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Biomedical subjects

A K Kubba

Publications and source records attributed to A K Kubba.

27 records · Page 2Linked to original sources
PubMed1996

Endoscopic injection for bleeding peptic ulcer: a comparison of adrenaline alone with adrenaline plus human thrombin.

BACKGROUND & AIMS: Endoscopic injection therapy improves outcome in bleeding peptic ulcer, but the optimum regimen is unknown. The aim of this study was to compare the efficacy of endoscopic therapy with dilute adrenaline alone vs. adrenaline plus human thrombin in the treatment of patients with major peptic ulcer hemorrhage. METHODS: One hundred forty patients with significant peptic ulcer hemorrhage and active arterial bleeding or a nonbleeding visible vessel were randomized to endoscopic injection with 1:100,000 adrenaline (70 patients; group 1) or to adrenaline plus 600-1000 IU of human thrombin (70 patients; group 2). The two groups were well matched for age, shock, hemoglobin concentration, comorbid disease, endoscopic findings, and consumption of nonsteroidal anti-inflammatory drugs. RESULTS: Fourteen patients from group 1 (20%) and 3 patients from group 2 (4.5%) rebled (P < 0.005). Seven patients from group 1 (10%) but no patients from group 2 died within 30 days of admission (P < 0.013). Patients from group 1 were administered a total of 297 units of blood compared with 219 units in group 2 (P < 0.041). CONCLUSIONS: Endoscopic injection using adrenaline plus human thrombin is superior to injection with dilute adrenaline alone and may represent the best treatment for bleeding peptic ulcers.

Adult↗
PubMed1996

The outcome of urgent surgery for major peptic ulcer haemorrhage following failed endoscopic therapy.

OBJECTIVE: To review the outcome of patients who underwent emergency surgery for major peptic ulcer haemorrhage after failed endoscopic therapy. To address whether 'conservative' or 'aggressive' surgery is best. DESIGN: A retrospective analysis of emergency surgery for ulcer bleeding which could not be controlled by endoscopic therapy. SETTING: The four admitting units in the Lothian region of Scotland. PARTICIPANTS: Sixty-seven patients who failed endoscopic therapy for bleeding peptic ulcer and underwent emergency surgery between December 1990 and December 1995. Simple underrunning or excision of ulcer alone was done in 31 patients whilst 36 had more radical surgery. MAIN OUTCOME MEASURES: Rebleeding and 30-day mortality rates. RESULTS: Rebleeding was significantly higher in patients treated by underrunning (7 versus 1, P < 0.013). There were fewer deaths in the radically treated group (5 versus 7, not significant). CONCLUSION: Patients undergoing surgical operation for severe peptic ulcer haemorrhage after failed endoscopic therapy may be best served by a relatively aggressive approach.

Aged↗
PubMed1996

Upper gastro-intestinal disease in Scotland: a survey of practice amongst Scottish gastroenterologists.

Given the range of causes of upper gastrointestinal disease (UGD), the evolving role of Helicobacter pylori in its pathogenesis and the variety of treatments available, one might expect complex management strategies in the management of these diseases. The aim of this study was to determine the current management strategies used in peptic ulcer disease and gastritis in Scotland and to identify areas where large and clinically important variations in practice exist between gastro-intestinal specialists. Between June and September 1994, 130 gastro-intestinal physicians and surgeons were sent a postal questionnaire based on their response to four hypothetical clinical scenarios. Eighty-one (63%) correspondents returned completed questionnaires. The case histories related to: bleeding duodenal ulcer; peptic ulceration whilst taking non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids; management of dyspepsia in the young; and management of gastritis. Thirty-eight per cent of clinicians surveyed advocated the use of intravenous acid reducing agents in peptic ulcer bleeding. A total of 88% advocated endoscopic therapy in the presence of stigmata of recent haemorrhage and 5% suggested a follow up of endoscopy to confirm healing after ulcer bleeding. In treating the patient with ulcer while on NSAIDs, 45% of clinicians would use H2 receptor antagonists, 37% would use omeprazole, 14% misoprostol and 4% helicobacter eradication. Of the clinicians surveyed, 63% said they would investigate a 25-year-old patient with dyspepsia by endoscopy and 84% of these will biopsy for H. pylori. Empirical treatment was favoured by 37% and 4% considered a barium meal. There was no consensus in the treatment of gastritis. There exists considerable divergence of opinion between clinicians in investigation and treatment of upper gastrointestinal disease. The role of endoscopy, the type and duration of medical treatment of bleeding and non bleeding ulcer and gastritis require further, more detailed investigation. A consensus document would be warmly welcomed.

