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Biomedical subjects

V R Kolluri

Publications and source records attributed to V R Kolluri.

At least 19 recordsLinked to original sources
PubMed2003

Outcome prediction model for severe diffuse brain injuries: development and evaluation.

BACKGROUND: Intensive care resources for the management of severe diffuse brain injury patients (SDBI) are limited. Their optimal use is possible only if we can predict at admission which patients are unlikely to improve. AIMS: To develop a simple and effective model to predict poor outcome in patients with SDBI in order to help guide initial therapy. MATERIAL AND METHODS: The prognostic factors and outcomes of 289 patients with severe diffuse brain injury (GCS 3-8) were analyzed retrospectively. The prognostic factors analyzed were age, mode of injury, GCS at admission, pupillary reaction, horizontal oculocephalic reflex, and CT scan findings. Outcome at 1 month was classified as unfavorable--death or persistent vegetative state, or favorable--improvement with or without some disability. A stepwise linear logistic regression analysis was used to identify the most important predictors of poor outcome. A prediction model (NIMHANS model-NM) was developed using these factors. NM and several currently available outcome prediction models were prospectively applied in a separate group of 26 patients with severe diffuse brain injury managed with a different protocol. RESULTS: The most important predictors of poor outcome were found to be the horizontal oculocephalic reflex, motor score of GCS, and midline shift on CT scan. NM was found to be more sensitive (75%) and specific (67%) than most other models in predicting unfavorable outcome. NM had high false pessimistic results (33%). CONCLUSION: Prediction models cannot be used to guide initial therapy.

Adult↗
PubMed2003

Evaluation of nimodipine in the treatment of severe diffuse head injury: a double-blind placebo-controlled trial.

AIMS: The aim of this study was to establish whether nimodipine given orally soon after severe diffuse head injury for a period of three weeks improved outcome. MATERIAL AND METHODS: The present report analyzes the results of a prospective randomized double-blind placebo-controlled trial of nimodipine in 97 severe head injury patients (GCS Score < or =8) treated at the Department of Neurosurgery, NIMHANS, between January 1995 and June 1996. The patients were randomly assigned to two groups which were matched for age, sex, mode of injury, time interval from injury to admission, neurological status and CT scan findings. One group was given nimodipine 30 mg Q6H and the other group was given a placebo. The outcome of these patients at 6 months was evaluated using the Glasgow Outcome Score by and a psychologist. RESULTS: Results showed no significant difference in the functional and psychological outcome between the two groups, even in patients with subarachnoid hemorrhage. No adverse drug events were recorded. CONCLUSION: Oral nimodipine given for three weeks does not improve outcome in patients with severe diffuse head injury.

Adolescent↗
PubMed2001

Prognostic factors in children with severe diffuse brain injuries: a study of 74 patients.

Severe diffuse brain injury in children has a devastating influence on their physical and psychological development. This retrospective study was undertaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (age < or =15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at the National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admission, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. The following factors were found to be independent predictors of poor outcome: GCS 3-5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1-3 (p < 0.001), absent pupillary reaction (p < 0.001), absent oculocephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemorrhage on CT scan (p < 0.002). These independent variables were then subjected to a stepwise logistic regression analysis, and the most important variables for predicting outcome were oculocephalic reflex and GCS, which together correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%. An early CT scan or a single CT scan did not have any prognostic significance.

Adolescent↗
PubMed2000

Laminoplasty: an evaluation of 24 cases.

Cervical expansive laminoplasty has been advocated as an alternative procedure to laminectomy for the decompression of the cervical spine. It provides favourable cord decompression and stabilisation of the cervical spine and is a simpler and safer alternative to anterior fusion and laminectomy for myelopathy and myeloradiculopathy, due to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. We report our experience in 24 patients with this procedure, 12 of whom had myelopathy and another 12 had myeloradiculopathy. The earliest symptom to improve was radicular pain or paraesthesia (75%). A reduction in spasticity was seen in 21 of the 24 patients (87.5%). Eleven patients had improvement in their motor power during a follow up period ranging from 1 month to 14 months. One patient deteriorated following the procedure and developed Brown Sequard features due to under riding of the lamina on the hinged side, another had severe post operative paraesthesias, while one patient had a CT scan evidence of 'closing of the door', without being symptomatic for it. The technique of the procedure is discussed and the pertinent literature reviewed.

Adult↗
PubMed1999

Diagnostic efficacy of stereotactic biopsies in intracranial tuberculomas.

