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Biomedical subjects

K V Menon

Publications and source records attributed to K V Menon.

18 recordsLinked to original sources
PubMed2004

Early changes in pulmonary function following thoracotomy for scoliosis correction: the effect of size of incision.

It is generally believed that minimal access surgery may produce less change in pulmonary function than conventional open thoracotomy for scoliosis correction. Though there is considerable literature regarding changes in pulmonary function tests (PFT) after thoracotomy, there is scant data available regarding the effect of the magnitude of thoracic wall disruption on pulmonary function, particularly in the early postoperative weeks. This study aims to evaluate the effect of the size of incision on pulmonary function after anterior release and fusion in patients with moderate thoracic curves due to adolescent idiopathic scoliosis. The study group was made up of 19 patients with thoracic curves due to adolescent idiopathic scoliosis. The subjects had had thoracotomy for anterior release, followed by posterior instrumentation and fusion at a second sitting. The ten patients who had had conventional, large thoracotomy were placed in group A and the nine minimal access cases in group B. PFTs consisting of volume (FVC) and flow (FEV1) were obtained before the anterior release, 2 weeks later (before the posterior instrumented fusion), and 3 months after the posterior fusion. The degree of deformity in the sagittal and the coronal plane preoperatively and postoperatively were measured and documented. The mean preoperative pulmonary function was significantly less than the predicted values for both patient groups. There was a decline in the postoperative pulmonary function (both percentage predicted value and absolute value) in both groups at 2 weeks and at 3 months. The deterioration of pulmonary function was less in the small-thoracotomy group, but this difference between the groups was statistically significant only for the 2-week values. Our study shows that there is significant pulmonary function restriction even in patients with moderate thoracic curves. There was a lesser decline in pulmonary function in the minimal-access group, as compared with the standard thoracotomy group, but this difference was only in the early postoperative period and became insignificant by 3 months.

Adolescent↗
PubMed2003

Multiport staging laparoscopy in esophageal and cardiac carcinoma.

Between February 1993 and September 2000, 320 patients with esophageal cancer were referred to our oesophagogastric unit. One hundred and thirty-three consecutive patients with histologically proven carcinoma of the esophagus were assessed with a view to resection using multiport staging laparoscopy. Multiport staging laparoscopy was performed as a short stay/day case procedure in 133 patients with esophageal and oesophagogastric junctional carcinoma. Multiple ports were used to inspect the liver, omentum, peritoneal surfaces, coeliac/left gastric lymph nodes and obtain biopsies and cytology. Satisfactory assessment was possible in 127 cases (95%). Laparoscopy detected incurable disease in 31 patients (24%), some of whom had more than one contraindication to surgery, including hepatic metastases (n = 10), peritoneal metastases (n = 12) and malignant small volume ascites (n = 5). Lymph node metastases were confirmed histologically by biopsy at laparoscopy in 26 patients (fixed nodes, n = 14; mobile nodes, n = 12). Sensitivity for the detection of liver and peritoneal metastases was 100%, and lymph node metastases were 83%. Specificity for detection of hepatic metastases was 99%, 100% for peritoneal metastases and 82% for lymph node metastases. Ninety-nine patients proceeded to definitive surgery and only two were unresectable. Multiport laparoscopic assessment of metastases in patients with esophageal carcinoma avoids unnecessary surgery and allows for more efficient use of theatre and intensive care time.

Adult↗
PubMed2003

Spinal fixation device: a 6-year postimplantation study.

Long-term tissue response to a metal device is described here. The components of a spinal fixation device were removed 6 years after implantation, following the need for revision surgery after a fall. Scanning electron microscopy (SEM) revealed changes in surface topography of the metal. Examination of the adjacent tissue showed a chronic inflammatory response with occasional metal debris. Immunohistochemistry identified the predominant macrophages and abundant neovascularization. The presence of macrophages in tissues adjacent to the implants, in an otherwise asymptomatic person, is noteworthy.

Bone Plates↗
PubMed2003

Use of epidural analgesia for pain management after major spinal surgery.

