Biomedical subjects

N Anand

Publications and source records attributed to N Anand.

At least 19 recordsLinked to original sources

PubMed1998

Modification of trabeculectomy with single-dose intraoperative 5-Fluorouracil application.

PURPOSE: To assess the outcome of trabeculectomy supplemented with intraoperative 5-Fluorouracil (5 FU) application in glaucoma patients. METHODS: A prospective non-randomized case series of 76 eyes of 76 consecutive patients who underwent trabeculectomy with intraoperative sponge 5 FU (25 mg/ml). Minimum follow-up was 6 months. There were 31 eyes in the low-risk group and 45 eyes in the high-risk group. The reduction in intraocular pressure (IOP) and any treatment complications were noted. RESULTS: The mean preoperative IOP was 28+/-7.72 mm Hg. The mean final postoperative IOP was 16.8+/-6.1 mm Hg. The average number of glaucoma medications required dropped from 1.8+/-0.8 preoperatively to 0.4+/-0.8 after the operation (p<0.001). Cumulative success rates (IOP less than 21 mm Hg) for all eyes were 93% and 81% at 6 and 12 months, respectively. There was no difference in outcome between the low- and high-risk groups if criteria for success were an IOP of less than 21 mm Hg or an IOP of less than 21 mm Hg and an IOP reduction of 30%. However, if success is defined as an IOP of 15 mm Hg or less and a 30% fall in IOP, then the low-risk group had significantly longer survival times than the high-risk group (p=0.033, log-rank test). Transient punctate keratitis and corneal epithelial defect were each observed in only 1 eye. Other serious complications include rapid progression of cataract in 2 eyes, endophthalmitis in 1 eye and hypotonic maculopathy after subsequent cataract extraction in 1 eye. CONCLUSION: Single dose intraoperative 5 FU appears to be a safe and useful adjunct to trabeculectomy. IOPs in the low teens were achieved in a greater proportion of low-risk eyes than high-risk eyes.

Antimetabolites↗

PubMed1998

The effects of perioperative blood salvage and autologous blood donation on transfusion requirements in scoliosis surgery.

Fifty consecutive cases of surgical instrumentation and fusion for adolescent idiopathic scoliosis were prospectively studied to test the hypothesis that the use of predonated autologous blood combined with judicious perioperative blood salvage could decrease the amount of homologous blood needed. All cases had posterior instrumentation and fusion. Nineteen patients had their rib prominence resected with an average of 4.8 ribs per patient. Our protocol called for perioperative blood salvage with the cell saver and reinfusion of postoperative drained blood if more than 300 ml were drained in 4 hours. Two units of predonated autologous blood was made available. Hypotensive anesthesia and meticulous hemostasis kept the blood loss to a minimum. The average total blood loss was 1,055 ml. Blood loss per segment was 91 ml with an average of 11 segments fused per patient. Patients with rib resection had a blood loss of 1,105 ml, while those without had a blood loss of 955 ml. The cell saver blood returned per case was 391 ml with the hematocrit of the product averaging 46%. Twelve patients were reinfused an average of 300 ml of the postoperative drained blood. The predonated autologous blood was used as part of the intraoperative fluid management. In no patient was homologous blood needed. The average starting hematocrit was 35.6%, with the hematocrit at discharge (seventh day) being 32.4%. There were no complications or blood transfusion reactions. Our results suggest that judicious perioperative blood management may decrease the need for homologous blood transfusion in selected posterior idiopathic scoliosis surgery.

Adolescent↗

PubMed1997

Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures.

OBJECTIVE: To determine whether intra-operative spontaneous electromyography (EMG) was superior to somatosensory evoked potentials (SSEP) in the prevention of iatrogenic sciatic nerve injury. DESIGN: Prospective, consecutive. SETTING: Tertiary referral, teaching Hospital in New York City. PATIENTS: Seventy-four patients with acutely displaced acetabular fractures. MAIN OUTCOME MEASURE: Group A consisted of 24 patients who underwent intraoperative sciatic nerve monitoring using SSEP only. Group B consisted of 50 patients who underwent monitoring using both SSEP and spontaneous EMG. Motor potentials were recorded from the tibialis anterior, peroneus longus, abductor hallucis, and flexor hallucis longus muscles. All patients had independent preoperative and postoperative evaluations by the same neurologist. RESULTS: One iatrogenic sciatic nerve injury occurred in group A and none in group B. Prolonged sciatic nerve compromise, demonstrated by significant intraoperative SSEP changes, occurred 2.4 times per case in group A and only 0.8 times per case in group B. In group B, spontaneous EMG noted compromise an average of 3.6 times per case (p < 0.0001). CONCLUSIONS: The results of this study support spontaneous EMG as feasible and superior to SSEP monitoring in detecting intraoperative sciatic nerve comprise in acute acetabular fracture surgery. Spontaneous EMG permits earlier detection of intraoperative sciatic nerve comprise, allowing a more rapid response of the surgical team to noxious nerve stimuli. This may prevent permanent neurologic sequellae.

Acetabulum↗

PubMed1997

Phacoemulsification trabeculectomy compared to other methods of combined cataract and glaucoma surgery.

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.

Aged↗

PubMed1997