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Biomedical subjects

K Harish

Publications and source records attributed to K Harish.

35 records · Page 2Linked to original sources

Testicular choriocarcinoma with gastric metastasis presenting as hematemesis.

We report a 28-year-old man who presented with hematemesis due to choricarcinoma of testis metastatic to the stomach. Gastroscopy showed a polypoidal lesion. Testicular wedge biopsy confirmed mixed germ cell tumor, the choriocarcinomatous portion alone getting metastasized to the stomach. He was initiated on chemotherapy with actinomycin-D, etoposide and methotrexate, but died due to multiple metastases to the lung and brain.

Adult↗

Hepatobiliary phaeohyphomycosis with secondary biliary cirrhosis.

We report a case of systemic phaeohyphomycosis in a 13-year old girl. The clinical presentation was with fever, weight loss, cholestatic jaundice with hepatosplenomegaly and generalized lymphadenopathy. The patient was diagnosed initially as tuberculous adenitis and was on antituberculous therapy, but with worsening of symptoms. Lymph node and liver biopsy showed granuloma with fungal hyphae suggestive of phaeohyphomycosis. The patient responded to antifungal therapy. Later she developed secondary biliary cirrhosis with cholangitis due to long stricture of the common bile duct and common hepatic duct requiring biliary stenting. To the best of our knowledge, this is the first report on phaeohyphomycosis causing biliary cirrhosis in the English lilterature.

Child↗

Tropical calcific pancreatitis presenting as kwashiorkor.

Tropical clacific pancreatitis can be accompanied by varying degrees of malnutrition but full-blown kwashiorkor is an extremely rare presentation. We report the case of a 10-year-old male who presented with clinical features of severe kwashiorkor. He had extensive pancreatic clacification and exocrine pancreatic deficiency. The child was treated with pancreatic enzyme replacement, and enteral nutrition supplemented with vitamins and micronutrients. Following therapy, he started gaining weight, the skin changes partly disappeared and his hair resumed its normal black colour.

Calcinosis↗

Sub-site specific time trends of carcinoma stomach in North Kerala--a retrospective analysis.

The time trends in the incidence of carcinoma stomach in the various sub-sites in stomach have been documented in the western population. The incidence of carcinoma of gastric cardia is found to be increasing, while that of the antrum is seen to be decreasing. Data from tropics is lacking on this aspect. This retrospective study was performed to look into the site-specific time trends of carcinoma stomach. Endoscopy registers maintained in the Department of Gastroenterology, Medical College, Kozhikode, Kerala in South India were screened over the period of 20 years from 1982 to 2001. Histopathologically confirmed cases of adenocarcinoma were included in the study. The cases were categorized according to different areas of stomach--cardia, fundus, body and antrum as per International classification of diseases 0-9 (zero-nine) codes. Time trend for each sub site was calculated using one-way ANOVA and Chi-square for trend. Of the 26,886 upper GI endoscopies done over 20 years, 1771 were found to be gastric adenocarcinomas. Gastric antrum was the most common site of cancer over the years (47.8%). There was a significant rising trend for gastric cancer of the cardia without a similar trend for the cancer of the body and antrum during the study period. The sub site-specific time trends of carcinoma stomach are not similar to the pattern seen in western countries. There is a rising trend for the cancer of the cardia with a stable trend for distal cancers over 20 years.

Carcinoma↗

Umbilical hemorrhage as first manifestation in a case of cirrhosis.

Portal hypertension is often associated with an extensive collateral circulation. The paraumbilical vein is a relatively common collateral pathway recognized in these patients but cutaneous bleeding from the umbilicus is rare; the same as first manifestation of cirrhosis is exceptional. We report a case of umbilical venous bleed causing hemodynamic compromise, which turned out to be a case of alcoholic cirrhosis with portal hypertension. The patient was managed with suture ligation of the vessels.

Adult↗

Listening to music decreases need for sedative medication during colonoscopy: a randomized, controlled trial.

BACKGROUND: Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. A prospective randomized, controlled trial was undertaken to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable. METHODS: Patients undergoing elective colonoscopy between October 2003 and February 2004 were randomized to either not listen to music (Group 1; n=40) or listen to music of their choice (Group 2; n=38) during the procedure. All patients received intravenous midazolam on demand in aliquots of 2 mg each. The dose of midazolam, duration of procedure, recovery time, pain and discomfort scores and willingness to undergo a repeat procedure using the same sedation protocol were compared. RESULTS: Patients in Group 2 received significantly less midazolam than those in Group 1 (p=0.007). The pain score was similar in the two groups, whereas discomfort score was lower in Group 2 (p=0.001). Patients in the two groups were equally likely to be willing for a repeat procedure. CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced during the procedure.

Adult↗

Prospective evaluation of abnormal liver function tests in pregnancy.

