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Biomedical subjects

M L Prasad

Publications and source records attributed to M L Prasad.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1986

Serious complications of sulfasalazine.

Whereas minor side effects of sulfasalazine are common, serious adverse reactions to this drug generally are considered rare. However, this report discusses three major complications of sulfasalazine that occurred within the past three years, one resulting in the death of a patient. As more patients with inflammatory bowel disease are being managed by physicians of various disciplines, it is important to become familiar with the potentially dangerous side effects of all medications prescribed. For this reason, a brief review of the pharmacology, clinical use, and toxicity of sulfasalazine is presented.

Absorption↗
PubMed1986

Preoperative antimicrobial preparation of the colon with povidone-iodine enema.

To evaluate the efficacy of povidone-iodine enemas as a means of preoperative bowel preparation in colonic surgery, 52 mongrel dogs were randomized into two groups. Group 1 received oral neomycin-erythromycin combinations in the usual clinical doses, while Group 2 received a single 500-ml 5 percent povidone-iodine enema preoperatively. Quantitative bacterial counts obtained at the time of colonic resection revealed that povidone-iodine was equally effective in reducing the anaerobes, but was significantly superior to neomycin-erythromycin combinations in reducing the aerobic colony counts. Bursting pressures, measured three weeks later, were equal in both groups. Despite elevated blood-iodine levels, no systemic toxicity was noted in Group 2 dogs. It is concluded that half-strength povidone-iodine, given as a single enema preoperatively, is equally effective as standard preoperative antibiotic preparations and may be the ideal preparation in urgent or emergency colonic operations. Due to reported toxicity of povidone-iodine in burn wounds, we suggest that initial trials be limited to emergency cases where the potential benefits possibly will be greater than the theoretic risk of iodine toxicity.

Animals↗
PubMed1985

Anal carcinoma presenting as a perirectal abscess or fistula.

In five years, 15 patients were seen with anal carcinomas presenting as perirectal abscesses or fistulas. Nine patients had acute abscesses without histories of chronic anorectal disease, and six patients had long-standing anorectal disease in which carcinoma developed. Operative exploration was needed to establish the diagnosis in all patients. Early definitive surgery would certainly have prevented most if not all of the cancers from developing in the group with chronic anorectal disease.

Abscess↗
PubMed1985

Early local complications from intestinal stomas.

A retrospective review of 610 consecutive patients with intestinal stomas constructed at Cook County Hospital, Chicago, was carried out to analyze early local complications with respect to stoma type and to compare complication rates by surgical specialty. A total of 197 complications were recognized in 158 patients for a corrected complication rate of 25.9%. Peristomal skin irritation (42.1%) was the most frequently recognized early complication in this study. Ileostomy was associated with the highest morbidity (40%) of any type of stoma. Emergency stoma formation seems to be associated with the highest complication rates, probably because of suboptimal stoma placement. The morbidity of stoma formation seems to be related to the amount of formal training in gastrointestinal tract surgery. Technical guidelines for stoma construction are presented to help minimize these complications.

Adolescent↗
PubMed1985

Ileoanal anastomosis 24 years after total proctocolectomy for ulcerative colitis.

The efficacy of constructing an ileal pouch in association with an ileoanal anastomosis after mucosal proctectomy has been well established. Ordinarily, the pouch is fashioned at the time of mucosal proctectomy. This report describes a patient whose end ileostomy was successfully converted to a J-pouch 24 years after intersphincteric resection of his rectum for ulcerative colitis. Postoperative anal manometric data are presented, and the potential for applying this operation to other patients who have had previous intersphincteric rectal resections is discussed.

Anal Canal↗
PubMed1985

Parasacrococcygeal approach for the resection of retrorectal developmental cysts.

Congenital developmental cysts are the most common retrorectal tumors. Five adult patients, two men and three women, with congenital developmental cysts were operated on via a posterolateral approach through a parasacrococcygeal incision. All wounds healed primarily with no infection or other complications. Recurrent perianal infections and repeated anorectal operations suggest the possibility of retrorectal growths; thus diagnosis requires physician awareness. Computerized tomography is the best preoperative diagnostic test to delineate anatomy and to rule out bony involvement. Because of an infection rate of approximately 30 percent, as well as the presence of symptoms and malignancy in 8 percent of the patients, surgical excision is the treatment of choice. The authors use a posterolateral approach that provides excellent exposure and obviates the need for removal of the coccyx or transection of the sphincter muscle. The authors believe this to be the procedure of choice for excision of retrorectal cystic lesions.

Adult↗
PubMed1985

A survey of technical considerations in the construction of intestinal stomas.

Reported complications rates for the construction of intestinal stomas are high. Many of these complications result from improper construction, improper location, or other technical errors. In order to sample the techniques of stoma construction currently in use, a survey was conducted at the 69th Annual Clinical Congress of the American College of Surgeons in Atlanta in conjunction with our scientific exhibit "Complications of Intestinal Stomas." A total of 245 surgeons completed the questionnaire with a mean age of 47.8 years. The routine use of fascial-seromuscular tacking sutures and primary maturation of a loop colostomy in the presence of distal obstruction were among the most controversial technical points considered. Many other subtle but important principles of stoma construction were also discussed. In addition, the authors contend that many of the techniques currently in use result from an underemphasis on the importance of proper stoma construction in many surgical training programs.

