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  1. Article: Evaluation and treatment of enuresis.

    Ramakrishnan, Kalyanakrishnan

    American family physician

    2008  Volume 78, Issue 4, Page(s) 489–496

    Abstract: Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older. It affects 5 to 7 million children in the United States. Primary nocturnal enuresis is caused by a disparity between bladder capacity and nocturnal ...

    Abstract Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older. It affects 5 to 7 million children in the United States. Primary nocturnal enuresis is caused by a disparity between bladder capacity and nocturnal urine production and failure of the child to awaken in response to a full bladder. Less commonly, enuresis is secondary to a medical, psychological, or behavioral problem. A diagnosis usually can be made with a history focusing on enuresis and a physical examination followed by urinalysis. Imaging and urodynamic studies generally are not needed unless specifically indicated (e.g., to exclude suspected neurologic or urologic disease). Primary nocturnal enuresis almost always resolves spontaneously over time. Treatment should be delayed until the child is able and willing to adhere to the treatment program; medications are rarely indicated in children younger than seven years. If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child's physical and emotional health and counseled about eliminating guilt, shame, and punishment. Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful. Desmopressin is most effective in children with nocturnal polyuria and normal bladder capacity. Patients respond to desmopressin more quickly than to alarm systems. Combined treatment is effective for resistant cases.
    MeSH term(s) Algorithms ; Antidepressive Agents, Tricyclic/therapeutic use ; Antidiuretic Agents/therapeutic use ; Behavior Therapy ; Child ; Combined Modality Therapy ; Deamino Arginine Vasopressin/therapeutic use ; Enuresis/diagnosis ; Enuresis/epidemiology ; Enuresis/therapy ; Humans ; Imipramine/therapeutic use ; Practice Guidelines as Topic ; Precipitating Factors ; Treatment Outcome
    Chemical Substances Antidepressive Agents, Tricyclic ; Antidiuretic Agents ; Deamino Arginine Vasopressin (ENR1LLB0FP) ; Imipramine (OGG85SX4E4)
    Language English
    Publishing date 2008-08-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 412694-4
    ISSN 0002-838X ; 0572-3612
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Techniques and tips for lipoma excision.

    Ramakrishnan, Kalyanakrishnan

    American family physician

    2002  Volume 66, Issue 8, Page(s) 1405

    MeSH term(s) Head and Neck Neoplasms/surgery ; Humans ; Lipoma/surgery
    Language English
    Publishing date 2002-10-15
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 412694-4
    ISSN 0002-838X ; 0572-3612
    ISSN 0002-838X ; 0572-3612
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  3. Article: Identifying and diagnosing the adult neck mass.

    Ramakrishnan, Kalyanakrishnan

    American family physician

    2003  Volume 67, Issue 6, Page(s) 1190, 1192, 1195

    MeSH term(s) Branchioma/diagnosis ; Diagnosis, Differential ; Head and Neck Neoplasms/diagnosis ; Humans ; Lymph Nodes/pathology ; Paraganglioma, Extra-Adrenal/diagnosis
    Language English
    Publishing date 2003-03-15
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 412694-4
    ISSN 0002-838X ; 0572-3612
    ISSN 0002-838X ; 0572-3612
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  4. Article: Patient safety and medical errors: a focus on care transitions of the vulnerable older patient.

    Salinas, Robert C / Ramakrishnan, Kalyanakrishnan

    The Journal of the Oklahoma State Medical Association

    2012  Volume 105, Issue 2, Page(s) 52–57

    Abstract: The delivery of quality medical care includes the reduction of patient exposure to potentially adverse events that can lead to unnecessary suffering and disability or possibly death. Elderly patients residing in long-term care facilities are often ... ...

    Abstract The delivery of quality medical care includes the reduction of patient exposure to potentially adverse events that can lead to unnecessary suffering and disability or possibly death. Elderly patients residing in long-term care facilities are often transferred to emergency rooms for evaluation and management of an exacerbation of a chronic medical condition or an acute injury. Studies show that nursing home residents may be at higher risk for experiencing adverse medical events that lead to serious patient safety and quality of care concerns. These risks may be attributable to lack of effective communication among caregivers who help transition patients across acute care settings. This article reviews some of the challenges inherent in a complex system of care as elderly patients traverse healthcare settings and discusses the need to create system wide changes that will help prevent medical errors and improve patient safety for an at risk vulnerable population.
    MeSH term(s) Age Factors ; Aged, 80 and over ; Humans ; Male ; Medical Errors/prevention & control ; Nursing Homes ; Patient Safety ; Patient Transfer/organization & administration
    Language English
    Publishing date 2012-02
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 131027-6
    ISSN 0030-1876
    ISSN 0030-1876
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  5. Article ; Online: Skin and Soft Tissue Infections.

