Browsing by Author "Ajay K. Khanna"

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A Hospital-Based Population Screening for Peripheral Arterial Diseases in a North-East University Hospital of India
(Springer, 2023) Ajay K. Khanna; Divya Khanna; Himanshu Verma; T.B. Singh; Satyendra K. Tiwary; Puneet Gupta
This study was carried out with an aim of screening the hospital-based population through ankle-brachial pressure index measurement to identify the asymptomatic patients of peripheral arterial disease. Further association of peripheral arterial disease with other risk factors was also studied. A total of 1000 patients of a surgical unit of a university hospital, Varanasi, India, were studied for a period of 2 years. Ankle-brachial pressure index in both lower limbs was measured. Patients aged less than 18 years and patients with blood pressure less than 90/60 mm Hg were excluded. History of claudication, smoking, hypertension, diabetes, coronary artery diseases, and family history of peripheral arterial disease were recorded. Patients with an ankle-brachial pressure index less than 0.9 were labeled as a case of peripheral arterial disease. Out of 1000 patients, 35 patients were symptomatic for peripheral arterial disease and all had ankle-brachial pressure index value < 0.9. Rest 965 patients were asymptomatic, out of which 155 (16.1%) had ankle-brachial pressure index less than 0.9. Elderly male smokers were the main victims. Hypertension was associated with an increased risk for peripheral arterial disease. Out of 15 patients with a history of coronary artery disease, 12 had peripheral arterial disease. The prevalence of peripheral arterial disease in an asymptomatic hospital-based population was 16.1%. Screening by measuring ankle-brachial pressure index can help in its early detection. Risk factors modification at this stage can prevent significant morbidity due to the disease. © 2021, Association of Surgeons of India.
A large metatarsal giant-cell tumor
(Informa Healthcare, 1990) Ajay K. Khanna; Subramaniyama V Sharma; Mohan Kumar
A case of 14-cm giant-cell tumor of the first metatarsal bone of a 35-year-old male is reported. A ray excision was carried out. the patient has now been free from disease for 3 years. © 1990 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
AgNOR count and subjective AgNOR pattern assessment (SAPA) score in carcinoma of the pancreatic head including periampullary tumors
(2005) Ajay K. Khanna; Sanjeev K. Yadav; Vinod K. Dixit; Mohan Kumar
Context: Only a few studies are available in the literature regarding the AgNOR (argyrophilic nucleolar organizer region) count in pancreatic adenocarcinoma but studies on the SAPA (subjective AgNOR pattern assessment) score are completely lacking. Objective: We attempted to estimate the AgNOR count and the SAPA score in carcinoma of the pancreatic head including periampullary tumors and to correlate them with other various clinico-histological parameters. Setting: Patients undergoing pancreatic resection at the University Hospital, Banaras Hindu University, Varanasi, India. Patients: Twenty-four cases of carcinoma of the pancreatic head including periampullary tumors. In addition, on the resected specimen of the pancreas, the area which was normal was chosen and, in that normal tissue, the AgNOR was also studied. Main outcome measures: Patients were studied for the AgNOR count and the SAPA score, and the values were correlated with the size of the tumor, the type of tumor and histological type and grade of tumor. Results: The values of the AgNOR count and the SAPA score were significantly higher in cases of pancreatic cancer than in the healthy pancreas. The AgNOR count was 1.6±0.1 in the healthy pancreas while it was 2.8±0.5 in cases of pancreatic carcinoma (P<0.001). The SAPA score was 5.6±0.2 in the healthy pancreas while it was 8.0±1.4 in pancreatic carcinoma (P<0.001). Tumors less than or equal to 2 cm in size had an AgNOR count of 2.6±0.08 while the AgNOR count was 3.4±0.02 in tumors larger than 2 cm (P<0.001). The SAPA score was also higher in tumors greater than 2 cm in size (7.3±0.2 vs. 9.4±0.8; P<0.001). Periampullary tumors had a significantly lower (P<0.001) AgNOR count (2.7±0.06) and SAPA score (7.8±0.2) as compared to carcinoma of the head of the pancreas (AgNOR count 3.3±0.03 and SAPA score 9.2±0.7). Well-differentiated carcinomas had significantly lower AgNOR counts as compared to other tumors except acinar cell carcinomas since acinar cell carcinomas are also well-differentiated tumors. The SAPA score was also higher in moderately-differentiated tumors and the difference between moderately-differentiated tumor and other types of tumors was significant although there was no significant difference between cystadenocarcinomas and unclassified tumors, and between acinar cell carcinomas and well-differentiated tumors on SAPA scoring. Conclusions: The values of the AgNOR count and the SAPA score are well-correlated with the size of the tumor, the type of tumor and the histological grade.