BACKGROUND: Stereotactic biopsies for diagnosing intracranial tuberculomas are often reported to be inconclusive, being confirmatory in only 28% of cases. We analyzed the role and diagnostic efficacy of stereotactic biopsies in the management of intracranial tuberculomas. METHODS: Twenty patients diagnosed with intracranial tuberculomas based on neuroimaging procedures underwent computerized tomography (CT) guided stereotactic biopsies for histological confirmation. In 10 patients (Group A), biopsies were obtained from the center of the lesion; in the other 10 (Group B), biopsies were obtained from both the enhancing rim and the isodense center and examined separately. The tissues were processed for paraffin sections and hematoxylin eosin staining. In addition, in the first five patients a squash smear from a small portion of the biopsy was prepared, and the cytological features of the cells were examined. All the patients received antitubercular medication and CT scans were repeated 4 months posttreatment. RESULTS: Histopathological features of the paraffin sections in 17 patients (Group A: 8, Group B: 9) were diagnostic of tuberculoma, whereas the other three revealed only chronic nonspecific inflammation. Based on the cytological features in squash smears, diagnosis could be made in one of five. In two, although the smear was not diagnostic, the histological section from the same specimen confirmed the tuberculous pathology. There was no procedural morbidity or mortality. One patient had a small asymptomatic hematoma at the biopsy site. Three patients died during the follow-up period, due to secondary complications of tuberculosis. Repeat CT scans during follow-up after antituberculous treatment confirmed the reduction in the size of the lesion in 15/17 patients. CONCLUSION: The high positive yield of stereotactic biopsies in diagnosing tuberculomas argues for their inclusion in the management protocol for tuberculous mass lesions.

Biopsy↗
PubMed1999

Neuroendoscopic third ventriculostomy in the management of fourth ventricular outlet obstruction.

Acquired fourth ventricular outlet obstruction, an uncommon entity, has been conventionally managed by ventriculoperitoneal shunt placements or excision of the obstructing membranes. The role of endoscopic third ventriculostomy is highlighted in the present communication. Three patients presenting with symptoms of raised intracranial pressure were diagnosed to have fourth ventricular outlet obstruction by neuroimaging studies and underwent endoscopic third ventriculostomy. All the patients had relief of their symptoms in the postoperative period. Neuroimaging studies performed at follow-up revealed decrease in ventricular size in all. Endoscopic third ventriculostomy is a useful alternative in the management of acquired fourth ventricular outlet obstruction.

Adult↗
PubMed1998

Spinal extradural cysticercosis: a case report.

An extremely rare case of extradural spinal cysticercosis in an adult male is presented. The patient had evidence of extradural granulation tissue with associated destruction of C4 and C5 pedicles and laminae, causing tetraparesis. Histopathological examination revealed evidence of a degenerated cysticercal cyst with host tissue reaction. The patient made a gradual and marked improvement after decompression. Though rare, cysticercosis as a possible etiology of extradural spinal compression may be considered in endemic area.

Adult↗
PubMed1998

Risk Score Estimation: a new method to determine optimal timing of aneurysm clipping for improved management outcome.

The outcome of 703 patients who underwent surgery following aneurysmal subarachnoid hemorrhage were analyzed with regards to age, associated medical conditions, vasospasm and clinical status at the time of operation. Patients with Hunt and Hess grade I, II, and III had a 96%, 90% and 93% favorable (good and fair) outcome respectively. In contrast only 58% of patients with grade IV had the same result. The outcome was unfavorable in 13% of the patients who were older than 60 years of age and only in 9% of the patients between 30-59 years of age. All the patients younger than 30 years old had a good outcome. Associated medical condition increased the incidences of poor outcome (7% vs. 12%). Patients harboring vertebro basilar aneurysms had a poorer outcome, as opposed to those with aneurysms located in the anterior circulation (20% vs. 8%). The presence of angiographic vasospasm alone did not influence outcome. A proposed point value was given for each of the adverse factors and from this the optimal surgical time was determined for each individual patient. This concept of Risk Score Estimation approach may improve the management outcome of patients with ruptured intracranial aneurysms.

Adult↗
PubMed1996

Ossification of the posterior longitudinal ligament of the cervical spine in Asian Indians--a multiracial comparison.

Ossification of the Posterior longitudinal ligament (OPLL) has been thought to be a predominantly Japanese disease with few reports among the non-orientals and Caucasians. A prospective clinicoradiological study of 47 symptomatic Caucasoid Indians is reported. Twenty-seven patients presented with myelopathy, twelve with myeloradiculopathy and six with radiculopathy. 'Total' configuration of OPLL was the most frequent (70%). The most frequent location was at C3 and C4 levels. The thickness of OPLL ranged from 2.5 mm to 11.5 mm. Canal stenosis was most severe in patients with 'total' type of OPLL. Ossification of other spinal ligaments were seen in 50% of the patients. Twenty-one patients underwent decompressive laminectomy and twenty of them improved. The difference in the cervical canal diameters and the configuration of OPLL between the Japanese and our population (Caucasoid Indians) may be of therapeutic relevance.