OBJECTIVE: This is a retrospective study of the role of postoperative epidural analgesia in major spinal surgical procedures. With the number and complexity of the procedures performed on the spine ever-increasing, this method of analgesia is becoming more important. METHODS: Results of 74 consecutive cases of major spinal surgeries between January 2000 and January 2001 at the Spine Division, Amritha Institute of Medical Sciences and Research Centre, Kochi, India, were studied. 32 cases were posterior procedures and the other 42 were anterior procedures of the thoracic and lumbar regions. The use of various combinations of local anaesthetic and opioid to control postoperative pain after spinal surgery were analysed. RESULTS: 36 (49%) of 74 patients did not require any parenteral supplements. Of the remaining 38 patients who required supplementary parenteral analgesia in the first 48 hours, 25 (34%) received a single dose and 13 (18%) required more than one dose. The number of patients requiring parenteral analgesia immediately after operation were 11; between 2 and 6 hours were 12; and between 6 and 24 hours were 11. Of the 74 patients, 67 had a sound sleep after epidural administration. There were 2 cases of respiratory depression and 2 of transient hypotension. CONCLUSION: Most epidural analgesic regimens significantly reduced postoperative pain, and the requirement for supplementary parenteral analgesics was minimal. Adverse effects were rare, yet we recommend that patients treated with this protocol be managed in high-dependency units.

Analgesia, Epidural↗
PubMed2002

Laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease.

Laparoscopic antireflux surgery has been performed in neurologically impaired and scoliotic children. We aimed to assess the effectiveness of laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease that failed to respond to medical therapy. Data were prospectively collected (symptoms, medical therapy, endoscopies' findings) on 12 children (nine boys, three girls) aged 9-15 years with gastroesophageal reflux disease. Pre- and postoperative ambulatory 24-h pH and DeMeester and Johnson scores were also recorded. Effectiveness of surgery was assessed by comparison of pre- and postoperative total acid exposure time, Visick grade, need for antireflux medication and symptom scores. In total, 11 children underwent a laparoscopic Nissen fundoplication and one underwent a Toupet procedure. Median length of stay was 2 (2-3) nights. The median preoperative pH acid exposure time (AET) was 4.7 (0.8-16.4) percent compared with postoperative AET of 0.4 (0-3) percent. Early postoperative dysphagia occurred in four out of 12 patients, requiring a total of six dilatations. Postoperative Visick scores were: grade I=7 and grade II=5. Laparoscopic fundoplication can be safely performed and is effective in children with GERD who have failed to respond to medical therapy.

Adolescent↗
PubMed2002

Can a district general hospital serving a population of 480,000 offer subspecialty training? --A prospective audit.

BACKGROUND: Subspecialty training has been mostly restricted to teaching hospitals. We aimed to assess whether higher surgical trainees can be offered subspecialty training in a district general hospital serving a large population. METHODS: The surgical unit consisted of four subspecialty firms (upper gastrointestinal, vascular, colorectal and breast/endocrine). Each firm consisted of two consultants, one higher surgical trainee and one basic surgical trainee. The breast/endocrine firm had, in addition, a staff grade surgeon. Trainees collected data prospectively on their subspecialty experience and this was then compared with the subspecialty workload in the respective firms. RESULTS: Subspecialty related workload was 48% on the vascular, 57% on the colorectal and 53% breast/endocrine firms. Subspecialty workload on the upper gastrointestinal firm (27%) was skewed by one non-specialist consultant Trainees on the respective firms were involved in 74% vascular, 82% upper gastrointestinal, 79% colorectal and 54% breast/endocrine index subspecialty operations. Supervision with regards to index operations was 63%, 70%, 81% and 100% on the colorectal, breast/endocrine, upper gastrointestinal and vascular firms, respectively. CONCLUSIONS: 50% of the workload on the vascular, breast/endocrine and colorectal firms is subspecialty-related with the potential for training. With shortened training and some specialities having disproportionately more trainees, higher surgical training committees need to identify more subspecialty units that offer such training.

Cardiology↗
PubMed2001

Bone disease in primary biliary cirrhosis: independent indicators and rate of progression.

BACKGROUND/AIMS: To identify indicators of osteoporosis and to determine the rate of bone loss in patients with primary biliary cirrhosis (PBC). METHODS: Bone mineral density of the lumbar spine and hip was measured at annual intervals over 7 years of follow-up in 176 patients with PBC. RESULTS: Osteoporosis (t-score below -2.5) was found in 20% of patients and occurred 32.1 times more frequently in patients with PBC than expected. Patients with histologic stage 3 or 4 disease had a 5.4-fold increased risk of osteoporosis compared to patients with stage 1 or 2. Age, body mass index, advanced stage (3 or 4), and history of fractures were the only independent indicators of osteoporosis. After 3 years of follow up, the rate of bone loss in patients with stage 1 or 2 increased and equaled that seen in patients with stage 3 or 4. Serum bilirubin level was the only variable independently associated with the rate of bone loss over time. CONCLUSIONS: Severity of the liver disease contributes significantly to the severity of bone disease in PBC. PBC patients who are older, thinner and have more advanced liver disease may have the most benefit from bone density measurements and treatment for their osteoporosis.