Abnormalities in liver function tests (LFT) during pregnancy are a commonly encountered problem often associated with serious consequences especially when it occurs in the third trimester. The spectrum of abnormal liver functions in pregnancy can be fairly wide and diagnostic work up often challenging. There is insufficient prospective data on the spectrum and outcome of liver disease in pregnant population from south India. This study was performed to assess the causes of deranged liver function in the pregnant population and also to prospectively determine the outcome of liver dysfunction in pregnancy. All abnormal LFT results observed in serum samples from pregnant patients attending the obstetric unit of our hospital from January 2003 to January 2005 were evaluated and prospectively followed throughout pregnancy. Laboratory investigations included coagulation profile, renal function tests, serology for viral markers (HBsAg, anti-HCV, IgM anti-HEV and IgM anti-HAV) and other relevant biochemical tests. In those with liver dysfunction in the third trimester the maternal and perinatal outcome was evaluated. A total of 125 patients were identified with abnormalities in LFT results during this period. The majority of causes were related to pregnancy specific conditions (57.6%). Most episodes of abnormal LFT occurred in the third trimester (59.2%). Hyperemesis gravidarum (55.8%) and viral hepatitis (47%) were the most common causes of abnormal LFT in the first and second trimesters respectively. HELLP (28.3%) and AFLP (14.8%) were the most common causes of abnormal LFT in the third trimester. There were no mAternal deaths due to liver dysfunction in the first or second trimester. Liver dysfunction in the third trimester (74 patients) was associated with serious consequences. DIC was the most common complication (20.2%). The overall and perinatal mortality was 20.2% and 24.6% respectively. AFLP and HELLP syndromes were associated with poor maternal and fetal outcome. We conclude that liver dysfunctions were directly related to pregnancy in the majority of patients especially in the third namely trimester. Incidence of the most serious conditions AFLP and HELLP syndromes is much greater than what has been reported and is often associated with a high maternal mortality and poor perinatal outcome.

Adult↗

Strongyloidiasis presenting as duodenal obstruction.

Small bowel obstruction due to Strongyloides stercoralis is rare especially in immunocompetent individuals. We report a case of a 45-year-old man who presented with a history of severe abdominal pain, intermittent low-grade fever and vomiting. An upper GI endoscopy revealed a diffusely edematous second portion of duodenum and narrowing in the third part of duodenum with food residue in the stomach. Barium contrast upper-GI radiography revealed partial small-bowel obstruction. Duodenal biopsy specimens revealed Strongyloides stercoralis in the submucosa with inflammatory infiltrate. The patient was treated with ivermectin and had complete resolution of symptoms.

Antinematodal Agents↗

Severe colitis induced by soap enemas.

Soap enemas causing severe colitis with stricture and complications have rarely been reported. We report three patients in whom soapsud enema caused severe colitis and complications like stricture requiring surgery.

Adult↗

Colitis due to Ancylostoma duodenale.

The larva of hookworm matures into the adult stage in the small intestine, causing chronic intestinal blood loss and iron-deficiency anemia. Hookworm infestation of colon has not been reported previously. We report a 35-year-old man who presented with diarrhea with blood and mucus in stools. Colonoscopy revealed several hookworms in the colon firmly adherent to the mucosa, with oozing of blood and surrounding mucosal erosions. He was treated with mebendazole and symptoms recovered completely.

Adult↗

Prevalence of Hepatitis B and C in the normal population and high risk groups in north Kerala.

BACKGROUND: Our aim is to assess the prevalence of Hepatitis B and Hepatitis C infections among normal healthy persons and high risk groups in the northern part of Kerala state in South India as there is insufficient published literature related to this subject. METHODS: HBsAg and AntiHCV screening were done in normal persons and in high risk groups. Normal persons screened included voluntary blood donors, those attending mandatory medical check up for jobs in middle east Asia and pregnant women. High risk groups were health care workers, intravenous drug abusers, commercial sex workers and male homosexuals. RESULTS: HBsAg and anti HCV antibody test results in the various groups were as follows. Voluntary blood donors--HBsAg was positive in 0.71 % and anti HCV was positive in 0.33%; job seekers to middle east Asia had 0.89% and 0.12% prevalence of HBV and HCV respectively. Among the pregnant women, 0.21% were HBsAg positive. Among the high risk groups, none of the health care workers were HbsAg positive and 0.79% were antiHCV positive. Among the IV drug abusers 2.7% were HBsAg positive and 51.89% were positive for antiHCV. In commercial sex workers, 3.47 % were HBsAg positive and 2.6 % were antiHCV positive. In male homosexuals, 4.49% were HBsAg positive and 3.37% were antiHCV positive. CONCLUSIONS: The prevalence of Hepatitis B and C in the normal population of Calicut in the northern part of Kerela is 0.52% and 0.24%. Compared to other areas of India, the seroprevalence of Hepatitis B and C are low in the normal population of Calicut. Among the high-risk groups, IV drug users have a high prevalence of AntiHCV.

Adult↗

Infected pseudocyst in tropical pancreatitis presenting as psoas abscess.

Infected pseudocyst as a consequence of tropical pancreatitis presenting as psoas abscess is unusual. We report a 40-year-old man who presented with pain in the right lumbar region. CT and MRI of the abdomen revealed pancreatic pseudocysts with abscess formation in the psoas muscle and evidence of chronic calcific pancreatitis. He was managed by percutaneous drainage of the abscess along with antibiotics and other supportive measures.

Adult↗