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Coimbatore, India

Rajasekaran S.,Ganga Hospital
International Orthopaedics | Year: 2012

Spinal tuberculosis is the most common cause of severe kyphosis in many parts of the world. Three percent of patients treated conservatively end up with a deformity greater than 60 degrees which can cause serious cosmetic, psychological, cardio-respiratory and neurological problems. Severe kyphotic deformities are usually the result of childhood spinal deformities and 'Spine at risk' radiological signs are helpful to identify children at risk of deformity. In children, a severe type of collapse, termed as 'Buckling Collapse' is also noted where the kyphosis is more than 120 degrees. Risk factors for buckling collapse include an age of less than seven years at the time of infection, thoracolumbar involvement, loss of more than two vertebral bodies and the presence of radiographic 'Spine-at-risk' signs. In correction of established deformity, posterior only surgery with a variety of osteotomies is now preferred. In patients with deformity of more than 90 degrees, an opening-closing wedge osteotomy must be done to prevent neurological deficit. © 2012 Springer-Verlag. Source

Rajasekaran S.,Ganga Hospital
European Spine Journal | Year: 2010

Burst fractures are common in the thoracolumbar junction and account for 17% of all major spinal fractures. There is a considerable controversy on the efficacy of conservative treatment and the need for surgical intervention. Need for additional stability, prevention of neurological deterioration, attainment of canal clearance, prevention of kyphosis and early relief of pain are the commonly quoted reasons for surgical intervention. However, a careful review of literature does not validate any of the above arguments. The available randomised control trials prove that the results of conservative treatment for burst fractures are equal to that of surgery and also with lesser complications. Surgery for burst fractures may, however, have definite advantages in patients with polytrauma or in the rare event of deteriorating neurology. It is also important for the treating surgeon to clearly distinguish a burst fracture from other inherently unstable injuries like fracture dislocations, chance fractures and flexion rotation injuries which require surgical stabilisation. © Springer-Verlag 2009. Source

Ravishankaran P.,Coimbatore Medical College Hospital | Karunanithi R.,Ganga Hospital
World Journal of Surgical Oncology | Year: 2011

Background: Breast cancer is a disease that continues to plague females during their entire lifetime. IL-6 and CRP are found to be elevated in various inflammatory and malignant diseases and their levels are found to correlate with the extent of the disease. The primary objective of this study was to determine the preoperative serum levels of IL-6 and CRP in breast carcinoma, and to correlate them with the staging of the disease and the prognosis.Methods: 59 female patients admitted for breast cancer were identified for the study and were subjected to thorough evaluation. Serum levels of IL-6 were assessed via Enzyme-Linked Immuno-Sorbent Assay (ELISA), and CRP was measured via immunoturbidimetry. Histological findings included tumour size, lymph node (LN) metastasis, and tumour staging. Relevant investigations were made to find out the presence of distant metastasis. Statistical analysis of the data was then processed.Results: Increases in cancer invasion and staging are generally associated with increases in preoperative serum IL-6 levels. IL-6 and CRP levels correlated with LN metastasis (P < 0.001, P < 0.001) and TNM stage (P < 0.001, P < 0.001). Tumour invasion and the presence of distant metastasis is associated with higher IL-6 levels (P = 0.001, P = 0.009). When we established the cutoff value for IL-6 level (20.55 pg/dl) by ROC curve, we noted a significant difference in overall survival (OS; P = 0.008). However, CRP evidenced no significance with regard to patient's OS levels. Serum IL-6 levels were correlated positively with CRP levels (r2 = 0.579, P < 0.01). Conclusion: Serum levels of IL-6 correlates well with the extent of tumor invasion, LN metastasis, distant metastasis and TNM staging thus enveloping all aspects of breast cancer. © 2011 Ravishankaran and Karunanithi; licensee BioMed Central Ltd. Source

Rajasekaran S.,Ganga Hospital
European Spine Journal | Year: 2013

The natural history of Pott's kyphosis is different from that of other spinal deformities. After healing of the spinal infection, the post-tubercular kyphosis in adults is static but in children variable progression of the kyphosis is seen. The changes occurring in the spine of children, after the healing of the tubercular lesion, are more significant than the changes that occur during the active stage of infection. During growth, there is a decrease in deformity in 44 % of the children, an increase in deformity in 39 % of the children and no change in deformity in 17 % of the children. The critical factor leading to the progress of the deformity is dislocation of the facets. This can be identified on radiographs by the "Spine-at-risk" signs. Dislocation of facets at more than two levels can lead to the "Buckling collapse" of the spine, which is characteristically seen only in severe tubercular kyphosis in children. Age below 10 years, vertebral body loss of more than 1-1.5 pre-treatment deformity angle of greater than 30° and involvement of cervicothoracic or thoracolumbar junction are the other risk factors for deformity progression. In children, the kyphosis can progress even after healing of the spinal infection and hence children with spinal tuberculosis must be followed-up till skeletal maturity. © Springer-Verlag 2012. Source

Purpose: Neglected anterior radial head dislocation in type I Monteggia lesions leads to restriction of movement, deformity and instability of the affected elbow. If left untreated this leads to a painful arthritic elbow due to secondary degenerative changes. This is a difficult problem to manage and many intra-articular, extra-articular and combined procedures have been described with variable results. We report a new technique of sliding angulation osteotomy for this condition, which allows both lengthening and angulation of the ulna.Methods: A novel technique of sliding angulation osteotomy of the proximal ulna was done to achieve reduction of the radial head. Four patients with persistent anterior radial head dislocation were treated at our institution with this technique.Results: All of them had good clinical and radiological outcomes at final follow-up.Conclusions: Sliding angulation osteotomy is a technically simple procedure, which achieves lengthening and angulation of the ulna simultaneously in the sagittal plane and reduces the radial head. © 2014, SICOT aisbl. Source

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