Biomedical subjects

G S Raju

Publications and source records attributed to G S Raju.

At least 19 recordsLinked to original sources

PubMed2007

The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions.

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed. Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.

Adult↗

PubMed2006

Effect of a novel pancreatic stent design on short-term pancreatic injury in a canine model.

BACKGROUND AND STUDY AIMS: Attempts to address the problem of injury to the pancreas by indwelling pancreatic stents are limited by our lack of knowledge of the pathogenesis of stent-induced injury and its relationship to stent morphology and the duration of stenting. The aim of our study was to evaluate pancreatic injury induced by 1 week of stenting with a 5F indwelling pancreatic stent of novel design, the "wing stent." METHODS: Pancreatic stents (5F) were placed surgically in eight dogs; wing stents (WS-5F) were used in four dogs and conventional stents (CS-5F) in another four. Two dogs underwent duodenotomy without stent placement (controls). The pancreas was harvested for microscopy at 1 week. A pathologist who was unaware of the source of the specimens graded the pancreatic injury. RESULTS: Although pancreatic injury was observed in both the CS-5F and WS-5F groups after 1 week of indwelling pancreatic stenting, it was considerably less severe in the WS-5F group compared with the CS-5F group (1.01 +/- 0.10 vs. 1.63 +/- 0.14, P < 0.01). All components of pancreatic injury were affected, with the most dramatic differences noted in inflammation, fibrosis, and edema. The differences were most marked in the stented segment ( P < 0.001) and in the upstream segment of the pancreas ( P < 0.05). CONCLUSIONS: Indwelling conventional pancreatic stents can cause significant pancreatic injury even when left in place for only 1 week. A wing design can significantly ameliorate stent-induced changes.

Animals↗

PubMed2005

Capsule endoscopy.

Video capsule endoscopy is a major innovation that provides high-resolution imaging of the entire small intestine in its entirety. In the 4 years since its introduction, capsule endoscopy has demonstrated its viability as a first-line investigation in patients with obscure gastrointestinal bleeding after a negative esophagogastroduodenoscopy and colonoscopy, and it has a positive impact on the outcome. Video capsule endoscopy is also useful in the evaluation of inflammatory and neoplastic disorders of the small bowel. Its role in children and in the evaluation of esophageal disorders is currently being explored and defined.

Capsules↗

PubMed2005

Graded esophageal mucosal ablation with cryotherapy, and the protective effects of submucosal saline.

BACKGROUND AND STUDY AIMS: Knowledge about the extent of damage with endoscopic cryotherapy is of critical importance before its potential as an ablative therapy is explored. The aims of this study were to evaluate the extent of transmural esophageal necrosis at 48 hours after cryospraying for varying durations, using a novel device based on the Joule-Thomson effect and with carbon dioxide as the refrigerant gas, and to examine the role of submucosal injection of saline in preventing deeper injury. METHODS: Cryospray was applied to several different segments of the esophagus for various lengths of time (15, 30, 45, 60, and 120 seconds) in a pig model. In another set of experiments performed subsequently, 2 ml of saline was injected into the submucosa and cryospray was applied for 60 seconds. RESULTS: Esophageal cryotherapy resulted in a dose-dependent injury to the esophagus: esophageal necrosis was minimal or limited to the mucosa after 15 seconds of cryospraying, extended to involve the submucosa after 30 seconds of cryospraying, and involved the muscularis propria also after 45 seconds, with frank transmural necrosis found after 120 seconds of cryotherapy. Prior submucosal saline injection protected against muscular necrosis from prolonged cryotherapy. CONCLUSIONS: We have shown a dose-dependent effect of cryotherapy on esophageal mucosal ablation. When more extensive lesions are encountered, it may be advisable to consider using submucosal saline injections as an additional safeguard against deeper injury.

Animals↗

PubMed2001

Gastric pacing is a new surgical treatment for gastroparesis.

BACKGROUND: Gastroparesis is a chronic gastric motility disorder affecting mostly young and middle-aged women who present with nausea, abdominal pain, early satiety, vomiting, fullness, and bloating. METHODS: From April 1998 to September 2000, 25 patients underwent gastric pacemaker placement. All had documented delayed gastric emptying by a radionucleotide study. Nineteen patients had diabetic gastroparesis, 3 had developed postsurgical gastroparesis, and 3 had idiopathic gastroparesis. Baseline and postoperative follow-ups were done by a self-administered questionnaire on which the patients rated the severity and frequency of nausea and vomiting. Gastric emptying times were also followed up using a radionucleotide technique. RESULTS: Both the severity and frequency of nausea and vomiting improved significantly at 3 months and was sustained for 12 months. Gastric emptying time was also numerically faster over the 12-month period. Three of the devices have been removed. One patient died of causes unrelated to the pacemaker 10 months postoperatively. CONCLUSIONS: After placement of the gastric pacemaker, patients rated significantly fewer symptoms and had a modest acceleration of gastric emptying.

Adult↗

PubMed2001