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N Umapathy

Publications and source records attributed to N Umapathy.

9 recordsLinked to original sources
PubMed2005

Percutaneous gastrostomy in patients with complete obstruction of the upper digestive tract.

Gastrostomy for nutritional support can be performed radiologically when endoscopic technique is not possible. In patients with complete obstruction of the upper digestive tract, the radiological technique in its conventional method may not be possible, as insertion of naso-gastric tube for gastric insufflation is not always successful. We reviewed our experience of gastrostomy insertion in nine such patients after failure of the conventional method. In seven of the nine patients, initial gastric puncture was achieved with a 22G needle under direct ultrasound visualisation. In the remaining two patients, initial puncture was made into locules of gas in the stomach with fluoroscopy. The stomach was then distended with air and a gastrostomy tube inserted by conventional technique. We conclude that percutaneous gastrostomy can be undertaken safely even in the presence of complete obstruction of the upper digestive tract and recommend this technique in this selective group of patients.

Aged↗
PubMed2005

Persistent epistaxis: what is the best practice?

Epistaxis is the commonest otolaryngological emergency, which is often managed by a nasal pack. A significant number of cases fail to respond to nasal packing and various surgical measures are available to control the nosebleed in these cases. However evidence is sparse regarding the best available surgical option for the management of persistent epistaxis. We designed a retrospective cohort study comparing endoscopic ligation of sphenopalatine artery (ELSA) and all other surgical options (non-ELSA) in the management of persistent epistaxis. All consecutive cases of persistent epistaxis between 1997-2004 (Feb) requiring operative intervention were included in the study and divided in two groups according to the surgical intervention. Postoperative epistaxis was excluded. Non-ELSA group consisted of various procedures including nasal cautery and packing, submucous resection, anterior ethmoid artery ligation, external carotid artery ligation, internal maxillary artery ligation. Both groups were matched for age, sex, risk factors, other medical conditions and medications. The main outcome measures evaluated were immediate success in arresting the bleeding and the mean hospital stay. Recurrence and patient acceptability of the procedure were the secondary variables investigated. We found that ELSA proved to be the best practice to manage persistent epistaxis on all measures of immediate success rate, shorter hospital stay, recurrence rate, and patient satisfaction.

Adult↗
PubMed2004

Buscopan in oesophageal food bolus: is it really effective?

Food bolus (FB) impaction of the oesophagus is one of the more common emergencies in otolaryngology. These patients are managed either conservatively or surgically. The guideline of the American Society of Gastrointestinal Endoscopy (ASGE) suggests that conservative management either with pharmacological agents or with an effervescent agent should be tried for 24 h usually prior to surgical intervention. Various pharmacological agents have been used to dislodge food bolus with varying success rates. We currently use buscopan as a pharmacological agent to dislodge obstruction. Our objective was to evaluate the efficacy of buscopan in the management of oesophageal food bolus. Dislodgement of food bolus and avoidance of oesophagoscopy were taken as a measure of the effectiveness of buscopan. There is no clear evidence in the literature for the time taken for spontaneous dislodgement or the proportion of cases needing oesophagoscopy. Reviewing the results in the last 5 years in our department, we found that food bolus obstruction was relieved in 68% of the patients who had buscopan and in 63% who did not have buscopan. There was no statistically significant difference in both groups (P = 0.37).

Adolescent↗
PubMed2003

Myringoplasty: is it worth performing in children?

OBJECTIVE: To evaluate the results of myringoplasty in children 4 to 14 years old at the time of surgery. DESIGN: Retrospective analysis of case notes for 100 consecutive children who had myringoplasty in a teaching hospital serving as a primary care and referral center. METHODS: Between March 1994 and March 1999, patients 14 years or younger at the time of surgery were identified by the computer database. There were 118 procedures performed in 100 patients (18 had a second procedure performed in the contralateral ear at a later date). Twenty-three patients were excluded because they underwent concurrent mastoid exploration, and 6 others because of inadequate follow-up, leaving 89 cases for analysis. Data from revision procedures were not included. MAIN OUTCOME MEASURES: Graft success was defined as an intact eardrum at 12 months postoperatively and middle ear effusion signaled graft failure. Success in terms of hearing was defined as an improvement in perception of pure-tone thresholds of 10 dB or greater over 2 consecutive frequencies compared with the results of the preoperative audiogram. RESULTS: Closure of perforation was achieved in 90% (80) of patients, but dropped to 88% (78) as 2 patients developed glue ear. Hearing improved in 64 patients (72%), deteriorated in 7 (8%), and remained unchanged in 18 (20%). There was no case of profound hearing loss. CONCLUSIONS: The success rate of myringoplasty in children is comparable to that reported for adults. The incidence of middle ear effusion in grafted ears is not higher than that reported for nongrafted ears, and children who have had myringoplasty can be treated as safely with ventilation tubes as any other children.

Adolescent↗
PubMed2003

Performance of parotidectomy in nonspecialist centers.

OBJECTIVE: To ascertain whether parotidectomy could be safely performed in smaller centers. The results of parotid surgery in a smaller center were reviewed and the major outcome measures compared with the results in the English literature from the best-known centers. DESIGN: Retrospective analysis of case series comprising 168 consecutive parotid surgical procedures in a district general hospital for a 15-year period (1985-1999). The follow-up ranged from 1 to 15 years with a mean of 8 years. Sixty-three patients had a follow-up of over 10 years. Revision procedures and surgery for malignant tumors were excluded from the study. SETTING: Warwick Hospital, a district general hospital in the United Kingdom, catering to a population of 300,000, with a case mix that is typical for a primary care hospital. MAIN OUTCOME MEASURES: Permanent facial palsy, temporary facial palsy, and recurrence rate. Other variables included age, sex, name of the surgeon, histopathologic features of the specimen, duration of follow-up, and other complications. RESULTS: There were 154 consecutive operations within the study period, performed by 2 ear, nose, and throat surgeons and 1 general surgeon. Eight cases were excluded because of cancer or revision, yielding a final figure of 146 for analysis. There were 25 cases of temporary facial palsy and no incidence of permanent facial palsy during the study period. However, recurrence of the tumor was noted in 4 patients, all of whom opted for revision surgery with successful outcomes. CONCLUSIONS: Parotid surgery for benign disease can be as safely performed in smaller centers as in larger centers. However, our study did not support the view that only a specified single surgeon should do parotid surgery, since there is no significant difference in the major outcome measures between different surgeons.

Adolescent↗
PubMed2003

Cervical lymphadenopathy in children.

The management of cervical lymphadenopathy in children varies widely between clinicians. It is recognized that clinical management can be improved by standardizing the diagnostic and treatment methods. This article presents an algorithm based on the available evidence for the management of cervical lymphadenopathy in children.

Algorithms↗
PubMed1999

Removal of a foreign body from the bronchial tree--a new method.

Tracheo-bronchial foreign bodies can be very difficult to remove. This may be related to the location and type of foreign body, the experience of the bronchoscopist and the availability of appropriate instruments. We report a case of an uncommon foreign body in an unusual location in an adolescent in whom conventional attempts to remove it failed. The foreign body was eventually recovered using a flexible bronchoscope and an intravascular wire loop snare under fluoroscopic control. The patient was saved from thoracotomy and possible lobectomy. To our knowledge, this combined fluoroscopic and endoscopic approach for the removal of a difficult tracheobronchial foreign body is the first reported case in the literature.

Adolescent↗