Browsing by Author "Jagdish, S"
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Item Aeromonas caviae as a cause of cholecystitis.(2000-04-24) Kumar, A; Kanungo, R; Jagdish, S; Badrinath, SItem Alveolar soft part sarcoma: a unique tumor with disputed histogenesis.(2003-04-13) Nair, Amit; Pai, Dinker R; Jagdish, S; Krishnan, RItem Anterior or posterior gastro-jejunostomy with truncal vagotomy for duodenal ulcer--are they functionally different?(2003-10-29) Umasankar, A; Kate, Vikram; Ananthakrishnan, N; Smile, S R; Jagdish, S; Srinivasan, KTruncal vagotomy with gastrojejunostomy (GJ) is the standard treatment for chronic cicatrizing duodenal ulcer with gastric outlet obstruction. We tried to determine if a significant functional difference exists in the early and late outcomes following anterior and posterior types of GJ to treat this condition. The case records of 106 patients who underwent truncal vagotomy and GJ at our institute from 1 January 1995 to 31 December 1999 were studied retrospectively. Patients were followed up with a personal interview. Perioperative and long-term parameters were compared in the anterior and posterior G.I. groups. Sixty-five patients (61.32%) were followed up; 31 in the anterior group and 34 in the posterior group. The median follow-up was 5 years (range 2.5-7.5 years). Except for a significant difference in length of afferent loop (p < 0.0001), there were no significant differences in the duration of hospital stay, nasogastric aspirates on postoperative days 1, 2, 3 and 4 and the day the nasogastric tube was removed. Early postoperative complications were uncommon and not different in the two groups and long-term outcomes were similar. The Anterior GJ, being technically easier and needing less operative time, may be advocated in all cases of chronic duodenal ulcer, with gastric outlet obstruction requiring truncal vagotomy and drainage.Item Changing trends in outcome of typhoid ileal perforations over three decades in Pondicherry.(2001-07-30) Chatterjee, H; Jagdish, S; Pai, D; Satish, N; Jayadev, D; Reddy, P STwo hundred and forty eight cases of proved typhoid ileal perforation were admitted and treated in three phases in the department of surgery during 1966-1998. Of these, 71% patients belonged to second and third decades of life. Male female ratio was 4:1. Abdominal pain (100%) fever (95%) and constipation (87%) were the main presenting symptoms. Abdominal guarding and rigidity (84%) were the principal physical signs. Plain radiograph of abdomen showed evidence of pneumoperitoneum in 57% of cases. The Widal test was positive for S. typhi in 74% of cases. Blood and bone marrow culture were positive for S. typhi in 9% and 30% respectively. Histology of the excised edges of perforation confirmed typhoid pathology in 62% of specimens. Many of the patients were treated conservatively in the first phase. In phase two and three vigorous resuscitation and early surgery was resorted to. Simple closure in two layers and wedge resection were the treatment of choice in most of the cases. Bypass, ileostomy and resection were done on few occasions. Chloramphenicol was the only drug used in the first phase. Other broad spectrum antibiotics were added to chloramphenicol with metranidazole in the second phase. Ciprofloxacin and metronidazole were the drugs of choice in the third phase. The mortality rate showed a dramatic improvement from 47.2% (first phase) to 17.7% (second phase) and as low as 7% in the last phase. The lag period (advent of symptoms to time of admission to hospital) showed definite correlation with mortality. Septicemia, wound infection, dehiscence, enterocutaneous fistula were the principal postoperative complications.Item Degos' disease: acute abdomen with skin rash.(2006-07-16) Rajesh, R; Basu, Adhish; Sistla, Sarath Chandra; Jagdish, S; Thappa, Davinder Mohan; Badhe, Bhawana AshokItem Evaluation of the effect of presence of blood in the stomach on endoscopic diagnostic tests for Helicobacter pylori infection.