Browsing by Author "Satyendra K. Tiwary"

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A case series describing 118 patients with lower limb necrotizing fasciitis
(2009) A.K. Khanna; Satyendra K. Tiwary; Puneet Kumar; Rahul Khanna; Anuradha Khanna
Necrotizing fasciitis of the lower limb is not uncommon, with poor outcome. This study reviewed 118 cases (78 males and 40 females) with mean age of 45 + 16.5 years (range 12-95 years) of lower limb necrotizing fasciitis admitted to the Department of Surgery, BHU in India between 1995 and 2007. Most patients (n = 97) presented with fever. Other presenting symptoms included painful swelling, bullae, erythema, ulcer, and necrosis. Comorbid conditions such as diabetes, tuberculosis, malignancy, and immunosuppressive therapy were associated in 72 (61%) cases. Amputations were done in 24 patients. Thirty one patients developed septic shock. Renal dialysis was done in 16 patients and ventilatory support was needed in 12 patients. The most common organism identified was 2-hemolytic streptococci (n = 42). Eighteen patients died, a mortality of 15%. The authors consider early diagnosis and aggressive surgical intervention to be crucial for the successful treatment of disease. © 2009 Sage Publications.
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.
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.
Approach to Lower Limb Oedema
(Springer Nature, 2022) Satyendra K. Tiwary
The book covers all aspects of lower limb oedema including aetiology, pathophysiology, clinical approach, investigations, differential diagnosis and management. It presents all the medical and surgical aspects of lower limb oedema in a well-illustrated manner for better understanding. It covers the lower limb oedema of different origins separately to highlight the different spectrums in their presentation and management. Separate chapters include special conditions like pregnancy, trauma and vascular malformations. The book augments the learning and knowledge for lower limb oedema management by illustrating all aspects of it. It suggests proceeding with every possible aetiology with a better understanding of pathophysiology and adequate designated investigations. It also includes clinical guidelines that help to solve the diagnostic dilemma in lower limb oedema management with infused points to reach a consensus in each and every possible cause. The book includes recent scientific literature and accepted guidelines adopted from the publications during the last ten years to provide latest knowledge in the field. The approaches discussed in the book with specific importance to clinical workup and meticulous investigation protocols will help the surgeons, physicians, primary care workers as well as surgical resident trainees to reach the correct diagnosis and proper management. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
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.
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.
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 Intraoperative Findings with Ultrasonographic Scoring for Predicting Difficult Laparoscopic Cholecystectomy
(Jaypee Brothers Medical Publishers (P) Ltd, 2021) Satendra Kumar; Sanjay K. Saroj; Raghunath S. More; Soham Roy; Amit ND Dwivedi; Satyendra K. Tiwary
Introduction: Nowadays laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease (GSD). Prediction of “difficult laparoscopic cholecystectomy” (DLC) may decrease morbidity and mortality as well as reduce the average cost of therapy. At present, very few scoring systems are available to predict the degree of difficulty during surgery. Aim and objective: To compare the outcome of intraoperative findings with preoperating scoring to predict DLC. Materials and methods: Two-hundred and nine patients were having GSD, operated by a single experienced surgeon in 2-year duration. Various preoperative predictors and intraoperative parameters of DLC were used for scoring and categorizing the difficulties, into (0–5), (6–10), and (10–15) as early, difficult, and very difficult surgical procedures, respectively. Result: History of hospitalization for acute cholecystitis, overweight with BMI ≥27.5 kg/m2, palpable gallbladder, wall thickness >4 mm, and impacted stone were the most accurate preoperative predictors of DLC in the age-group of above 50 years. Statistically, a significant association was determined by comparing preoperative evaluation with the intraoperative outcome. Conclusion: The preoperative and intraoperative scoring system can be helpful for assessment, experience, and decision-making. These scoring systems deserve a large-scale prospective study for validation. © The Author(s).
Craniofacial Cirsoid Aneurysm: 2-Stage Treatment
(2007) Satyendra K. Tiwary; Rahul Khanna; A.K. Khanna
[No abstract available]
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]
Effect of autologous epidermal cell suspension transplantation in chronic nonhealing wounds: A pilot study
(Canadian Medical Association, 2010) Vijay K. Shukla; Satyendra K. Tiwary; Shruti Barnwal; Anil K. Gulati; Shyam S. Pandey
Background: Chronic nonhealing wounds are difficult to manage. Various substances are being used to heal these wounds. We sought to observe the effects of autologous epidermal cell suspension dressings on chronic nonhealing ulcers. Methods: We enrolled patients of the wound clinic at University Hospital, Varanasi, India, with nonhealing wounds of more than 6 weeks' duration. We treated the wound beds with sterile dressings and antibiotics until the swab cultures became sterile. We prepared autologous epidermal cell suspensions from skin grafts and used them on the ulcer beds along with Vaseline gauze dressings. Follow-up visits with patients occurred weekly for assessment of wound healing and other changes. Results: Fifteen patients enrolled in our study. Of these, 6 patients had completely healed at 12 weeks, 1 patient at 16 weeks and 2 patients at 20 weeks after treatment. We observed a slow healing response in 6 patients, of whom 1 patient had healed completely at 32 weeks and another at 48 weeks. One patient needed skin grafting, and 3 patients were lost to follow-up. Conclusion: Autologous noncultured epidermal cell suspension transplantation seems to be an effective, simple and time-saving method to treat chronic nonhealing wounds. © 2010 Association médicale canadienne.