    Ramakrishnan, Kalyanakrishnan / Salinas, Robert C / Agudelo Higuita, Nelson Ivan

    American family physician

    2015  Volume 92, Issue 6, Page(s) 474–483

    Abstract: Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the infection and by patient comorbidities. Infections can be classified as simple ( ... ...

    Abstract Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the infection and by patient comorbidities. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. Most community-acquired infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus. Simple infections are usually monomicrobial and present with localized clinical findings. In contrast, complicated infections can be mono- or polymicrobial and may present with systemic inflammatory response syndrome. The diagnosis is based on clinical evaluation. Laboratory testing may be required to confirm an uncertain diagnosis, evaluate for deep infections or sepsis, determine the need for inpatient care, and evaluate and treat comorbidities. Initial antimicrobial choice is empiric, and in simple infections should cover Staphylococcus and Streptococcus species. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for debridement. Superficial and small abscesses respond well to drainage and seldom require antibiotics. Immunocompromised patients require early treatment and antimicrobial coverage for possible atypical organisms.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/therapeutic use ; Child ; Child, Preschool ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Education, Medical, Continuing ; Female ; Humans ; Infant ; Male ; Middle Aged ; Practice Guidelines as Topic ; Skin Diseases, Infectious/diagnosis ; Skin Diseases, Infectious/drug therapy ; Soft Tissue Infections/diagnosis ; Soft Tissue Infections/drug therapy ; United States ; Young Adult
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2015-09-15
    Publishing country United States
    Document type Journal Article ; Patient Education Handout
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
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  6. Article: Anorectal conditions: anal fissure and anorectal fistula.

    Fox, Audralan / Tietze, Pamela H / Ramakrishnan, Kalyanakrishnan

    FP essentials

    2014  Volume 419, Page(s) 20–27

    Abstract: Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful ... ...

    Abstract Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening.
    MeSH term(s) Family Practice ; Fissure in Ano/diagnosis ; Fissure in Ano/therapy ; Humans ; Laxatives ; Rectal Fistula/diagnosis ; Rectal Fistula/therapy ; Risk Factors
    Chemical Substances Laxatives
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2159-3000
    ISSN 2159-3000
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  7. Article: Anorectal conditions: fecal incontinence.

    Fox, Audralan / Tietze, Pamela H / Ramakrishnan, Kalyanakrishnan

    FP essentials

    2014  Volume 419, Page(s) 35–47

    Abstract: Although fecal incontinence occurs in all age groups, it is more common among older adults, especially nursing home residents, and it is more common among women than men. It often is associated with urinary incontinence. Etiologies are broadly ... ...

    Abstract Although fecal incontinence occurs in all age groups, it is more common among older adults, especially nursing home residents, and it is more common among women than men. It often is associated with urinary incontinence. Etiologies are broadly categorized to include anatomic/physiologic changes due to trauma, surgery, vaginal deliveries, radiation, or disease states; neurologic disorders; drugs; and functional impairments. Evaluation is aimed at identifying etiologies, and scoring systems can be used to estimate severity and monitor outcomes. The first step in treatment is managing possible etiologies and implementing conservative measures, including increasing dietary fiber intake, using antidiarrheal drugs, removing fecal impactions, and using biofeedback. If these measures fail to control incontinence, further testing can characterize specific defects. Tests include endorectal ultrasound, anorectal manometry, and pudendal nerve terminal motor latency. After the defect is characterized, management options include injecting biocompatible material to bulk up a rectal sphincter with a defined defect, suture repair of sphincter defects, transfer of gracilis or gluteal muscle to create a new sphincter, implanting an artificial sphincter or neurostimulator, creating an ostomy through which retrograde enemas can be administered, and colostomy to prevent feces from reaching the rectum. Anal plugs are a last resort.
    MeSH term(s) Age Factors ; Antidiarrheals ; Biofeedback, Psychology ; Diet ; Family Practice ; Fecal Incontinence/diagnosis ; Fecal Incontinence/etiology ; Fecal Incontinence/therapy ; Humans ; Sex Factors ; Urinary Incontinence
    Chemical Substances Antidiarrheals
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2159-3000
    ISSN 2159-3000
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  8. Article: Anorectal conditions: hemorrhoids.