Adult↗
PubMed1995

Transurethral resection of the prostate in 539 patients at a district general hospital.

This study audited length of hospital stay, mortality and morbidity associated with transurethral resection of the prostate (TURP) in a district general hospital over a 4-year period between 1990 and 1993. Five hundred and thirty-nine TURPs (409 benign and 130 malignant; median age 69 years) were carried out, which represented a twofold increase over the 4-year period. Although the mean duration of stay was 5 days, 92.5% of patients had a hospital stay of less than 7 days. One (0.2%) death occurred in a patient with ischaemic heart disease on the first postoperative day. The commonest cause of morbidity and delayed discharge from hospital was presence of outflow symptoms in nine (1.7%) patients. Transurethral resection of the prostate is a safe procedure in an ever-increasing elderly population with concomitant medical illness, but improved identification of 'at-risk' patients is required in order to further lower the morbidity associated with this procedure.

Aged↗
PubMed1994

Nephrectomy: changing indications, 1960-1990.

OBJECTIVE: To review the indications for nephrectomy over the period 1960-1990. PATIENTS AND METHODS: A total of 1470 nephrectomies were performed (excluding transplant-related nephrectomies) over this period. Data were collected by means of a pathology report review and the indications were classified according to aetiology. RESULTS: The total number of nephrectomies performed has not significantly changed over this 31-year period. There was a significant decrease in the number of partial nephrectomies performed and an increase in the number of nephrectomies performed for tumour. This change was equally distributed between both renal adenocarcinomas and transitional cell tumours. The number of nephrectomies for chronic pyelonephritis decreased over this period. The change seen was not as great as might have been anticipated in view of the advent of modern antibiotics. Nephrectomies performed for tuberculosis decreased, although this change was not established until the 1980s. In the 1960s and early 1970s, most tuberculous nephrectomies were performed in patients from the native community. By the 1980s, most patients in this category were from the ethnic Asian immigrant community. Nephrectomy rates for polycystic kidney and trauma remained unchanged. CONCLUSIONS: Despite changes in the investigation and management of renal tract pathologies, which contributed to a change in the indications for nephrectomy, the overall number of nephrectomies performed has remained constant over a 31-year period.

Humans↗
PubMedDate not supplied

Role of photodynamic therapy in the management of gastrointestinal cancer.

BACKGROUND: Surgery for cancer of the gastrointestinal tract is associated with high morbidity and mortality, especially in older patients. A significant proportion of patients cannot be cured and would be referred for palliative therapy. Others may have early cancer but are deemed unfit for surgery. Chemotherapy and external radiotherapy are suitable for only a proportion of patients. Therefore, photodynamic therapy may have a role in the management of these patients. It was the possibility of achieving selective tumour necrosis with sparing of normal tissue that made this treatment extremely appealing compared to other conventional tumour therapy. METHOD: The literature is reviewed (after an extensive Medline search 1975-1997) regarding the scientific basis of photodynamic therapy and the clinical experience to date with this therapy in the management of malignancies of the gastrointestinal tract. RESULTS AND CONCLUSIONS: Photodynamic therapy holds the promise of an eradication form of treatment for early cancer especially for patients deemed unfit for other treatment. It may also prove a useful supplement to other techniques in order to eliminate small residual areas of tumour left after the main bulk has been removed by other methods. The use of photodynamic therapy in the palliative management of gastrointestinal tract cancer is likely to be limited.

Animals↗