Biomedical subjects
Publications and source records attributed to N Ananthakrishnan.
A case of giant ureteric calculus 12 cm in length is reported. Only 11 cases of such calculi measuring 12 cm or more have been previously reported in the literature. The relevant features of giant ureteric calculus are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Tumoral calcinosis is an interesting clinical entity. It is not uncommon in certain countries. We report our experience with 22 patients with this condition seen over a 7-year period and review in detail the modalities of clinical presentation, theories of etiogenesis, histological appearances, and treatment modalities.
A trial of omentoplasty was carried out on 20 patients with unilateral filarial lymphoedema to assess its role in the reduction of oedema volume after failed lymphonodo-venous shunt (LNVS) or as a primary procedure. Omentoplasty was done through a midline laparotomy. The omentum was mobilized from the colon, preserving both gastroepiploic vessels, and transferred to the thigh either through the lower end of the laparotomy incision or through a separate stab and placed subcutaneously in the upper third of the thigh. There was no operative mortality. Morbidity was mainly incisional hernia and superficial wound infection. Fourteen of 18 patients had more than 25% reduction in oedema volume during the immediate postoperative period, and 5 of the 18 had more than 50% reduction. However, there was a gradual loss of response with time. Age, gender, grade of lymphoedema, duration, and previous surgery did not influence the outcome. The incidence of incisional hernia could be reduced by transferring the omentum through the midline. There was a statistically significant reduction in postoperative adenolymphangitis attacks whether or not the oedema volume was reduced. In some patients the oedema was reduced sufficiently to permit subcutaneous excision of the lymphoedematous tissue. There appears to be a definite but limited role for omentoplasty in patients who have failed LNVS.
Necrotizing fasciitis is a polymicrobial infection of the skin, subcutaneous tissue, and fascia with a fulminant course and a high morbidity and mortality. It rarely affects the breast. We report a postmenopausal woman presenting with necrotizing infection of the breast requiring mastectomy.
BACKGROUND: Although several studies have been published on lymphonodovenous shunt, there are no objective data either on the outcome of lymphoedema or on various parameters likely to influence the results. METHODS: A trial of lymphonodovenous shunt was carried out in 75 patients with unilateral filarial lymphoedema. The primary aim of the trial was to identify a cohort of responders as against non-responders and to correlate the outcome with various factors such as age, gender, duration and preoperative grade of lymphoedema, number of preoperative attacks of adenolymphangitis, operative impression of the lymph node, effect of venous reflex and type of nodovenous anastomoses. Change in oedema volume was measured objectively by water displacement method using the normal limb as a control. RESULTS: There was no operative mortality. Predominant postoperative complications included wound haematoma (8.5%), wound infection (13.6%) and transient lymphorrhoea (13.6%). In the immediate postoperative period, a reduction of 25%-50% in the oedema volume was recorded in 46.7% of cases and of more than 50% in 17.3% cases. The difference in response with respect to the type of lymphonodovenous shunt was not statistically significant, although the end-to-side type of shunt showed marginally better results. The response was significantly higher in patients with preoperative oedema volume more than 2 L. There was a significant reduction in postoperative attacks of adenolymphangitis, irrespective of the reduction in oedema volume. Of the 75 patients, 22 showed regression of oedema volume to preoperative or higher levels in the postoperative phase. A majority (21/22) could be identified as non-responders within 3 months of surgery. CONCLUSION: The best results of lymphonodovenous shunt were seen in patients with large-volume lymphoedema. The results are better when combined with early excisional surgery. Other factors did not significantly affect the outcome. Non-responders could be identified within 3 months after surgery. Even in patients who did not respond well, a significant decrease in the frequency of adenolymphangitis attacks was observed. Higher initial oedema volume and history of higher frequency (25-50 per year) of adenolymphangitis attacks can be considered as indicators for good response to lymphonodovenous shunt.
H. pylori is currently identified as the dominant risk factor for chronic duodenal ulcer. The effect of surgery in the form of truncal vagotomy and drainage on the H. pylori status is not well known. Forty three patients with obstructed duodenal ulcer who were positive for H. pylori preoperatively by the urease test on the antral mucosal biopsy specimens were recalled for repeat endoscopy and urease test from the same site at 1 month, 3 months, 6 months and more than 1 year after surgery. The H. pylori positivity declined from 100% preoperatively to 69%, 71%, 73% and 80% at these intervals postoperatively respectively. The fall in H. pylori status after surgery was significant at all intervals. Since surgery for duodenal ulcer in the form of truncal vagotomy and drainage is curative for duodenal ulcer in over 90% of patients whereas H. pylori is suppressed in approximately 20% of patients only, it appears that its effect is independent of H. pylori status. Further studies are required to confirm whether a fall in H. pylori positivity in the antrum is absolute or is due to proximal migration of the organism.
