An endoscopic method for removal of duodenal phytobezoars.
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Aged↗
Biomedical subjects
B S Anand
Publications and source records attributed to B S Anand.
Helicobacter pylori infection does not reduce the viscosity of human gastric mucus gel.
The mechanism by which Helicobacter pylori undermines host defence mechanisms is unclear. Several in vitro studies using soluble mucins have suggested that H pylori may compromise mucus function. Gastric mucus gel was obtained from 13 H pylori infected patients; six untreated subjects and seven after eradication of the infection. Gastric mucus is a non-Newtonian substance in that its viscosity changes with changing rates of shear, requiring mucus viscosity to be measured in a rotational cone-plate microviscometer. Viscosity was measured at shear rates varying from 1.15 s-1 to 46 s-1. The gastric mucus viscosity was significantly higher in patients infected with H pylori compared with mucus gel obtained after eradication of the infection. The results of our study suggest that the previous studies using in vitro methods involving soluble mucins or its components may have lead to erroneous conclusions about the in vivo interactions of H pylori and gastric mucus gel. The present findings argue against the hypothesis that degradation of gastric mucus by H pylori is important in the pathogenesis of peptic ulcer.
Female↗
Isoniazid-induced acute pancreatitis.
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Acute Disease↗
Comparative assessment of phenolphthalein and phenolphthalein glucuronide: is phenolphthalein glucuronide a better laxative?
BACKGROUND: Phenolphthalein is widely used as a safe and effective laxative. After oral administration, phenolphthalein is absorbed in the small bowel and is conjugated in the liver to phenolphthalein glucuronide which passes into the colon where it is deconjugated and the active compound, phenolphthalein, is released. Since phenolphthalein glucuronide does not undergo enterohepatic circulation it should theoretically have a more rapid onset of action and a lower threshold dose for laxation. The present study was designed to examine this issue. METHODS: Ten normal healthy subjects volunteered for the study. All subjects were administered placebo, phenolphthalein (at doses of 15, 30, 45, 60, 75 and 90 mg) or phenolphthalein glucuronide (at equivalent doses of 24, 48, 72, 96, 120 and 144 mg) in a random order. Stool weight, the frequency and consistency of stools, and the development of symptoms were recorded at 12-h intervals for 84 h. RESULTS: There was a significant increase in the mean stool weight obtained within the first 24 h of administration of a 30 mg dose of phenolphthalein and its glucuronide equivalent compared to the values obtained with placebo. A further increase in the dose did not improve the therapeutic response. There was no difference between phenolphthalein and phenolphthalein glucuronide with respect to the rapidity of action, the threshold dose, effectiveness of laxation, or the frequency of adverse effects. CONCLUSIONS: The therapeutic response and side effect profile of the different doses favoured 30 mg phenolphthalein as the optimum laxative dose. Although theoretically superior, phenolphthalein glucuronide was not found to be a more effective laxative compared to phenolphthalein in normal subjects.
Cathartics↗
Pancreatic secretion in man: effect of fasting, drugs, pancreatic enzymes, and somatostatin.
The inhibitory effect of different drugs on pancreatic secretions was assessed in a patient with a posttraumatic pancreatic-cutaneous fistula. The various drugs examined were: pancreatic enzymes, cimetidine, verapamil, propantheline, acetazolamide, and somatostatin analog octreotide. Only fasting and octreotide reduced pancreatic secretion. The optimum dose of octreotide was 50 micrograms bid given subcutaneously; increasing the dose up to 100 micrograms tid had no additional benefit. A stable pancreatic-cutaneous fistula is an excellent model to assess the effect of different therapeutic measures on pancreatic secretion.
Acetazolamide↗
Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens.
It is often difficult to establish the diagnosis of intestinal tuberculosis because of close similarities with other conditions, in particular, Crohn's disease. In the present study, we used the polymerase chain reaction (PCR) assay on endoscopic biopsy specimens obtained from a patient with chronic diarrhea. Positive hybridization was obtained with the Mycobacterium tuberculosis probe and the patient was treated with anti-tuberculous drugs with complete resolution of the endoscopic abnormalities. This study demonstrates that polymerase chain reaction assay can be used on endoscopic biopsy specimens to diagnose intestinal tuberculosis.
Adult↗
Eder-Puestow and Savary dilators.
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Dilatation↗
Pathogenesis of peptic ulcer in rheumatoid arthritis.
To assess the pathogenesis of the gastro-duodenal mucosal lesions in rheumatoid arthritis, 36 patients, consisting of 23 (group I) receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 13 (group II) on alternative forms of treatment, were examined by fibreoptic upper gastrointestinal endoscopy. Ten (43%) of 23 patients receiving NSAIDs showed mucosal damage in the form of erosions or a definite ulcer crater, compared to only one (8%) of 13 in group II (p less than 0.05). There was no correlation between the duration of illness and the incidence of mucosal lesions. These findings indicate that the high incidence of gastroduodenal mucosal abnormalities seen in rheumatoid arthritis is related to the use of NSAIDs and not to the underlying disease process.