Effect of four-layer dressing on the microbiological profile of venous leg ulcer
(MA Healthcare Ltd, 2023) Satyendra K. Tiwary; Katyayani K. Choubey; Gopal Nath; Puneet Kumar; Ajay K. Khanna
Objective: Venous leg ulcer (VLU) is a chronic disease and has periods of exacerbation and remission. Various bandage systems single-layered, double-layered and multiple-layered with elastic and non-elastic components have been developed. The requirement for sustained pressure brought about the introduction of the four-layer bandage. We studied the bacteriology of VLUs and the effect of four-layer bandages on their healing. Method: Clinical details of all patients, with wound size measurement by gauze piece, wax paper and scale, were recorded. The wounds were initially debrided and photographic records of all patients were maintained. Patients were followed up every week, when the dressings and four-layer bandages were changed. Results: A total of 60 patients were recruited to the study with four patients having bilateral disease and so a total of 64 VLUs were evaluated. Of these, 60 (93.8%) healed completely, one (1.6%) healed partially and three (4.7%) did not heal. After excluding the four VLUs that did not fully heal, 10 (16.7%) had recurrence while 50 (83.3%) had no recurrence in the follow-up period, which lasted for one year. During the first visit (baseline), meticillin-resistant Staphylococcus aureus (MRSA) was isolated in 29 (45.31%) VLUs and Pseudomonas spp. in 20 (31.25%) VLUs. With subsequent dressing, the VLU size decreased and the culture of the VLU was sterile from the third culture onwards in 45 cases. There was a significant correlation (p <0.001) between VLU size and the number of dressings. Conclusion: Compression therapy is the mainstay of treatment of VLU, with rapid healing and improvement in bacteriological profile. Compression in the range of 30 40mmHg is the most effective treatment for uncomplicated VLUs with adequate arterial competency. Declaration of interest: The authors have no conflicts of interest to declare. © 2023 MA Healthcare Ltd. All rights reserved.
Effect of four-layer dressing on venous ulcer
(Edizioni Minerva Medica, 2020) Satyendra K. Tiwary; Katyayani K. Choubey; Soumya Khanna; Puneet Kumar; Ajay K. Khanna
Background: Venous ulcer is a chronic disease and has periods of exacerbation and remission. it takes a long time to heal, resulting in physical and psychological discomfort thereby negatively affecting the functional status of the patients. Various bandage systems, single layered, double layered and multiple layered with elastic and non elastic components have been commercialized. A requirement of sustained pressure brought the four-layer bandage into picture. We tried to study the bacteriology of the venous ulcers and the effect of our layer bandage on the healing of the ulcer. Methods: Sixty patients were recruited for the study. however, 4 patients had a bilateral disease and so a total of 64 limbs were taken into consideration in the study. clinical details of all patients with wound size measurement by gauze piece, wax paper and scale was done. the wounds were initially debrided and photographic records of all patients was maintained. Patients were followed up every week and the dressing was changed every week. Results: 93.8% had complete healing while 1.6% had partial healed ulcer and 4.7% had non healing ulcer. After excluding the four ulcers that did not heal, 16.6% had recurrence while 50 out 60 had no recurrence in the follow-up for one year. There was a significant correlation (P<0.001) between ulcer size and the number of dressings. Conclusions: compression therapy is the mainstay of treatment of venous ulcer. compression in the range of 30 mmhg to 40 mmhg is the most effective level for uncomplicated venous ulcers with adequate arterial competency. © 2020 Edizioni Minerva Medica. All rights reserved.
