Necrotising soft tissue infection of fungal origin in two diabetic patients.
Explore the source record for details and available documents.
Administration, Oral↗
Biomedical subjects
N Ananthakrishnan
Publications and source records attributed to N Ananthakrishnan.
Morbidity and mortality of colostomy and its closure in children.
BACKGROUND: This study evaluated the complications of colostomy and its closure in infants and children. METHODS: One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung's disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis. RESULTS: Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children's age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P =.009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%). CONCLUSIONS: A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.
Abnormalities, Multiple↗
Chronological change in H. pylori antibody titers after treatment and its utility in follow-up.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Can fall in anti-H. pylori IgG titres indicate eradication?
At present, it is not clear whether a fall in serological titres of anti-H. pylori IgG can be used for confirming eradication. A prospective study was conducted using varying cut-off levels from (10% to 50%) fall in anti-H. pylor IgG levels as a test of eradication in comparison to urease and histology. It was found that sensitivity was highest using a 10% cut-off but specificity wasvery low. Increasing cut-off values increased specificity but resulted in declining sensitivity without altering accuracy much. It appears that in the short term, percentage decline in serological titres can at best serve as a crude test of eradication.
Breath Tests↗
Effect of Helicobacter pylori eradication on the ulcer recurrence rate after simple closure of perforated duodenal ulcer: retrospective and prospective randomized controlled studies.
BACKGROUND: The possible advantage of eradication of Helicobacter pylori in patients with perforated duodenal ulcer is unknown. This study was planned to assess the prevalence of H. pylori after simple closure of a perforated duodenal ulcer and to study the effect of H. pylori eradication on ulcer persistence and recurrence. METHODS: Some 202 patients were followed prospectively for 2 years after simple closure of a perforated duodenal ulcer (prospective group). A second group of 60 patients was reviewed 5 years or more after perforation closure (retrospective group). The prevalence of H. pylori in patients with perforated duodenal ulcer was compared with that in controls. Patients in the prospective group were randomized to receive either ranitidine alone or quadruple therapy (ranitidine, colloidal bismuth subcitrate, metronidazole and tetracycline) after operation. The incidence of H. pylori infection after the two treatments and the association with residual or recurrent ulcer were studied. In the retrospective group long-term ulcer recurrence was correlated with H. pylori status. RESULTS: The prevalence of H. pylori in patients with perforated duodenal ulcer was not significantly different from that in controls. At every interval of follow-up in the prospective group and in the retrospective group the H. pylori infection rate was significantly higher in patients who had recurrent or residual ulcers. CONCLUSION: Eradication of H. pylori after simple closure of a perforated duodenal ulcer should reduce the incidence of residual and recurrent ulcers.
Adolescent↗
Island pectoralis major myocutaneous flap for pharyngo-oesophageal strictures prior to oesphagocoloplasty.
Pharyngo-oesophageal strictures are not uncommon in corrosive injuries either alone or in association with dense strictures further down the oesophagus. Strictures at the pharyngo-oesophageal junction require preliminary correction prior to oesophageal bypass since surgical bypass to the pharynx above the cricopharyngeal junction is associated with risk of aspiration. A one stage island pectoralis major myocutaneous flap has been used in four patients who had a non-dilatable dense cricopharyngeal stricture leading to a segment of near normal oesophagus followed by dense stricturing of the thoracic oesophagus. This procedure was followed by oesphagocolic bypass at a second stage from the cervical oesophagus to the stomach. The preliminary pectoralis major flap correction avoids problems such as aspiration or choking associated with pharyngo-colic anastomosis for oesophageal bypass. All four patients had uncomplicated healing. Post-operative endoscopy showed easy passage through the cricopharynx with a dilated cervical oesophagus partly lined by skin. Normal swallowing was restored by a second stage oesphago-colic bypass 6 weeks after the pectoralis major flap repair in two patients while the other two are awaiting the second stage. Island pectoralis major myocutaneous flap is simple, has a dependable vascularity and offers one stage correction for isolated cricopharyngeal corrosive stricture. It can also be used prior to oesophagocolic bypass in patients who have further strictures in the thoracic oesophagus.
Anastomosis, Surgical↗
Prospective randomized comparison of sodium tetradecyl sulphate & polidocanol for oesophageal variceal sclerotherapy.
