Browsing by Author "Dinesh Shukla"

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Augmentation gastroplasty using a segment of transverse colon for corrosive gastric stricture
(2006) Anand Kumar; Mumtaz Ansari; Dinesh Shukla; Anuj Kumar Tripathi; Rohit Shyam
Background and aims: Diffuse corrosive gastric stricture is a relatively rare entity, and gastric ablative procedures are traditionally recommended for it. We emphasize the importance of preservation of a cicatrized stomach and describe its augmentation using a segment of transverse colon. Case report and procedure: A young female with a history of corrosive acid ingestion presented to our surgical unit with nonbilious vomiting following meals, consistent weight loss and features of gastric outlet obstruction. A barium study revealed a small-capacity stomach with pyloric stricture. We planned to augment the stomach capacity by using a segment of transverse colon. After documentation of a normal colon by barium examination, a 15-cm segment of transverse colon was harvested based on middle colic artery. This vascularized patch of bowel was united with the stomach that was opened up by a longitudinal incision made along the body. Result and finding: A barium study on the tenth postoperative day revealed a good capacity and contour of the stomach and free entry of Barium into the small intestine. The patient is tolerating a normal meal and has no vomiting. At 3 months follow-up, the patient had a normal stomach radiologically and endoscopically, with a weight gain of 7 kg. Conclusions: Augmentation of corrosive gastric stricture by a segment of transverse colon is an innovative, practical, and useful procedure, although long-term results are awaited. © Springer-Verlag 2005.
Pain in acute and chronic wounds: a descriptive study.
(2005) Dinesh Shukla; Anuj Kumar Tripathi; Saurabh Agrawal; Mumtaz Ahmad Ansari; Amit Rastogi; Vijay Kumar Shukla
The significance of pain in wound healing is much neglected because of biases against pain management in general, a lack of knowledge of available analgesics, and difficulties associated with pain measurement. To assess pain in patients suffering from acute and chronic wounds, a 1-day descriptive study was conducted involving 50 patients, 26 with acute wounds and 24 with chronic wounds, served by the wound clinic of a university hospital. Patients responded to questions regarding onset, location, type, and intensity of pain using the Visual Analog and Visual Reporting Scales and to statements about aggravating and relieving factors and overall impact on their quality of life using a 5-point scale where 5 = totally agree and 1 = completely disagree. Results showed pain was commonly mild to moderate (41 patients, 88%), located in and around wound (43 patients, 93.5%), occurred most frequently during dressing change (30 patients, 65%), and was relieved by medications (39 patients, 84.8%) and positioning (17 patients, 37%). The most commonly affected quality of life variables were physical activity (40 patients, 87% of patients) and social functioning (23 patients, 50%). Controlling wound pain can play a major role in improving patient quality of life.
Repair of uterocutaneous fistula
(2006) Dinesh Shukla; Suruchi Pandey; Lakshmi Kant Pandey; Vijay Kumar Shukla
BACKGROUND: Uterocutaneous fistula is a rare condition that may be difficult to manage. CASE: A young woman who underwent surgical intervention for cryptomenorrhea 3 years ago developed menstrual discharge from the abdominal scar. A fistulous tract leading from the infraumbilical midline scar to the uterus was demonstrated on contrast study. Genital examination revealed vaginal agenesis. A vaginoplasty was performed as the first stage. This was followed one year later by excision of the fistulous tract and establishment of cervicovaginal communication. The patient is now menstruating from the vaginal passage. CONCLUSION: This case shows that a stepwise, well-planned, and well-executed procedure can lead to a satisfactory repair of an uterocutaneous fistula. © 2006 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Results of a one-day, descriptive study of quality of life in patients with chronic wounds
(HMP Communications, 2008) Vijay K. Shukla; Dinesh Shukla; Anuj K. Tripathi; Saurabh Agrawal; Satyendra K. Tiwary; Vivek Prakash
Quality of life is a subjectively interpreted phenomenon that can be profoundly altered by the presence of a wound. Particularly when complete and expedient healing seems unrealistic, quality of life becomes the focus of care. To assess the influence of a variety of chronic wounds on patient quality of life, a 1-day, descriptive study was conducted among 50 consecutive outpatients (64% men, 36% women; age range 14 to 78 years) with chronic wounds who attended the Wound Clinic of the University Hospital, Varanasi, India. A quality-of-life questionnaire containing six parameters (physical activities, feelings, household duties, leisure time activities, social relations, and general activities) was developed and administered. Demographic information was available as a result of a previous study at this institution. Quality-of-life scores were grouped as satisfactory and unsatisfactory and participants were grouped by age (<30 years old, 30 to 60 years old, >60 years old). Wounds were classified by cause (diabetes, venous disease, pressure ulcer, and tuberculosis) and size (<10 cm2, 10 to 50 cm2, >50 cm2). The most common site was the lower limb or foot (39, 78%), followed by upper limb (six, 12%) and head, neck, and trunk (five, 10%). More than half (28, 56%) of all patients had an unsatisfactory overall quality-of-life score. The percentage of patients with satisfactory scores was higher in patients with smaller versus larger wounds and wounds located on upper rather than lower limbs, as well as in middle-aged versus younger or older patients. This patient-centered instrument helped document important quality-of-life concerns among chronic wound patients.
Risk assessment for pressure ulcer: A hospital-based study
(2008) V.K. Shukla; Dinesh Shukla; Abhisek Singh; A.K. Tripathi; Sushil Jaiswal; Somprakas Basu
AIM: To identify patients at risk for developing pressure ulcer among hospitalized patients and the prevalence of pressure ulcer in this group. PATIENTS AND METHOD: A prospective study included 100 patients from medical and surgical wards. Data were collected on admission, and subjects were followed up at regular intervals. The Waterlow pressure ulcer risk assessment tool was completed and patients were stratified "as not at risk," "at risk", "high risk", and "very high risk". Subjects were then monitored for 2 weeks and the actual incidence of pressure ulcer formation was analyzed in the various risk groups. RESULTS: Of 100 patients studied, 20% were at risk, 10% were assessed at high risk, and 7% were classified as at very high risk for developing a pressure ulcer. Necessary preventive measures were taken (posture change, specialized beds/mattresses, nursing care, nutritional input, etc) for those patients at risk of development of pressure ulcer. Four of 7 patients (57.1%) who were at very high-risk developed pressure ulcer as compared with 2 of 10 patients (20%) categorized in the high-risk category within a period of 2 weeks. No patient who was classified as not at risk on the Waterlow pressure ulcer risk assessment tool developed a pressure ulcer within the observation period. CONCLUSION: Pressure ulcers developed in identified risk groups despite adequate available preventive measure being taken to prevent their development. It is of extreme importance to identify patients at risk for the development of pressure ulcers so that preventive measures can be instituted to reduce the incidence of hospital-acquired pressure ulcers. © 2008 by the Wound, Ostomy and Continence Nurses Society.