Ambulatory venous pressure studies and its correlation with CEAP grading of varicose veins
(Edizioni Minerva Medica, 2020) Ajay K. Khanna; Shivanshu Singh; Satyendra K. Tiwary; Soumya Khanna; Shripad B. Deshpande; Ram C. Shukla; Puneet Kumar
BACKGROUND: Venous hypertension in the lower limb is predisposing factor for the chronic venous insufficiency and resultant skin changes. In a normal limb, during ambulation, there is a fall in lower limb venous pressure as the calf muscle pump and unidirectional valvular activity propel the blood from the lower limbs to the heart. Failure of this mechanism results in ambulatory venous hypertension predisposing to chronic venous insufficiency. The current study aimed at studying the lower limb ambulatory venous pressure in varicose veins, its co-relation with clinical severity of the disease according to the clinical grading of clinical-etiological-anatomical-pathophysiological (CEAP) classification and whether these measurements can help in assessing the anatomical sites of incompetence. METHODS: A prospective study was carried out at a University Teaching Hospital in Northern India. Ambulatory venous pressure was measured in 67 limbs. Limbs were classified according to the CEAP grading. Four groups were divided as follows: group 1, CEAP-0 (7 limbs); group 2, CEAP-1, 2 (24 limbs); group 3, CEAP-3, 4 (21 limbs); and group 4, CEAP-5, 6 (15 limbs). Following the duplex scan, limbs were also grouped according to the anatomical sites of incompetence. For pressure measurement, dorsal foot vein was cannulated with a 20-gauge cannula and connected to a physiograph through a pressure transducer filled with heparinized saline. Patient performed a standard 10 tip-toe exercise and following parameters were assessed: resting pressure in the sitting and standing position, mean ambulatory venous pressure, maximum fall in pressure, percentage decrease in pressure, 50%, 75%, 90% recovery time, initial recovery rate, recovery in first 4 seconds, pressure relief index. RESULT S: Median ambulatory venous pressure showed a progressive increase from group 1 (18.0 mmHg) to group 2 (51.5 mmHg) to group 3 (69.0 mmHg) and group 4 (91.0 mmHg). Median recovery times for 50%, 75% and 90% recovery of pressure after cessation of exercise were significantly lower while the percentage recovery in first 4 seconds was significantly higher in the ulcer group. Median pressure relief index showed a significant stepwise decreasing trend from group 1 to group 4 (2790.0 mmHg-sec in group 1to 534.0 in group 2 to 534.0 in group 3 to 40.0 in group 4; P<0.001). The prevalence of ulceration increased significantly with increasing median ambulatory venous pressure and decrease in time required for 90% recovery and median pressure relief index. None of the parameters showed significant variation among all the groups divided based on anatomical sites of incompetence. CONCLUSIONS: Ambulatory venous pressure measurement correlates with the clinical grading of the CEAP classification of varicose veins. Ambulatory venous pressure measurements do not help in determining the anatomical sites of incompetence. Pressure relief index, the recovery time intervals and the mean ambulatory venous pressure are the important parameters that can help in identifying and grading the severity of the disease. © 2020 EDIZIONI MINERVA MEDICA.