BACKGROUND & OBJECTIVE: A number of sclerosing agents have been tried for sclerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of oesophageal varices. METHODS: A total of 100 consecutive patients with bleeding oesophageal varices were included in the study. Patients with associated gastric varices and hypersplenism were excluded. Of the 100 patients, 50 received emergency sclerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cent polidocanol, randomized using the sealed envelope technique. Following control of bleeding, these patients were included in the elective sclerotherapy schedule. The remaining 50 patients with past history of bleeding varices received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals. RESULTS: There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute variceal bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0.3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2.7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher than that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetradecyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complications such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fever (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleeding rate and mortality rate were not significantly different between the two groups. INTERPRETATION & CONCLUSION: Polidocanol is superior to sodium tetradecyl sulphate as it has lower incidence of complications, even though the drugs are similar in efficacy in the control of bleeding and obliteration of varices in long-term.
Adult↗
Clinical and sonographic findings in carcinoma of the penis.
PURPOSE: This study was performed to assess the accuracy of high-resolution sonography in measuring penile carcinoma. METHODS: Sonography was performed using a 7.5-MHz linear-array transducer in 59 patients with penile carcinoma. The sonographic measurement of tumor extent was compared with clinical and pathologic measurements. The tumor extent measured by gross pathologic evaluation on cut sections of the fresh penectomy specimen was used as the definitive standard. The echogenicity of the tumor was compared with that of the surrounding normal penile tissue to classify the tumor as hyperechoic, hypoechoic, or of mixed echogenicity (containing both hyperechoic and hypoechoic elements). We evaluated the relationship between the echogenicity of the tumor and both tumor morphology (exophytic or infiltrative) and tumor grade as determined on pathologic examination. RESULTS: The overall mean difference +/- standard deviation in the tumor extent between clinical and gross pathologic evaluation was 3.9 +/- 5.3 mm (range, 1-9 mm), whereas the overall mean difference between sonographic and gross pathologic evaluation was 1.2 +/- 1.7 mm (range, 1-7 mm). As determined with reference to the gross pathologic extent, the error in measuring the extent on clinical examination was significantly greater than the error on sonography (p < 0.001). Lesions involving the glans alone were more often underestimated by clinical examination than were lesions involving the shaft (with or without glanular involvement). The error in measuring the extent of tumor by sonography was not related to the site of the tumor. The tumor was hyperechoic in 21 cases (36%), hypoechoic in 28 cases (47%), and of mixed echogenicity in 10 cases (17%). There was no significant association between echogenicity and tumor morphology or grade. CONCLUSIONS: Sonography gives a more accurate estimate of penile tumor extent than does physical examination. Routine use of sonography for such measurements should enable preservation of more of the penis.
Adult↗
The histological extent of the local spread of carcinoma of the penis and its therapeutic implications.
OBJECTIVE: To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. PATIENTS AND METHODS: Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test. RESULTS: Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. CONCLUSIONS: Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.
Humans↗
Composition of gallstones and sequential events in biliary lithogenesis--is it different in south India compared to north?
AIMS: This study was carried out to determine the gross type and composition of gallstones from South India in order to compare it with published results from the North to see whether the sequential events in biliary lithogenesis are different in these two geographical areas. MATHODOLOGY: A total of 76 stones collected from various hospitals in South India including JIPMER were analysed using X-ray crystallography. Patient characteristics were recorded. Gross typing was done according to Bockus' morphological criteria. RESULTS: Patients with gallstones in South India were found to be older in age with near equal gender distribution. Pigment calcium stones accounted for 56.5%, pigment stones for 17.2% and mixed stones for 14.2% of gallstones. Bilirubin and its salts were the most frequently identified class of compounds by crystallography. Analysis of gallstones layer by layer revealed equal distribution of bilirubin compounds between the centre and outer layers except crystalline bilirubin which was found only in outer layers. Vaterite, a polymorph of calcium carbonate was found in the nucleus, whereas vaterite and aragonite were found in the outer layers. Combination of anhydrous cholesterol and cholesterol II were found in the nucleus. Epitaxial relationship were found to hold good except for vaterite and aragonite. CONCLUSION: Gallstones from South India are probably due to infection rather than supersaturation as evidenced by predominance of pigment calcium stones and various types of bilirubin and calcium carbonate compounds. Vaterite is important for nucleation. Further growth of stones is influenced by epitaxial relationship. These findings are dissimilar to that reported from North India indicating a different stimulus for stone precipitation in these two areas.
Adult↗
Predicting regional lymph node metastasis in carcinoma of the penis: a comparison between fine-needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy.