(2011-10) Mittal, S; Trakroo, S; Kate, V; Jagdish, SIntroduction: Presence of blood in the stomach has been thought to affect the performance of diagnostic tests used in detecting Helicobacter pylori (H. pylori) in the stomach. This study evaluated the effect of blood on the efficacy of rapid urease test (RUT) and microscopic appearance of the biopsy after staining with Giemsa stain. Materials and Methods: Patients with bleeding oesophageal varices who met the inclusion criteria were tested for H. pylori by RUT and microscopic examination of the biopsy. A repeat endoscopy, RUT and histology were done one month following initial presentation. The performance of the diagnostic tests was evaluated with and without the presence of intraluminal blood. A combined result of the two tests, RUT and histology, carried out in presence or absence of blood for the diagnosis of H. pylori, when considered together was considered as the gold standard. Results: Thirty six patients included in the study were in the ages ranging between 15-60 years (mean age = 44.14 years ±2.1). The combination of tests at both visits showed 20/36 (55.6%) patients were positive for H. pylori. The decrease in H. pylori positivity in the presence of blood was significant for RUT (8.3% vs. 38.9%; P=0.005) and combined test (19.4% vs. 47.2%; P=0.02) but the decrease in positivity for histology (11.1% vs 30.6%) was not significant (P=0.08). In the presence of blood, the sensitivity of RUT, histology and combined tests were 15%, 20% and 35%, respectively. In the absence of blood, the sensitivity of RUT, histology and combination of tests was 70%, 55% and 85%, respectively. Conclusion: Blood in the stomach significantly decreased the sensitivity of RUT, histology and the combination of both. Negative results of these tests in acute upper gastro intestinal (GI) bleeding should therefore be interpreted carefully.Item Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch.(2002-10-02) Kumar, K; Pai, D; Srinivasan, K; Jagdish, S; Ananthakrishnan, NBACKGROUND: Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome. METHODS: A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid. RESULTS: Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. CONCLUSION: Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.Item Fetus in fetu or differentiated teratomas?(2006-10-23) Basu, Adhish; Jagdish, S; Iyengar, Krishnan R; Basu, DebdattaTwo cases of congenital teratoma were operated upon. In view of the high degree of organoid differentiation of the teratomas with rudimentary limbs, intestine, brain-like and pulmonary tissues, it was difficult to distinguish it from fetus-in-fetu. In the light of the data obtained and extensive review of related literature, we consider that fetus-in-fetu and teratoma may not be unrelated entities. Our cases support the view held that fetuses in fetu are highly differentiated teratomas.Item Gastrojejunocolic fistula following surgery for peptic ulcer.(1997-10-05) Subramaniasivam, N; Ananthakrishnan, N; Kate, V; Smile, S R; Jagdish, S; Srinivasan, KThis article aims to emphasize that gastrojejunocolic fistula following peptic ulcer surgery, though uncommon in the post vagotomy era, still continues to occur. We stress the changing trends in its epidemiology, aetiopathogenesis and treatment. The case records of 12 patients with gastrojejunocolic fistula (seen over a 15 year period) were reviewed. Details regarding clinical presentation, investigations and treatment were analyzed and the results compared with previous published series. All the 12 patients in this study had a short loop posterior retrocolic gastrojejunostomy as part of the primary peptic ulcer surgery. Diarrhoea and profound weight loss was present in all of them. Incompleteness of vagotomy was proved in all the six patients investigated for the same. The fistula was demonstrated in all of them on barium enema, while it was seen on upper GI endoscopy in 4. Eight patients were treated by a one stage resection and repair of fistula. A three stage procedure was performed in two.Item Helicobacter pylori positivity in esophageal and esophagogastric junction adenocarcinoma.(2008-11-02) Rathod, Kirtikumar J; Kalayarasan, R; Kate, Vikram; Jagdish, S; Ananthakrishnan, N; Parija, S CItem Hirschsprung’s disease in adults presenting as sigmoid volvulus: a report of three cases.(2011-10) Alagumuthu, M; Jagdish, S; Kadambari, DItem A hospital-based study of splenomegaly with special reference to the group of indeterminate origin.