Menon J.K.R.,Kerala Institute of Medical science Hospital |
Nair R.M.,PVS Memorial Hospital |
Priyanka S.,Sree Chitra Tirunal Institute for Medical Science and Technology
Journal of Laryngology and Otology | Year: 2014
Objective: To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis.Method: A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation.Results: Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p <0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria.Conclusion: Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery. © 2014 JLO (1984) Limited.
PubMed | Scb Medical College, Osmania Medical College & Hospital, G Hospital & Post Graduate Institute, Population Health and Research Institute and 5 more.
Type: Journal Article | Journal: Journal of clinical and experimental hepatology | Year: 2015
The study aimed at assessing the therapeutic efficacy and safety of metadoxine versus placebo on the ultrasonographic and histological features of non-alcoholic steatohepatitis (NASH).134 subjects with biopsy-confirmed NASH were randomized to receive metadoxine 500mg two times daily (n=75) or placebo (n=59) added to the standard of care, over 16 weeks.Originally, the primary efficacy endpoint was the composite of: reduction in the steatosis by 1 grade, reduction in hepatic necro-inflammation by 1 grade and ALT normalization. Since >50% of patients refused the second biopsy, it was decided to analyze only the individual parameters.There was no significant difference between the treatment and the placebo groups in either liver histology or ALT or AST. Overall, as expected both groups showed reduction in serum ALT and AST compared to baseline. Compared to placebo (9 out 54), patients on metadoxine (34 out of 75) had significantly higher rates of improvement in 1-point in steatosis grade on ultrasound (P-value <0.001). Safety and tolerability did not differ between treatments.Metadoxine is not effective in improvement of liver histology or serum ALT or AST in patients with NASH. However, there was significant improvement of steatosis assessed by ultrasound. To properly estimate the effects on histology and transaminases, further studies of longer duration and at higher doses are needed.
Abraham G.P.,Lakeshore Hospital and Research Center |
Das K.,Lakeshore Hospital and Research Center |
Ramaswami K.,PVS Memorial Hospital |
Siddaiah A.T.,Lakeshore Hospital and Research Center |
And 3 more authors.
Journal of Endourology | Year: 2012
Purpose: To narrate our experience with laparoscopic reconstruction of obstructive megaureter (MGU) and assess the intermediate-term outcome achieved. Patients and Methods: Patients were evaluated in detail including presenting complaints, biochemical profile, and imaging (ultrasonography [USG], diuretic renography [DR], magnetic resonance urography [MRU], and voiding cystourethrography [VCUG]). All patients with a diagnosis of obstructive MGU and salvageable renal unit were offered laparoscopic reconstruction. The standard laparoscopic exercise included ureteral adhesiolysis until the pathologic segment, dismemberment, straightening of the lower ureter, excisional tapering, and a nonrefluxing ureteroneocystostomy. Operative and postoperative parameters were recorded. Patients were evaluated postprocedure on a 3-month schedule. Follow-up imaging included USG and VCUG at 6 months and 1 year postprocedure and then at yearly intervals. MRU and DR were repeated at 1 year postprocedure. Results: Twelve patients (13 units-11 unilateral, and 1 bilateral) underwent laparoscopic tailoring and reimplantation for obstructive MGU. Mean age was 98.6 months. All patients were male. Mean body mass index was 17.69 kg/m 2. Presenting complaints were flank pain (n=8) and recurrent urinary infection (n=12). All procedures were completed via a laparoscopic approach. Mean operation duration was 183 minutes, and mean blood loss was 75 mL. Mean duration of hospital stay was 2.1 days. No major intraoperative or postoperative happenings were recorded. All patients were asymptomatic at follow-up with stable renal profile. Follow-up MRU revealed a decrease in ureteral and upper tract dilatation with satisfactory drainage in all. Follow-up VCUG demonstrated grade I vesicoureteral reflux in one patient. Eight patients completed 3-year follow-up with a satisfactory outcome. Conclusion: Laparoscopic reconstruction of obstructive MGU offers satisfactory immediate- and intermediate-term outcome without undue prolonged morbidity. Copyright © 2012, Mary Ann Liebert, Inc. 2012.
