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Biomedical subjects

S V Thomas

Publications and source records attributed to S V Thomas.

14 recordsLinked to original sources
PubMed1998

Neurological aspects of eclampsia.

Eclampsia accounts for a third of maternal mortality in developing countries. The neurological manifestations of eclampsia consist of seizures and alteration of sensorium or coma on a background of pre-eclampsia. Occasionally there can be focal neurological deficits too. Recent studies with CT scan and MRI have demonstrated the presence of cerebral edema and/or cerebral hemorrhage in eclampsia. EEG in patients with eclampsia has revealed evidence of diffuse cerebral dysfunction (delta waves) and epileptiform transients (spikes or sharp waves). There is also evidence of extensive vasculopathy within the brain parenchyma. A variety of mechanisms have been suggested to explain these changes, the most important being failure of autoregulation of cerebral blood flow that leads to cerebral edema and hemorrhage. There is considerable controversy regarding the treatment of seizures in eclampsia. Recent studies have shown that magnesium sulfate is superior to phenytoin or diazepam in the treatment of eclamptic seizures and prevention of eclamptic seizures in women with pre-eclampsia.

Animals↗
PubMed1997

First ever seizures in the elderly: a seven-year follow-up study.

The clinical characteristics and prognosis of first ever seizures among the elderly (aged 65 years or more) were ascertained by following up a cohort of patients for 7 years. Twenty-three patients (mean age, 69.9 +/- 4.9 years) were registered in the Neurology Service between January 1988 and March 1989. Twelve patients had partial seizures with or without generalization. Three patients had status epilepticus, whereas ten had presented for single seizure. On presentation 61.9% patients had neurological deficits and 73.9% had one or more systemic disorder. Head computerized tomography scans were abnormal in 17 cases. Seizures were attributed to acute stroke (26.1%), trauma (8.7%), subdural haematoma, degenerative diseases of the brain, cerebral metastasis, or central nervous system infections. The cause was unknown in 43.5% cases. At the end of 7 years, follow-up was complete for 15 patients (65.2%). The mean duration of follow-up was 68.6 +/- 28.7 months. Eight (53.3%) patients had died. Nine patients (60%) had attained 2-year remission of which three remained seizure free throughout. Six of the seven living patients were continuing antiepileptic drugs treatment. Forty per cent of them were dependent on others for the activities of daily life.

Aged↗
PubMed1996

Management and referral patterns of epilepsy in india.

Evaluation of management and referral pattern is very important in the organization of medical services for epilepsy. In order to study the management and referral pattern of epilepsy, a structured questionnaire was administered to 100 epilepsy patients attending a referral hospital in Kerala State, India. Of these, 61.4% of them were living in villages; 65% had a monthly income less than Rs. 1000. Seventy-five percent of the patients had generalized seizures. The mean delay in diagnosis was more for those from villages (13.5 months) as compared to those from urban areas (6.4 months) and for women (11.7 months) as compared to men (7.8 months). Previous consultation before referral to this Institute included general practitioners (61%), specialists (50%) and neurologist or neurosurgeon (27%). Eighty-eight patients have had EEG and 51 patients have had CT Scans. Thirty-nine per cent of patients required hospitalization for control of seizures that was significantly (P = 0.036) higher among those living in an urban area. Seventy-five per cent of patients were collecting drugs from private pharmacies. No patient was collecting antiepileptic drugs from government institutions even though such a facility was available within 5 km of their residence. This study has revealed that the organization and delivery of neurological services for epilepsy leaves much to be desired.

Adolescent↗
PubMed1996

Nipple reconstruction with a new local tissue flap.

We present a one-staged local cutaneous-fat flap for nipple reconstruction. It has proven reliable in producing a geometrically correct nipple without complication. It represents a modification of existing cutaneous or dermal-fat flaps with theoretical and apparent benefits inherent in its design.

Female↗
PubMed1996

Reversible non enhancing lesions without focal neurological deficits in eclampsia.

Nine patients with eclampsia, were subjected to computerized tomographic scan (CT scan) of the head to ascertain the changes in the brain that accompany seizures and encephalopathy of eclampsia. Only those patients who had a seizure within the past 24 h were included in this study. None of the patients had any focal neurological deficit. Six of the nine patients had abnormal findings on CT scan consisting of multiple non enhancing hypodensities in the cerebral white matter. One patient also had subependymal haemorrhage over the lateral ventricle. These changes were found to have disappeared when the CT scan was repeated on the seventh day. There was no correlation between the mean arterial blood pressure or the number of seizures and the presence of hypodensities in the brain. These findings suggest that subclinical changes in the form of reversible hypodensities and rarely bleeding can occur in eclampsia even when patients have no focal neurological deficits. It appears that these lesions represent focal areas of cerebral oedema, secondary to failure of autoregulation of cerebral blood flow.

Adult↗
PubMed1995

Microsurgery without a microscope: laboratory evaluation of a three-dimensional on-screen microsurgery system.

