Effectiveness on Nodovenous shunts in filarial lymphedema of lower limbs: An Evaluation

Chandramohan, K (2007) Effectiveness on Nodovenous shunts in filarial lymphedema of lower limbs: An Evaluation. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Filariasis is a name given for a group of diseases caused by nematodes belonging to the family Filaridae which are transmitted by haemophagus mosquito Culex fatigans. In India the causative organism are Wucheria Bancrofti and Brugia Malayi. About 250 million people live in the endemic area and about 32 million people are affected by it. Among these 90% of infected people comprise asymptomatic carriers. The management of the disease, apart from chemotherapy and surgery includes preventive aspect of vector control through Vector Research and Control Centre and through National Filarial Control programme launched in 1955. BACKGROUND OF STUDY: Since Thanjavur is an endemic filarial area, filarial lymphedema of lower limbs is one of the commonest problem we see in our out patient Department. We conduct filarial clinic on all mondays and treat around 4000 patients every year. Antibiotic prophylaxis and Diethyl carbamazine were given to all patients once in 15 days. We perform annually an average of 75 Nodovenous shunts and 30 cases of reduction annually. All the patients are classified into four grades according to the history, size of the limbs and skin changes. MATERIALS AND METHOD: This study was conducted in Thanjavur medical college during the year 2005-2007. A total of 100 patients were takenup for study which includes 60 females and 40 males. All patients were screened for caries tooth, inguinal adenitis,hydrocele and skin changes in lower limbs. All patients were subjected to regular Antibiotic prophylaxis, Compression garments and physical therapy for affected limbs. All lymphedematous patients were classified to grades I – IV. All grade I and II patients were grouped according to the presence or absence of enlarged inguinal node. Node positive patients were grouped for study. Node negative patients were taken as control. OBSERVATION: General Characters of Study Group - 100 patients of various grades of lower limb filarial lymphedema were included in the study. Among these 60 were grade I & II and another 40 were grade III & IV. 30 patients of grade I & II with enlarged inguinal lymphnodes were taken up for nodovenous shunt in addition to routine non surgical methods were taken for study. Another 30 patients of grade I and II without enlarged inguinal nodes managed with non surgical methods were kept as control group. 20 patients of grade III & IV were taken up as study group and equal number of 20 patints were taken as control group randomly. RESULTS OF THE STUDY: MEASUREMENTS IN GRADE I & II - In grade I & II patients there was reduction in size and volume in both control and study group. In study group there was volume reduction in 17 patients, 6 patients showed increase in volume measurement, 7 patients showed no change in volume measurement. In control group there was volume reduction in 7 patients, 19 patients showed increase in volume measurement, 4 patients showed no change in volume measurement. CONCLUSION: The evaluation of results in control and study group shows volume reduction in the study group who underwent nodovenous shunt in addition to all other measures followed in control groups is very significant. Filarial lymphedema is a common surgical problem around Thanjavur. In order to decompress the overloaded lymphatic system , lymphonodovenous shunts and drainage procedures are performed. The primary pathology in filarial lymphedema being in lymph nodes ( regional inguinal ) and the stasis in distal level is more a secondary effect. By passing the lymph to the venous blood by nodovenous shunt which done without microscope and which has produced consistant reduction in all stages of filarial lymphedema , , Nodovenous seems to be most appropriate surgical procedure suited for the magnitude of the problem and resources available. The initial reduction in thigh circumference of in grade III and IV is good and the resultant skin laxity is utilized for the excisional procedures followed here.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Nodovenous shunts ; filarial lymphedema ; lower limbs.
Subjects: MEDICAL > Plastic and Reconstructive Surgery
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 02:03
Last Modified: 22 Dec 2018 13:21
URI: http://repository-tnmgrmu.ac.in/id/eprint/3584

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