Rammohan K.,TD Medical College Hospital |
Mundayadan S.,PVS Memorial Hospital |
Mathew R.,Pushpagiri Institute of Medical science and Research Center
Journal of Neurosciences in Rural Practice | Year: 2016
Context: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2-6 cm in diameter. Aims: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. Settings and Design: A prospective, observational study conducted in a tertiary care center. Materials and Methods: Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. Results: A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36-60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. Conclusion: Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain. © 2016 Journal of Neurosciences in Rural Practce.
News Article | January 26, 2017
Doctors in India took out a long pork tapeworm from a man's gut through his mouth, according to a report published in the New England Journal of Medicine. The Taenia solium tapeworm that was found in the man's gut was nearly 2 meters long. This was the longest tapeworm ever seen by Dr. Cyriac Philips, the liver doctor at PVS Memorial Hospital in India who took out the tapeworm from the patient. The 48-year-old patient had been experiencing abdominal pains and lethargy for two months before seeking medical attention. The patient exhibited signs of pallor, and lab results showed mild anemia. The doctors performed a colonoscopy test on the patient to reveal a proglottid from a tapeworm. Next, a gastroduodenoscopy was conducted using cameras inserted into the man's digestive system in order to reveal the location of the worm. The doctors were surprised to find a long tapeworm curled up in the man's small intestine. They used a gastroscope and forceps to reach the tip of the tapeworm and pulled it out through the patient's mouth. The worm ended up measuring 188 centimeters (6.16 feet) long and was identified as Taenia solium, also known as the pork tapeworm. Treatment of Taenia solium infection usually means the administration of antiparasitic medications such as praziquantel or albendazole. In this case, a dose of praziquantel was administered to the patient. The endoscopy and extraction took an hour and 15 minutes, and the patient was sedated during the entire process. One month after the extraction, the patient showed no signs of having additional symptoms. According to the National Library of Medicine, tapeworms can grow up to a maximum of 11.5 feet. They can live for many years in a human gut without the person being aware of their presence because they do not show symptoms, except for some abdominal pain and discomfort. In other tapeworm-related news, Alaskan salmon was found to be carrying a Japanese tapeworm parasite known as the Diphyllobothrium nihonkaiense. This particular parasite has been found in 2,000 illnesses in Japan and other Asian countries, affecting people who eat infected fish. Jayde Ferguson of the Department of Fish and Game inspected 64 wild Alaskan salmon in 2013. Ferguson's group discovered larvae that measured 15 millimeters long in the internal organs of the fish they inspected. At least four types of Pacific salmon are now known to have the Japanese tapeworm infection: the chum salmon, pink salmon, masu salmon, and sockeye salmon. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
Prakash K.,PVS Memorial Hospital |
Kamalesh N.,PVS Memorial Hospital |
Pramil K.,PVS Memorial Hospital |
Vipin I.,PVS Memorial Hospital |
And 2 more authors.