In microvascular surgery, procedures may be both technically and physically demanding. Precise movements sustained over long hours in addition to typically compromised surgeon and assistant positioning lead quickly to physical and mental fatigue. Many of the positioning problems encountered are related to the fact that the eyes of the surgeon must be continually fixed to the microscope eyepieces. This study explores a possible solution: a microscope system that eliminates the need to view the operative field through the microscope eyepieces. A Three-dimensional On-screen Microsurgical System (TOMS) was used and contrasted with conventional operative microvascular surgery in the laboratory setting. The surgeon's comfort, his ability to instruct microsurgical technique, pertinent technological performance, and the procedure itself were evaluated using a standardized questionnaire. Based on data collected in this study, we conclude that divorcing the surgeon's eyes from the microscope eyepieces using the TOMS may make prolonged microvascular procedures less physically demanding and may increase the comfort level of both the surgeon and his assistant, although refinements to the technology are required.

Anastomosis, Surgical↗
PubMed1995

Interictal EEG changes in eclampsia.

The pathogenesis of seizures and encephalopathy in eclampsia remains obscure even today. There are only a few reports on EEG findings in eclampsia. This is a report of the interictal EEG changes in 8 patients with eclampsia who were evaluated prospectively. The major EEG changes observed were (1) slowing of the background activity (generalized slowing in 4 patients and focal slowing in 3 patients) and (2) intermittent spike and sharp wave transients (5 patients). These abnormalities had disappeared in all except 2 patients when the EEG was repeated on the seventh day. A comparison is drawn between eclampsia and hypertensive encephalopathy for the clinical, EEG and CT/MRI findings. The pathogenesis of seizures and encephalopathy could be similar in these two conditions. It is worth while considering these EEG changes while planning the treatment of eclampsia.

Adult↗
PubMed1995

Prolonged brainstem auditory evoked potential latencies in tropical pancreatic diabetics with normal hearing.

Twenty patients with Tropical Pancreatic Diabetes (TPD) were evaluated by Brainstem Auditory Evoked Potentials (BAEP) in order to detect any possible subclinical involvement of auditory pathways. The latencies of BAEP Wave III (p < 0.009) and V (p < 0.47) as well as the Interpeak Latencies I-III (p < 0.002), and I-V (p < 0.019) were significantly prolonged in patients with TPD when compared to age and sex matched healthy volunteers. There was correlation between the abnormalities of BAEP and duration of diabetes (p < 0.006), male sex of patients (p < 0.05), and the presence of retinopathy (p < 0.003) and nephropathy (p < 0.38). There was no significant correlation with the age of the patients, type of treatment, blood sugar levels and presence of peripheral neuropathy. These changes suggest a subclinical involvement of the auditory pathways in TDP patients.

Adult↗
PubMed1993

Balloon tamponade for liver injuries: case report.

A tamponade device for control of refractory liver bleeding is occasionally indicated. This report documents to our knowledge the first reported use of Foley catheter balloon tamponade for severe liver injury.

Adult↗
PubMed1993

Visual evoked potential changes in patients with tropical pancreatic diabetes.

Visual impairment is an important complication of diabetes. There are conflicting reports on Visual Evoked Potential (VEP) changes in diabetes. P100 latency of VEP was evaluated in twenty patients with Tropical Pancreatic Diabetes (TPD) and compared with that of age and sex matched controls. There was no statistically significant difference in the P100 latency between the two groups. There was no correlation between the P100 latency and the severity of diabetes or presence of defective vision or retinopathy. The defective vision in diabetes is likely to be due to ocular causes rather than due to a defect in the central visual pathways.

Adult↗
PubMed1989

Regional differences in capillary density of the normal human dermis.

Quantitative study of the capillary density of normal dermis of 113 biopsy specimens taken from 20 body sites from 6 cadavers was carried out. Histologic quantification of dermal capillaries using the alkaline phosphatase method to delineate vascular endothelium and automated image analysis demonstrates statistically significantly greater capillary density in the head-face/neck region both in the papillary and reticular dermis than in the lower parts of the body. The smallest numbers of the dermal capillary density were noted in the calf and shin areas. These data support the hypothesis that random-pattern skin flaps can be safely raised longer in the face and neck than in other parts of the body.

Aged↗
PubMedDate not supplied

Postal follow up of patients with epilepsy.

BACKGROUND: Epilepsy services in India are mostly located in urban areas and are often overcrowded. It is difficult, therefore, to organize long term management programmes. We report our experience at a tertiary referral centre on follow up of patients with epilepsy through regular postal review. METHODS: One hundred consecutive patients with epilepsy (63 men, 37 women, mean age 17 years) who had only seizures were followed up by post using a questionnaire, instead of reviewing them in a clinic. The safety, utility and efficiency of this system were evaluated. RESULTS: Sixty patients had generalized seizures, 30 had complex partial seizures and 10 had other types of seizures. The indication for shifting to postal review was good control of seizures in 87 cases and economic reasons in the remaining. Postal review constituted 60% of the total follow up period in 55 cases. Sixty-six patients could be maintained on postal review which was suspended or discontinued in 34 patients. Of these 34, 16 were returned to it after being seen in the clinic on a further occasion. Poor control of seizures, fresh medical or social problems, lack of confidence or a combination of these were the reasons for discontinuing the postal review. The economic benefit to a patient by way of savings in travel, incidental expenses and lost wages was estimated to be Rs 750 per annum. The work load in the epilepsy clinic was decreased by 40%. No serious medical problems or mortality were reported in the study population. CONCLUSION: Systematic postal review is a cost-effective alternative to clinic review in the long term follow up of a certain group of patients with epilepsy.

Adolescent↗