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Biomedical subjects

G Choudhuri

Publications and source records attributed to G Choudhuri.

81 records · Page 5Linked to original sources
PubMedDate not supplied

The clinical spectrum of fibrocalculous pancreatic diabetes in north India.

BACKGROUND: Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes, unique to tropical countries. In earlier reports, patients with FCPD had severe insulin-requiring diabetes, malnutrition and a dismal prognosis. With Improvements in nutrition and medical care, the presentation and prognosis of FCPD may have changed. We report on the clinical profile and prognosis of a cohort of FCPD patients from north India and compare our findings with earlier reports. METHODS: Eighty consecutive FCPD patients who presented to the Diabetes, Gastroenterology and Surgical Gastroenterology services were evaluated for their nutritional status, clinical presentation, beta-cell function (fasting C-peptide) and exocrine function (faecal chymotrypsin). All patients diagnosed between 1994 and 2000 (n = 32) were followed prospectively for weight gain and glycaemic control. RESULTS: Only 55% of FCPD patients had a low body mass index (< 18 kg/m2). At the time of diagnosis of diabetes, only 26 (33%) patients presented with severe insulin-requiring diabetes; these patients were younger [23.7 (8.3) years v. 28.7 (10.6) years, p = 0.04], and had higher haemoglobin A1c [9.7 (3.8)% v. 7.3 (2.6)%, p = 0.005] than those requiring diet control or oral hypoglycaemic agents. FCPD patients had a wide range of fasting serum C-peptide (0.03-0.76 nmol/L). C-peptide was negatively associated with increasing duration of diabetes (r = -0.48, p = 0.001), but there was no correlation with faecal chymotrypsin. On prospective follow up (mean 2.3 years), there was significant improvement in body mass index [19.4 (2.9) kg/m2 v. 17.0 (3.7) kg/m2, p < 0.01] and haemoglobin A,c [6.4 (1.6)% v. 8.0 (3.0)%, p < 0.001]. CONCLUSION: FCPD patients differed from those described in earlier reports in many respects, Including improved nutritional status, a wide range of 3cell function and a more favourable prognosis.

Adolescent↗
PubMedDate not supplied

Solitary non-parasitic cysts of the liver: presentation and management.

Four cases (one asymptomatic and three symptomatic) of solitary non-parasitic cysts of the liver are presented. The asymptomatic cysts was an incidental finding at laparotomy. The other three patients presented with abdominal distension, jaundice and malignant transformation respectively. Management of these patients has been discussed and the literature reviewed.

Adult↗
PubMedDate not supplied

Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertension.

BACKGROUND/AIMS: Para-esophageal venous collaterals and perforating veins have recently been suspected to play an important role in the development of esophageal varices and their recurrence after initial obliteration in patients with portal hypertension. We undertook this study to look at the cross-sectional venous anatomy around the gastro-esophageal junction, with special attention to those venous structures, using the Endoscopic Ultrasound (EUS) in patients with different grades of esophageal varices. MATERIAL AND METHODS: EUS examination was performed on the upper stomach, GE junction, and lower esophagus in 50 patients with liver cirrhosis, 20 of whom had small (grades 1 & 2) and 30 had large (grades 3 & 4) esophageal varices. RESULTS: Esophageal varices could be detected in all the 30 (100%) patients with large, but in 9 (45%) of patients with small varices. Gastric Varices were detected significantly more often by EUS (33; 66%) compared with endoscopy (17; 34%, p < 0.005). The mean number (2.8 +/- 1.4 and 4.7 +/- 1.78, p < 0.0005) and size 3.41 +/- 0.57 and 5.98 +/- 1.66, p < 0.00001) of paraesophageal veins were higher in patients with large varices compared with those with small varices. When the lower 5 cm of the esophagus was scanned in patients with small and large varices, perforating veins connecting the para-esophageal and the submucosal veins (varices) could be identified in 3 (15%) and 21 (70%, p < 0.0005) of patients, respectively. CONCLUSION: Perforating veins connecting the paraesophageal with the submucosal veins (varices) in the lower esophagus, demonstrated for the first time by EUS, may have an important role in the development of varices and in their recurrence after sclerotherapy.

Adult↗
PubMedDate not supplied

Falciparum malaria with acute liver failure.

INTRODUCTION: Falciparum malaria occasionally presents with encephalopathy, jaundice and fever mimicking fulminant hepatic failure. PATIENTS: We recently managed seven cases (mean age 34 years, range 20-45; all men) of acute falciparum malaria presenting with a short history [mean duration 8.1 (4-15) days] of fever, jaundice, altered sensorium and oliguria. Only one patient had splenomegaly. Investigations revealed jaundice (bilirubin 1.9-30.7 mg/dl), moderate to severe anaemia (Hb 4-8 gm/dl), increased liver enzymes (2-4 times normal) and azotaemia (serum creatinine 1.6-7.4 mg/dl). Coagulation parameters were deranged in 3 with clinical bleeding in two cases. One patient without a past history of diabetes had increased blood glucose values with ketonuria. HBsAg was negative in all cases. Patients received supportive therapy along with intravenous quinine. Peritoneal dialysis was done in one patient. Three patients showed rapid recovery and four succumbed to the disease. Post-mortem liver biopsy showed Kupffer cell hyperplasia, pigment deposition, foci of steatosis and necrosis along with submassive necrosis in one case. CONCLUSIONS: In areas endemic for malaria, awareness of this entity is a must. In a patient with jaundice and altered sensorium, disproportionate anaemia, azotaemia and only mild elevation of liver enzymes should help differentiate these patients from cases of fulminant hepatic failure. The diagnosis can be confirmed by peripheral blood examination. Early institution of specific therapy may be the only life saving measure in these patients.

Adult↗
PubMedDate not supplied

Percutaneous transhepatic biliary drainage in the management of obstructive jaundice.

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) has been employed for decompression of the obstructed biliary tract to palliate jaundice and pruritus and for the management of cholangitis. We present our data to review the indications, therapeutic results and associated mortality and complications of this procedure. We have also studied the effect of size of drainage catheters on the improvement in liver functions and procedure related complications. METHODS: PTBD was attempted in 41 patients (18 men, age 56 +/- 12 years; 23 women, age 55 +/- 11 years) with obstructive jaundice (37 malignant, 4 benign). RESULTS: PTBD was successful in 39 (95%) patients. Mean serum bilirubin and alkaline phosphatase concentration declined significantly (p < 0.000001 for both) after 1 week, however thereafter decline was slow. Complete relief of pruritus and cholangitis was noted in most patients. Major complications such as cholangitis, bile leak into the peritoneum, malfunction of drainage catheter, intraperitoneal haemorrhage and renal failure, occurred in 11 (28%) patients, 2 (5%) of whom died. Large catheters (> 10 Fr) were superior to small size catheters (< 10 Fr) in relief of jaundice and had lower catheter related cholangitis. CONCLUSIONS: We conclude that PTBD is useful for palliation of malignant obstructive jaundice with intractable symptoms and cholangitis. Catheters larger than 10 Fr should be used.

Cholangitis↗