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Teja V.S.,Sri Ramachandra Medical College | Agarwal P.,Sri Ramachandra Medical College | Bagdi R.K.,Apollo Hospitals
Journal of Minimal Access Surgery | Year: 2017

Background: Subcutaneous endoscopic excision of benign lesions of the head, neck and trunk is a new dimension in paediatric minimally invasive surgery. This study is a case series where cases are operated endoscopically with minimal scars. Patients and Methods: This is a prospective study where in 13 patients who underwent Stealth surgery were enrolled in this study. Factors such as intraoperative time, blood loss, intraoperative complications, postoperative recovery and appearance and placing of minimal scars at inconspicuous sites were taken into consideration. Results: All patients underwent successful surgery without converting to open surgery. Out of 13 patients, five were torticollis, four were suprasternal dermoid, one had chest wall swelling, one had swelling of arm, one had back lipoma and one had forehead lipoma. The mean operation time was 50 min (range 32-70). All patients were followed up regularly postoperatively. All patients were operated as daycare, less postoperative pain, no evident scars, lower complications related to scars. Conclusion: Subcutaneous endoscopic surgery addresses concerns related to scarring by replacing large visible incisions with smaller incisions placed in inconspicuous locations. This is a safe and effective procedure of early recovery. © 2017 Journal of Minimal Access Surgery.


Kalaiselvi V.S.,Sree Balaji Medical College and Hospital | Saikumar P.,Sree Balaji Medical College and Hospital | Prabhu K.,Sree Balaji Medical College and Hospital | Prashanth Krishna G.,Sri Ramachandra Medical College
Journal of Clinical and Diagnostic Research | Year: 2012

Background: Ovarian Reserve (OR) is a term which describes the functional potential of the ovary, which constitutes the size of the ovarian follicle pool and reflects the number and quality of the oocytes which are within it. Assessment of the OR helps in reflecting the reproductive potential of women. Various markers are available for assessing the OR and the best marker is the Anti Mullerian Hormone (AMH) which reflects the ovarian follicular pool in the ovary. In this study, the serum level of AMH/MIS(Mullerian Inhibiting Substance)was estimated to assess the ovarian reserve in both fertile and infertile women. Objective: To assess the ovarian reserve in women of the fertile and subfertile groups with regular cycles, who were in the age range of 26 -33yrs, by estimating the level of AMH and those of other hormones like FSH and E2 and also to calculate the ovarian volume and the Antral follicular count by an ultrasonographic method. Materials and Methods: Thirty fertile and thirty sub fertile women whose ages ranged from 26-33yrs were included as group 1 and group 2 respectively. The hormones like AMH, FSH and oestradiol were assayed. Measurement of the ovarian volume and the antral follicular count by doing a transvaginal ultrasonogram, was done in all the subjects who were involved in both the groups. The correlation test was studied between the variables and the test of significance of the variables between the 2 groups was also analyzed by the Statistical Package Of Social Sciences (SPSS). Results: The Antral Follicular Count (AFC) and the ovarian volume were negatively correlated with the age. The ovarian volume was positively correlated with the AFC. The FSH negatively correlated with the AFC. The Anti Mullerian Hormone negatively correlated with the age, and it positively correlated with the AFC. The mean values of AFC, FSH, and AMH were also statistically significant between the two groups. Conclusion: AMH can be considered as a marker for assessing the ovarian reserve, as it is cycle independent as compared to the other hormones. The women in the subfertile group with low levels of AMH should be insisted to proceed for ART as early as possible.


Arun-Muthuve V.,Sri Ramachandra Medical college | Jaya V.,Sri Ramachandra Medical college
Asian Pacific Journal of Cancer Prevention | Year: 2014

Purpose: To evaluate the diagnostic performances of risk of malignancy index. (RMI), CA-125 and ultrasound score in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostic test for referral of suspected malignant ovarian cases to gynaecologic oncologists. Materials and Methods: This prospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July 2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnostic values of each parameter and the RMI were determined and compared using Statistical Packages for Social Sciences Version 14.0.1. Results: In our study, 61% of ovarian tumors were malignant in the post-menopausal age group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer. CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivity of 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies. Ultrasound when used individually had the best sensitivity but poor specificity. Conclusions: Our study has demonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients with pelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist. Other models of preoperative evaluation should be developed to improve the detection of early stage invasive, borderline and non-epithelial ovarian cancers.