(2008-03-21) Sundaresan, J Balaji; Dutta, Tarun Kumar; Badrinath, S; Jagdish, S; Basu, DebadattaIn any study there remains a proportion of cases, about 25-40%, where cause of splenomegaly is not identified on usual evaluation, that is labelled as indeterminate group. The aim of this study was to evaluate various causes of splenomegaly. Thereafter the patients with splenomegaly of indeterminate origin were to be re-evaluated with detailed investigations (for the cause of splenomegaly). Causes of splenomegaly were looked into 100 adult patients with splenomegaly, admitted over a period of ten months in a teaching hospital in South India. Patients having ascites were excluded from the study. Malaria was the commonest cause of splenomegaly, observed in 22 patients. Other causes, in order of importance, were chronic myeloid leukaemia (n=11), non-cirrhotic portal fibrosis (n=9), enteric fever (n=9), cirrhosis of liver (n=8) and hyper-reactive malarial splenomegaly also called as tropical splenomegaly syndrome (n=7) and so on. Hyper-reactive malarial splenomegaly was the commonest cause (7 of 24 patients) of massive splenomegaly. Twenty-three patients had splenomegaly of indeterminate origin ie, cause could not be detected on first assessment. Detailed re-evaluation with repeat investigations including liver biopsy revealed the causes as follows: Hyper-reactive malarial splenomegaly -7 (30.4%), non-cirrhotic portal fibrosis - 4 (17.4%), cirrhosis of liver - 4 (17.4%) and iron deficiency anaemia - 5 (21.7%). In 3 patients (13.0%), no diagnosis could be arrived at despite best efforts. Obscure splenomegalies may be due to conditions like hyper-reactive malarial splenomegaly, non-cirrhotic portal fibrosis, iron deficiency anaemia, and even cirrhosis of liver, while malaria is still the most important cause of splenomegaly in India. Whereas the overall incidence of hyper-reactive malarial splenomegaly was only 7% in this study, it stood as the leading cause (29.2%), when analysed among patients with massive splenomegaly. Liver biopsy should be performed in all cases of obscure splenomegaly to arrive at the final diagnosis.Item An in-vitro SEM comparative study of debridement ability of K-Files and Canal Master.(1996-10-01) Valli, K S; Lata, D A; Jagdish, SThe aim of this study was to compare in vitro the debridement ability of Canal Master and K-Files using scanning electron microscope. One hundred and twelve freshly extracted human upper central incisor teeth were divided into two groups of 56 each. One group was instrumented using Canal Master and another group was instrumented using K-Files. The teeth were sectioned longitudinally and examined under the SEM. Scanning electron micrographs were qualitatively and statistically analysed for the degree of cleanliness with regard to the presence of debris, smeared layer and patency of dentinal tubules in the apical third of each root canal. In order to determine whether there is a difference between the two instrumentation techniques, a chi-square test of equal proportions was used. This test gave a chi-square value of 24.19 (P < .001). Both the instrumentation techniques were ineffective in completely debriding the canals. However, the results showed that the Canal Master produced cleaner showing lesser debris than that produced by K-Files.Item Inguinal herniorrhaphy under local anaesthesia and spinal anaesthesia--a comparative study.(1999-05-01) Sultana, A; Jagdish, S; Pai, D; Rajendiran, K MA prospective study was conducted at JIPMER, Pondicherry from September 1993 to June 1995. Fifty cases of inguinal herniorrhaphy were done under local anaesthesia (LA) and 60 cases under spinal anaesthesia (SA). The aim was to assess the safety and efficacy of inguinal herniorrhaphy under LA. The parameters studied were: (i) Efficacy of the anaesthesia, (ii) safety and postoperative course, and (iii) patient satisfaction. The LA group patients had better postoperative analgesia and earlier return to ambulation. They did not suffer the postspinal complications of headache and urinary retention. However, intra-operative discomfort was significantly more in this group compared to the SA group.Item Laparoscopic control of spontaneous external hemorrhage from umbilical varix.