Biomedical subjects
Publications and source records attributed to S Rajasekaran.
A patient is described in whom a wooden splinter penetrated the finger and impaled the flexor tendons. It was pulled out but part remained inside and the finger could not be moved until an operation was performed and the remaining part of the splinter removed.
The case of eighty-one patients who had tuberculosis of the spine that was treated by debridement and anterior arthrodesis were reviewed eight years or more postoperatively. We studied the progression of the kyphosis and evaluated the function and fate of the bone grafts that were used. At eight years, the results with respect to the progression of the kyphosis were classified as excellent or good in forty-eight patients (59 per cent), all of whom had had minimum destruction of the vertebral bodies; limited surgical excision of bone, resulting in a small post-debridement defect that needed only a short graft; marked intraoperative correction of the deformity; and involvement of lower lumbar segments. Fifteen patients (19 per cent) had a fair result and eighteen (22 per cent), a poor result. An increase in the deformity was common in patients who had extensive involvement of the vertebral bodies that had resulted in a large post-debridement defect necessitating a graft spanning more than two disc spaces. Lesions of the thoracic vertebrae were associated with many of the poor results, and patients who had a marked kyphosis before treatment also did not do well. A stable graft that provided structural support was observed in only thirty-three patients (41 per cent), and failure of the graft due to slippage, fracture, absorption, or subsidence was seen in forty-eight patients (59 per cent). The length of the graft also played a role: the graft failed most often in patients in whom it spanned more than two disc spaces. We concluded that it is unwise to rely solely on the graft to prevent vertebral collapse in patients in whom the length of the graft exceeds two disc spaces. These patients may benefit from additional measures, such as an extended period of non-weight-bearing, posterior arthrodesis after six to twelve weeks, and prolonged use of a brace until complete consolidation is evident.
The cases of ninety patients who had tuberculous lesions in the thoracic and thoracolumbar spine were studied. A comparison of the angles of the gibbus deformity at onset and six years later showed statistically significant differences between the patients who underwent treatment by radical surgery and those who underwent treatment by one of two non-surgical regimens. Analysis of the amount of the initial loss of vertebral body and of the final angle of the gibbus deformity at six years showed a correlation coefficient of 0.83. Using the formula y = a + bx, the final angle of the gibbus deformity was predictable with 90 per cent accuracy in the patients who were not treated surgically. The ability to predict the final angle of the gibbus deformity allows the surgeon to select the patients who will require radical resection and bone-grafting to prevent a severe kyphosis.
The Ziehl-Neelsen method is probably the best known and most frequently used procedure for staining tubercle bacilli. The method requires controlled heating for its success. However, in developing countries, such as India, where most laboratories rely mainly on spirit lamps as a source of heat, the Ziehl-Neelsen method often cannot be carried out because rectified spirit is difficult to obtain. The study describes a cold staining technique that uses the same staining solutions as the conventional Ziehl-Neelsen method. For direct smears, the correlation of results of the cold staining procedure with those of the Ziehl-Neelsen method was 97% and for concentrated smears was 99%. The method described is suitable for use in basically equipped laboratories.