Babu R.,Sri Ramachandra Medical College | Gopinath V.,Sri Ramachandra Medical College
Indian Journal of Urology | Year: 2015

Introduction: A conventional urodynamic study (UDS) is considered invasive while uroflowmetry is considered inadequate in the evaluation of children with lower urinary tract dysfunction. The aims of this study were to identify the role of uroflowmetry with electromyography (UFEMG) in this group. Methods: A cohort of 121 children (age 5-12 years; M:F = 2:3) with symptoms of lower urinary tract dysfunction underwent a detailed voiding history and clinical assessment. Those with evidence of neurological abnormality, obstructive uropathy or active urinary tract infection were not included. They were prospectively studied using UFEMG first, followed by UDS on the same day. Results: A total of 76 (63%) children had abnormality on UFEMG while only 12 (10%) had abnormality on UDS. UFEMG was significantly superior in picking up abnormality (P = 0.03). Three types of UFEMG abnormalities were identified: (1) dysfunctional voiding (prolonged staccato trace with active pelvic floor and normal voided volume: n = 42), (2) idiopathic detrusor overactivity (shortened trace with quiet pelvic floor and reduced voided volume: n = 16) and (3) detrusor underutilization disorder (prolonged flat trace with quiet pelvic floor and large voided volume: n = 18). Conclusions: UFEMG is ideal non-invasive test in children with lower urinary tract dysfunction. It helps in identifying the different patterns and the appropriate treatment modality. © 2015 Indian Journal of Urology.


Anandarani V.S.,Sri Ramachandra Medical College
Biomedicine | Year: 2011

Anomalous pancreatico biliary junction is an unusual variant of pancreatico biliary anatomy of clinical importance. It is a congenital anomaly where the common duct formed by the union of main pancreatic duct and bile duct is more than 15 mm in length. According to the mode of termination two different types are described .Each type is associated with specific clinical conditions.


Saminatha P.,Karpagam University | Rajendran P.,Sri Ramachandra Medical College
International Journal of Pharma and Bio Sciences | Year: 2014

Biosurfactant are surface active compounds produced by microorganisms. These molecules reduce surface tension between aqueous solutions and hydrocarbon mixtures. Hundred hydrocarbon saturated soil samples were collected from thirty different areas in Chennai, TamilNadu, India. Seventy two bacterial strains were isolated and cultured by enriching carbon (Glycerol) source. Each culture medium was screening to confirm the ability of biosurfactant production. These were conducted using surface tension and emulsification activity methods. The result reveals that fifty four strains of bacteria showed surface tension in the range between 0.026Nm-1 to 0.072Nm-1. The emulsifying capacity evaluated by the E24 emulsification index range from 36-85% EA. Among 54 isolates, 9 isolates displayed highest activity after detection with emulsification index method. They were identified for potent biosurfactant production. These were conducted using series of screening methods.


Ram G.G.,Sri Ramachandra Medical College | Suresh P.,Sri Ramachandra Medical College | Vijayaraghavan P.V.,Sri Ramachandra Medical College
Chinese Journal of Traumatology - English Edition | Year: 2014

Objective To assess the accuracy of the clinically estimated blood loss (EBL) when compared with the actual blood loss (ABL) in replacement surgeries. Methods This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013. Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits. Exclusion criteria were intake of anti-platelet drug or anti-coagulant, bleeding disorders, thrombotic episode, and haematological disorders. There were 65 men and 75 women. In this study, the consultants were free to use any clinical method to estimate the blood loss, including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carried in all the mops and gauzes), measuring blood lost to suction bottles and blood in and around the operative field. The ABL was calculated based on a modification of the Gross's formula using haematocrit values. Results In 42 of the 140 cases, the EBL exceeded the ABL. These cases had a negative difference in blood loss (or DIFF-BL < 0) and were included in the overestimation group, which accounted for 30% of the study population. Of the remaining 98 cases (70%), the ABL exceeded the EBL. Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL > 0). We found that when the average blood loss was small, the accuracy of estimation was high. But when the average blood loss exceeded 500 ml, the accuracy rate decreased significantly. This suggested that clinical estimation is inaccurate with the increase of blood loss. Conclusion This study has shown that using clinical estimation alone to guide blood transfusion is inadequate. In this study, 70% of patients had their blood loss underestimated, proving that surgeons often underestimate blood loss in replacement surgeries. © 2014 Daping hospital and the Research Institute of Surgery of the Third Military Medical University.