Adult↗
PubMed1984

End-loop ileocolostomy for massive trauma to the right side of the colon.

In patients with severe trauma to the right side of the colon, who might have intraoperative contraindications to primary ileocolostomy, we use a new technique called end-loop ileocolostomy, which allows for complete diversion of the fecal stream with the distinct advantage that it precludes the need for formal laparotomy at the time of subsequent closure. This has been used successfully in eight patients.

Colon↗
PubMed1984

Perianal abscesses and fistulas. A study of 1023 patients.

In a five and one-half year period, 1023 patients with anorectal abscesses and fistulas were treated. Under regional anesthesia the abscesses were unroofed and debrided and a primary fistulotomy was performed whenever a low fistula was identified. In 355 (34.7 per cent) an internal fistulous opening was demonstrated at the time of abscess drainage. Thirty-two patients had suprasphincteric fistulas and underwent two-stage fistulotomy using a seton. Perianal abscesses were encountered in 42.7 per cent of the patients, followed by ischiorectal (22.7 per cent), intersphincteric (21.4 per cent), and supralevator (7.33 per cent). The patients with supralevator and intersphincteric abscesses had a high incidence of fistula identified during abscess drainage. The recurrence rates were 3.7 per cent in the group with abscess drainage only and 1.8 per cent in the group that had primary fistulotomy along with abscess drainage. The follow-up period averaged 36 months. To accomplish adequate drainage and identify the deeper components and associated fistulous opening (34.7 per cent of the entire group), careful examination under regional anesthesia is recommended. Early aggressive treatment of an anorectal abscess and fistula significantly reduces the possibility of recurrent abscesses and/or the need for further surgery.

Abscess↗
PubMed1984

End-loop colostomy.

A new method of "end loop" colostomy is described which avoids the conventional large bulky loop colostomy. The proximal and distal lumens can be easily irrigated or studied. The possibility of prolapse of the distal limb of the colostomy is minimized. After proper training in irrigation, the patients are able to use a stoma cap instead of colostomy bags.

Colostomy↗
PubMed1983

Bacteremia associated with lower gastrointestinal endoscopy: fact or fiction? II. Proctosigmoidoscopy.

In an effort to elucidate whether bacteremia occurs during endoscopic examination of the lower gastrointestinal tract, two prospective studies were undertaken involving patients undergoing colonoscopy and proctosigmoidoscopy. The former group has been presented earlier, and the second study, which includes the proctosigmoidoscopy group, is the basis for this study. Fifty-seven patients undergoing proctosigmoidoscopy were studied. Excluded from the study were patients with fever, diarrhea, inflammatory bowel disease, valvular heart disease, vascular prosthesis, chemotherapy, and immunosuppression. Aerobic and anaerobic blood cultures were taken before, during, and after proctosigmoidoscopy. Additional cultures were taken after a biopsy or polypectomy. Skin cultures were taken from the venipuncture site prior to venipuncture. No bacteremia was demonstrated. Three blood cultures were positive, but all were considered contaminants on the basis of the nature of organisms. No correlates could be drawn as to the depth of insertion, length of time, or position of patient during the procedure. It is concluded that no significant bacteremia occurs during proctosigmoidoscopy. Further studies are warranted in the excluded high-risk group.

Biopsy↗
PubMed1983

York Mason procedure for repair of postoperative rectoprostatic urethral fistula.

Rectoprostatic fistula is a rare complication after transurethral resection of the prostate or prostatectomy for benign and malignant neoplasms of the prostate. Repair of these fistulas is difficult, especially when previous treatment includes radiation therapy to the prostate. Various operative approaches have been described to close these inaccessible fistulas. Because of their location near the outlet of the pelvis, access to or exposure of these fistulas is quite limited. These fistulas can be easily exposed and repaired through the posterior wall of the rectum (transsphincteric approach). Three patients with rectoprostatic urethral fistulas were repaired successfully by using this method.

Aged↗
PubMed1983

Recurrent anorectal abscesses.

A prospective study of 100 recurrent anorectal abscesses in 97 patients was carried out to elucidate the cause of recurrence. Sixty-four patients had had one, 12 had had two, and the rest had had more than two prior abscesses. In 32 patients, the previous diagnosis was erroneous; the patients had hidradenitis suppurativa which was excised. In 68 patients, the cause of recurrence was insufficient prior treatment. Thirty-one patients (45 per cent) had fistulous abscesses requiring fistulotomy. Twenty-two patients (32 per cent) had large abscesses associated with fistula necessitating unroofing of the abscess along with fistulotomy. In 15 patients (22 per cent), no associated fistula was detected, but they were found to have missed components (i.e., ischiorectal, supralevator, postanal abscesses) and were successfully treated with drainage of the missed abscess component. All recurrent abscesses must be examined carefully under anesthesia to identify associated fistulas or missed components, or to exclude hidradenitis suppurativa.

Abscess↗
PubMed1983

The role of seton in fistulotomy of the anus.

A five year experience with 45 patients who underwent two stage fistulotomies using seton has been reviewed. The use of seton in suprasphincteric fistulas yields excellent anatomic and physiologic results. It is recommended that a seton be used in all high, complex and suprasphincteric fistulas or when there is doubt as to the extent of the sphincter muscle involved in the fistulous process.

Abscess↗