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Biomedical subjects

S Govil

Publications and source records attributed to S Govil.

At least 19 recordsLinked to original sources
PubMed2006

Using the ovarian vein to find the ovary.

Computed tomograms of 68 adult women who had undergone contrast-enhanced, 5-mm helical computed tomography of the abdomen and pelvis were retrospectively reviewed to determine whether the ovarian vein could be used to locate the ovary. Subjects were 17 to 84 years of age (mean 45 years); 31 scans were normal, and 37 showed pelvic masses. Both ovarian veins were identified at their termination and were followed into the pelvis by scrolling through the set of venous phase images with a manual cine-paging tool. All 68 left ovarian veins and 67 of 68 right ovarian veins were identified. All visualized ovarian veins led to a normal ovary or to an ovarian mass. There were no anatomic variations. In 13 ovaries displaced by pathology in the pelvis, the ovarian vein was correspondingly displaced and indicated the altered ovarian position. In all 14 patients with non-ovarian pelvic masses, ovarian veins led to the normal ovary; the vein and ovary were markedly displaced in three of these patients. On computed tomography, the ovarian vein can be consistently identified. By tracing the vein into the pelvis, the ovarian or non-ovarian nature of a pelvic mass can be determined.

Adolescent↗
PubMed1999

Value of splenic preservation during distal pancreatectomy for chronic pancreatitis.

BACKGROUND: Pain relief after distal pancreatectomy for chronic pancreatitis is reportedly satisfactory in 50-80 per cent of patients. This study attempted to determine clinical and radiological features that might select patients likely to benefit from distal pancreatectomy, and whether splenic preservation influenced the outcome. METHODS: Thirty-eight patients with chronic pancreatitis, who underwent distal pancreatectomy between 1982 and 1998, were reviewed retrospectively. The outcome of surgery was correlated with the aetiology of pancreatitis and radiological appearance on endoscopic retrograde cholangiopancreatography and computed tomography. RESULTS: Good results were achieved in 23 of 36 patients for whom follow-up (median 48 months) was available, including all 11 with obstructive pancreatitis. The spleen was preserved in 22 patients. Twelve patients became diabetic after surgery: three of 20 in whom the spleen was preserved and nine of 16 who underwent splenectomy. CONCLUSION: Non-alcoholic patients with a normal pancreas proximal to a dominant ductal stricture had a consistently good outcome from surgery. Spleen-preserving distal pancreatectomy, although technically demanding, can be performed safely with results equivalent to those of distal pancreatectomy with splenectomy or autotransplantation. Splenic preservation, apart from preventing postsplenectomy sepsis, might also delay the onset of diabetes.

Adult↗
PubMed1999

Efficacy of non-breath-hold magnetic resonance cholangiography at midfield strength.

The efficacy of non-breath-hold magnetic resonance (MR) cholangiography at mid-field strength (0.5 Tesla) was evaluated for delineating biliary anatomy and the cause and extent of biliary obstruction. We performed 65 MR cholangiograms on a mid-field 0.5 Tesla MR unit and correlated them with contrast cholangiography and/or surgery. MR cholangiography was found to be both sensitive and specific in the detection of biliary obstruction and in the definition of its cause (sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 85.7%, accuracy 98%). MR cholangiography accurately predicted the level of obstruction in 94 per cent of strictures. Normal caliber intra-hepatic biliary radicles were visualised in only 6 per cent of the MR cholangiograms. In contrast, 94 per cent of dilated intrahepatic biliary radicles were demonstrated. The confluence, and right and left hepatic ducts were visualized in 98 per cent; the gall bladder in 65 per cent; the cystic duct in 45 per cent and the cystic duct insertion in 25 per cent. The extrahepatic bile duct was seen in 82.7 per cent. A normal caliber pancreatic duct was seen in 18 per cent while a dilated pancreatic duct was seen in 86 per cent. The pancreatico-biliary junction was visualised in 7 per cent. Non-breath-hold MR cholangiography at midfield strength is a highly accurate method of evaluating the cause and level of biliary obstruction, comparable to high-field MR cholangiography. The spatial resolution however is inadequate for the detection of variations in biliary or pancreatic ductal anatomy when the ducts are of normal caliber.