Adult↗
PubMed2001

Regional and systemic hemodynamic disturbances in cirrhosis.

In cirrhosis of the liver there is an imbalance between factors mediating vasodilatation such as nitric oxide and factors mediating vasoconstriction such as endothelins. These imbalances result in portal hypertension, hepatorenal syndrome, portopulmonary hypertension, hepatopulmonary syndrome, as well as alterations in cerebral blood flow.

Animals↗
PubMed2001

Late hepatic allograft dysfunction.

1. Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients. 2. Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity. 3. In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management. 4. Recurrence of disease is the most common cause of late hepatic allograft dysfunction. 5. Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation. 6. Major advances have been made in preventing recurrence of hepatitis B by the use of hepatitis B immune globulin in combination with lamivudine therapy. 7. Autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis have a recurrence rate of approximately 20% to 30%. 8. In patients developing recurrence of autoimmune hepatitis, steroid withdrawal is the most common cause. 9. Recurrent hepatocellular cancer can be markedly reduced if strict guidelines are adhered to in selecting patients. 10. Drug hepatotoxicity must always be considered in the differential diagnosis of late hepatic allograft dysfunction.

Biliary Tract Diseases↗
PubMed2001

Pathogenesis, diagnosis, and treatment of alcoholic liver disease.

Alcohol-related liver disease is a major cause of morbidity and mortality in the United States. Alcoholic liver disease encompasses a clinicohistological spectrum, including fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is a benign and reversible condition, but progression to alcoholic hepatitis and cirrhosis is life-threatening. Alcoholic hepatitis is diagnosed predominantly on clinical history, physical examination, and laboratory testing, although liver biopsy is often necessary to secure the diagnosis. The major focus of management is abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Corticosteroid therapy is controversial but should be considered in patients with a discriminant function greater than 32 and/or presence of spontaneous hepatic encephalopathy in the absence of infection, gastrointestinal bleeding, and renal failure. The only curative therapy for advanced alcoholic cirrhosis is liver transplantation. Several recent advances in understanding the pathogenesis of alcoholic liver disease may lead to novel future treatment approaches, including inhibition of tumor necrosis factor a, antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.

Diagnosis, Differential↗
PubMed2000

What do we need to know about non-A-to-E viral hepatitis?

The list of potential hepatotrophic viruses continues to grow, with the recent discovery of the GB virus-C, the TT virus, and the SEN virus. Prevalence rates of the GB virus-C have ranged from 1.2% to 13% among healthy blood donors from all over the world. Higher prevalence rates have been reported among intravenous drug users. Similarly, the TT virus has a global distribution. However, in spite of numerous reports of the presence of both of these viruses in various kinds of liver diseases, definite evidence linking it to a specific disease or illness is lacking. The SEN virus is thought to be a novel viral agent that may be linked to cryptogenic chronic hepatitis, but data are awaited.

Hepatitis Viruses↗
PubMed2000

Managing the complications of cirrhosis.

The 3 major and potentially fatal complications of cirrhosis of the liver result from portal hypertension and include variceal bleeding, ascites, and encephalopathy. The cause of other complications, eg, thyroid dysfunction and hepatopulmonary syndrome, is uncertain. Several recent advances have occurred in the treatment of varices. However, treatment of ascites is still primarily confined to achieving a negative sodium balance, and therapy for encephalopathy centers on the use of lactulose. Although effective therapy may be available for most complications of cirrhosis, a major complication indicates a poor long-term prognosis. Liver transplantation is the only effective long-term treatment of complications due to cirrhosis.

Adrenergic beta-Antagonists↗
PubMed2000

Emergency surgical admissions in patients aged more than 80 years: a study over four decades.

