Browsing by Author "Kumar, D."

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Anal sphincter defects. Correlation between endoanal ultrasound and surgery
(Lippincott Williams and Wilkins, 1993) Deen, K.I.; Kumar, D.; Williams, J.G.; Olliff, J.; Keighley, M.R.
OBJECTIVE: This study was performed to (1) correlate and sphincter defects, identified by endoanal ultrasound with operative findings, and (2) define the appearance of such sphincter defects as seen at operation. SUMMARY BACKGROUND DATA : Endoanal ultrasonography is a minimally invasive method of imaging the anal sphincter complex and enables identification of anal sphincter defects. Little is known about the accuracy and limitations of endoanal ultrasound in identifying such defects. Furthermore, there are no data about the appearances of these endosonic sphincter defects as seen at operation. METHODS: Forty-four patients (40 women; age range, 26 to 80 years; mean age, 56 years) with fecal incontinence, undergoing pelvic floor repair, were investigated by endoanal ultrasound before operation. Endosonic findings were correlated with the appearances of external anal sphincter, internal anal sphincter, and intersphincteric space, at operation. Diagnosis of the site and type of defect was made by macroscopic appearances. Uncertainty about the type of sphincter defect was resolved by obtaining muscle biopsies for histology. RESULTS: All external sphincter defects seen by endoanal ultrasound (n = 23) were confirmed at operation. Twenty-one of 22 internal sphincterdefects identified by endosonography also were confirmed at operation. In ten patients with a neuropathic anal sphincter complex, the morphology was normal on endosonography, and this was confirmed at operation. (Sensitivity and specificity of 100% for external anal sphincter; 100% and 95.5%, respectively, for internal and sphincter) CONCLUSIONS: These data show that endoanal ultrasound is an accurate method of identifying anal sphincter defects.
Elephants in Indian Art: with Special Reference to Magadha (Bihar)
(Centre for Asian Studies, University of Kelaniya, Sri Lanka, 2016) Kumar, D.
Elephant has been an important motif in Indian Art. It has been a popular motif in all the three popular religions of India i.e. Hinduism, Buddhism and Jainism. It is always represented in Gaja-Laksmi images on either side of Laksmi, some time with pitchers. The God of Gods Indra is believed to have a white elephant named Airavata as his vehicle (vāhan). Lord Ganesha, one of the most popular Indian deities and the Lord of Wisdom bears an elephant head. The elephant head symbolizes great intellect and wisdom. Gajalakshmi images are depicted since Sunga period. Gajalakshmi, i.e., Lakshmi with elephants, is one of the most significant Ashtalakshmi aspects of the Hindu goddess Lakshmi. In this aspect, the goddess is depicted seated on a lotus, flanked on both sides by an elephant (gaja). She is shown as seated in Padmasana yogic posture and has four arms. In each of her upper pair of arms, she carries a lotus and the lower hands are generally shown in abhya and varadamudra. The elephants flanking her are shown as pouring water from their trunk over the goddess. This aspect like most other aspects of Lakshmi is representative of prosperity, good luck and abundance and the Gajalakshmi motifs are very common in Hindu and Buddhist iconography. The earliest available depictions of Gajalakshmi appear on a coin (3rd century) from Kausambi. Even in Buddhism elephant is a popular animal It is said that before the birth of the Buddha, the elephant is associated with Queen Māyā of Sakya and the mother of Gautama Buddha saw a dream in which a white elephant entering her womb. It is also noticed on pillar of Ashok. It is one of the four animals depicted on Saranath pedestal depicting four lion pillars. The first massive representation of this animal is also noticed in the Mauryan Art at Dhauli in Orissa. In Jainism it was a lañchana depicted with Ajith Nath. Elephant was quite popular even as an animal with terracotta artists. Several terracotta figurines of elephants have been discovered from various excavated sites of Northern India, particularly from Bihar of Mauryan period. The story of Udayana and Vasavadatta is also not complete without the depiction of an elephant. Elephants are also a symbol of royalty as Maharajas and kings used to ride them during processions as well as during war. Megasthenes, the Greek Ambassador to the court of Chandragupta Maurya reported the use of war elephants during warfare. The motif of three riders on an elephant occurs several times in terracotta and stone sculpture as well as in rock cut monument. Thus, the form might be invested with a symbolic meaning which far exceeds the episodic value in literature. In fact, this symbol of royalty has been quite popular with artists. In my paper, I will try to give a basic knowledge of this animal motif in religious as well as secular art.
Fistulas in ano: endoanal ultrasonographic assessment assists decision making for surgery
(British Medical Assosiation, 1994) Deen, K.I.; Williams, J.G.; Hutchinson, R.; Keighley, M.R.; Kumar, D.
Eighteen patients with a clinical impression of a complex fistula in ano, had anal endosonography to delineate the anatomy of the fistula track and identify associated areas of sepsis. The clinical impression of a complex fistula was refuted by endosonography and subsequent surgical exploration in two cases. Horseshoe tracks were identified in nine (50%) patients and fluid collections, not evident on clinical examination were identified in eight (45%) patients. Accurate identification of the internal opening with a 7 MHz transducer was possible in two (11%) cases. External sphincter damage was evident in four (22%) patients. Surgical findings matched endosonographic appearances in all but one case (94%). Anal endosonography is an accurate and minimally invasive method of delineating the relation of fistula tracks to the anal sphincters and identifying deep areas of sepsis in relation to such fistulas.
