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Biomedical subjects

N Ananthakrishnan

Publications and source records attributed to N Ananthakrishnan.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch.

BACKGROUND: Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome. METHODS: A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid. RESULTS: Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. CONCLUSION: Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.

Adult↗
PubMedDate not supplied

Bacterial adherence to cotton and silk sutures.

BACKGROUND: Silk and cotton sutures are the most commonly used materials for skin closure, the choice being largely based on tradition. We undertook this study to compare the bacterial adherence in vitro to these two materials because it is well known that the physicochemical characteristics of a suture material influence its ability to attract bacteria and consequently promote wound infection. METHODS: We determined the bacterial adherence in vitro to cotton and silk for Staphylococcus aureus and Escherichia coli, common organisms found in postoperative infection at our institute, using three inoculum strengths. The sutures were incubated with the organisms and bacterial counts per suture material calculated after 20, 60, 120 and 180 hours of incubation. The bacterial counts for the sutures were then compared at these intervals. RESULTS: The bacterial adherence for both organisms at all time intervals was significantly greater to silk than to cotton, except at 60 hours for Staphylococcus aureus. The bacterial count for each suture material appeared to be an intrinsic property of the suture and did not vary with the concentration of the bacteria in the initial inoculum. The cost of an equivalent thickness of silk is 50 times that of cotton. CONCLUSION: We suggest that cotton should be the preferred suture for skin closure because bacterial adherence to it is lower and it is much cheaper than silk.

Bacterial Adhesion↗
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Diagnostic peritoneal lavage (DPL)--is it useful decision making process for management of the equivocal acute abdomen?

Patients with a traumatic or non-traumatic acute abdominal conditions often have equivocal findings regarding the need for surgery. Ultrasound and computed tomography, though useful, have limitations and not always available in peripheral hospitals. Diagnostic peritoneal lavage (DPL) was investigated as an aid to decision-making in such patients. After preliminary X-ray and ultrasound, DPL was performed in 50 patients with an equivocal acute abdomen (18 trauma, 32 non-trauma). It was found that overall sensitivity, specificity, accuracy, and positive and negative predictive values were high for patients with trauma. All the above parameters except specificity and negative predictive value (NPV) were also found to be high for the non-trauma group. DPL was found to be a bedside investigation, which helped in taking the decision to operate on patients with both traumatic and non-traumatic acute abdomen.

Abdomen, Acute↗
PubMedDate not supplied

Can duodenal ulcer perforation be linked to herpes simplex virus infection?

BACKGROUND: Both Herpes simplex infection and duodenal ulcer recur frequently, tend to remain localized, and show remissions and exacerbations. Published data on a link between the two are contradictory, and there are no data on the association of Herpes simplex infection with perforated duodenal ulcer. METHODS: 187 patients in four groups were studied: group I--controls (n = 35), group II--non-ulcer dyspepsia (n = 35), group III--chronic non-perforated duodenal ulcer (n = 35), and group IV--perforated duodenal ulcer (n = 82). Titers of IgG antibodies against HSV-1 and HSV-2 were determined using enzyme immunoassays. RESULTS: The seropositivity rate for both HSV-1 (80%) and HSV-2 (77%) was high in the control population. Among patients with perforated duodenal ulcer, antibodies against HSV-1 (94%) but not those against HSV-2 (83%), were found more frequently than in groups I and III. HSV-1 seropositivity was significantly higher in patients with a short duration of preperforation symptoms. Absolute titers for both anti-HSV-1 and anti-HSV-2 were higher in patients with perforated duodenal ulcer than in controls and those with chronic non-perforated duodenal ulcer. CONCLUSION: Herpes simplexvirus, especially HSV-1, may have a role in the causation of perforated duodenal ulcers.

Duodenal Ulcer↗
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Anterior or posterior gastro-jejunostomy with truncal vagotomy for duodenal ulcer--are they functionally different?

Truncal vagotomy with gastrojejunostomy (GJ) is the standard treatment for chronic cicatrizing duodenal ulcer with gastric outlet obstruction. We tried to determine if a significant functional difference exists in the early and late outcomes following anterior and posterior types of GJ to treat this condition. The case records of 106 patients who underwent truncal vagotomy and GJ at our institute from 1 January 1995 to 31 December 1999 were studied retrospectively. Patients were followed up with a personal interview. Perioperative and long-term parameters were compared in the anterior and posterior G.I. groups. Sixty-five patients (61.32%) were followed up; 31 in the anterior group and 34 in the posterior group. The median follow-up was 5 years (range 2.5-7.5 years). Except for a significant difference in length of afferent loop (p < 0.0001), there were no significant differences in the duration of hospital stay, nasogastric aspirates on postoperative days 1, 2, 3 and 4 and the day the nasogastric tube was removed. Early postoperative complications were uncommon and not different in the two groups and long-term outcomes were similar. The Anterior GJ, being technically easier and needing less operative time, may be advocated in all cases of chronic duodenal ulcer, with gastric outlet obstruction requiring truncal vagotomy and drainage.

