Mettupalayam, India
Mettupalayam, India

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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.


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.


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.


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

Although the discovery of effective antituberculosis drugs has made uncomplicated spinal tuberculosis a medical disease, the advent of multi-drug-resistant Mycobacterium tuberculosis and the co-infection of HIV with tuberculosis have led to a resurgence of the disease recently. The principles of drug treatment of spinal tuberculosis are derived from our experience in treating pulmonary tuberculosis. Spinal tuberculosis is classified to be a severe form of extrapulmonary tuberculosis and hence is included in Category I of the WHO classification. The tuberculosis bacilli isolated from patients are of four different types with different growth kinetics and metabolic characteristics. Hence multiple drugs, which act on the different groups of the mycobacteria, are included in each anti-tuberculosis drug regimen. Prolonged and uninterrupted chemotherapy (which may be 'short course' and 'intermittent' but preferably 'directly observed') is effective in controlling the infection. Spinal Multi-drug-resistant TB and spinal TB in HIV-positive patients present unique problems in management and have much poorer prognosis. Failure of chemotherapy and emergence of drug resistance are frequent due to the failure of compliance hence all efforts must be made to improve patient compliance to the prescribed drug regimen. © Springer-Verlag 2012.


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.


The authors report the utility of diffusion tensor tractography in demonstrating the partially severed spinal cord tracts on one side with normal, intact, distally traceable tracts on the opposite side in a patient with posttraumatic Brown Sequard syndrome. A 30-year-old man presented with typical clinical features of a hemisection injury of the thoracic spinal cord, 2 months after he had sustained a back stab injury. Routine MRI showed T2 hyperintense zones in the thoracic spinal cord at the level of T5. We did axial single shot echo planar diffusion tensor imaging with a 1.5 Tesla MR machine. Tractography effectively depicted the injured spinal cord tracts on the left side with normal intact tracts on the right side, which could be traced distally. The fractional anisotropy and apparent diffusion coefficient values showed significant changes at the level of injury. Tractographic demonstration of human spinal cord injury is reported for the first time.


STUDY DESIGN.: A prospective randomized controlled trial. OBJECTIVE.: To assess the ability of local vancomycin powder in controlling postoperative infection in spine surgery. SUMMARY OF BACKGROUND DATA.: Despite improvements through the use of prophylactic systemic antibiotics, surgical site infections remain a significant problem in spine surgical procedures. Various retrospective and prospective studies have reported the efficacy of local application of vancomycin powder in reducing the infection in animal and human studies. However, there were no randomized control trials that reported on its efficacy. METHODS.: Prospective randomized controls of 907 patients with various spinal pathologies were treated surgically during a period of 18 months. The control group received standard systemic prophylaxis only, whereas the treatment group received vancomycin powder in the surgical wound in addition to systemic prophylaxis. Patient demographics, comorbidities, level of spinal pathology, estimated blood loss, nutritional status, and hemoglobin were recorded. Incidence of infection was the primary outcome evaluated. RESULTS.: There were 8 infections (1.68%) in the control group (6 instrumented and 2 noninstrumented, 6 deep and 2 superficial) with bacteria cultured in 3 (1 Escherichia coli and 2 Staphylococcus aureus). In the treatment group, 7 infections (1.61%) were observed (6 instrumented and 1 noninstrumented surgical procedures, 6 deep and 1 superficial) with bacteria cultured in 3 (1 Staphylococcus aureus and 2 Klebsiella). No adverse effects were observed from the use of vancomycin powder. Statistically no significant difference was seen in infection rate between the treatment group and control group. CONCLUSION.: The local application of vancomycin powder in surgical wounds did not significantly reduce the incidence of infection in patients with surgically treated spinal pathologies. The use of vancomycin powder may not be effective when incidence of infection is low. © 2013, Lippincott Williams & Wilkins.


Rajasekaran S.,Ganga Hospital | Kanna R.M.,Ganga Hospital | Shetty A.P.,Ganga Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2012

The identification of the extent of neural damage in patients with acute or chronic spinal cord injury is imperative for the accurate prediction of neurological recovery. The changes in signal intensity shown on routine MRI sequences are of limited value for predicting functional outcome. Diffusion tensor imaging (DTI) is a novel radiological imaging technique which has the potential to identify intact nerve fibre tracts, and has been used to image the brain for a variety of conditions. DTI imaging of the spinal cord is currently only a research tool, but preliminary studies have shown that it holds considerable promise in predicting the severity of spinal cord injury. This paper briefly reviews our current knowledge of this technique. ©2012 British Editorial Society of Bone and Joint Surgery.


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.


STUDY DESIGN.: Prospective observational cohort study. OBJECTIVE.: To analyse the efficacy of Diffusion Tensor Imaging (DTI) anisotropy indices in predicting the post-operative recovery in Cervical Spondylotic Myelopathy (CSM) patients and to describe post-operative changes in the DTI indices based on neurological recovery after surgery. SUMMARY OF BACKGROUND DATA.: Surgical results of CSM are unpredictable and cannot be estimated based on preoperative MRI. DTI indices were found to have good sensitivity to detect changes in CSM but their efficacy in predicting post-operative recovery and post operative changes in DTI indices have not been studied before. METHODS.: Thirty-five patients who underwent surgical decompression for cervical spondylotic myelopathy underwent DTI evaluation pre-operatively and post-operatively at 12 months. DTI indices- Fractional anisotropy (FA), Apparent diffusion coefficient (ADC), Relative anisotropy (RA), Volume ratio (VR) and eigen vectors (E1, E2 and E3) were obtained and clinical evaluations were made pre-operatively and 12 months post-operatively. RESULTS.: Twenty-six patients were available for final follow up at 12 months. Twenty patients showed improvement by at least 1 Nurick grade, 5 maintained the pre-operative Nurick grade status and 1 patient was noted to have deterioration by 1 grade. The pre-operative DTI values could not predict neurological recovery patterns post-operatively. While conventional MRI showed adequate decompression in all patients irrespective of the clinical outcome, DTI indices showed variable results. There were significant improvements in postoperative DTI indices for ADC (P?=?0.002), E1 (p?

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