Adult↗
Pyoderma gangrenosum in ulcerative colitis.
We present a patient with pyoderma gangrenosum, a rare complication of ulcerative colitis. The patient's disease was limited to the distal colon, was clinically mild and responded quickly to treatment, and yet it was associated with pyoderma gangrenosum and arthritis, complications generally associated with more severe and extensive ulcerative colitis.
Abdominal Muscles↗
Separate pancreatic and biliary ductal openings in alcoholic chronic pancreatitis.
Endoscopic retrograde cholangiopancreatograms of 49 patients with chronic pancreatitis (alcohol related 18; idiopathic 31) were assessed retrospectively. Thirteen (72%) of 18 patients with alcohol-related chronic pancreatitis had separate openings of the common bile duct and the main pancreatic duct into the duodenum. This was significantly more frequent (p less than 0.01) than in previously studied controls (37%). Although this finding was seen more frequently in patients with alcohol related chronic pancreatitis than in those with idiopathic chronic pancreatitis (14 of 31, 45%), the difference was not statistically significant. It is concluded that alcohol-related chronic pancreatitis, but not idiopathic chronic pancreatitis, is associated with the presence of separate openings of the common bile duct and main pancreatic duct into the duodenum.
Adolescent↗
Post-cholecystectomy syndrome due to a broken T-tube.
Breaking of a biliary T-tube during removal is unusual. One such case who presented with features of post-cholecystectomy syndrome is presented.
Adult↗
Development of carcinoma in chronic calcific pancreatitis.
Development of carcinomas of the pancreas over an underlying chronic pancreatitis is a rare event. Diminution of pancreatic calcification, following the development of carcinoma, has been previously reported only once. We report another such case.
Calcinosis↗
Aspirin concurrently administered with ranitidine does not delay healing of duodenal ulcer.
Sixty-nine patients with endoscopically diagnosed duodenal ulcer were randomised to either Group I or Group II. Group I patients (n = 35) received tablet ranitidine 150 mg twice daily along with tablet aspirin 600 mg three times a day while Group II patients received only tablet ranitidine 150 mg twice daily. Eight patients (four in each group) dropped out of the trial but were included in the final analysis as failure of treatment. At the end of four weeks 51.4% ulcers healed in Group I compared to 58.8% in Group II. The difference between the two groups was not significant. There was also no statistical difference in the time required for relief of pain, number of patients relieved of pain and the complication rate. It is concluded that aspirin concurrently administered with ranitidine is safe and does not delay the healing of uncomplicated duodenal ulcers.
Adult↗
Pancreatic duct abnormalities in gall stone disease: an endoscopic retrograde cholangiopancreatographic study.
This study was carried out to assess pancreatic duct abnormalities in gall stone disease. Endoscopic retrograde cholangiopancreatograms of 50 patients with gall stone disease were analysed and the results compared with those obtained in 33 patients investigated for cholestatic jaundice who were found to have a normal biliary tree (control group). Abnormal pancreatograms were obtained in 24 (48%) patients with gall stone disease and in only two (6%) in the control group; the differences were statistically significant (chi 2 = 14.3; p less than 0.001). The patients in the control group showed mild abnormalities as did those in the gall stone group. The frequency of various abnormalities were: mild 16 (32%), moderate five (10%), and severe three (6%). Pancreatic duct abnormalities were more severe and occurred more frequently in patients with gall stones who had stones in the biliary tree than in patients with a normal biliary tree (postcholecystectomy patients, 55% v 25%) but the difference between the two groups just failed to be significant (chi 2 = 3.34). In conclusion, nearly half of all patients with gall stone disease have pancreatic duct abnormalities and in 16% these were severe enough to be labelled as chronic pancreatitis.
Adult↗
Long term behaviour of healed duodenal ulcer with and without maintenance therapy.
Seventy six patients who showed complete ulcer healing at endoscopy were treated within 48 hr with either placebo (41 patients) or cimetidine 400 mg nocte (35 patients) as a maintenance therapy for a period of one year in a double blind controlled study. Patients were reviewed every month and an endoscopy was performed every 3 months after starting the treatment or earlier if there was recurrence of symptoms. During the first three months of treatment the relapse rate in the two treatment groups were similar. The difference between the two first became obvious at 4 mo, but statistically significant difference appeared only at 6 mo: 70.7% in the placebo group suffered a relapse compared to 42.9% in the cimetidine group (x2 = 6.01; p less than 0.02). The difference remained significant until the 10th mo (78.1% vs 48.6%; x2 = 7.16; p less than 0.01). At 12 mo, the difference was not significant (80.5% vs 62.9%; x2 = 2.93). The age, sex, duration of illness, previous treatment and blood group status did not influence ulcer relapse. However, two factors had an influence on the relapse rate: a) in patients receiving placebo the relapse rate was significantly greater in smokers compared to non smokers; no such difference was observed in the cimetidine group. Moreover, smokers on cimetidine had a significantly lower relapse rate at 6.9 and 12 mo compared to smokers on placebo (50% vs 88.9%, 50% vs 94.4% and 53.3% vs 94.4%; p less than 0.01 for each).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Conventional versus on-demand therapy for duodenal ulcer: results of a controlled therapeutic trial.
