Biomedical subjects
Publications and source records attributed to K Das.
The Hepatopulmonary Syndrome (HPS) is one of many extrahepatic manifestations of liver failure. It consists of a triad of liver dysfunction, intrapulmonary vascular dilatation and hypoxemia. We present a case of post necrotic cirrhosis (HBV related) who developed exertional dyspnoea subsequent to the development of hepatopulmonary syndrome.
We report a 50-year-old woman presenting with isolated massive hepatomegaly. Liver histology showed dilated sinusoids within which some atypical cells, probably of hematopoeitic origin, were identified. Bone marrow was densely packed with similar atypical cells with high nucleo-cytoplasmic ratio, which tested positive for plasma cell markers. Plasma protein electrophoresis showed a distinct M spike in the gamma globulin fraction and skeletal survey revealed multiple lytic lesions in the skull and pelvic bones. Thus, a final diagnosis of multiple myeloma was made. The patient has received six cycles of chemotherapy and is doing well.
BACKGROUND: Gastric stasis, common in patients with gall-bladder carcinoma (GBC), results from anatomical obstruction or motor abnormalities. We studied patients with GBC for antroduodenal motor dysfunction using manometry. METHODS: Forty-one patients with GBC without endoscopic gastric outlet obstruction and 10 healthy controls were evaluated using a symptom scoring system for gastric stasis, saline load test and water perfusion antroduodenal manometry. Fasting, post-prandial and post-octreotide motility were recorded and analysed on a computer using GiPC manometry software. RESULTS: Sixteen of 41 patients (39%) with GBC reported recurrent vomiting; patients with vomiting had a higher symptom score (13 [11-17] v. 6 [4-10], p<0.0001] and higher volume of aspirate on the saline load test (460 ml [210-650] v. 160 ml [70-260], p<0.0001) as compared with those without vomiting. Healthy subjects more often had spontaneous fasting migratory motor complex than patients with GBC (9/10 v. 13/41, p=0.002). The amplitudes of contractions in the antrum and duodenum were significantly lower in patients with GBC than in healthy subjects. Patients with GBC had lower fasting (157 [68-284] v. 190.5 [150-284], p=0.01) and post-prandial (200 [96-395] v. 284 [178-395], p<0.0001) antral motor indices than healthy subjects. Patients with GBC and vomiting had significantly lower contraction amplitude and motility indices than those without vomiting. Motility indices correlated inversely with the symptom score and volume of aspirate on the saline load test (Spearman correlation, p = 0.01 for all). CONCLUSION: Antroduodenal motor abnormalities are common in patients with GBC. These may explain the symptoms of gastric stasis and abnormal results of the saline load test in the absence of anatomical obstruction in such patients.
The goal of our study was to assess the effects of unrestrained ambulation and of passive motion and delayed ambulation on the occurrence of adhesions after controlled uterine injuries, produced by conventional surgical techniques, in rats. A classic Pomeroy ligation was performed on the left uterine horn and a 1 cm x 3 mm rectangular flap hysterotomy on the right uterine horn in 48 rats, which were subsequently divided into four groups of 12 each. Group 1 served as controls and were allowed to ambulate without restriction following recovery from the anesthetic. Group 2 remained anesthetized for 12 hours, during which time each was passively moved from one lateral decubitus position to the opposite every 15 minutes. Group 3 were anesthetized for 12 hours and group 4 animals for 24 hours, following which unrestricted ambulation was allowed. All animals were killed 3 weeks after the operation and the left and right uterine horn adhesions were graded separately using a macroscopic system. The adhesion score of the left horn in group 2 animals (3.5) was significantly higher (P less than .025) than in the control animals (2.25). Group 3 animals had adhesion scores on the left (2.75), but did not differ significantly from controls (P greater than .05). Group 4 animals demonstrated significantly higher adhesion scores of the left uterine horn (3.3) than control animals. Group 2 animals, but not group 3 or group 4, had higher mean adhesion scores of the right uterine horn than control animals (P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)
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A self-expanding metallic esophageal prosthesis was placed in a patient with carcinoma esophagus complicating achalasia cardia. Dysphagia was successfully palliated at 9 months follow up.
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