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Kalyanakrishnan Ramakrishnan

Publications and source records attributed to Kalyanakrishnan Ramakrishnan.

11 recordsLinked to original sources
PubMed2005

Selecting patients for flexible sigmoidoscopy. Determinants of incomplete depth of insertion.

BACKGROUND: Flexible sigmoidoscopy (FS) is an effective method to prevent and reduce mortality from colorectal carcinoma (CRC). Incomplete depth of insertion (IDI) during FS may result in missed polyps and carcinomas. To determine whether it is possible to predict IDI, the authors analyzed factors that affected the depth of insertion in FS. METHODS: For the current study, FS results were recorded prospectively over a 5-year period. A questionnaire was administered to the patient by the investigator prior to FS to collect data, including age, gender, weight, comorbid illnesses, history of prior abdominal and pelvic surgeries, family history of colon carcinoma or polyps, and prior FS or colonoscopies. The depth of insertion of the flexible sigmoidoscope from the anal verge, which was defined as the reading on the outside of the instrument at its maximal insertion, was measured in centimeters. IDI was defined as a depth of insertion < 50 cm. Classification and regression tree analysis was used to develop a model that included variables predictive of IDI. RESULTS: The best classification tree included gender, age < 69 years (in women), and a history of hysterectomy. Men had a < 5% risk of an IDI and women age < 69 years without a hysterectomy fared as well (6.6%). Older women and younger women who underwent hysterectomy had higher rates of IDI (29.2% and 22.3%, respectively.) CONCLUSIONS: The authors developed a model based on age, gender, and hysterectomy status that, after further validation, may be useful for predicting which patients likely will have an incomplete examination. In those patients who have a high probability of IDI, the choice can be made to offer colonoscopy or perform FS under sedation, with analgesia, or with the help of distraction techniques.

Age Distribution↗
PubMed2005

Diagnosis and management of acute pyelonephritis in adults.

There are approximately 250,000 cases of acute pyelonephritis each year, resulting in more than 100,000 hospitalizations. The most common etiologic cause is infection with Escherichia coli. The combination of the leukocyte esterase test and the nitrite test (with either test proving positive) has a sensitivity of 75 to 84 percent and a specificity of 82 to 98 percent for urinary tract infection. Urine cultures are positive in 90 percent of patients with acute pyelonephritis, and cultures should be obtained before antibiotic therapy is initiated. The use of blood cultures should be reserved for patients with an uncertain diagnosis, those who are immunocompromised, and those who are suspected of having hematogenous infections. Outpatient oral antibiotic therapy with a fluoroquinolone is successful in most patients with mild uncomplicated pyelonephritis. Other effective alternatives include extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole. Indications for inpatient treatment include complicated infections, sepsis, persistent vomiting, failed outpatient treatment, or extremes of age. In hospitalized patients, intravenous treatment is recommended with a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin. The standard duration of therapy is seven to 14 days. Urine culture should be repeated one to two weeks after completion of antibiotic therapy. Treatment failure may be caused by resistant organisms, underlying anatomic/functional abnormalities, or immunosuppressed states. Lack of response should prompt repeat blood and urine cultures and, possibly, imaging studies. A change in antibiotics or surgical intervention may be required.

Acute Disease↗
PubMed2004

Vasectomy: a "seminal" analysis.

Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over the relative merits of the various techniques of isolating and sealing the vasal ends. Postoperative complication rates remain minimal regardless of the technique used, and no single strategy attempting to maximize patient compliance with postoperative semen analysis has enjoyed unmitigated success. Long-term consequences, other than regret, are rare. Finally, issues regarding residency training in the procedure and its impact on procedure morbidity are scarcely addressed in the literature. This study reviews the evolution of vasectomy as a contraceptive procedure and attempts to summarize current literature addressing these unresolved issues.

Clinical Competence↗
PubMed2002

The place of the nasogastric tube.

Physicians frequently take care of patients in hospital and emergency room settings where they have to utilize a variety of invasive diagnostic and therapeutic procedures in patient care. It is important that we be fully aware of the potential for complications and limitations of these techniques. The use of the nasogastric tube in patient care is not without adverse effects, and recent literature has called its routine use into question for a variety of situations. This paper is an attempt to illustrate some of these concerns, and suggests that physicians exercise greater restraint and judgment when considering its use.

Clinical Competence↗
PubMed2002

Incomplete rupture of the esophagus--a case report.

Patients with an intramural rupture of the esophagus are likely to present to the emergency department with a history of vomiting bright red blood and associated chest pain. Most esophageal tears begin as esophageal hematomas. Interventions that induce further emesis can exacerbate the problem, further disrupting the mucosa and esophageal muscle layers. We suggest that naso-gastric tube placement should therefore be avoided whenever possible in situations in which esophageal damage is suspected.

Adult↗
PubMedDate not supplied

Predictors of incomplete flexible sigmoidoscopy.

OBJECTIVES: Flexible sigmoidoscopy (flex sig) is an easily administered method of screening for colorectal polyps and cancer. In some patients, the depth of insertion is incomplete, which may result in missed polyps and cancers. To address the question of prospective patient selection for this procedure, we analyzed the factors affecting depth of insertion of sigmoidoscopies performed in outpatients over a 3-year period. STUDY DESIGN: The study involved retrospective chart review of procedures performed by one endoscopist over a 3-year period. OUTCOMES MEASURED: Variables that might affect the extent of depth of insertion of the flexible sigmoidoscope. RESULTS: We developed separate logistic regression models of incomplete depth of insertion for women and men because sex was an effect modifier for many factors. For women, incomplete depth of insertion was related to inadequate preparation [odds ratio (OR) 3.59; 95% confidence interval (CI), 1.66 to 7.78]. Comparisons were made with the lowest risk group-women younger than 70 years with no hysterectomy. For women younger than 70 years, those with a hysterectomy were more likely to have an incomplete examination (OR 6.89; 95% CI, 2.68 to 17.73). For women 70 years and older, the odds ratio for women with a hysterectomy (OR 2.68; 95% CI, 0.96 to 7.46) was similar to that of women without a hysterectomy (OR 4.79; 95% CI, 2.27 to 10.12). For men, incomplete depth of insertion was related to age older than 75 years (OR 6.51; 95% CI, 1.72 to 30.40), history of abdominal surgery (OR 3.15; 95% CI, 0.95 to 10.41), and weight loss (OR 9.62; 95% CI, 1.98 to 46.67). CONCLUSIONS: Our study showed a relationship between incomplete examination and increasing age, female sex (more than 75% of the incomplete examinations were in women), poor bowel preparation (in women), hysterectomy, abdominal surgery (in men) and weight loss (in men). Further research is necessary to determine whether a predictive model can be developed that would be useful to select patients most appropriate for flex sig. In those patients in whom difficulty is anticipated, the choice can be made in to perform flex sig under sedation, analgesia, with the help of distraction techniques, or offer primary colonoscopy.

Age Factors↗