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Biomedical subjects

B R Mittal

Publications and source records attributed to B R Mittal.

42 records · Page 3Linked to original sources
PubMedDate not supplied

Comparison between contrast-enhanced magnetic resonance imaging and technetium 99m glucohepatonic acid single photon emission computed tomography with histopathologic correlation in gliomas.

OBJECTIVE: : To determine and compare the accuracy of contrast-enhanced magnetic resonance imaging (MRI) and Technetium 99m glucohepatonic acid single photon emission computed tomography (Tc-GHA SPECT) in grading of gliomas, compared with neuropathologic findings. MATERIALS AND METHODS: : The study included 20 adult patients (13 men and 7 women) with clinical/radiological suspicion of brain tumor (glial tumor) who were subjected to magnetic resonance examination and Tc-GHA brain SPECT.The lesions were evaluated by using MRI imaging score, based on 9 MRI criteria. Based on the discrimination threshold of 0.9 for mean MRI score, the gliomas were graded as low- or high-grade glioma. The Tc-GHA SPECT retention index was calculated as the ratio between delayed and early uptake ratios. Based on the discrimination threshold of 1 for Tc-GHA SPECT retention index, the gliomas were graded as low- or high-grade glioma.The diagnosis was verified by means of histopathologic examination in all patients (open surgery in 19 patients and stereotactic biopsy in 1 patient). Correlation between MRI findings/scores, SPECT scores, and histopathologic grades was done in all the patients, and comparison between MRI and Tc-GHA SPECT was made using paired Student t test and correlation coefficient. RESULTS: : The study revealed significant difference between the mean MRI scores and early uptake ratio, delayed uptake ratio, and retention index of low-grade (grades I-II) and high-grade (grades III-IV) gliomas. No statistically significant difference could be demonstrated between the abilities of contrast-enhanced MRI and Tc-GHA SPECT to allow differentiation between high- and low-grade gliomas. The accuracy of MRI (78.4%), however, was slightly higher than that of Tc-GHA SPECT (73.68%). However, Tc-GHA SPECT allowed differentiation between high-grade gliomas (between grades III and IV gliomas). CONCLUSIONS: : The accuracy of contrast-enhanced MRI in the distinction of high- and low-grade malignancy was higher than that of Tc-GHA SPECT. The performance of Tc-GHA SPECT adds little in determining tumor grade when MRI is performed. However, it may act as a useful adjunct to differentiate between grades III and IV gliomas.

Adult↗
PubMedDate not supplied

Effect of erythromycin and cisapride on emptying of the vagally denervated intrathoracic stomach.

BACKGROUND: Subsequent to esophagectomy and reconstruction among patients with esophageal cancers, the intrathoracic denervated stomach acts as a passive conduit without peristalsis. OBJECTIVE: The study was designed to assess the impact of two prokinetic drugs viz. erythromycin and cisapride on the emptying of vagally denervated intrathoracic stomach. METHODS: Twenty consecutive patients of carcinoma esophagus, who had undergone one stage transhiatal oesophagectomy with cervical esophagogastrostomy and were disease free at three months postoperative follow-up, were included in the study. These patients were randomised into two groups of ten each. The patients in group A received erythromycin, while patients in group B received cisapride. The gastric emptying was studied by scintigraphy, using a standard test meal containing 99m Tc sulphur colloid labelled 'IDLIS' [rice based radio labelled food] before and after the drug treatment. RESULTS: The pre and post treatment mean gastric half emptying time of the patients in the erythromycin group was 52.6 min and 49.7 min (p > 0.1) and in cisapride group it was 53.76 and 26.4 min respectively (p < 0.05). Intergroup comparison of the difference was not statistically significant. CONCLUSION: Cisapride is an effective prokinetic agent in the treatment of gastric stasis of the vagally denervated intrathoracic stomach.

Adult↗
PubMedDate not supplied

Clinical profile, diagnosis and management of patients presenting with symptomatic pulmonary embolism.

OBJECTIVE: To study the clinical profile and diagnostic methods in patients with symptomatic pulmonary embolism (PE). METHODS: Prospective assessment of clinical features, radiology and outcome of patients presenting with symptomatic PE over an 18-month period. RESULTS: During study period, 24 patients with a mean age of 39 +/- 12.1 years were diagnosed to have symptomatic pulmonary embolism. Dyspnoea (91.7%) and cough (58.3%) were the predominant complaints. Spiral computed tomographic pulmonary angiography (CTPA) was performed in 21 (87.5%) patients and perfusion scans in 14 (58.4%) patients. Echocardiography performed in all patients revealed evidence of pulmonary artery hypertension and right ventricular dyskinesia in 20 (83.3%) and 15 (62.5%) patients, respectively. Thrombolysis with streptokinase was performed in 14 (58.3%) patients. All patients received low molecular weight heparin followed by warfarin. Of the 24 patients, 20 (83.3%) were discharged and are under regular follow-up; four patients died. CONCLUSIONS: Pulmonary embolism is a common problem and can be easily diagnosed provided it is clinically suspected. Early diagnosis and aggressive management is the key to successful outcome.

Adult↗
PubMedDate not supplied

Bile leak after T-tube removal--a scintigraphic study.

BACKGROUND/AIMS: A prospective study was performed to evaluate the incidence of bile leak after T-tube removal, using 99mTc labelled BULIDA scintigraphy. PATIENTS AND METHODS: Thirty seven patients with choledocholithiasis underwent choledocholithotomy and T-tube drainage. T-tubes were removed on 9--26 postoperative day (mean 13.4 days). RESULTS: Six (16%) patients had scintigraphic evidence of bile leak; 4 patients had leak demonstrated in the early phase only. One patient each had partial persistent leak and complete bile leak. All patients were managed nonsurgically; conservative treatment: (4), percutaneous drainage (PCD) of intra-abdominal collection (1) and endoscopic sphincterotomy and PCD of intra-abdominal collection (1). There was no significant difference in the leak rate when T-tubes were removed at < 2 weeks versus later than 2 weeks (P=.97). CONCLUSIONS: T-tubes should be removed with extreme caution and treatment of symptomatic patients should be guided by clinical and scintigraphic findings.

Bile↗
PubMedDate not supplied

Gastric emptying in patients with non ulcer dyspepsia (dysmotility type).

Non ulcer dyspepsia is a clinical entity characterized by chronic recurrent upper gastrointestinal symptoms in the absence of identifiable organic or systemic cause. Many such patients may have delayed gastric emptying which can easily be documented using radionuclide food markers. We evaluated gastric emptying patterns in 20 patients having non ulcer dyspepsia and 30 healthy controls. Gastric emptying was studied using indigenously prepared radiolabelled vegetarian solid food marker, the integrity of which had already been established and reported by us. Nine of the 20 (45%) non ulcer dyspepsia patients showed delayed gastric emptying. All these patients were administered cisapride and on reevaluation showed improvement in their upper gastrointestinal symptoms.

Adolescent↗