To compare the efficacy of conventional versus on-demand (symptomatic) treatment of duodenal ulcer, 81 patients were randomized into two groups. Group A (n = 40) patients were treated with ranitidine 150 mg twice daily until complete ulcer healing was achieved. Group B (n = 41) received a similar dose of ranitidine until complete relief of pain was achieved, irrespective of ulcer healing. Recurrence of ulcer in group A was treated with a full course of treatment until complete healing of the ulcer was achieved again, whereas, in group B, treatment was given only until pain recurrence was symptomatically controlled. Endoscopic examination was performed each month. Analysis of the results at 8 wk and 28 wk showed that 1) ulcer healing in group A was significantly superior to that in group B up to 24 wk, but at 28 wk the difference was no longer statistically significant (95% vs 70%), 2) the number of painful days were similar in the two groups, 3) group A patients took treatment for a significantly longer period than those in group B, 4) the cost of treatment per patient in group A was significantly greater than that in group B, 5) the recurrence rate assessed in patients followed for 28 wk after complete ulcer healing was similar in the two groups, and 6) the ulcer-related complications were not significantly different in the two groups. These findings indicate that, although on-demand treatment results in slower ulcer healing, it is not associated with an increase in the duration of pain and incidence of complications. A major advantage of this approach was a significant reduction in the cost of treatment. It is concluded that on-demand treatment is an attractive alternative therapeutic approach in the management of duodenal ulcer disease.
Adult↗
Colonoscopic polypectomy. North Indian experience.
Colonoscopic snare polypectomy was carried out in 70 patients (40 children, 30 adults). There was a male preponderance in both the groups with a combined male: female ratio of 4.4:1. The majority of patients (85%) were aged 20 years or below. All patients presented with intermittent bleeding per rectum, ranging from 2 months - 6 years (mean 1.2 +/- 1.1 years) in children and 1-14 years (1.9 +/- 2.3) in adults. The majority of patients polyps were located in the rectum (73%) or in the rectosigmoid region (21%). Polyps were significantly more common in the rectum (80% vs 63%; P less than 0.01) and less frequent in the rectosigmoid (15% vs 30%; p less than 0.01) in children as compared to adults. A single polyp was present in 49 (70%) patients; 17 (24%) had 2-10 polyps, while 4 patients (2 children, 2 adults) had more than ten polyps. Most patients (94%) had polyps of less than 2 cm size. Histologically, the most polyps (91.5%) were of the juvenile variety; 39 (97.5%) children and 25 (83%) adults had this variety of polyp. The remaining 5 (17%) adults and one (2.5%) child had adenomatous polyps. The difference in the polyp histology between the two age groups was statistically significant (p less than 0.05). Only one patient (1.4%) had excessive bleeding following polypectomy. The present study suggests two important differences in the nature of polyps as compared to the West: 1) our patients were much younger, and polyps were rare after 40 years; and (2) histologically, the commonest polyps were of the juvenile variety (91.5%) while adenomatous polyps were rare (8.5%).
Adolescent↗
Endoscopic sphincterotomy--experience with 110 patients.
During the last two years, 116 endoscopic sphincterotomies (ES) were attempted in 110 patients. The indication for ES was choledocholithiasis in 102 (93%) patients, including 37 (36.2%) with gallbladder in situ and 65 (64%) post-cholecystectomy patients; the other 8 (7%) were performed for stricture of the lower end of the common bile duct (CBD) with cholangitis (2), insertion of nasobiliary drain (2), restenosis after previous sphincterotomy (1), stone in the cystic duct stump causing cholangitis (1), papillary stenosis (1) and post-cholecystectomy cholangitis with no obvious cause (1). ES was achieved in 113 (97.4%) attempts in 107 (97%) patients and was overall successful in 81% of patients. Of the 95 patients with choledocholithiasis in whom ES could be performed and a follow-up was available, 79 (83%) cleared their CBD. Of 98 patients with choledocholithiasis, 79 (80.6%) finally cleared their CBD of stones. Three patients developed complications, one needing emergency operation. There were no deaths. ES was found to be effective in patients with retained stones and also in patients with choledocholithiasis with gallbladder in situ, especially those who were poor surgical risk.
Adult↗