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Biomedical subjects

V Santhanam

Publications and source records attributed to V Santhanam.

8 recordsLinked to original sources
PubMed2004

Surgical management of incompletely excised basal cell carcinomas of the head and neck.

We made a retrospective audit of all basal cell carcinomas excised in the Maxillofacial Units at St. Richard's Hospital, Chichester and the Worthing and Southlands NHS Trust between 1990 and 1999. A total of 3795 BCCs were excised. Of these, 3560 were completely excised (93.8%) and 235 were incompletely excised (6.2%), which compares favourably with other series. Of these, 84 patients had further excision, 11 had radiotherapy, and 140 were kept under review. Residual tumour was present in 45% of the re-excised specimens. Of the 140 cases managed by observation, 21% recurred. Notably, 31% of patients in the observation cohort died of other causes without recurrence. Incomplete excision was significantly more likely (P < 0.001) if multiple lesions were excised at the time of operation. Involvement of multiple margins was not a significant risk factor for recurrence in the 'observed' cohort. This study shows that a flexible strategy, which balances observation, further excision and radiotherapy, is superior to any single approach.

Basal Cell Carcinoma↗
PubMed2000

Refractory vasospasm with a malignant course.

We present a patient with two rare disorders, recurrent vasospastic angina leading to cardiac transplant and acute aortic occlusion. The patient had recurrent episodes of coronary vasospasm presenting with unstable angina, acute myocardial infarction, and sudden cardiac death in spite of adequate therapy with nitrates and calcium-channel blockers. He went on to have a cardiac transplant. The patient later presented with acute aortic occlusion with concomitant renal and mesenteric artery spasm. The circumstances of the presentation raise the possibility of a generalized vasospastic predisposition that is responsible for both events. Smoking, the only known major risk factor other than atherosclerosis, was noted to be temporally related to both events in our patient.

Acute Disease↗
PubMed1998

Aortic dissection in a young corticosteroid-treated patient with systemic lupus erythematosus--a case report.

We report a rare case of acute aortic dissection in a young, corticosteroid-treated hypertensive patient with a long-standing history of systemic lupus erythematosus (SLE). A brief review of literature on aortic dissection in lupus erythematosus is presented. A low threshold for performing transesophageal echocardiography in the management of chest pain syndrome in SLE is emphasized.

Acute Disease↗
PubMed1990

Left ventricular hypertrophy is associated with worse survival independent of ventricular function and number of coronary arteries severely narrowed.

Left ventricular (LV) hypertrophy has been repeatedly shown to be associated with a marked increase in mortality risk. Available data, however, do not provide evidence that the risk associated with the increase in cardiac muscle mass is independent of the severity of preexistent coronary artery disease. In a cohort of predominantly black patients with a high prevalence of hypertension and LV hypertrophy, LV mass as estimated by echocardiography was found to be a powerful prognostic factor independent of ejection fraction and obstructive coronary disease. After excluding patients with either a dilated LV cavity (diastolic internal diameter greater than 5.8 cm) or asymmetric septal hypertrophy (septal:posterior wall ratio greater than 1.5) LV mass/height remained significantly increased in decedents compared to survivors (116 +/- 38 vs 131 +/- 47 g/m, p = 0.014), while the thickness of the ventricular septum and the posterior wall were even more highly predictive of a fatal outcome (p = 0.003 and 0.001, respectively). After exclusion of patients with eccentric LV hypertrophy, differences in LV muscle mass in survivors and decedents were due entirely to increased thickness of the ventricular wall, and no differences in cavity dimensions or LV ejection fraction were noted. Stepwise regression analysis was used to demonstrate that measures of LV hypertrophy were the most important predictors of survival and eliminated the contribution of all other prognostic factors to the model except the number of stenotic vessels. The relative risk associated with a 100-g increase in mass was 2.1, while a 0.1-cm increase in posterior wall thickness was associated with approximately a 7-fold increase in the risk of dying.(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗
PubMed1988

Sickle cell heart disease. Two-dimensional echo and Doppler ultrasonographic findings in the hearts of adult patients with sickle cell anemia.

Sickle cell anemia (SCA) is a commonly diagnosed condition in the black population in the United States. With better medical management, patients with SCA are living longer and what were previously uncommon sequelae are being recognized frequently, including those involving the cardiovascular system. Previous reports on the cardiovascular effects of SCA have focused predominantly on children, but the conclusions remain controversial. To study this question further, 40 adult patients with documented SCA were examined using two-dimensional and Doppler cardiac ultrasound. Valvular structures were normal despite an increased incidence of flow murmurs. Abnormalities were found more frequently in the left heart than the right, as manifested primarily by increased left ventricular mass, and left ventricular and left atrial dilatation with preservation of systolic function. Pulmonary hypertension, which was present in two thirds of the sample, was minimal to moderate as assessed by our Doppler technique. The effects of SCA on the heart seem to be minimal and similar to those of other anemias, predominantly confined to the left atrium and ventricle with passive elevation of pulmonary pressures. Clinical murmurs were most often physiologic; there was no association with myxomatous valvular degeneration or mitral valve prolapse.

Adult↗
PubMed1987

Outcome of coronary artery bypass grafting in black persons.

Relatively little attention has been given to coronary artery disease in black persons in the United States. During 31 months, 73 consecutive black patients drawn from an urban working class inner city population who had undergone coronary artery bypass grafting were studied. In the total series of elective and emergency operations, 3 patients (4%) died within the first 30 days and 3 more died by the end of the first year of follow-up. Functional capacity was assessed by interviews and a questionnaire in a subset (n = 39) at least 6 months after operation. Although 79% of the patients felt that the operation had resulted in improvement of symptoms, half of them continued to report angina. Only one-third of the patients were working in the period immediately before the operation; 13% were working postoperatively. Coronary artery bypass grafting had an acceptable mortality risk in these patients, although the functional outcome was disappointing.

Adult↗