Duodenal Ulcer↗
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Evaluation of long-term results of choledochoduodenostomy for benign biliary obstruction.

The role of choledochoduodenostomy (CDD) in the management of lower common bile duct (CBD) obstruction is controversial because of the long-term complications such as ascending cholangitis, sump syndrome and alkaline reflux gastritis. In spite of the good long-term results observed in some studies, CDD is considered a last trial for lower CBD obstruction. This study was done to analyze the efficacy and long-term results observed in patients who underwent CDD. A total of 21 patients who underwent side-to-side CDD for various causes of lower CBD obstruction from 1992 to 2002 in our institute were analyzed retrospectively. Symptoms, indications and complications were noted from the hospital records. Long-term follow-up evaluation was done through personal communication, examination, and subsequent ultrasonography and endoscopy in symptomatic patients. The most common presenting symptom was abdominal pain (95.2%) and the most frequent indication for CDD was multiple CBD stones (61.9%). Eighteen of the 21 patients (85.7%) had a normal postoperative recovery without any complications. One patient (4.8%) had an anastomotic leak and peritonitis, and 2 (9.5%) had wound infection. Long-term follow-up was possible in only 15 patients as the others were lost to follow-up. Nine patients (60%) were asymptomatic and 6 (40%) were occasionally symptomatic (abdominal pain and bilious vomiting), to an extent which did not affect their day-to-day life. Recurrent or retained stones were not noted, in any patient. All 6 symptomatic patients showed duodenogastric reflux but alkaline reflux gastritis was seen in only 1 patient (6.66%). Anastomotic stoma was patent in all the patients subjected to endoscopy. Features of cholangitis or sump syndrome were not noted in any patient. Side-to-side CDD is a safe and definitive procedure for the decompression of lower CBD obstruction. It has good long term results with infrequent complications.

Adult↗
PubMedDate not supplied

Handgrip strength and endurance as a predictor of postoperative morbidity in surgical patients: can it serve as a simple bedside test?

Postoperative morbidity is related to preoperative nutritional status. Current methods of assessing this are cumbersome, lack sufficient accuracy to completely separate all those at risk from others, and require a laboratory backup. This study was done to evaluate handgrip manometry, a simple bedside test as an indicator of preoperative nutritional status to predict risk of postoperative complications. Normal values for maximal grip strength and endurance times were established in 496 controls. Similar values were recorded in 100 patients undergoing elective surgery preoperatively. Postoperative variables studied included complication rate and hospital stay. The efficacy of four parameters, serum albumin, clinical nutritional score based on subjective global assessment, maximal grip strength (MGS), and grip endurance time, in predicting complications were studied. It was found that age and presence of co-morbidity increased risk of complications. Of the four predictive parameters studied, it was found that MGS is better than serum albumin. Clinical scoring was superior to MGS in predicting risk of complications. MGS is a simple bedside test, which can be easily performed. It can be used as a complimentary test to clinical scoring in identifying patients at risk of complications after surgery. Patients with abnormal MGS require urgent preoperative correction to reduce the risk of complications.

Adolescent↗
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Spontaneous antegrade enteral migration of feeding jejunostomy tube.

Spontaneous migration of enteral feeding tubes is unusual. We report an 18-year-old man with corrosive stricture of the upper esophagus in whom feeding jejunostomy was performed using an 18F Levine's tube. Thirteen months later, he presented with absence of the tube. The patient was tolerating liquid diet and was managed conservatively. Serial radiographs and colonoscopy showed a steady progress of the tube through the gut. The tube was passed out spontaneously after 20 days.

Adolescent↗
PubMedDate not supplied

Effect on gallbladder function subsequent to truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer.