Journal of Minimal Access Surgery | Year: 2013
Introduction: Laparoscopic colorectal surgery is being widely practiced with an excellent short-term and equal long-term results for colorectal diseases including cancer. However, it is widely believed that as the experience of the surgeon/unit improves the results get better. This study aims to assess the pattern of case selection and short-term results of laparoscopic colorectal surgery in a high volume centre in two different time frames. Materials and Methods: This study was done from the prospective data of 265 elective laparoscopic colorectal resections performed in a single unit from December 2005 to April 2011. The group was subdivided into initial 132 patients (Group 1) from December 2005 to December 2008 and next 133 patients (Group 2) between December 2008 and April 2011 who underwent laparoscopic colorectal resections for cancer. The groups were compared for intraoperative and perioperative parameters, type of surgery, and the stage of the disease. Results: The age of patients was similar in Groups 1 and 2 (57.7 and 56.9, respectively). Patients with co-morbid illness were significantly more in Group 2 than in Group 1 (63.2% vs. 32.5%, respectively, P≤0.001). There were significantly more cases of right colonic cancers in Group 1 than in Group 2 (21.9% vs. 11.3%, respectively, P<0.02) and less number of low rectal lesions (20.4% vs. 33.8%, respectively, P≤0.02). The conversion rates were 3.7% and 2.2% in Groups 1 and 2, respectively. The operating time and blood loss were significantly more in Group 1 than in Group 2. The ICU stay was significantly different in Groups 1 and 2 (31.2± 19.1 vs. 24.7± 18.7 h, P≤0.005). The time for removal of the nasogastric tube was significantly earlier (P=0.005) in Group 2 compared to Group 1 (1.37± 1.1 vs. 2.63±1.01 days). The time to pass first flatus, resumption of oral liquids, semisolid diet, and complications were similar in both groups. The hospital stay was more in Group 1 than in Group 2 ( P≤0.01). The numbers of lymph nodes retrieved was similar in both groups. The T stage of the disease in Groups 1 and 2 were similar, however, the number of T4 lesions was significantly more in Group 2 (8.3% vs. 18.7%, respectively, P<0.01). Conclusion: This study shows that with increasing experience, laparoscopic colorectal surgery can be practiced safely with minimal conversion rates and morbidity. As the units experience improves, there is a trend towards selecting advanced cases and performing complex laparoscopic colorectal procedures. With increasing experience, there is a trend towards better short-term outcome after laparoscopic colorectal surgeries.
Prakash K.,PVS Memorial Hospital |
Kamalesh P.,PVS Memorial Hospital
Journal of Minimal Access Surgery | Year: 2013
Primary perineal hernia is a rare clinical condition wherein herniation of viscera occurs through pelvic diaphragm. They are usually mistaken for sciatic hernia, rectal prolapse or other diseases in the perineum. Correct identification of the type of hernia by imaging is crucial for planning treatment. We present a case of primary posterior herniation of urinary bladder and rectal wall through levator ani repaired laparoscopically using a mesh repair.
PubMed | PVS Memorial Hospital
Type: Journal Article | Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract | Year: 2015
Whether octreotide prevents pancreatic fistula following pancreatoduodenectomy is controversial and it is believed to be beneficial in soft glands and normal-sized ducts. The aim of this study is to assess the potential value of octreotide in reducing the incidence of pancreatic fistula, postoperative complications, morbidity and hospital stay in patients with soft pancreas and non-dilated ducts.A total of 109 patients undergoing elective pancreatoduodenectomy with soft pancreas and non-dilated duct were randomized to octreotide group versus no octreotide-the control group. Surgical steps were standardized and incidences of pancreatic fistula, complications, death and hospital stay were assessed.There were 55 patients in octreotide group and 54 in the control group. Demographic features and pancreatic duct diameter of the groups were comparable. The rates of clinically significant pancreatic fistulae (grades B and C) were 10.9 and 18.5 % (p=ns), and morbidity was 18 and 29.6 % (p=ns), respectively. Patients who received octreotide resumed oral diet early and had a shorter hospital stay.This study demonstrated no statistical difference in pancreatic fistulae with the use of octreotide, though there was a trend towards fewer incidences of pancreatic fistulae, morbidity and shorter hospital stay. ClinicalTrials.gov Identifier: NCT01301222.
PubMed | PVS Memorial Hospital
Type: Journal Article | Journal: Journal of minimal access surgery | Year: 2015
Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon.To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre.This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome.A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group.MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well.
PubMed | PVS Memorial Hospital
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2016
Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal pathology. Complications that follow this common procedure include dislodgement, dysfunction, infection, gastric/colonic perforation, bleeding, peritonitis, or death. The emergency physician should be aware of the complications and symptoms/signs associated for appropriate management of these patients. We present a case of a young lady who developed a cerebral infarction following amniotic fluid embolism during her cesarean section and had undergone a PEG tube placement. She developed displacement of this PEG tube and underwent another PEG tube placement. She later presented to us with PEG tube migration into the transverse colon and required surgical removal of the same PEG tube.