Influence of Nalanda bronzes on the art of neighbouring countries
(University of Kelaniya, 2013) Kumar, D.
The Prevalence of anal sphincter defects in faecal incontinence: a prospective endosonic study
(British Medical Assosiation, 1993) Deen, K.I.; Kumar, D.; Williams, J.G.; Olliff, J.; Keighley, M.R.
Forty six patients (median age 61 years; 42 women) with faecal incontinence and 16 age and sex matched controls undergoing a restorative proctocolectomy were assessed by clinical examination, anorectal physiology, and anal endosonography. Forty patients (87%) with faecal incontinence had a sphincter defect demonstrated on anal endosonography (31 external and 21 internal anal sphincter defects). The commonest cause of faecal incontinence was obstetric trauma. This occurred in 35 women, 30 of whom exhibited a morphological defect in the anorectal sphincter complex. In 22 of these patients with a history of a perineal tear or episiotomy, 21 (95%) had a sphincter defect. Sphincter defects were commonly located at the level of the midanal canal.
Randomized trial of internal anal sphincter plication with pelvic floor repair for neuropathic fecal incontinence
(Lippincott Williams and Wilkins, 1995) Deen, K.I.; Kumar, D.; Williams, J.G.; Grant, E.A.; Keighley, M.R.B.
PURPOSE:This study was designed to examine the role of adjuvant internal anal sphincter plication in women with neuropathic fecal incontinenceundergoing pelvic floor repair. METHODS: We completed a randomized trial with symptomatic and physiologic assessment before and after surgery. RESULTS: There was no symptomatic advantage of adding internal sphincter plication; the mean improvement of functional score was 3.61 +/- 1.82 (standard deviation; P < 0.01) following pelvic floor repair alone compared with 2.80 +/- 1.66 (standard deviation; P < 0.01) when adjuvant internal and sphincter plication was added. The addition of internal sphincter plication was associated with a significant fall in maximum anal resting and squeezing pressures (P < 0.01). CONCLUSIONS: Addition of internal sphincter plication is not advised in women with neuropathic fecal incontinence treated by pelvic floor repair.
RE-CREATING BUSINESS AS A SOCIAL ENTERPRISE.
(Department of Marketing Management, University of Kelaniya,Sri Lanka., 2017) Gupta, P.; Kumar, D.
There is growing realisation today that companies cannot continue to operate the way they have in the past, because they cannot sustain the usual practice of plundering resources merely for a profit. There is also a rethinking about the model of capitalism that dominates world economies. It is increasingly being felt that while the economic system has contributed to increased wealth and better quality of life, it also has deep negative environmental and social impacts. Profit generation and maximization, while being legitimate objectives of companies, must therefore also be accompanied by economic, social and environmental betterment. In other words, the world is heading to a more “humane” capitalism. Companies realise that the “business-as-usual” approach – one in which natural resources are exploited ruthlessly – is creating problems of pollution and sustainability across the globe. If such development goes unchecked, we are in for great social and environmental upheavals that may destroy the planet completely. The re-orientation of business as a social enterprise is now recognised as essential for the future of business itself. Writing that the global economic system is under threat, Bower, Leonard and Paine point out in their book, Capitalism at Risk (2011), “business must serve both as innovator and activist – developing corporate strategies that effect change at the community, national, and international levels.”Stigliz (2002) had written, “Globalization today is not working for many of the world’s poor; it is not working for much of the environment; it is not working for the stability of the global economy.” We have a system today in which the rich are reaping the benefits of development, while vast numbers of poor live in deprivation. It is also being felt that the limits of sustainability have been reached – the planet cannot sustain the runaway consumption that the economic system dictates. This can best be described as an unstable system. A positive future for the planet depends on a new paradigm that links business and development and promotes social, economic, and environmental stability around the world. Corporations thus have a broader role in society. Porter and Kramer (2002) write, “We are learning that the most effective way to address many of the world’s most pressing problems is to mobilize the corporate sector where both companies and society can benefit.” It is time that companies understood that social and economic goals are integrally connected. Preserving the environment benefits not only society but companies too, because reducing pollution and waste can lead to a more productive use of resources. Boosting social and economic conditions in developing countries can create more productive locations for a company’s operations as well as new markets for its products. Because of this understanding, companies too are realising that they have a broader purpose than the blind pursuit of profits. The future or rural marketing depends on how companies fulfil their objectives of profits, sustainability and inclusive growth. Indeed, many companies are doing so. This paper analyses the corporate initiatives taken to empower local communities and introduce a sustainable way of doing business. It takes pointers from these experiences and tries to draw conclusions as to the nature of future business. It also dwells on the future of capitalism that may well evolve due to changes in business thinking.
Scintigraphic defecography: quantitative and dynamic assessment of anorectal function
(Lippincott Williams and Wilkins, 1993) Hutchinson, R.; Mostafa, A.B.; Grant, E.A.; Smith, N.B.; Deen, K.I.; Harding, L.K.; Kumar, D.
