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Biomedical subjects

R Nambiar

Publications and source records attributed to R Nambiar.

At least 19 recordsLinked to original sources
PubMed1992

Splenic abscess.

Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non-specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases. Pseudomonas species as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choice.

Abscess↗
PubMed1992

Prevalence of protein calorie malnutrition in general surgical patients.

The prevalence of protein calorie malnutrition (PCM) based on ten nutritional parameters was studied in 307 patients undergoing major elective surgical operations. These parameters included anthropometric measurements (weight/height, triceps skin fold thickness, arm muscle circumference) and biochemical (serum total proteins, albumin, transferrin, prealbumin, retinol binding protein) and immunological tests (total lymphocyte count and delayed hypersensitivity test). Using these criteria, the prevalence of PCM was high. Eighty-six percent of patients had at least one abnormal parameter. The prevalence of PCM as judged by weight/height and arm muscle circumference was 49% and 62% respectively. The incidence was higher in cancer than non cancer patients (63% vs 43%). Although serum albumin and total protein levels were normal in 93.5% of patients, acute serum protein markers such as transferrin, prealbumin and retinol binding protein were low in 20-30%. Lymphopenia of 1500 cells/cu mm or less was found in 18% and abnormal delayed hypersensitivity test in 60%. We found that only weight/height, serum protein, transferrin and lymphopenia had predictive values in postoperative morbidity and mortality. By identifying PCM patients early, adequate nutritional support can be given in order to reduce the risk of major surgical complications.

Adolescent↗
PubMed1991

Primary resection and anastomosis in obstructed descending colon due to cancer.

Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.

Adenocarcinoma↗
PubMed1991

Palliative gastrojejunostomy for advanced carcinoma of the stomach.

The outcome of 51 patients who underwent gastrojejunostomy for unresectable gastric cancer with outlet obstruction was studied to evaluate the palliative benefit. The operative mortality and postoperative complication rates were 22% and 55% respectively. The mean duration of postoperative hospital stay was 13 days and median survival period 14 weeks. Delayed gastric emptying occurred in 21%, mostly in patients with extensive tumour involvement of the stomach and was associated with a poor outcome. Among the survivors, 87.5% were able to take a soft diet by the eighth postoperative day and 60% could cope with the progression of the disease at home. We conclude that gastrojejunostomy offers satisfactory palliation in patients with advanced gastric cancer.

Adult↗
PubMed1991

Malignant axillary lymphadenopathy--a problem for management.

Axillary lymph node enlargement can be the first and only manifestation of malignancy. Although lymphoma and metastasis from melanoma, breast and lung cancers are known causes, the primary tumour may remain undetected in some cases despite exhaustive investigations. Therefore, once the diagnosis of malignancy is confirmed by clinical examination followed by histology, further investigations should be limited to a search for treatable malignancies only. Extensive investigations with a hope of discovering the primary is useless and not cost effective. Close follow up may occasionally reveal new clinical signs when further investigations can be justified. This paper reports the clinical approach to diagnosis and management of such cases with examples of illustrative cases.

Adult↗
PubMed1991

Leiomyoma of the oesophagus.

Leiomyoma of the oesophagus is an uncommon lesion but should be considered in the differential diagnosis of younger patients presenting with dysphagia or mediastinal mass. This report deals with the management of 14 cases of leiomyoma seen during a 12 year period.

Adult↗
PubMed1990

Impact of fine needle aspiration cytology on the management of solitary thyroid nodules.

To evaluate the impact of the routine use of fine needle aspiration cytology (FNAC) on the management of solitary thyroid nodules, 102 consecutive patients were assessed in regard to the proportion of patients being subjected to surgery and the corresponding yield of malignancy. This cohort was compared with a historical control where FNAC was not routinely applied as a diagnostic selection criterion. The percentage of patients operated on had decreased from 95% to 60% (P less than 0.001) without any significant decrease in the field of malignancy: 18.6% vs 17.6% (P = 0.97). The yield of malignancy of patients operated on had increased from 18.4% to 26.2%. Of those not subjected to surgery, 14 patients or 14% of the original cohort experienced spontaneous complete resolution of their nodules after a mean follow-up period of 5.5 months (s.d. = 3.5) (non-resected group). In the retrospective evaluation of diagnostic discriminants to maximize yield of malignancy while minimizing unnecessary surgery for thyroid nodules, the use of combined parameters of clinical suspicion, positive FNAC and age greater than or equal to 50 years detected 100% of malignancies with only 50% of patients requiring surgery. This was superior to other modalities including clinical parameters and expensive investigations of radionuclide scans and ultrasonography. In conclusion, the use of FNAC in the evaluation of solitary thyroid nodules has resulted in a decreased proportion of patients requiring surgery and cost saving while maintaining the yield of malignancy.

