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Biomedical subjects

S R Parikh

Publications and source records attributed to S R Parikh.

16 recordsLinked to original sources
PubMed1998

Retrieval of "old" foreign bodies from the cardiovascular system in children.

Several techniques have been developed to retrieve catheter and guide wire fragments that have embolized to the heart and pulmonary vasculature. In most instances, retrieval of the embolized fragments is performed soon after the event has occurred. In this report, we summarize our experience with the removal of these fragments in 3 children after a significant amount of time had elapsed since the time of embolization. The embolized catheter and guide wire fragments were removed without any complications. We also describe the techniques used for their removal, and the problems encountered during the removal of these "old" foreign bodies.

Adolescent↗
PubMed1998

Pharyngocutaneous fistulae in laryngectomy patients: the Toronto Hospital experience.

OBJECTIVE: The purpose of this study was to determine the rate of post-laryngectomy pharyngocutaneous fistulae and its association with age, gender, preoperative radiation, TNM staging, patients comorbidity factors, choice of ablation, choice of reconstruction, modality of postoperative feeding, and whether or not a primary tracheoesophageal puncture was performed. DESIGN: Retrospective clinical study. SETTING: The Toronto Hospital/Princess Margaret Hospital, University of Toronto, Toronto, Ontario. METHOD: One hundred and twenty-five consecutive laryngectomy procedures performed between July 1, 1992, and October 1, 1996, were reviewed. RESULTS: There was an overall fistula rate of 22%. No association found was between fistula rates and age, gender, patient comorbidity factors, TNM stage, choice of ablation, choice of reconstruction, modality of postoperative feeding, or whether a primary tracheoesophageal puncture was performed or not. CONCLUSIONS: At this tertiary care head and neck oncology centre, pharyngocutaneous fistulae remain an unpredictable and serious complication with an estimated economic cost of Cdn $400,000 per year.

Adult↗
PubMed1996

Prospective angiographic study of the abnormalities of systemic venous connections in congenital and acquired heart disease.

UNLABELLED: Angiographic definition of systemic venous connections was obtained prospectively in 780 consecutive patients with congenital heart disease and 102 patients with acquired valvular heart disease undergoing cardiac catheterization. Attempts were made to enter the innominate vein and perform a balloon occlusion angiogram in each patient. In patients with congenital heart disease, bilateral superior vena cava were present in 32/771 patients (approximately 4%) with levocardia and 3/9 patients with dextrocardia. Among patients with bilateral superior vena cava (n = 35), an innominate vein of variable size that could be entered was present in six patients. Small tributaries connecting the right and left superior vena cava were found and entered in six patients. The superior vena cava was entered via its connection to morphologic left atrium in five patients and via the coronary sinus in 17 patients. Abnormalities of the inferior vena cava were seen in 7/780 patients. The following abnormalities of the inferior vena cava were noted: azygous continuation of rightsided inferior vena cava in levocardia -- 3 patients, hemiazygos continuation of the leftsided inferior vena cava in levocardia -- 1 patient, azygos continuation of the leftsided inferior vena cava in dextrocardia -- 1 patient, interruption of inferior vena cava below the liver with a plexus of veins joining the azygos vein -- 1 patient, and an inferior vena cava draining into the leftward aspect of the common atrium -- 1 patient. Abnormalities of the systemic venous connections were seen in 2/102 patients with acquired heart disease: bilateral superior vena cava in 1 patient and bilateral inferior vena cava in 1 patient. CONCLUSIONS: Abnormalities of systemic venous connections were seen in approximately 5% patients with congenital heart disease and approximately 2% patients with acquired heart disease. Small tributaries or an innominate vein of variable size often connect left and right superior vena. Contrast material can be injected into these connections to document the presence of bilateral superior vena cava.

Adolescent↗
PubMed1994

Liver abscess after hemorrhoidectomy. Report of two cases.

PURPOSE: Pyogenic liver abscess after hemorrhoidectomy is extremely rare. Only two such cases have been previously reported; the diagnosis in each was made intraoperatively. We report two additional cases of hepatic abscess after hemorrhoidectomy, both treated nonoperatively with a successful outcome. METHODS: The two cases were analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: In both cases, the patients presented within one week of the hemorrhoidectomy. Treatment with broad-spectrum intravenous antibiotics was successful in achieving significant clinical improvement. The liver function test values reverted back to normal and follow-up computed tomography (CT) scans of the liver revealed marked improvement of the abscesses. Laparotomy was avoided in both of the patients. CONCLUSIONS: Increased awareness of this serious complication will afford earlier diagnosis. In addition, proper aerobic and anaerobic bacterial isolation techniques will allow appropriate nonoperative therapy, decreasing the high morbidity and mortality rates associated with this complication.

Adult↗
PubMed1991

Ventricular function in the single ventricle before and after Fontan surgery.