An accessory tongue
(2009) S. Kumar; S.K. Tiwary; Ajay K. Khanna
An accessory tongue is a rare anomaly. In the literature, only a few case reports have been cited. We report a 28-year-man with this anomaly. The patient was treated with a simple surgical excision.
Approach to a Case of Ulcer of Extremity
(Springer Nature, 2023) Ajay K. Khanna; Soumya Khanna
An ulcer is a break in the skin or mucus membrane caused by the microscopic death of tissues. Ulcers can occur in any portion of the body, at any age, and in either gender. Ulcers can be either acute or persistent. Acute ulcers normally heal quickly, but chronic ulceration occurs when the ulcer lasts longer than 6 weeks and shows no signs of healing after three or more months. Ulcers are lesions that have a “full thickness depth”, and chronic ulcers heal slowly. Skin ulceration may be extremely painful and even fatal in severe cases. Chronic ulcers are frequently difficult to heal and may be related with a variety of psychological issues. It has a negative impact on one’s quality of life since it is connected with discomfort, swelling, and discharge that can be foul-smelling or bleeding. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
Approach to a Case of Vascular Malformation
(Springer Singapore, 2021) Mohd Zeeshan Hakim; Ajay K. Khanna
Vascular Malformations are often misdiagnosed and misunderstood in general practice; varying from small birthmarks to malformations involving entire extremities. Their size, differentiation, and presence of malformation in the lymphatic, arterial, and venous systems have often been the basis of their classification. Understanding the basic nature of these entities is essential from a vascular surgeons’ point of view as it entails a proper planning and often a staged management. A thorough clinical evaluation has been the cornerstone in the diagnosis of most diseases, however, the same cannot be mandated for vascular anomalies that may be more extensive than clinically appreciable and truncal anomalies are difficult to identify without the help of imaging modalities. Diagnostic Imaging has made it easier to map out the entire malformation and also helps in aiding any planned intervention. Radiological interventions have become the mainstay of treatment for many a case, however, the role of conventional surgery is still defined and reconstructive methods are evolving to deal with the challenges afforded by these malformations. © Springer Nature Singapore Pte Ltd. 2021.
Assessment of Quality of Life in venous ulcer
(Edizioni Minerva Medica, 2021) Satyendra K. Tiwary; Manoj Kumar; Soumya Khanna; Puneet Kumar; Ajay K. Khanna
BACKGROUND: Typically, venous ulcers are recurrent in nature and with increased treatment cost leads to personal, social, mental and economic impact affecting Quality of Life (QoL). Generic tools are widely available in various languages have been frequently used to assess QoL. Among the various specific tools, Charing Cross Venous Leg Ulcer (CCVLU) Questionnaire showed high reliability, validity and responsiveness and shows good correlation with SF-36 in assessing HRQoL(Health related Quality of Life). METHODS: This study included 50 patients with venous ulcer and 56 limbs (six patients had bilateral ulcers). Quality of Life of venous ulcer patients was assessed by using SF-36 Questionnaire, The Charing Cross Venous Ulcer Questionnaire (CXVUQ) and Revised venous clinical severity score (VCSS), the changes in Quality of Life after treatment was compared to initial presentation in venous ulcer patients. RESULTS: After treatment, venous ulcer healed in all, except in 7 (12.5%) patients. Recurrence of venous ulcer was seen in 12 (21.43%) limbs. Quality of Life of patients prior to treatment and after the treatment by using SF-36 Questionnaire, Charing Cross Venous Ulcer Questionnaire, Revised Venous Clinical Severity Score showed that there was significant improvement in Quality of Life of patients after treatment with P value of <0.001. CONCLUSIONS: In our study, we found significant improvement in Quality of Life in patients of Venous ulcers after giving various modality of treatment which included Endovascular intervention and Four-layer dressing. © 2021 Edizioni Minerva Medica. All rights reserved.