Adolescent↗
PubMed1998

Problem in diagnostic imaging: pancreaticoduodenal arcade in splanchnic arterial stenosis.

This paper features a problem in diagnostic imaging in which a pre-transplant abdominal angiogram of a potential liver recipient shows filling of the hepatic artery via the superior mesenteric artery and the pancreaticoduodenal arcade. The routing of this unusual supply to the liver is explained by careful study of abdominal aortic angiograms and a sagittal MRI made through the aorta.

Celiac Artery↗
PubMed1997

Transjugular liver biopsy: a comparison of aspiration and trucut techniques.

The results of 67 transjugular liver biopsies are described. Two failures were encountered due to inability to pass the needle into acutely angulated hepatic veins. Thirty-four patients underwent a liver aspiration biopsy using a Colapinto needle, while the remainder were biopsied using a trucut needle. The success rate with the Colapinto needle was 68% and with the trucut model, 97%. Capsular perforation occurred in three cases, but without significant morbidity or mortality. It is concluded that the trucut needle biopsy is more reliable than aspiration biopsy, when the transjugular approach is mandated, in obtaining optimal liver tissue for histopathological diagnosis.

Adult↗
PubMed1997

Choledochal cysts in adults.

The clinical features and management of 14 adults with choledochal cysts who presented to our hospital are discussed. There were 10 Todani type I, and four type IV cysts. The cysts were fusiform in all but three cases. The pancreatobiliary junction was abnormal in only two patients. Ten patients had cystolithiasis. Six patients had undergone previous biliary surgery, three of whom presented with biliary strictures. We recommend that choledochal cyst be considered as a differential diagnosis in all patients with dilated bile ducts, especially when symptoms persist after biliary surgery. In two patients who had undergone endoscopic sphincterotomy and stone clearance, and in whom the diagnosis was still in doubt after cholangiography, hepatic iminodiacetic acid (HIDA) scan confirmed the diagnosis of choledochal cyst by showing persistent biliary stagnation despite free flow of bile across the sphincter of Oddi. Complete resection of the cyst was achieved in all cases with one postoperative death. A modification of the standard surgical technique is described which makes mobilisation of the cyst easier. The need to demonstrate the pancreatobiliary ductal confluence as an aid to complete excision of the cyst is emphasised.

Adolescent↗
PubMed1996

Monitoring of antibiotic use in a primary and tertiary care hospital.

Prophylactic and curative use of antibiotics was studied prospectively in 87 consecutive medical and surgical cases of a tertiary care hospital and in 98 cases of a primary care hospital. Based on Kunins' criteria, antibiotic prophylaxis was found to be more inappropriate in the primary care hospital (49%) than in the tertiary care hospital (34%). Antibiotic therapy, however, was more appropriate at the primary level; 67% as opposed to 60% at the tertiary level. This resulted in a similar overall level of inappropriate antibiotic use in the two hospitals. Surgical prophylaxis was started postoperatively in 68% of the primary care hospital cases. Though prophylaxis was always perioperative in the tertiary care hospital, the postoperative duration was more than 7 days in one third of the cases. The nosocomial infection rate in those given prolonged prophylaxis was higher than those who received antibiotics for less than 72 hours. Antibiotics were started empirically in 78% of tertiary hospital care cases and 100% of cases in the primary hospital. Though culture sensitivity was done in 80% of the tertiary care cases, more than half the specimens were sent after multiple doses of antibiotics were started. The choice of antibiotic did not always correlate with the sensitivity report. Though cost-effective drugs were chosen in 50% of cases, in more than 20% of cases expensive drugs were started. The study highlights the need for an antibiotic audit and suggests the necessity of having an ongoing peer audit.

Anti-Bacterial Agents↗
PubMed1993

Colonic sonography: preliminary observations.