    Fox, Audralan / Tietze, Pamela H / Ramakrishnan, Kalyanakrishnan

    FP essentials

    2014  Volume 419, Page(s) 11–19

    Abstract: Hemorrhoids are engorged fibrovascular cushions lining the anal canal. Constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids. Approximately 1 in 20 Americans and almost one-half of individuals older than 50 ... ...

    Abstract Hemorrhoids are engorged fibrovascular cushions lining the anal canal. Constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids. Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids. Bright red, painless rectal bleeding during defecation is the most common presentation. Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer (eg, adults older than 50 years) should still undergo colonoscopy to exclude cancer as the etiology. Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs. If nonsurgical management is unsuccessful, rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids. Surgical hemorrhoidectomy is indicated after failure of nonsurgical management and office-based procedures and also as initial management for grades III and IV hemorrhoids. Several different procedures can be used. For acutely thrombosed external hemorrhoids, excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management. Prolapsed and strangulated hemorrhoids are best managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery; residual hemorrhoids are banded or excised later.
    MeSH term(s) Age Factors ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Diagnosis, Differential ; Diet ; Family Practice ; Hemorrhage/etiology ; Hemorrhoidectomy/methods ; Hemorrhoids/diagnosis ; Hemorrhoids/surgery ; Hemorrhoids/therapy ; Humans ; Life Style ; Ligation/methods ; Prevalence ; Risk Factors ; Severity of Illness Index ; United States/epidemiology
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2159-3000
    ISSN 2159-3000
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  9. Article: Anorectal conditions: rectal prolapse.

    Fox, Audralan / Tietze, Pamela H / Ramakrishnan, Kalyanakrishnan

    FP essentials

    2014  Volume 419, Page(s) 28–34

    Abstract: Rectal prolapse, the protrusion of the layers of the rectal wall through the anal canal, may be partial (mucosal) or complete (full thickness). Although prolapse is most common among older women, it affects individuals of all ages, including children. ... ...

    Abstract Rectal prolapse, the protrusion of the layers of the rectal wall through the anal canal, may be partial (mucosal) or complete (full thickness). Although prolapse is most common among older women, it affects individuals of all ages, including children. Associated fecal incontinence and constipation are typical. Urinary incontinence and uterovaginal/bladder prolapse also may coexist. Some patients may have rectal ulcers. Diagnosis is predominantly clinical; visualization of the prolapse may require the patient to strain while sitting or squatting. Imaging studies, including fluoroscopic or dynamic magnetic resonance defecography, can confirm the prolapse if the diagnosis is uncertain, and endoscopy can aid in detecting other colonic/extracolonic pathology. Nonsurgical management (eg, increased fiber intake, fiber supplements, biofeedback) often is therapeutic in minor (first- or second-degree) mucosal prolapse and can help alleviate constipation and incontinence before and after surgery for patients with full-thickness prolapse. However, for full-thickness prolapse, transabdominal procedures are the most effective management and are favored for healthy patients, irrespective of age. Perineal procedures (eg, rubber band ligation, mucosal excision) can be used for patients with full-thickness prolapse who are not candidates for transabdominal surgery and for those with second- and third-degree mucosal prolapse.
    MeSH term(s) Age Factors ; Biofeedback, Psychology ; Constipation/epidemiology ; Diet ; Family Practice ; Fecal Incontinence/epidemiology ; Humans ; Ligation ; Rectal Prolapse/diagnosis ; Rectal Prolapse/epidemiology ; Rectal Prolapse/therapy ; Severity of Illness Index ; Sex Factors
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2159-3000
    ISSN 2159-3000
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: The broken (fractured) Implanon.

    Myrick, Laura / Howell, Captola / Ramakrishnan, Kalyanakrishnan

    The Journal of the Oklahoma State Medical Association

    2012  Volume 105, Issue 10, Page(s) 394–395

    MeSH term(s) Adult ; Contraceptive Agents, Female/administration & dosage ; Contraceptive Agents, Female/adverse effects ; Desogestrel/administration & dosage ; Desogestrel/adverse effects ; Drug Implants ; Equipment Failure ; Female ; Humans ; Menstruation Disturbances/etiology ; Weight Gain/drug effects ; Young Adult
    Chemical Substances Contraceptive Agents, Female ; Drug Implants ; etonogestrel (304GTH6RNH) ; Desogestrel (81K9V7M3A3)
    Language English
    Publishing date 2012-10
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 131027-6
    ISSN 0030-1876
    ISSN 0030-1876
    Database MEDical Literature Analysis and Retrieval System OnLINE

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