PubMed Health⌕ Search

Biomedical subjects

M L Prasad

Publications and source records attributed to M L Prasad.

At least 19 recordsLinked to original sources
PubMed1992

Multifactorial index of preoperative risk factors in colon resections.

Our aim was to analyze the predictive value of a variety of preoperative risk factors on operative outcomes. We reviewed all colorectal resections performed in a single hospital between January 1985 and May 1990. Nine hundred seventy-two resections were performed on 825 patients. We studied 17 preoperative risk factors generated from various medical risk categories. Using the multivariate discriminant function analysis, we calculated that 11 of the 17 risks were of significance in predicting outcomes (all with P less than or equal to 0.031). These factors included emergent operation, age greater than or equal to 75 years, congestive heart failure (CHF), prior abdominal or pelvic radiation therapy, corticosteroid use, albumin less than 2.7 g/dl, chronic obstructive pulmonary disease (COPD), previous myocardial infarction (MI), diabetes, cirrhosis, and renal insufficiency. The classification function generated by the discriminant analysis was used to categorize patients into one of four risk groups depending on their "risk score." The index used to develop each patient's "risk score" ranged from six points for an emergency operation to one point for diabetes. The mortality rates for the various risk groups were as follows: Group 1, zero to four points, 1 percent; Group 2, five to eight points, 10 percent; Group 3, 9 to 13 points, 19 percent; Group 4, greater than 13 points, 33 percent. In contrast to previous reports, we showed that age greater than or equal to 75 years alone is not a major preoperative risk factor but, rather, acts as a modifier for the other predictors of postoperative complications. We then assessed clinical questions concerning specific preoperative risks, such as steroid use, obesity, inflammatory bowel disease, COPD, and prior laparotomy, and their associated specific postoperative complications and have developed prevention strategies based on these findings. Through the use of the risk index, we also were able to assess an individual patient's operative risk more accurately.

Adolescent↗
PubMed1992

Solitary spinal osteochondroma causing neural syndromes.

Three cases of solitary osteochondroma of the spine are reported. Two presented with cervical myelopathy and one with radiculopathy. Plain radiography or tomography is adequate for the diagnosis in the majority of cases; nevertheless, a CT scan or MRI is of immense help in planning surgical treatment. The radiological features of spinal exostoses are reviewed.

Adolescent↗
PubMed1992

Idiopathic inflammatory myopathy: clinicopathological observations in the Indian population.

The present study attempts to investigate the pathological basis of the two clinically different forms of idiopathic inflammatory myopathy (IIM) namely, polymyositis (PM) and dermatomyositis (DM). Clinicopathological analysis of 73 cases showed that muscle fibre necrosis and regeneration were more frequent in PM than in DM, the latter being significantly so (P < 0.05). On the other hand, vasculitis was more associated with DM while perifascicular atrophy of the muscle fibres was confined to it. Vasculitis was present in eight cases. Its incidence in patients with myositis with systemic connective tissue disease (4/9) was significantly more than in other PM and DM patients (P < 0.01). An equally significant higher frequency of perimysial inflammatory infiltrate was also seen in the former as compared to the latter. Interestingly, idiopathic DM affected men as often as women and juvenile IIM affected boys more frequently than girls. A female predilection was noted in the remaining groups of IIM. These observations indicate that there may be some basic immunopathogenetic differences between polymyositis and dermatomyositis as well as between idiopathic PM/DM and that associated with systemic connective tissue diseases. Though the number of patients studied is small, the absence of female predilection in idiopathic DM and juvenile IIM may be peculiar to the IIM in the tropics.

Adolescent↗
PubMed1992

Anorectal manometry.