BACKGROUND: In India, no study is available regarding the use of operative choledochoscopy in the management of choledocholithiasis. ERCP facilities are not always available at many centres and usually require the expertise of a medical gastroenterologist. In contrast, operative choledochoscopy is a simpler procedure that can easily be learned and practised by many surgeons at the time of CBD exploration. AIMS: To study the role of the flexible choledochoscopy in the diagnosis and management of calculous biliary tract disorders. METHODS: Twenty four patients with choledocholithiasis underwent flexible choledochoscopy. Stones were removed either with Desjardin's forceps or by choledochoscopic instrumentation. Postoperative T-tube cholangiography was done to detect any retained stones. RESULTS: Flexible choledochoscopy was performed in a total of 24 patients. Choledochoscopy was done through a choledochotomy in 23 and through the cystic duct in one patient. The choledochoscope was used following conventional CBD exploration in 18 of the 23 patients. Complete clearance of stones was confirmed by choledochoscopy in 12 of the 18 patients and additional stones were seen in the remaining 6 patients. Fogarty balloon catheter and Dormia forceps were used to extract these stones. A CBD stricture was seen in 4 of these 18 patients and choledochoscopic biopsy was done in one of them. In 5 of the 23 patients, the choedochoscope was used as the initial exploring instrument. Impacted CBD stones were detected in 3 of the 5 patients, external compression of the CBD due to periampullary carcinoma in one and stones in both the ampulla and common hepatic duct in the last patient. Postoperative T-tube cholangiography was done in 10 patients and did not reveal any retained stones. Drainage procedures were carried out in 13 patients: 11 had choledochoduodenostomy and 2 had transduodenal sphincteroplasty. Choledochoscopy was a direct aid in choosing the operative procedure in 21 patients. CONCLUSIONS: Flexible choledochoscopy is the most effective method of CBD exploration and is essential in all patients with choledocholithiasis. No additional morbidity or mortality is caused by this procedure.
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OBJECTIVES: To study the distribution of H. pylori in the stomach before and after truncal vagotomy and drainage (TV + D) for chronic duodenal ulcer. METHODS: Twenty two consecutive patients studied prospectively. H. pylori positivity detected by urease test and histology (Giemsa stain). One or both tests positive indicated positive H. pylori status. Biopsies taken from antrum, body, fundus and stoma (postoperatively) to document H. pylori status before and 6 months after TV + D. RESULTS: Antral prevalence of H. pylori significantly decreased after surgery while fundal colonization significantly increased. No change was seen in body of stomach. CONCLUSION: There is significant redistribution of H. pylori after TV + D. This has important diagnostic implications in evaluation of postoperative symptoms.
BACKGROUND: The operation theatre complex of a hospital represents an area of considerable expenditure in a hospital budget and requires maximal utilization to ensure optimum cost-benefit. There is paucity of data in India on the use of available operating time and the reasons for less-than-optimal utilization have not been studied. METHODS: This audit was done prospectively over a period of 12 months in the department of general surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry. Operation theatre utilization was studied with respect to the starting and closing of the operation theatre, interval between surgical procedures, cancellation of surgical procedures and reasons thereof. RESULTS: The operation theatre was functional for 279 days during the year of the study, and 1773 cases were operated (6.3 cases per day). The total operating time utilized was 91.5%. The major reasons for cancellation of a total of 310 cases were lack of operating time (65.2%), emergency surgery during the elective list (13.9%), and preoperative lack of fitness (11.3%). Among all the lists, 43.6% started late and 63.6% of lists finished well before the scheduled closing time. Absence of monitoring equipment and non-availability of additional qualified anaesthetists necessitated induction of anaesthesia in the main operating room and accounted for 11% of the total operating time. CONCLUSION: Delay in starting lists, under-scheduling, interruption due to emergency surgeries, administrative reasons, induction of anaesthesia and recovery policies are the main factors that account for inefficient use of operating facilities. The correction of these factors would increase the available operating time by nearly 20%.
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INTRODUCTION: There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. METHODS: A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. RESULTS: It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. CONCLUSION: Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.
BACKGROUND: Lymphoedema is a major cause of morbidity in patients with lymphatic filariasis. There is no effective medical treatment and the results of surgery are uncertain. There are very few published studies assessing the volumetric response to the use of sequential intermittent pneumatic compression (SIPC) in patients. METHODS: A 12-celled instrument capable of providing sequential compression from the distal to proximal direction was used in 28 patients with unilateral grades II (n=17) and III (n=11) filarial lymphoedema in a planned 4-week session. The patients were followed up for 6 months after compression therapy by water displacement volumetry. RESULTS: We found that 12 patients with grade II filarial lymphoedema had >26% reduction in oedema volume immediately after compression, but this reduction (>26%) was maintained in only 7 at 6 months. The corresponding figures for grade III filarial lymphoedema were 6 and 4, respectively. The effect in grade III was less sustained than grade II. No complications attributable to SIPC were seen. An added advantage of SIPC was a significant decrease in attacks of adenolymphangitis after compression when compared to pre-compression frequency. These observations were seen even with non-compliance to both foot care measures and use of bandages to maintain reduction in oedema volume. CONCLUSION: SIPC reduces morbidity in filarial lymphoedema though the effect is not sustained. It is simple, easy to use and could form part of the morbidity control programme for lymphatic filariasis.