Adolescent↗
PubMed1990

Primary torsion of the greater omentum. Case report.

Four cases of primary torsion of the greater omentum are reported. The most common clinical picture in this condition mimics acute appendicitis. Primary torsion with spontaneous derotation of the greater omentum may be an important cause of right iliac fossa pain of obscure origin. Scrutiny of the omentum during negative appendiceal exploration is extremely important. Treatment is excision of the twisted, infarcted omentum.

Emergencies↗
PubMed1989

Fine needle aspiration cytology in the management of solitary thyroid nodules--a comparison with other diagnostic modalities in cost-effectiveness.

This paper assesses the cost effectiveness of fine needle aspiration cytology (FNAC) as a selection criteria for surgery in solitary thyroid nodules compared to scintigraphy and ultrasonography. 98 patients who had FNAC and histological confirmation, scintigraphy and/or ultrasonography were studied. The use of combined diagnostic discriminants of positive FNAC, clinical suspicion and age above 50 years detected all malignancies and would have resulted in fewer patients being subjected to surgery--51% (FNAC) vs 90% (Scans, U/S). This resulted in cost savings of $800 per patient seen. We conclude therefore that FNAC should be the diagnostic modality of choice and that the routine use of scintigraphy and ultrasonography is not justifiable.

Biopsy, Needle↗
PubMed1989

Adenocarcinoma associated with chronic anal fistula.

Adenocarcinoma in association with chronic anal fistula is a rare disease entity with a male preponderence in most reported series. The patient typically presents with a long history of perianal disease. Diagnosis is often delayed because of failure to obtain biopsy evidence of the condition. A chronic anal fistula may become malignant. However, despite delay in diagnosis, complete removal which usually entails abdominoperineal resections with wide excision of perianal skin and ischiorectal fossa is necessary to achieve good results. We relate our experience with two such rare cases and a literature review on the current views on the relationship between adenocarcinoma and the occurrence of anal fistula is presented.

Adenocarcinoma↗
PubMed1989

Multiple splenic abscesses following Pseudomonas sepsis.

Splenic abscess is an unusual clinical entity, which in most cases is secondary to metastatic spread of bacteria from a primary site of infection. Before the antibiotic era, Salmonella typhi was a common offending organism but now staphylococci and streptococci are predominant organisms. We report two rare cases of multiple splenic abscesses caused by Pseudomonas infection. One case followed Pseudomonas septicaemia and the other was secondary to Pseudomonas pseudomallei osteomyletis of the femur. Both cases underwent splenectomy and promptly recovered.

Abscess↗
PubMed1989

Major surgery in the elderly--a study of outcome in 295 consecutive cases.

The results of major surgery in 295 consecutive patients over the age of sixty years were analysed. In this series, 70% were electives and 30% emergency cases with a male preponderance of 3:2. The overall mortality was 11.2%. Mortality following emergency operations was three times more than electives. Seventy percent (70%) of deaths after elective surgery followed palliative operations for advanced cancer. For elective surgery, complications of peptic ulcers were associated with a high mortality rate whereas deaths were fairly uniform in the emergency group. In general, concomitant medical diseases and postoperative complications were the major determinants of outcome of surgery in the elderly.

Aged↗
PubMed1988

Breast cancer--the need for early diagnosis.

A retrospective study was undertaken of 265 women with breast cancer treated at the Department of Surgery, Toa Payoh Hospital, Singapore, during 8 years from 1977 to 1985. The average patient was aged 51.0 years, with a tumour 4.9 cm in diameter, staged at T2aN1bMO (Stage II). In comparison with an earlier series from the same Unit, an increase in the number of younger patients was noted, although overall a larger proportion of 'early' cases (TNM Stage I) was found. In contrast to recent western series, breast cancer in Singapore is diagnosed at a later stage and generally unsuitable for conservative treatment by lumpectomy and radiotherapy. The standard treatment was modified radical mastectomy, or simple mastectomy with axillary clearance, followed by Radiotherapy if ipsilateral axillary lymphnodes were histologically involved.

Age Factors↗