronically ill and debilitated, use of expandable stents provides a good alternative to complex reconstructive surgery.

Adult↗
PubMed1994

Focal occlusive disease of the common femoral artery: a report of 20 cases.

Occlusive disease localized to the common femoral artery without contiguous involvement of the external iliac and superficial femoral arteries is distinctly uncommon in vascular surgical practice. Twenty patients with focal occlusive disease in 21 common femoral arteries are featured in this report. All except one had severe disabling symptoms: Fontaine classification was stage I in one patient, stage IIb in 13, and stage III in six patients. The probable aetiology, based on clinical features and angiographic observations, was identified as atherosclerosis (nine cases), thromboangiitis obliterans (three) and Takayasu's arteritis (two). Histological features of mucoid vasculopathy, a novel disorder, was seen in one patient while no specific aetiology was evident in five patients. Associated lesions were seen in fourteen patients: aortoiliac in one, femoropopliteal in seven (without any continuity to the common femoral lesion), internal iliac in three and tibial in three. Balloon angioplasty of the common femoral artery lesions was attempted in 14 patients with successful outcome in nine. Three patients (including two with failed balloon angioplasty), underwent thromboendarterectomy and two bypass procedures (iliofemoral, one; femoropopliteal, one). Late reocclusion occurred in one patient each in the angioplasty and surgical groups. There were no procedure-related complications in either group.

Adolescent↗
PubMed1993

Multiple pulmonary-artery aneurysms due to mucoid vasculopathy--angiographic and histological observations.

Multiple peripheral pulmonary artery aneurysms were diagnosed by computed tomography and confirmed angiographically in a 7-year-old boy. On histological examination unusual mucoid vasculopathic changes were noted in the pulmonary artery aneurysms and pulmonary vasculature as a part of systemic vascular involvement. This case demonstrates a new association between mucoid vasculopathic changes and pulmonary aneurysms. Mucoid vasculopathy could represent one more disorder having a causative role in the etiology of intrapulmonary arterial aneurysms.

Aneurysm↗
PubMed1993

Takayasu arteritis: initial and long-term follow-up in 16 patients after percutaneous transluminal angioplasty of the descending thoracic and abdominal aorta.

PURPOSE: To analyze results of percutaneous transluminal angioplasty (PTA) for stenosis of the descending thoracic and/or abdominal aorta caused by Takayasu arteritis (TA). MATERIALS AND METHODS: Subjects were 16 patients (12 female and four male, aged 6-46 years) with symptoms of hypertension or severe bilateral lower limb claudication. Total aortography revealed stenotic lesions in the descending thoracic aorta in five, in the abdominal aorta in 10, and in both vessels in one patient. Involvement of arch vessels in four patients and of the renal artery in four patients was also noted. Double-balloon angioplasty was performed in eight patients. RESULTS: Initial technical and clinical success was 100%. The maximum follow-up period was 52 months (mean, 21 months 2 weeks). Ankle-brachial index as determined with Doppler ultrasound improved considerably in 10 patients. Three patients had symptoms of restenosis during follow-up. Cumulative patency rate by life-table analysis was 67%. CONCLUSION: PTA has a definite role in the management of TA in view of its procedural simplicity, cost-effectiveness, and results compared with surgical revascularization procedures.

Adolescent↗
PubMed1993

Role of angiographic catheters in surgery of popliteal arteriovenous fistulas.

A 50-year-old woman with a chronic, traumatic popliteal arteriovenous fistula was treated surgically by closure of the fistula. Placement of an angiographic catheter across the fistula into the venous sac immediately before surgery helped to locate the fistula accurately and quickly at operation. This simple manoeuvre will facilitate surgical treatment, particularly in cases of long-standing, chronic arteriovenous fistulas.

Angiography↗
PubMedDate not supplied

Hyperperfusion syndrome following balloon angioplasty and bypass surgery of aortic arch vessels: a report of 3 cases.

Hyperperfusion syndrome is a rare complication following revascularization for severe cerebrovascular occlusive disease. We report 2 cases with milder manifestations of this syndrome in the form of unilateral headache following balloon angioplasty of brachiocephalic arteries, and 1 case with massive cerebral hemorrhage after aorto-carotid bypass surgery. The mechanism of autoregulation of cerebral blood flow and the pathophysiology of cerebral hyperperfusion are discussed. The importance of recognizing this phenomenon and possible means of preventing its occurrence are emphasized.

Adult↗