BACKGROUND: The proportion of older patients in the community is rising. The aim of this study was to determine the trend in emergency surgical admissions in patients over 80 years of age in 1997 compared with the previous three decades. PATIENTS AND METHODS: Data were obtained on all patients over 80 years of age admitted as general surgical emergencies in 1997 to the Royal Berkshire and Battle Hospitals, Reading, UK. Reasons for admission, management, mortality and duration of hospital stay were recorded and compared with results from 1966, 1976 and 1989. RESULTS: During 1997, 4807 patients over the age of 80 years were admitted as emergencies to all specialities. Of these, 447 (9.3%) were surgical. This compares with 122 in 1966, 248 in 1976 and 339 in 1989. Emergency surgical workload in patients over 80 years of age had increased from 6.2% in 1966 to 12% in 1997. A random sample of 261 patients was analysed. In-patient mortality was 13.8% in 1997 compared with 21.8% for 1976 and 22.4% for 1989. Median length of stay was 8 days (range, 0-41 days) for 1997 and 1989 compared with 14 days in 1976. Twenty-four patients either needed admission to other specialities or need not have been admitted as emergencies at all and were classified as inappropriate admissions to the general surgical ward. CONCLUSIONS: The trend of increased number of patients over the age of 80 years being admitted as emergencies to general surgery continues through four decades. There has been a decrease in mortality and length of stay since 1966, but no decrease in length of stay in 1997 compared with 1989. Avoiding inappropriate admissions would result in a significant improvement in bed utilisation for elective surgery and help to reduce waiting lists.

Aged↗
PubMed1999

Body mass index, height and cumulative menstrual cycles at the time of diagnosis are not risk factors for poor outcome in breast cancer.

Obesity, height and age at menarche have been shown to be risk factors for the development of primary breast cancer. However, their prognostic influence on breast cancer once it has presented is uncertain. The present study analysed 448 patients with primary breast cancer to determine whether or not body mass index (BMI), height and cumulative menstrual cycles at diagnosis are independent prognostic variables. The effects of all three variables on survival time and disease free interval were estimated. Of the 448 patients after a median follow up of 6 years, 190 (42%) developed recurrence and 162 (36%) had died. Body Mass Index and height could be calculated from available data in 403 patients and cumulative menstrual cycles in 388 patients. There was no evidence of an effect of BMI on survival time (P=0.99; hazard ratio=1.000; 95% Confidence Interval 0.968-1.034) or disease free interval (P=0.92; hazard ratio=1.002; 95% Confidence Interval 0.973-1.031). Similarly, height and cumulative menstrual years did not influence outcome in patients with primary breast cancer. However, nodal status and tumour size were both significant prognostic factors (P<0.001). The present study found no association between Body Mass Index, height and cumulative menstrual years and outcome in patients with primary breast cancer.

Journal Article↗
PubMed1999

Surgical patients with methicillin resistant staphylococcus aureus infection: an analysis of outcome using P-POSSUM.

The significance of MRSA infection in surgical patients was studied using the P-POSSUM scoring system. All surgical patients undergoing operation between 1/10/96 and 30/09/97 were prospectively scored using P-POSSUM. A subset of these patients with MRSA infection was analysed using P-POSSUM predicted mortality. Physiological and operative severity scores were compared with non-MRSA surgical patients and length of hospital stay with P-POSSUM matched non-MRSA controls. Thirty of the 1,132 patients were MRSA positive and of these five died, giving a P-POSSUM observed/expected deaths ratio of 1.7 (not significant; 95% CI -0.24 to 0.10). The P-POSSUM physiology score of 30 MRSA positive patients, compared with the non-MRSA group (n = 1102), was significantly more severe (20.9 v/s 17.4; 95% CI 1.09 to 5.95) as was the operative severity score (15.6 v/s 9.2; 95% CI 4.40 to 8.42). The length of stay for surviving MRSA positive patients was significantly longer than P-POSSUM matched controls. MRSA infection in surgical patients does not increase mortality. However, patients who contract MRSA infection are more debilitated and have undergone a greater surgical insult.

Adult↗
PubMed1998

Inferior vena caval filters: an overview of current use.

Inferior vena cava filters trap dislodged clot and decrease recurrent pulmonary embolism. The main indications are pulmonary embolism or extensive deep vein thrombosis when anticoagulants are contraindicated, and recurrent pulmonary embolism despite adequate anticoagulation. Newer filters trap clinically significant emboli while maintaining patency, making them safe and effective.

Contraindications↗
PubMed1991

Irreducible skin penetration of the ulnar head in Colles fracture--case report.

Three cases out of four of skin penetration by the ulnar head associated with Colles fractures were found to be irreducible. On exploration they had identical pathologic anatomy, viz, buttonholing of the ulnar head between the flexor carpi ulnaris, flexor digitorum profundus, pronator quadratus, and the flexor retinaculum. Incising the flexor retinaculum facilitated reduction.

Adult↗