(2006-07-16) Basu, Adhish; Sistla, Sarath Chandra; Jagdish, SSpontaneous external hemorrhage from an umbilical varix is rare. We describe a 40-year-old man with cirrhosis and portal hypertension, who presented with recurrent external bleeding from an umbilical varix. The first episode was controlled by transfixation of the vein under local anesthesia. Contrast-enhanced CT scan demonstrated a hugely distended recanalized umbilical vein arising from the left branch of the portal vein and ending in the umbilical cicatrix. Recurrent bleeding necessitated laparoscopy and in-situ clipping of the bleeding vein in the falciform ligament. At six months' follow up the patient has no further bleeding.Item Partial cholecystectomy in elective and emergency gall bladder surgery in the high risk patients--a viable and safe option in the era of laparoscopic surgery.(1996-01-01) Subramaniasivam, N; Ananthakrishnan, N; Kate, V; Smile, R; Jagdish, S; Srinivasan, KPartial cholecystectomy was performed in this Institute in fifteen patients in the last 8 years. Three were performed in cirrhotic patients with bleeding diathesis. The other indications were obscure anatomy, intraperitoneal adhesions, Mirizzi syndrome and poor general condition of the patient. None of these had any major morbidity in the immediate postoperative period. Partial cholecystectomy is a safe and viable option in a difficult situation.Item Pattern of nontyphoid ileal perforation over three decades in Pondicherry.(2003-07-26) Chatterjee, H; Pai, D; Jagdish, S; Satish, N; Jayadev, D; Srikanthreddy, PTwo hundred and twelve cases of ileal perforation due to different causes (excluding typhoid) were treated in 3 phases in the Department of Surgery, JIPMER Hospital, Pondicherry, during the periods 1966-78 (phase I), 1981-88 (phase II) and 1990-1998 (Phase III). Forty per cent of the patients were in the second and third decades of life. Male-to-female ratio was 2.2:1. The majority of the perforations (52.8%) were due to non-specific causes. Trauma (19.3%) and mechanical factors (12.7%) were the other principal aetiologies. Pain abdomen (92.3%), constipation (63.6%) and fever (44.3%) were the principal presenting features. Abdominal guarding and rigidity (89%) were the main physical signs. Pneumoperitoneum was present in 66.8% of cases on plain X-ray abdomen. Widal and blood culture for Salmonella typhi were negative in all. Laparotomy was done in most of the cases after adequate resuscitation. Simple closure of the perforation, wedge resection and resection anastomosis were the different procedures of management. Histology of the margin of perforation/excised gut gave added evidence of a non-typhoid etiology. Broad-spectrum antibiotics in different combinations with metronidazole were administered postoperatively. Mortality was 28.2% in Phase I, and 9.4% and 11.9% in phases II and III respectively. The lag period (advent of symptoms and hospitalization) showed definite relationship with mortality and morbidity. Wound infection, wound dehiscence, enterocutaneous fistula and septicaemia were the principal postoperative complications.Item Spontaneous appendicocutaneous fistula.(1996-01-01) Jagdish, S; Ninan, S; Pai, D; Ratnakar, CSpontaneous appendicocutaneous fistula is a rare complication of appendicitis. We report a case of appendicular carcinoid who presented with appendicocutaneous fistula.Item Transection of common bile duct following blunt injury to abdomen.(1997-07-01) Krishnamurthy, B; Jagdish, S; Pai, D; Babu, PIsolated complete transection of the common bile duct due to blunt abdominal trauma is rare. We report such a case following an assault.Item Volvulus of stomach in childhood.(1993-07-01) Chatterjee, H; Jagdish, S; Rao, K S; Srivastava, K KSix children, aged upto one year, with volvulus of the stomach are reported. Vomiting and regurgitation of feeds were the main presenting symptoms. Eventration of the left hemidiaphragm was present in four cases. Barium meal confirmed the diagnosis. Five cases were operated on through an abdominal approach. Plication of the diaphragm (3 cases), colonic displacement (2) and gastrostomy (3) were resorted to. One child needed reoperation for a missed Ladd's band. There was no operative mortality.