OBJECTIVE: To evaluate the accuracy of clinical examination and fine-needle aspiration cytology (FNAC) in detecting groin metastases in patients with carcinoma of the penis, and to assess the positive and negative predictive value (PPV, NPV) of a preliminary sentinel lymph-node biopsy (SNB) and biopsy of the most medial of the horizontal group of inguinal lymph nodes (MIN) in selecting patients for an ilio-inguinal block dissection. PATIENTS AND METHODS: The study comprised 28 patients (56 groins) with Stage I (one), Stage II (11) and Stage III (16) carcinoma of the penis. All patients underwent a detailed clinical examination followed by FNAC of the palpable inguinal nodes, and were subsequently submitted for block dissection. The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases. RESULTS: The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both MIN and SN were 100%. The sensitivity and NPV of MIN were higher than for SN, although not significantly so. CONCLUSION: Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection. FNAC is accurate and specific when nodes are palpable; in those with impalpable nodes a preliminary MIN biopsy followed by SNB if the MIN biopsy is negative will accurately select all patients with metastases in the groin nodes. This can be performed by examining frozen sections of the lymph nodes; if positive, block dissection can be carried out at the same time.
Adult↗
Helicobacter pylori infection and erosive gastritis.
One hundred and eleven patients were included in the study. Thirty seven had erosive gastritis, thirty four chronic gastritis and forty were controls without any gastrointestinal diseases confirmed by symptoms and upper gastrointestinal endoscopy. Patients with erosive gastritis were divided into non-steroidal anti-inflammatory drug (NSAID) users and non-users. H pylori status was determined by urease test, serology and/or histology. The prevalence of H pylori was compared between the various groups. The prevalence of H pylori infection in erosive gastritis, chronic gastritis and controls was 68%, 76% and 65%, respectively, the difference was not significant (P > 0.05), 8 out of 11 patients with erosive gastritis and NSAID use (73%) were positive for H pylori. Likewise 17/26 patients with erosive gastritis without NSAID use (65%) were positive for H pylori (P > 0.05). Body of the stomach (65%) was the commonest site for erosions compared to antrum (43%) or fundus (27%) (P < 0.02). H pylori infection does not predispose to erosive gastritis. NSAID use does not affect H pylori prevalence. Routine H pylori eradication is, therefore, not indicated in patients with erosive gastritis infection. Body of the stomach is the most predominant site for erosions.
Adult↗
Bleeding duodenal ulcer: is Helicobacter pylori a risk factor?
Explore the source record for details and available documents.
Adult↗
Tropical vaginal hydroceles: are they all filarial in origin?
Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.
Adult↗
Can regional lymph node involvement be predicted in patients with carcinoma of the penis?
OBJECTIVE: To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre-operatively by clinical and histological parameters. PATIENTS AND METHODS: Seventy-eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes. RESULTS: The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases. CONCLUSIONS: In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow-up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow-up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.
Amputation, Surgical↗
Mid-colon oesophagocoloplasty for corrosive oesophageal strictures.
Corrosive strictures of the oesophagus are common and being long and dense frequently require surgical replacement of the oesophagus. Presently available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of ischaemic necrosis of the colon, cervical salivary fistula or oesophagocolic stenosis. A method of mid-colon oesophagocoloplasty using an isoperistaltic colonic segment from the mid-ascending to the mid-descending colon is reported. The procedure was carried out in 33 patients. The conduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck and abdominal dissection, near-total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of ileocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon available for anastomosis. A wide side to side oesophagocolic anastomosis in the neck, resection and discarding of the bulky terminal ileocaecal segment after completion of the cervical anastomosis, closure of the terminal end of the colon and its placement adjacent to the hypopharynx and end to side cologastric anastomosis complete the procedure. There was no mortality and there was no instance of colonic necrosis. The procedure restored an ability to eat normal food in 93.9% of patients compared to only 39.2% of patients with bougienage.(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗
Accuracy of fine needle aspiration cytology of abdominal masses without radiological guidance.
This study was undertaken to evaluate the accuracy of FNAC of abdominal masses without the help of radiological guidance and to determine factors which affect the outcome of the procedure. Five hundred consecutive patients were studied. FNAC was reported by a single cytopathologist without knowledge of subsequent histology. In calculating indices of accuracy of FNAC only those patients in whom both FNAC and histology reports were available (N = 383) were considered. The overall incidence of unsatisfactory specimens was 5.6%. Consistency of the mass did not affect accuracy of FNAC. However, age (below 12 years) plane of the swelling, mobility of mass and size of the swelling, all significantly affected the adequacy of cytological yield. The overall true positive rate was 100.0% and there were no false positives. The true negative rate was 40.2% and false negative rate was 70.9%. The high false negative rates in hepatic and pancreatic lesions can be reduced by imaging techniques. Luminal organs had poor accuracy rates. The overall accuracy rate was 73.5%, comparable to that reported in literature. A positive diagnosis of malignancy had a 100% predictive value. Overall, it appears that nonguided FNAC is as accurate as guided FNAC except for very small lesions or discrete lesions such as hepatic secondaries where guidance may be useful.
Abdominal Neoplasms↗