Biomedical subjects
Publications and source records attributed to G Choudhuri.
A Gianturco type metallic stent placed in the common bile duct migrated into the duodenum. The device remains in situ, and has caused no ill-effects to date. This raises the possibility that such stents may be deployed in the gastrointestinal tract.
A case of symptomatic colonic lipoma, mimicking malignant tumour on colonoscopy, barium contrast studies and at laparotomy, is reported. The diagnosis was established on histopathology after left hemicolectomy.
A case of isolated benign non-traumatic inflammatory stricture of the mid portion of the common bile duct presenting with recurrent jaundice and cholangitis is reported. The histological features suggested that this was not due to sclerosing cholangitis.
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Periampullary carcinoma in a young female with situs inversus viscerum is reported. Endoscopy was difficult because of the altered anatomy.
A case with tetanus presenting with progressive dysphagia due to lower esophageal dysfunction is described. A barium swallow at the onset of symptoms showed esophageal dilatation with a smooth tapering at the lower end suggestive of achalasia cardia. The patient recovered from tetanus over the ensuing three weeks; repeat barium swallow at this time was normal, suggesting that esophageal dysfunction was a manifestation of tetanus.
To investigate the relationship between amoebic gut infection and the presence of serum antiamoebic antibodies in a community where amoebiasis is highly endemic, a cross-sectional population survey was conducted covering 982 subjects in 2 adjacent villages in rural India. E. histolytica was detected in fecal smears in 18.1% (88/487) and antiamoebic antibodies by micro-ELISA in 28.7% (251/874) subjects. In 450 subjects in whom there was no clinical evidence of invasive amoebic disease or history of ingestion of antiamoebic drugs in the previous year and from whom both stool and matched serum samples were obtained, correlation of gut infection with seropositivity was attempted. Seropositivity in 80 cyst passers (23.8%) was significantly lower than in 370 non-cyst passers (35.1%; p less than 0.05). Conversely the rate of gut infection with E. histolytica was lower in seropositive subjects (19/149; 12.8%) as compared to seronegative subjects (61/301; 23%, p less than 0.05). In the population where E. histolytica infection was highly endemic, the rate of gut infection with the parasite was inversely related to seropositivity. Our data suggests that invasive E. histolytica infection (mostly asymptomatic) evokes good gut immunity in the host with clearing of the parasite from the colon and/or resistance to reinfection. High prevalence rate of amoebic antibodies indicates good "herd" immunity.
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Extracorporeal shock wave lithotripsy (ESWL), generated by the Siemens lithotripter (Lithostar), was used in six patients (two males, four females, aged 28 to 70 years) with large bile duct stones (diameter 16 mm to 30 mm; single in five, multiple in one) in whom routine endoscopic measures had failed. Disintegration of stones was achieved in four patients. The mean number of shocks delivered per patient, at energy levels generated by 19 kv, was 18,267 (range 4200-39,000) over 1 to 8 sessions, with a maximum of 6000 shocks per session. Exacerbation of cholangitis occurred in one patient after stone disintegration. Cutaneous petechiae were noted in four patients. Our report describes the use of a very high number of shock waves in the treatment of bile duct stones, with no appreciable short term complications noted in this small experience. Our initial experience of treating large bile duct stones with ESWL appears encouraging and safe.
Seven patients with uncomplicated hepatic hydatid cysts (Echinococcus granulosus) were treated with albendazole 10 mg/kg/day for 2-6 months (mean 4 months). Serial sonographic evaluation showed reduction in cyst size in only 1 patient (the anteroposterior diameter decreased from 16.5 cm to 4.9 cm). Therapy in this patient was discontinued after 4 months due to development of jaundice. Albendazole appears to have a limited role in the treatment of hydatid disease of the liver.
The reported incidence of post sclerotherapy esophageal ulcers has shown marked variation, possibly due to lack of uniform criteria for their diagnosis. Using fixed criteria (size greater than or equal to 5 mm, duration greater than or equal to 2 weeks), we prospectively studied 82 patients with portal hypertension, who underwent four or more sessions of endoscopic sclerotherapy (EST), for the occurrence and behaviour of these ulcers. Post sclerotherapy ulcers occurred after 43 (9.2%) of 465 EST sessions in 30 (36.6%) of 82 patients. Ulcers were significantly associated with two complications: rebleed during the course of sclerotherapy (33% of ulcers bled compared to 3% from variceal rupture; p less than 0.001) and esophageal stricture formation (66.7% of strictures occurred in patients who had ulcers; p less than 0.05). Ulcers occurred more frequently in patients with poor liver function (61.5% in Child's C grade compared with 31.9% in Child's A or B grades; p less than 0.05) and after injection into larger varices (83.7% in varices grades 3 and 4, 16.3% in lower grades; p less than 0.005). Severe persistent chest pain (p less than 0.001) and pyrexia (p less than 0.01) after sclerotherapy were clinical pointers of ulcerogenesis.
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Obstructive jaundice occurring in a patient with portal hypertension is a rare association. In this report, a 24-year-old patient is described who had biliary obstruction due to a portal cavernoma compressing the common bile duct and in whom surgical decompression of the portal system resulted in relief of the biliary obstruction, thus proving that the dilated portal vein collaterals were compressing the biliary tract and producing jaundice. Although biliary obstruction due to a portal cavernoma has been described earlier, this is, to the best of our knowledge, the first case described in which improvement followed shunt surgery.
Spontaneous massive gastrointestinal hemorrhage occurring in patients with pancreatitis is an uncommon and difficult clinical problem, especially in a tropical third world country where the underlying causes of pancreatitis and facilities for its diagnosis and management are different from those in the developed West. Of 7 such cases seen by us in 3 years, 2 were due to hemosuccus pancreaticus, 2 were due to gastric variceal hemorrhage consequent to splenic vein obstruction, and one each due to contiguous pancreatic inflammation involving the duodenum, an aneurysmal bleed from the left gastric artery and a pseudocyst rupturing into the transverse colon. A fiberoptic endoscopic examination was helpful in all the 7 cases and delineated the cause of bleeding, whereas angiography, performed in 4 patients contributed little to management. The mortality rate was 14%. It is suggested that a timely endoscopic examination during active bleeding, which may be repeated if necessary, is extremely rewarding in the diagnosis and management of such patients and often obviates the necessity of angiography which is a time-consuming and cumbersome investigation in a critically ill patient and facilities for which are usually not available in most third world country hospitals.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.