Mohan P.,Stanley Medical College | Ramu B.,Stanley Medical College | Bhaskar E.,Sri Ramachandra Medical College | Venkataraman J.,Stanley Medical College
Annals of Hepatology | Year: 2011

Background. Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking in the developing world may predispose cirrhotic individuals to skin infection. Aims. To determine the prevalence, risk factors, spectrum of infective organism and outcome of bacterial skin infection in cirrhosis. Methods. Consecutive newly diagnosed patients with cirrhosis (n = 200) between September 2007 and September 2008 were studied. Patients with congestive heart failure (n = 50) and chronic kidney disease (n = 50) on follow up at the same institution served as controls. Baseline demographic details, history of outdoor barefoot walking, details of skin infection along with cultures from skin and blood were obtained. The association between patient factors and risk of skin infection was evaluated using logistic regression. Results. Alcoholism was the predominant etiology for cirrhosis. (50%) Most of them were of Child B cirrhosis. Walking on barefoot was found to be similar in cases and controls. 21(10.5%) patients with cirrhosis had skin infection, three fourth of them had a history of barefoot walking. None of the controls had skin infection. Cellulitis with hemorrhagic bullae, leg ulcers, infected callosity and abscess were observed. The infective organism could be isolated in 17 patients. Escherichia coli was the most frequent organism identified. Logistic regression showed outdoor barefoot walking and serum albumin < 2.5 gm/dL as risk factors for skin infection. Four patients died. Conclusion. The prevalence of skin infection in cirrhosis was 10.5% with a mortality of 19%. Escherichia coli was the commonly implicated organism. Outdoor barefoot walking was a strong risk factor for skin infection in cirrhosis.


Sriram K.,Sri Ramachandra Medical College | Babu R.,Sri Ramachandra Medical College
Indian Journal of Urology | Year: 2016

Introduction: There are multiple techniques for surgical correction of vesicoureteral reflux (VUR). We compared the outcomes of extravesical versus Cohen's reimplantation for VUR in children. Methods: Records of all children (n = 118) who underwent reimplantation for VUR between 2003 and 2014 were analyzed (male: female = 43:75). Children with secondary VUR, duplication anomalies, and ectopic ureter were excluded from our study. Extravesical reimplantation (EVR) was performed bilateral in 32 children (Group 1a) and unilateral in 19 (Group 1b), while bilateral Cohen's reimplantation was performed in 67 (Group 2). Parameters compared were length of the surgical procedure, average duration of stay in the hospital, postoperative bladder spasms, significant hematuria >72 h, and long-term complications. Results: The mean age at operation was 15 months in Group 1, and 36 months in Group 2. The mean duration of surgery was significantly less (P = 0.0001) in Group 1a (n = 32; mean 104 min; standard deviation [SD] 18 min) compared to Group 2 (n = 67; mean 128 min; SD 15 min). The mean (SD) postoperative stay was significantly lower (P = 0.0001) at 4.5 (1.5) days in Group 1a compared to 6.5 (0.5) days in Group 2. Postoperative bladder spasms were significantly lower (P = 0.03) at 10/32 in Group 1a compared to 37/67 in Group 2. All patients responded well with anticholinergics. Postoperative hematuria and bladder spasms were significantly lower (P = 0.03) in Group 1a compared to Group 2. There was no significant difference in persistent VUR between Group 1 and Group 2. At 1 year follow, none of them had any evidence of ureteral obstruction. Conclusions: EVR has lower operative time, less postoperative discomfort and shorter hospital stay compared to Cohen's reimplantation. Both techniques are equally effective in treating reflux. © 2016 Indian Journal of Urology.


Karthick N.,SRM University | Dillara K.,Sri Ramachandra Medical College | Poornima K.N.,SRM University | Subhasini A.S.,Sri Ramachandra Medical College
Journal of Clinical and Diagnostic Research | Year: 2013

Background: In overt hypothyroidism, many lipid abnormalities have been documented. This study was intended to demonstrate the levels of lipid in women with subclinical hypothyroidism (SH). Material and Methods: This was a case control study which was done at referral Centre in Chennai. Women with subclinical hypothyroidism and euthyroid women attending our master health checkup clinic were enrolled in this study.Their lipid profile, fasting blood sugar, T3,T4 and TSH levels were measured. In subclinical hypothyroidism, various parameters were compared. Results: Thirty euthyroid and 30 age matched subclinical hypothyroid women were enrolled in this study. There were significant dyslipidaemic changes is SH women as compared to euthyroid controls. Serum total cholesterol and triglyceride levels were significantly higher as compared to those in controls. LDL levels were higher is SH women, but did not reach statistical significance and lower levels of HDL were noticed in SH subjects as compared to those in euthyroid women. A positive association was also reported between serum TSH and lipid parameters in our study group. Conclusion: SH, the earliest form of thyroid failure, has negative metabolic effects on the affected subjects. SH could be one of the causes of secondary hyperlipidaemia and should be viewed as an independent risk factor for atherosclerosis, along with obesity, hypertension, diabetes, etc.

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