Anorectal manometry is used in the treatment of complex anorectal disorders, such as fecal incontinence and intractable constipation. In a 3-year period at one institution 308 anorectal manometries were performed. A total of 168 procedures were performed for complaints of fecal incontinence, 77 for constipation, and the remainder for a variety of anorectal disorders. Anorectal manometry in those under 20 years of age was performed most often to differentiate Hirschsprung disease from functional constipation, as well as to provide a differential diagnosis related to congenital anorectal anomalies. In patients between the ages of 21 and 40 years, evaluation of fecal incontinence (especially obstetrical injuries) was most significant. Fecal incontinence accounted for twice the number of anorectal manometries for those between the ages of 41 and 60. For those over 60 years of age, the majority of anorectal manometries were done for fecal incontinence rather than for constipation (nearly a 4:1 ratio). Anorectal manometry is a valuable physiologic adjunct in the evaluation, diagnosis, and treatment of organic and functional disorders of the anorectum.

Adolescent↗
PubMed1991

Medulloblastoma with extensive calcification.

Calcification in cases of medulloblastoma has been described with varying frequency (10%-15.4%) on computed tomographic (CT) scan. Usually these calcifications are small in size and speckled. The authors report a case of medulloblastoma with extensive calcification in the lateral hemisphere of the cerebellum in an 18-year-old boy.

Adolescent↗
PubMed1991

Fibrosarcoma of the scalp following postoperative radiotherapy for medulloblastoma.

A rare case of fibrosarcoma of the scalp following postoperative radiotherapy for medulloblastoma is reported. A review of similar cases in the literature was undertaken in an attempt to find a correlation between the dose of radiation, the length of the latent period, and the nature of the neoplasm. A significantly shorter latent period was found for sarcomas. No relationship was observed between the radiation dose and the latent period. The present case is unique in that the post-irradiation neoplasm (PIN) occurred in a predominantly extracranial site after treatment for a desmoplastic medullobastoma and had a remarkably short latent period.

Cerebellar Neoplasms↗
PubMed1991

Bilateral gluteus maximus transposition for anal incontinence.

Seven patients (five men and two women) ranging in age from 26 to 65 years (means = 44) underwent bilateral gluteus maximus transposition for complete anal incontinence. The indications for operation were sphincter destruction secondary to multiple fistulotomies (n = 4), bilateral pudendal nerve damage (n = 2), and high imperforate anus (n = 1). The procedure is performed without the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated, and tunneled subcutaneously to encircle the anus. The ends are then sutured together to form two opposing slings of voluntary muscle. Postoperatively, six patients regained continence to solid stool, two to liquid stool as well, and only one patient in this group was able to control flatus. Although resting pressures remained unchanged, voluntary squeeze pressures were restored by this operation. In addition, rectal sensation was markedly improved, which helps make this a worthwhile procedure for properly selected patients.

Adult↗
PubMed1991

Rodless end-loop stomas. Seven-year experience.

The rodless, end-loop stoma was developed as an alternative to the more traditional loop stoma to minimize patient management problems. A retrospective review of our seven-year experience in 229 patients with end-loop colostomies (135), ileocolostomies (70), and ileostomies (24) is presented. A total of 30 stoma-related complications were observed in 27 stomas, for an overall complication rate of 13.1 percent. The most common complications were skin excoriation secondary to leakage (3.5 percent), retraction (3.5 percent), partial necrosis (2.6 percent), and peristomal sepsis (1.8 percent). Mucocutaneous separation, prolapse, and stenosis were each seen in less than one percent of patients. No cases of stomal herniation, obstruction, or hemorrhage were encountered. Twelve deaths occurred, but none was attributed to stoma-related complications. The rodless, end-loop stoma is a simple and safe procedure with many advantages and a low incidence of complications.

Adolescent↗
PubMed1991

Inverted U-pouch construction for restoration of function in patients with failed straight ileoanal pull-throughs.

Patients who have undergone straight ileoanal pull-through operations without a reservoir in adult life frequently have unsatisfactory results. Operative correction of this problem has been difficult. We propose a new operation that preserves the ileoanal anastomosis, constructs a reservoir, and has resulted in good restoration of bowel function in three patients. The operative procedure consists of division of the ileum 30 cm above the dentate line. The distal ileum is then folded over itself so that the point of division reaches into the pelvis, between the rectal muscular cuff and pulled-through ileum, to a point just proximal to the dentate line. The two limbs of ileum are connected using a stapler, completing the reservoir construction. The proximal divided ileum is anastomosed, end-to-side, to the pouch. A protective ileostomy that can be closed in three months is constructed.