Expression analysis of aryl hydrocarbon receptor repressor (AHRR) gene in gallbladder cancer
(NLM (Medline), 2021) Puneet Kumar; Manoj Yadav; Khushi Verma; Ruhi Dixit; Juhi Singh; Satyendra K. Tiwary; Gopeshwar Narayan; V.K. Dixit
Background: The aryl hydrocarbon receptor repressor (AHRR), a member of the growing superfamily, is a basic helix-loop-helix/PerAHR nuclear translocator (ARNT)-Sim (bHLH-PAS) protein. AHRR has been proposed to function as a putative new tumor suppressor gene based on studies in multiple types of human cancers. This current study aims to investigate AHHR expression and its prognostic significance in gallbladder cancer. Methods: The study includes 48 gallbladder cancer and 34 chronic cholecystitis cases as controls. The expression level of AHRR was analyzed by using semi-quantitative PCR and immunohistochemical staining. The results were correlated with different clinical parameters. Results: We demonstrate that the expression of AHRR is significantly down-regulated in gallbladder cancer tissue samples as compared to that in chronic cholecystitis tissue samples by reverse transcriptase PCR (RT-PCR) (P = 0.017) and immunohistochemistry analysis (P = 0.002). Interestingly, our RT-PCR data revealed that AHRR mRNA expression is frequently down-regulated (45.8%; 22/48) in cases as compared to 14.7% (5/34) in controls. Similarly, immunohistochemical analysis data show significant down-regulation of AHRR expression in 77.1% (37/48) of gallbladder cancer cases than 44.1% (15/34) in controls (P < 0.017). Reduced mRNA and protein expression is significantly associated with advanced T-stage (P = 0.001), histological differentiation (P = 0.001), and tumors with nodal metastasis (P = 0.001). Decreased expression of AHRR is significantly associated with poor prognosis in gallbladder cancer patients. Conclusion: In conclusion, the present study suggests that low AHRR expression may be critical in gallbladder cancer development. Our data suggests that AHRR may act as a tumor suppressor gene and its expression profile may be useful as a diagnostic marker in gallbladder cancer.
Fibroadenoma in axilla: Another manifestation of ectopic breast
(BMJ Publishing Group, 2015) Satyendra K. Tiwary; Puneet Kumar; Ajay Kumar Khanna
Fibroadenoma of an accessory breast is a rare disease. The clinical significance lies in the fact that a number of cystic, inflammatory, neoplastic diseases similar to those of a normal breast have been reported in accessory breasts as well. Vigilant self-assessment and complete clinical examination are always encouraged to detect earliest malignancy in the axilla. We report two cases of ectopic breast fibroadenoma with the relevant literature.
Hemorrhoids banding with bands prepared from Foley's catheter [6]
(2007) Satyendra K. Tiwary; Rahul Khanna; A.K. Khanna
[No abstract available]
Iatrogenic femoral artery aneurysms in orthopaedic practice
(2007) Satyendra K. Tiwary; Sanjeev Kumar; Rahul Khanna; A.K. Khanna
Background: Iatrogenic injury to the femoral vessel is a rare complication after fracture of hip. Pseudoaneurysm formation of superficial femoral artery or profunda femoris artery is detected quite late. We present our experience for surgical management of pseudoaneurysm of femoral artery after iatrogenic trauma during management of fracture of femur. Methods: A retrospective analysis was carried out for eight patients with femoral artery pseudoaneurysm treated surgically during the last 10 years in one surgical unit. Results: Of eight patients with pseudoaneurysm of femoral artery, six had superficial femoral artery aneurysm and two profunda femoris artery aneurysm. Mean duration for presentation was 4 months (range 2-6 months). Methods of surgical intervention were direct closure of arterial defect after aneurysmectomy in six cases and use of saphenous vein patch graft for repair of artery in two cases. Mean size of aneurysm was 12 × 7 cm (range 8 × 4 cm to 20 × 12 cm). All patients were doing well during a mean follow up of 72 months (range 6-110 months). Conclusion: Large pseudoaneurysms of femoral arteries after iatrogenic injury during management of fractures of femur should be managed by aneurysmectomy and arterial repair with or without saphenous vein patch graft. © 2007 Royal Australasian College of Surgeons.
Introduction of Lower Limb Edema
(Springer Nature, 2022) Satyendra K. Tiwary; Vivek Kumar Katiyar; Ankush
Lower limb edema is a multifactorial condition affecting a large number of patients and generating considerable burden on the healthcare system. Patients with lower limb swelling may suffer from functional as well as cosmetic compromises requiring lifelong treatment and psychological support. The pathophysiology of edema is mainly based on disturbances in the microcirculation. For the diagnosis, we have to consider whether the swelling is acute or chronic, localized or generalized, congenital or acquired, symmetric or asymmetric. Asymmetry is usually present in chronic edema which arises from venous or lymphatic disease, whereas symmetric lower limb swelling is generally suggestive of systemic or central causes, such as heart failure and nephrotic syndrome. In systemic disorders, medications of the underlying pathology are central in the management while localized underlying causes such as chronic venous disorder, lymphedema, deep vein thrombosis, cellulitis, and trauma may need intervention and meticulous follow-up from time to time. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
Investigations for ulcer of the lower extremity
(Springer India, 2016) Satyendra K. Tiwary
[No abstract available]