Adult↗
PubMed1995

Prognosis of extradural haematomas in children.

102 children treated surgically for intracranial extradural haematoma from 1982 to 1991 were evaluated retrospectively and their prognosis was compared with 387 adults treated during the same period. Children had a better prognosis than adults even with a low Glasgow Coma Scale (GSC) score at surgery. Children had a higher incidence of frontal and posterior fossa haematomas. The GCS score and the associated parenchymal injuries had a strong correlation with the outcome both in adult and children, whereas the site of haematoma had no correlation with the final outcome.

Adolescent↗
PubMed1995

Primary mycotic abscess of the brain caused by Fonsecaea pedrosoi. Case report.

A case of cerebral abscess caused by Fonsecaea pedrosoi is reported in a nonimmunocompromised 15-year-old boy. In the absence of a primary cutaneous lesion, this fungus was considered to be a primary neuropathogen. The fungus was cultured and characterized from the abscess material obtained at surgery. Prompt therapy using amphotericin B and 5-flucytosine helped in the successful recovery of this patient.

Adolescent↗
PubMed1990

Exophytic gliomas of the spinal cord.

Intradural extramedullary glial tumours of the spinal cord are rare. We report for such tumours arising from the dorsal cord. Myelography and operative findings were almost similar to that of an intradural neurofibroma. Surgical removal had resulted in rewarding neurological recovery. One of them had a recurrence after six years and was re-explored. Anterolateral attachment near the root entry zone suggests its origin probably from the spinal cord with an exophytic growth.

Adult↗
PubMed1990

Prognosis in traumatic intraventricular haemorrhage.

Traumatic intraventricular haemorrhage (TVH) is rare. The clinical profile and prognosis in 16 patients with traumatic intraventricular haemorrhage after blunt head injury are evaluated. Majority of the patients (94%) had low Glasgow coma score (less than 8) on admission and none had a lucid interval. CT showed haematoma adjacent to the foramen of Monroe in 5 patients and localised to the frontal horn or the body of the lateral ventricle in six. The mortality was 62.5% in this subgroup of patients with head injury. Our findings are compared to those of previous reports in the literature. The poor prognosis of cases with TVH reflects the severity of trauma and general brain damage and is probably not related only to the intraventricular bleeding.

Adolescent↗
PubMed1989

Changes in regional levels of putative neurotransmitter amino acids in brain under unilateral forebrain ischemia.

The levels of the neurotransmitter amino acids glutamate, aspartate, and GABA were determined in different brain regions during ischemia and post-ischemic recirculation periods using the unilateral carotid artery occlusion model of stroke in gerbils. The levels of glutamate, aspartate and GABA in ischemic hemisphere were increased significantly by 10 min of ischemia and later declined with time. Reperfusion for 30 min following 10 min. of ischemia further enhanced the levels of glutamate and aspartate. Increase in GABA levels were found during early periods of reperfusion. Regional variations in the changes of amino acids' levels were noticed following ischemia. Hippocampus showed the highest increase in glutamate levels followed by striatum and cerebral cortex. Aspartate levels in striatum and hippocampus increased during 10 min ischemia (46% and 30%) and recirculation (70% and 79%), whereas in cerebral cortex the levels were doubled only during recirculation. Ischemia induced elevations of GABA levels were observed in cerebral cortex (68%) and in hippocampus (30%), and the levels were normalized during recirculation. No changes in GABA levels were found in striatum. It is suggested that the large increase in the levels of excitatory neurotransmitter amino acids in brain regions specially in hippocampus during ischemia and recirculation may be one of the causal factors for ischemic brain damage.

Animals↗
PubMed1989

Prognosis in traumatic basal ganglia haematoma.

Twenty two patients with traumatic basal ganglia haematoma were studied. The mean Glasgow Coma Score on admission was 7. 17 patients had sustained high acceleration/deceleration injuries. The location and size of haematoma did not correlate with prognosis. Outcome was poor in 7 patients, while 8 patients died.

Adolescent↗
PubMed1989

Progressive unilateral hydrocephalus in adults.

Unilateral dilatation of the lateral ventricle in adults is rare. We report 2 cases of unilateral hydrocephalus with obstruction at the foramen of Monro. Both patients presented with symptoms of raised intracranial pressure.

Adult↗