Transrectal instillation of water is a recently described technique for improved sonological imaging of the lumen and wall of the colon. In order to assess the accuracy of this technique, termed colonic sonography (CS), in the detection of abnormalities of the large bowel, 100 consecutive patients were subjected to colonic sonography and the results were compared with the results of colonoscopy and surgery. The technique showed a sensitivity of 91% for the detection of colonic tuberculosis, 89% for ulcerative colitis and 83% for colonic cancers. Small mucosal ulcers, polyps less than 7 mm in diameter and the changes of non-specific colitis were not detected. Sonography displayed the entire colon more consistently than colonoscopy. The extent and extra-colonic spread of disease were better appreciated. The procedure was not adversely influenced by the presence of faecal material within the colon and was well tolerated. Colonic sonography is a promising new technique for detecting significant colonic pathology and merits further comparison with existing modalities.

Adolescent↗
PubMed1992

Pedunculated colonic polyp diagnosed by colonic sonography.

A solitary hamartomatous polyp of the colon in a four year old boy was diagnosed by colonic sonography while barium enema and colonoscopy were non-diagnostic. Colonic sonography provides an additional simple, relatively non-invasive modality for evaluation of the colon.

Barium Sulfate↗
PubMed1992

Culture appropriate indicators for monitoring growth and development of urban and rural children below 6 years.

In this cross sectional study, 2000 apparently normal children aged 0-6 years (1200 urban and 800 rural), were nutritionally and developmentally assessed and their environment scrutinized for possible risk factors. Measurement of mid upper arm circumference (MUAC) using standard techniques revealed malnutrition in 44% of the rural and 24% of the urban children especially in the 2-6 years of age group. Culture appropriate indicators of psycho-social development picked up gross delays in gross motor (GM), vision and fine motor (V&FM) and language skills. Self help, concept hearing (SHCH) skills were recorded as normal while social skills were advanced particularly in the 0-2 years old urban group. By the use of the family protocols, low socio-economic status, malnutrition and 9 other risks factors have been generated for the urban group. No risk factor could be identified for the rural group. Better income emerged as the only real protective factor for the sample showing a direct positive relationship with the 45 skills tested, especially in the 2-6 years age group. Nineteen developmental skills were identified as powerful predictors of development. A prototype home based screening record was constructed for monitoring of growth and development which can be even used by minimally trained primary care worker.

Child↗
PubMedDate not supplied

Adrenal histoplasmosis: clinical presentation and imaging features in nine cases.

BACKGROUND: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region. METHODS: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative. RESULTS: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences. CONCLUSION: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.

Adrenal Gland Diseases↗
PubMedDate not supplied

Choledochal cysts: evaluation with MR cholangiography.

BACKGROUND: To determine where magnetic resonance (MR) cholangiography can accurately demonstrate the presence, extent, and type of choledochal cysts. METHODS: Ten patients with sonographically suspected choledochal cysts were evaluated with a non-breath-hold MR cholangiography technique. The presence, extent, and type of choledochal cyst were determined. Visualization of the pancreatobiliary junction was recorded. MR cholangiographic findings were correlated with the gold standard of surgery in six patients, endoscopic retrograde cholangiography in two, and a 99mTc hepatobiliary scintigram in one. Three patients underwent intraoperative cholangiography. RESULTS: All MR cholangiograms were correlated with findings at surgery, endoscopic retrograde cholangiography, or 99mTc hepatobiliary scintigraphy. There were seven Todani type 1 and two Todani type 5 choledochal cysts (Caroli's disease). The extent of involvement was correctly demonstrated on all MR cholangiograms. The pancreatobiliary junction could not be identified in any of the cases. Calculi and sludge were correctly identified on the MR cross-sectional images in three patients but were not seen on MR cholangiograms in two. In one patient with an initially misinterpreted choledochal cyst, MR sectional images showed the typical appearance of a hydatid cyst, which was confirmed at surgery. CONCLUSION: MR cholangiography can be used to confirm the diagnosis of choledochal cysts and define the extent of involvement preoperatively. The pancreatobiliary junction, however, is difficult to visualize. Non-biliary cysts such as a hydatid cyst can mimic a choledochal cyst on the MR cholangiogram and should be correlated with the MR cross-sectional images to avoid misinterpretation.

Adolescent↗