PURPOSE: Conventional assessment of anorectal function with defecating videoproctography is semiquantitative and the high radiation exposure precludes prolonged or repeated testing. The aim of this study was to develop a dynamic scintigraphic method of assessing anorectal function. METHODS: Fourteen patients with fecal incontinence, 18 patients with chronic constipation, and 8 control subjects were assessed by scintigraphicdefecography. This involves introduction of a technetium-99m-radiolabeled artificial stool into the rectum of the subject and acquisition of gamma camera images during evacuation. RESULTS: Mean evacuation rate was 2.8 percent/second in incontinent patients and 0.9 percent/second in constipated patients (P < 0.001). The mean anorectal angles were 136 degrees and 133 degrees, respectively. There were 18 cases of pelvic floor descent and 6 rectoceles. Scintigraphicdefecography provides quantitative information on rectal evacuation. Anorectal angle and pelvic floor movement can be examined. The radiation dose to pelvic organs is significantly less than with videoproctography. CONCLUSION: We believe that scintigraphic defecography is the investigation of choice for objective and dynamic assessment of anorectal function
Sculptural art of Bihar
(Centre for Asian Studies, University of Kelaniya, 2015) Kumar, D.
Sculptural art of Bihar
(Centre for Asian Studies, University of Kelaniya, 2015) Kumar, D.
Stone sculptures occupy an important place in the history of plastic arts of India. Bihar is one of the most important Indian states, which has yielded various types of Stone Sculptures beginning at least as far back as 3rd Century B.C down to end of the Pāla period. The history of Sculptural art of India won’t be complete without the study of Bihar sculptures. In the historical period, it was the Mauryan rulers who got carved sculptures in stone for the first time. The Asokan pillars were surmounted with anim figures which were magnificent and vigorous in physic. The human figures were also magnificent. The most important example is undoubtedly the famous Chauri-bearer from Didarganj. This life size figure is quite charming, enchanting and bewitching. The anatomical treatment of her body is superb. The sculpture has a lustrous mirror like superb shining polish of the Mauryan Period. After the Mauryas, the Śungas succeeded the throne of Magadha. It was during their reign period, the railing of Bodh Gaya was carved. They are undoubtedly one of the best specimens of Śunga railing art. The Śālabhanjikā figure from Rajendra Nagar is the best example of the monolithic art of Śunga period of Bihar. This figure, made of monolith sandstone, is depicted on both sides and presents somewhat standing view of her face. She is depicted in her full youthful posture in quite a graceful manner. In the Kushana period also certain sculptures were carved in Bihar. Though we are not certain whether the Kushana ruled over Bihar or Not. One of the best examples of this period is the trio from devangarh in Nawada District, there Vasudeva, Balrama and Eknamsa are shown standing on a separate pedestal for the first time in the history of Indian art. The “Gupta Art” in stone reflects a marked refinement in the grace and charm and liveliness of a female image. The most remarkable features of the art of Gupta period is the depiction of the lower garment (or even upper garment) in an attractive manner which is diaphanous or transparent character, but at the same it maintains the decency of the body represents. The depiction of transparency of cloth has been achieved by the artist in such a refined manner, which is indeed worth to be appreciated. Secondly, the ornamentation of the image is also quite simple but very attractive ornaments are there and it is not elaborate, nevertheless it adds charm and grace to the image. The face is not broader but is oval in shape with delicate touch imparting greater charm and grace of the figure. The adornment of hair on the head in a most attractive manner and with a clear representation of hair arrange nicely further adds beauty to the image. The entire body presentation is quite captivating and attractive. It presents a deliberate look. The rhythm of the body is quite perceptible in a delicate and refined manner by providing a lifelike appearance to the image. The depiction of eyes is quite captivating which is in keeping with the life like representation and this further adds grace and charm to the image. It may also be pointed out here that the nose of the figure is quite sharp and the upper lip generally is thin, but the lower lip is depicted thicker but it maintains the beauty of the face of the images. Further, it is to be mentioned here that the stele of the image where ever it exists is quite simple and is never decorative – generally a cable molding type incision of lines or lines showing floral petals around the border of the steel is depicted. Secondly, the stele in shape is almost oval which is simple without having any decorative motif, miniature figure or designs over it, but at the same time it maintains the charm and grace of the image. The female image from Sakarigali Rajmahal is the best example of this period. The female figure inside the door jamb is shown feeding a parrot in a most delicate charming and artistic manner. The figure as a whole is very beautiful, artistically and delicately designed and chiseled inside the door jamb and is standing in a most artistic manner which is very graceful and quite charming and attractive. We have a few specimens of art in stone of the Pāla period, which are not doubt top ranking and outstanding Pieces. Among them a group of three Buddhist stone sculpture from village Vishnupur in Gaya Distt. deserve special mention. These images are of (1) Lord Buddha (2) Boddhisattva Avalokitesvra and of (3) Materiya – the future Buddha. These images are full of life and vigour and produce a sense of feeling and sentiment all that is the characteristics of a human being.