Atypical leg ulceration
(Springer India, 2016) Ajay K. Khanna; Divya Khanna
[No abstract available]
Bacteriological Study of Varicose Vein Specimens
(Springer, 2023) Ajay K. Khanna; Awaneesh Katiyar; Soumya Khanna; Gopal Nath; Puneet Kumar; Satyendra K. Tiwary
Varicosity and chronic venous insufficiency (CVI) are thought to be due to reflux or pathologic retrograde flow caused by an incompetent venous valve leading to venous hypertension followed by reflux. A variety of factors have been postulated in association with varicose veins. Venous hypertension leading to reflux and varicosity may be associated with inflammation due to microbiological activity. This study was carried out with the objective that infection can be an etiological factor for varicose veins. A prospective study was carried out at a tertiary health care center from June 2014 to December 2020. A total of 100 patients with varicose veins (with 120 limb involvement) were recruited. Samples of normal leg veins were taken as control from 10 patients who were undergoing saphenous vein bypass grafting or amputated limb following road traffic accidents. We studied the primary varicose veins for microbiological etiology of the disease by culture studies of varicose veins and further confirmation by 16 s-rRNA PCR analysis. The sample of veins harvested during intervention was submitted for microbiological culture. Out of 42 cultures, Pseudomonas spp. in 6 cases (14.29%), Klebsiella spp. in 4 cases (9.52%), 2 cases (4.76%) each of Staphylococcus aureus and Proteus spp., and one case of Citrobacter on bacterial culture of truncal veins and on 16 s-rRNA PCR on DNA extracted from truncal varicose vein samples. Pseudomonas spp., Staphylococcus aureus, Klebsiella spp., Proteus spp., and Citrobacter spp. were detected in 10 cases (23.81%), 6 cases (14.29%), 5 cases (11.9%), 2 cases (4.76%), and 1 case (2.38%), respectively. In the ten specimens of normal vein, taken as control, 9 cases show no bacterial growth and 1 (10%) case shows a growth of micrococci. In consideration of the results of the present study, microbiological etiology of varicose veins is a distinct association which was confirmed in this study. © 2021, Association of Surgeons of India.
Carcinoma of the fourth part of the duodenum
(2006) Mallika Tewari; Ajay K. Khanna
Primary carcinoma of the duodenum is uncommonly encountered. This is a report of a 45-year-old gentleman who was admitted to our unit with a one-month history of upper abdominal distention. Barium study revealed a narrowed segment of the fourth part of duodenum. A hard stenosing growth was found in the fourth part of duodenum, at laparotomy. He was treated by distal segmental resection and regional lymphadenectomy, that relieved his symptoms. He is asymptomatic and recurrence free at one year follow up.
Clinical anatomy of lower extremity
(Springer India, 2016) Soumya Khanna; Ajay K. Khanna
[No abstract available]
Co-existent Median Arcuate Ligament Syndrome and Superior Mesenteric Artery Syndrome
(Springer, 2024) Panchanana Panigrahy; Soumya Khanna; Puneet; Ajay K. Khanna
Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are well known abdominal vascular compression syndrome, but coexistence of these is rarely described in literature. We report a patient presenting with chronic abdominal pain, occasional emesis and weight loss and was diagnosed as having coexistent MALS and SMAS. The patient underwent release of celiac artery compression with posterior gastrojejunostomy with good outcome. Coexistent MALS and SMAS is a rare entity. © Association of Surgeons of India 2024.
Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction
(2006) Satyendra K. Tiwary; Manish K. Singh; Rahul Khanna; Ajay K. Khanna
Background: Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. Case presentation: A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. Conclusion: Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel. © 2006 Tiwary et al; licensee BioMed Central Ltd.
Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson's Hemorrhoidectomy
(2010) Rahul Khanna; Seema Khanna; Shilpi Bhadani; Sanjay Singh; Ajay K. Khanna
Conventional hemorrhoidectomy for grade III and IV hemorrhoids is a tedious procedure associated with significant morbidity and a prolonged convalescence. We compared Ligasure™ hemorrhoidectomy with conventional 'closed' Ferguson's hemorrhoidectomy for the treatment of grade III and IV hemorrhoids. Forty-eight consecutive patients of grade III and IV hemorrhoids were randomized to either the Ligasure™ hemorrhoidectomy (28 patients) or Ferguson's hemorrhoidectomy (20 patients). The hemorrhoidal predicle was coagulated with Ligasure™ in the Ligasure™ group and transfied with 2/0 chromic catgut in Ferguson's method. In comparison with Ferguson's method, Ligasure™ hemorrhoidectomy had a shorter operating time (29 vs 12.5 min), less blood loss (22 vs 11.5 ml), less post operative pain as measured on VAS scale and less postoperative complications including hemorrhage (10% vs 3.5%), urinary retention (10% vs 3.5%) and wound breakdown (20% vs 14%). The submucosal dissection technique with Ligasure™ coagulation of the hemorrhoidal pedicle is safe and effective. The blood vessels and tissue are reduced to a wafer thin seal with good hemostasis. Suturing is not required as the mucosal tissue over the pedicle is sealed off with the current. There is minimal lateral spread of either thermal or electrical energy. The external components of the hemorrhoids can also be treated at the same time. Because of its ease of use and less postoperative pain and complication Ligasure™ hemorrhoidectomy can be preformed as a day-care procedure. © Association of Surgeons of India 2010.
Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis
(2013) Ajay K. Khanna; Susanta Meher; Shashi Prakash; Satyendra Kumar Tiwary; Usha Singh; Arvind Srivastava; V.K. Dixit
Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24 hrs of admission, whereas Ranson and Glasgow scores after 48 hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study. © 2013 Ajay K. Khanna et al.
Correction to: Evidence-Based Clinical Practice Points for the Management of Venous Ulcers (Indian Journal of Surgery, (2018), 80, 2, (171-182), 10.1007/s12262-018-1726-3)
(Springer India, 2018) Ravul Jindal; D.B. Dekiwadia; Pinjala Rama Krishna; Ajay K. Khanna; Malay D. Patel; Shoaib Padaria; Roy Varghese
The originally published article contained an error in the Methodology section. The correct paragraph is given below. © 2018, Association of Surgeons of India.
Deep vein thrombosis: does platelet hyperaggregation have any role?
(Edizioni Minerva Medica, 2024) Satyendra K. Tiwary; Anand K. Das; Puneet Kumar; Debabrata Dash; Ajay K. Khanna
[No abstract available]
Detection of human papilloma viruses 16 and 18 DNA sequences in oral squamous cell carcinoma [4]
(2007) Rahul Khanna; G.R.K. Rao; Satyendra K. Tiwary; Ashish Rai; Seema Khanna; Ajay K. Khanna
[No abstract available]
Determinants of uptake of cervical cancer screening in northern india
(Institute of Medico-Legal Publications, 2019) Divya Khanna; Sunita Vashist; Anuradha Khanna; Ajay K. Khanna
Background: The launch of operational framework for India’s first national cancer screening programme in 2016 was a landmark event in the background of poor screening coverage status. Our study aims to determine the factors deciding the uptake of cervical screening amongst women in rural India. Method: A cross-sectional, observational study was carried out amongst the women attending a secondary health centre of a district from Northern India. A total of 1250 women aged above 30 years who were never diagnosed or treated for cervical cancer were enrolled. After taking informed consent all women were interviewed about their bio-social profile and if they ever underwent screening of cervical cancer. Chi-square or Fisher’s exact test was applied to find out significant difference in distribution of bio-social variables (predictors) amongst the study population. The significant predictor variables were subjected to Binary and Multiple Logistic Regression. Unadjusted and Adjusted Prevalence Odds Ratio with 95% Confidence Interval were generated. Results: Religion, working status of the women, history of multiple sexual contacts were important factors influencing the utilization of screening. Conclusion: We conclude that cervical cancer screening is a cost-effective strategy in saving lives. We can tap its benefits only when we identify and remove the hurdles in the utilization of cervical cancer screening. © 2019, Indian Journal of Public Health Research and Development. All rights reserved.