The effect of truncal vagotomy on gallbladder function and on the incidence of lithogenesis has remained controversial. A prospective and retrospective investigational study was undertaken to evaluate the effect of truncal vagotomy and gastrojejunostomy on gallbladder function. The study included a total of 76 patients and 77 controls. In Group I (Prospective group), 32 consecutive patients with chronic duodenal ulcer and gastric outlet obstruction undergoing truncal vagotomy and gastrojejunostomy were included. Group II included 25 age and gender matched controls (prospective group). Group III included 44 patients who had undergone truncal vagotomy and gastrojejunostomy 3 years or more prior to presentation (Retrospective group) and Group IV included 52 age and gender matched controls for the retrospective group. The patients in the prospective groups were followed up for a period of 1 year. An alkaline tide test was done in the prospective and retrospective group to assess for the completeness of vagotomy. Gallbladder contractile response to fatty meal and the presence of stones and sludge were noted in all the four groups by ultrasonography. There were 30 patients in the prospective group and 40 in the retrospective group after excluding patients with incomplete vagotomy. On ultrasound examination, there was no significant difference in the gallbladder volume and contractility of the study group when compared with the controls. Gallbladder sludge was found in 16 to 25% of patients in the prospective group (group I) during follow up, where as similar finding was documented in 8% of the matched control (group II (P>0.1). However, in the retrospective (group III) 10% (4 out of 40) had calculi and 20% of patients demonstrated sludge which was significantly higher when compared with the controls (p = 0.001). Truncal vagotomy and gastrojejunostomy did not affect gallbladder contractility, but it might predispose to the formation of sludge and subsequent calculi in a proportion of patients in long term.

Adolescent↗
PubMedDate not supplied

Role of eradication of Cag A Helicobacter pylori in non ulcer dyspepsia.

The role of Helicobacter pylori (H.pylori) in patients with non ulcer dyspepsia (NUD), the relationship of the virulence of the organism to the occurrence and severity of NUD and the need for eradication of H. pylori in alleviating symptoms of NUD remain controversial. This study was carried out for the purpose of determining the interaction between virulent H.pylori and symptoms of NUD and to clarify whether H. pylori eradication is beneficial in-patients with NUD. Sixty consecutive patients who fulfilled standard criteria for the diagnosis of NUD and who were positive H. pylori status by the urease test were studied. NUD was classified into ulcer-like and dysmotility-like as per standard criteria. All patients were treated with a triple drug regimen for H. pylori for 10 days, which consisted of Clarithromycin, Amoxicillin and Omeprazole. Blood was drawn for IgG antibodies against Cag A strains and H. pylori by ELISA. All patients were evaluated at 6 months for symptomatic improvement, which was, correlated with Cag A H. pylori positive status. No significant difference was seen in the H. pylori Cag A prevalence between ulcer-like and dysmotility-like dyspepsia. While there was a trend towards a better symptomatic improvement with H.pylori eradication in patients with ulcer-like NUD as opposed to dysmotility-like NUD, this did not reach significance (73% vs. 57%, p= 0.18). However "there was a statistically significant benefit of eradication of H. pylori in-patients with ulcer-like NUD who were positive for Cag A H.pylori status (p=0.02). No such benefit was seen in-patients with dysmotility-like NUD. H. pylori eradication seems to confer significant benefit as regards symptomatic relief inpatients with ulcer like NUD who are positive for Cag A strain for H. pylori.

Adult↗
PubMedDate not supplied

Improvement in dysphagia and quality of life with self-expanding metallic stents in malignant esophageal strictures.

BACKGROUND: Carcinoma of the esophagus often presents at an advanced stage, with absolute dysphagia or aspiration. Palliative procedures have an important role in improving the quality of life (QOL) of patients who are not candidates for curative therapy. We report on the efficacy and complications of self-expanding metallic stents (SEMS) in such patients. METHODS: Ultraflex nitinol SEMS were placed under endoscopic guidance in patients with malignant esophageal strictures. Dysphagia, pain and QOL were assessed before and after SEMS placement. RESULTS: Thirty patients were treated with SEMS. QOL score improved significantly from 62-94 before stenting to 80-133 after the procedure. There was improvement in dysphagia grades. Pain was the most common complaint noted on follow up. There was no major morbidity or mortality related to the procedure. CONCLUSIONS: SEMS placement is a safe and effective treatment modality for palliation of dysphagia due to malignant esophageal strictures. It provides lasting relief in dysphagia and improvement in QOL, without major complications.

Deglutition Disorders↗
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Combined x-ray diffraction and microchemical gallstone analysis in determining the sequential events in biliary lithogenesis.

Seventy-five gallstones were analyzed layer by layer by x-ray diffraction and microchemical techniques. Microchemical analysis showed that protein was present in 96% of stone nuclei. Application of x-ray diffraction analysis to biliary calculi revealed that cholesterol in three crystalline polymorphs and the three forms of calcium carbonate were the predominant crystalline components. "Cholesterol" and "mixed calculi" revealed differences in their composition. The value of the application of multiphasic qualitative analytical techniques to gallstones is discussed and the pattern of the probable sequence of events in the formation of "mixed" gallstones indicated. It appears that in this process of biliary lithogenesis epitaxy may play a significant role especially in the growth of calculi after formation of the nidus.

Bile Pigments↗