Adult↗
PubMed1991

Defecography as part of the evaluation of anorectal dysfunction.

Defecography is the evaluation of the anus and rectum during the act of defecation. We have devised a very simple method of performing this examination in conjunction with the Radiology Department. The entire procedure takes less than 15 minutes from start to finish. In our hospital, we have performed over 130 of these tests. A high level of patient cooperation has been noted in our experience. For the most part, the entire procedure from bowel preparation to final films is well tolerated.

Barium Sulfate↗
PubMed1991

Lymphocytic hypophysitis: can open exploration of the sella be avoided?

A case of lymphocytic hypophysitis (LYHY) in a menopausal woman is presented. A review of the literature suggests that conservative treatment may be tried in suspected cases of LYHY, if the vision of the patient is not threatened. A transphenoidal stereotactic biopsy of the mass may be performed if the patient fails to improve or deteriorates, thus avoiding open exploration of the sella in selected cases.

Adult↗
PubMed1990

HLA-B27, arthritis and spondylitis in an isolated community in Papua New Guinea.

Rheumatic complaints in a sample of 109 individuals from an isolated community in Papua New Guinea were documented and 92/109 were tissue typed for HLA-B27. Eleven (10.1%) subjects had active peripheral arthritis, but 38 (34.9%) had previously suffered an episode of arthritis. In those with current peripheral arthritis, 6/10 (60%) were HLA-B27 positive compared to 15/58 (25.9%) with no history of arthritis (P less than 0.05). In total, 16/34 (47.1%) with either current or a previous history of peripheral arthritis were HLA-B27 positive compared to the 15/58 (25.9%) with no history of arthritis (P less than 0.05). Back pain was common. In 84/109 individuals the cause was mechanical injury; 24/72 (33.3%) of these were HLA-B27 positive. Ankylosing spondylitis was identified in one HLA-B27-negative woman.

Adolescent↗
PubMed1990

Papillary carcinoma of a thyroglossal duct remnant with Hashimoto's thyroiditis.

A rare case of papillary carcinoma of the thyroglossal duct remnant with Hashimoto's thyroiditis of the nonneoplastic ectopic thyroid tissue and the thyroid gland is described. The need for fine-needle aspiration cytologic examination in the management is stressed. The prognosis is excellent when the tumor is limited to the ectopic thyroid tissue and managed by a combination of the Sistrunk procedure and subtotal thyroidectomy followed by long-term thyroid suppression.

Adult↗
PubMed1988

Antigen and haplotype frequencies at three human leucocyte antigen loci (HLA-A, -B, -C) in the Pawaia of Papua New Guinea.

The genetic profile of the Pawaia, a seminomadic, linguistic isolate from the highlands fringe of Papua New Guinea, is described in terms of antigen and haplotype frequencies at three class I human leucocyte antigen loci (HLA-A, -B, and -C). The Pawaia, like other Papua New Guinea populations, exhibit restricted polymorphisms at all three loci studied, both in the number of alleles segregating and in the level of average heterozygosity. An extremely high frequency (52.9%) of HLA-B27, the antigen implicated in the pathogenesis of seronegative arthropathies, was found. A novel HLA-C locus specificity, CNG, resulting probably from a gene duplication event, was also observed in significant numbers. Although the gene frequency comparisons suggest their strong affinities with the highlanders, the Pawaia haplotypes reveal significant admixture from other neighbouring groups as well. The usefulness of HLA haplotypes in tracing the movements of human populations in the New Guinea area is discussed.

Anthropology, Physical↗
PubMed1986

Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse.

This report describes a one-stage perineal operation for the treatment of complete rectal prolapse aimed at restoration of anal continence in addition to resection of the prolapsed segment of rectum. This procedure was performed on 25 patients, most of whom were elderly or debilitated, over the past three years without local or systemic complications. Significant improvement in continence was seen in 88 percent of the patients within four weeks of operation, and in the remainder of the patients, within three months postoperatively.

Aged↗