Biomedical subjects
Publications and source records attributed to B Nagi.
Gastric volvulus is a rare condition. Upper gastrointestinal bleeding in gastric volvulus is extremely rare. We describe two patients with gastric volvulus who presented with upper gastrointestinal bleeding.
Anomalous junction of pancreatobiliary ducts (AJPB) is known to be associated with choledochal cyst and gallbladder cancer. This report describes our experience with eight patients with AJPB, six of whom were diagnosed at endoscopic retrograde cholangiography and two at transhepatic cholangiography. Four of the patients with AJPB had an associated congenital choledochal cyst, two had a normal biliary tree and one each had inspissated bile syndrome and cholangiocarcinoma. The last two associations have not been previously described. It is felt that the clinical spectrum of AJPB may unfold further with the widespread use of the cholangiographic techniques.
Total esophageal exclusion and substernal gastric bypass were performed on eight patients with unresectable carcinoma of the thoracic esophagus who had received radiotherapy as the primary treatment. One patient died postoperatively. Three patients developed cervical anastomotic leaks which settled with conservative treatment. Average survival after the surgery was eight months and all seven survivors were able to eat normally. The simplicity and effectiveness of the operation have been emphasized.
A case of small cell anaplastic carcinoma of bronchus is described. Primary tumour had metastasized in the stomach and there was production of amylase by the tumour evidenced by raised serum amylase and pleural fluid amylase.
A case of asymptomatic, large, epiphrenic diverticulum of oesophagus associated with sliding hiatus hernia and gall stones is reported.
Of a total of 969 barium enemas performed over a three year period, 23 (2.4%) showed colonic diverticulosis. The mean age of the patients was 58 years and the commonest site involved was the sigmoid colon. All the patients were urbanised and were obligatory vegetarians. Six (25%) of the patients had a complication of the disease and three of them required surgery. The possible relationship of the disease with socio-economic changes is highlighted.
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A prospective study was undertaken to determine the radiological, endoscopic and histological changes of upper gastro-intestinal mucosa in patients with end-stage renal failure and the effect of haemodialysis. Of the 30 patients studied, 28 (93%) had presented with upper gastrointestinal symptoms. Abnormal findings on upper gastrointestinal endoscopy were observed in 66.7% patients. These comprised oesophagitis (23.3%) gastritis (30%), duodenitis (33.3%) and peptic ulcer (6.7%). Histological study of the mucosal tissue biopsy in 24 patients showed oesophagitis, gastritis and duodenitis in 12.5%, 45.8% and 37.5% respectively. Ten patients were re-evaluated after institution of haemodialysis therapy for a minimum of one month. Though there was a significant improvement in gastrointestinal symptoms (p less than 0.05), there was no effect on endoscopic changes. The study documents a high incidence of mucosal inflammatory changes rather than that of ulcer disease in chronic renal failure.
Real time sonography followed by splenoportography was performed in 38 cases with non-cirrhotic portal hypertension. Eleven of these cases, in whom porto-systemic shunt surgery was done, were also evaluated by real time sonography post-operatively. The ultrasound findings correlated well in 37 cases (98%) with splenoportography. All the post-operative cases also revealed a patent portosystemic shunt on sonography. Ultrasonography, a valuable, non-invasive, initial investigation of portal hypertension, may thus be used as the only investigation to distinguish intra- from extra-hepatic obstruction and to evaluate patency of surgically created porto-systemic shunts. Invasive portography may be performed only if surgical treatment is anticipated.
We have prospectively evaluated 41 patients who ingested acid for location, extent, severity, and outcome of the injury to the upper gastrointestinal tract. The injury was assessed within 36 h of acid intake by endoscopy or surgery, or at autopsy. Symptoms and signs were unreliable in predicting the extent and severity of injury. The degree of burns was classified as follows: grade 0 in 2 patients, grade 1 in 3, grade 2 in 16, and grade 3 in 20. Esophageal injury was seen in 87.8% of the patients, gastric injury in 85.4%, and duodenal injury in 34.1%. All patients with grade 0, 1, and 2a injury recovered without sequelae. Acute complications occurred in 39.1% of the cases, and death in 12.2%. It is significant that all such patients had grade 3 burns. Five of the 8 patients with grade 2b injury and all survivors of grade 3 injury developed esophageal or gastric cicatrization, or both, which subsequently needed endoscopic or surgical treatment. We find that endoscopy is not only the tool of choice for diagnosis in such cases but also aids in deciding upon treatment and prognosis. We conclude that acid injury of the upper gastrointestinal tract is a very serious condition that affects the esophagus and stomach equally and results in high morbidity and mortality.
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Hernia through the foramen of Morgagni is uncommon in adults. Chronic gastric volvulus within the foramen of Morgagni is very rare. In this report, we describe a patient who presented with symptoms of gastric outlet obstruction due to chronic intermittent gastric volvulus in the foramen of Morgagni.
Pneumatic dilatation of achalasia cardia was performed on 22 patients using Rider-Moeller bag under fluoroscopic control-during a three year period. The diagnosis was established at barium study and endoscopy. A total of 28 dilatations were performed on 22 patients. Sixteen patients required a single dilatation, five required another sitting while one patient had to be dilated thrice. Surgery was not required in any patient. There was a single complication in the form of an intramural leak which could be successfully managed conservatively. Our short term follow up results reiterate the consensus that pneumatic dilatation should be the initial form of management in these cases.
Forty-six patients with suspected esophageal disease were studied by tube esophagography. This was performed by positioning a rubber tube in the proximal esophagus, followed by swallowing of high density barium suspension and insufflation of air through the tube. Comparison in 20 cases showed superiority of tube study over conventional double contrast barium, with alteration in diagnosis in six cases and additional information in 14 cases. Tube esophagogram is a safe, simple and valuable adjunctive technique leading to accurate and definitive radiological diagnosis of esophageal disease.
Three cases of retrograde jejunogastric intussusception who were managed endoscopically are described. The diagnosis was made by means of endoscopy in one case and contrast radiology of the stomach in the other two. Endoscopic management consisted of reduction of the intussusception, followed by placement of a feeding tube deep in the intussuscepting segment. The patients responded very well and surgery could be avoided in all of them.
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Hypersensitivity reactions can occur after the administration of barium products and all caused by one of the many additives. These reactions are extremely unusual. Authors report on a patient who developed urticaria shortly after a conventional barium examination.
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