To better delineate the importance of ventricular function in patients with a single ventricle and assess its relation to outcome after the Fontan procedure, 47 patients with a single ventricle were studied. Ventricular ejection fraction was estimated by radionuclide angiocardiography. Before Fontan surgery, ejection fraction was 0.57 +/- 0.10 (mean +/- standard deviation). This differed significantly from the normal mean left ventricular ejection fraction of 0.68 +/- 0.09 (p less than 0.001) derived in our laboratory by radionuclide angiocardiographic methods. Age, ventricular morphology and the presence of pulmonary artery band or systemic to pulmonary artery shunts had no statistical relation to ventricular ejection fraction in patients with a single ventricle. Serial preoperative evaluation in 15 patients over 3.8 +/- 1.3 years revealed no significant change in ventricular ejection fraction; however, increased atrioventricular valve regurgitation was documented in 4 of these 15. Modified Fontan procedure was performed in 24 of the 47 study patients; 7 have died, 1 has undergone cardiac transplantation and 1 faces possible transplantation. No difference was noted in preoperative ejection fraction between survivors and nonsurvivors. Ventricular morphology, age at Fontan surgery and operative factors such as bypass and cross-clamp time were not related to functional outcome. Preoperative ejection fraction of 0.52 +/- 0.08 decreased to 0.39 +/- 0.11 (p less than 0.001) when evaluated 1.16 +/- 0.44 years after Fontan surgery. In patients with a single ventricle (1) ventricular ejection fraction is less than that of the normal systemic ventricle; (2) during childhood, ejection fraction is not related to age or ventricular morphology; and (3) ventricular ejection fraction frequently decreases after a Fontan repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1991

Preoperative and postoperative "aneurysm" associated with coarctation of the aorta.

The reported incidence of aortic aneurysm after surgical repair or balloon angioplasty for aortic coarctation varies widely. To determine the incidence of aneurysm formation after surgery, preoperative and postoperative cineangiograms from 65 patients who underwent operation at age 1.5 +/- 3.4 years were examined. Repair included a prosthetic patch in 14 patients, end to end anastomosis in 28 and subclavian flap in 23. Aneurysm was documented by change in contour or irregularities in contour at the repair site or by abnormal dimensions at the repair site, defined by the ratio of the widest measurement at the repair site to the measurement of the aorta at the diaphragm. An aneurysmal bulge above the ductus diverticulum was identified in 14 (23%) of 60 patients preoperatively; the area showed no change 4.72 +/- 4.07 years after surgery. Significant changes at the repair site were seen in only three patients, all of whom had Dacron patch repair. One patient had a change in contour at the repair site, one had an abnormally high repair site to diaphragmatic aorta ratio and one had a progressive increase in this ratio. Thus, during childhood years, 3 (5%) of 65 patients were diagnosed as having aneurysm at the surgical repair site. In conclusion, 1) comparison with preoperative cineangiograms, especially for aneurysmal bulges above the ductus arteriosus, is essential before an aneurysm can be attributed to coarctation repair by any technique, and 2) aneurysm developed only in patients subjected to Dacron patch repair.

Aortic Aneurysm↗
PubMed1990

Abdominal surgery in the elderly patient.

The accurate diagnosis of abdominal disease is important in the elderly, both to avoid negative exploration and to plan timely and appropriate operation. Emergency abdominal surgery has a higher mortality than elective surgery and is best avoided. A definitive planned elective procedure in the well-prepared elderly patient will avoid multiple operations and reduce mortality and morbidity.

Abdomen↗
PubMed1983

[Levels of serum lipids during abortion induced by a hypertonic saline solution].

Studies were carried out on serum lipid levels in 30 women in good health who were pregnant for the first time with a pregnancy of between 15 and 20 weeks duration, who had the pregnancies terminated by the use of a hypertonic saline solution. They showed a rise only in the cholesterol level (5.83 mmol/l +/- 0.17) in the phase of actively aborting (a period of maximum stress) as compared with a level of cholesterol in the pre-abortion phase (4.93 mmol/l +/- 0.17). Between 12 and 15 hours after the termination the cholesterol level dropped sharply as did the levels of phospho-lipids and triglycerides. The levels became of the order of 4.1 mmol/l +/- 0.25, 2.73 mmol/l +/- 0.097 and 1.03 mmol/l +/- 0.06 respectively according to the phase the termination was in. The levels of serum lipids after the termination were, surprisingly, almost the same as those in non-pregnant women. The poor rise in serum lipids during termination induced by hypertonic saline solution shows that probably labour was of low intensity.

Abortifacient Agents↗
PubMedDate not supplied

Rings, slings and such things: diagnosis and management with special emphasis on the role of echocardiography.

Vascular anomalies of the aorta and pulmonary artery that cause tracheal, esophageal, or tracheoesophageal compression form an important group of congenital cardiovascular malformations. The diagnostic approach to the patient with possible vascular ring is variable. This article presents a systematic approach to the evaluation and management of this fascinating group of malformations, with special emphasis on the role and limitations of echocardiography. Using this approach between September 1990 and March 1992, we identified and defined vascular anomalies of aorta and pulmonary artery in eight children.

Aorta, Thoracic↗