Search PubMed⌕ Search

Biomedical subjects

M Dwivedi

Publications and source records attributed to M Dwivedi.

At least 19 recordsLinked to original sources
PubMed1992

A prospective randomized trial comparing repeated endoscopic sclerotherapy and propranolol in decompensated (Child class B and C) cirrhotic patients.

A prospective randomized study was conducted to compare the efficacy of long-term endoscopic sclerotherapy vs. propranolol in Child class B and C patients with variceal bleeds within the 30 days before the study. Forty-five and 46 patients were randomized to receive sclerotherapy and propranolol, respectively, after preentry stratification for Child scores. Sclerotherapy was administered with 1% polidocanol at 10-day intervals until obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 25%. Rebleeding occurred in 19 patients undergoing sclerotherapy and in 31 receiving propranolol (p less than 0.05). The number of episodes of rebleeding was higher (p less than 0.05) in the propranolol group (n = 64) than in the sclerotherapy group (n = 35). The mean bleeding risk factor, number of hospitalizations for rebleeding and blood transfusion requirement were also significantly higher in the propranolol-treated patients. The median bleed-free period was more than 36 mo in the sclerotherapy group and 2.5 mo in the propranolol group (p less than 0.01). The median survival time was significantly longer in the sclerotherapy group (greater than 36 mo) than in the propranolol group (greater than 24 mo). We conclude that in decompensated cirrhotic patients, long-term endoscopic sclerotherapy is superior to propranolol in preventing rebleeding and improving survival.

Adult↗
PubMed1992

Endoscopic sclerotherapy versus propranolol in prevention of recurrent variceal bleeding in patients with child's B and C cirrhosis: a preliminary report.

Thirty two patients with cirrhosis of the liver of Child's B and C class and an episode of endoscopically proven variceal bleed were randomly assigned to receive endoscopic sclerotherapy (EST) or oral propranolol for the prevention of recurrent upper gastrointestinal bleeding. EST was performed at 3 week intervals using 1% polidocanol intravariceally, till eradication of varices. Propranolol dose was adjusted to reduce the resting heart rate by 25% of the basal value (mean +/- SD, 194.3 +/- 63.9 mg/day) Two patients in the propranolol group were excluded within 48 hours due to side effects of the drug. Thirty patients (EST-16, propranolol-14) completed the trial. Patients were followed up for a maximum of 480 days. Mean follow-up in the EST and propranolol groups was 217 and 243 days respectively. The median bleeding free intervals were 480 and 194 days and number of rebleeding episodes was eight and 16 respectively in the EST and propranolol groups (both p = ns). Our study suggests a trend in favor of EST in preventing variceal rebleeding in patients with hepatic cirrhosis who belong to Child's B and C classes.

Adult↗
PubMed1992

Sucralfate versus ranitidine in non-ulcer dyspepsia: results of a prospective, randomized, open, controlled trial.

In an open trial, 100 patients with non-ulcer dyspepsia were randomized to receive either ranitidine 150 mg twice daily (n = 47) or sucralfate 1 g four times a day (n = 53) for four weeks. An 'intention to treat' analysis revealed that global relief in symptoms was significantly more frequent in the sucralfate group than in the ranitidine group after two weeks (77.4% vs 59.6%; p less than 0.05) and four weeks (86.8% vs 63.8%; p less than 0.001) of treatment. It is concluded that sucralfate is superior to ranitidine in providing symptomatic relief in patients with non-ulcer dyspepsia.

Adult↗
PubMed1991

Do gallstones cause chronic pancreatitis?

Gallstones are well known to cause acute pancreatitis. However, the role of gallstone disease in the causation of chronic pancreatitis is still controversial. Abnormalities of the pancreatic duct have been noted in about one-half of patients with calculous biliary disease undergoing endoscopic retrograde cholangiopancreatography (ERCP), but despite this, it is generally believed that gallstones rarely, if ever, cause chronic pancreatitis. The clinical significance and the natural history of the pancreatographic changes seen in patients with gallstone disease is not known. Studies of the pancreatic functions and long-term follow-up of patients with calculous biliary disease, especially those who have abnormal pancreatograms, and the effect of removal of the gallstone on the pancreatographic abnormalities and pancreatic functions are needed to clarify the issue.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1991

Gallbladder dynamics in patients with irritable bowel syndrome and essential dyspepsia.

To assess whether gallbladder motility is altered in patients with irritable bowel syndrome (IBS) or essential dyspepsia (ED), we studied gallbladder function in 25 healthy volunteers, 20 patients with IBS, and 22 with ED. By real time ultrasonography, we studied the following parameters: (a) fasting gallbladder volume, (b) maximum percent of gallbladder emptied, (c) time required for maximal contraction, (d) residual volume after maximal contraction, and (e) percent fasting volume at 2 h. All parameters, except fasting gallbladder volume, were measured after a high-fat meal. The fasting gallbladder volume, maximum percent of gallbladder emptied, time required for maximal contraction, residual volume after maximal contraction, and percent fasting volume at 2 h in controls and patients with IBS was 19.3 +/- 8.8 ml and 24.4 +/- 9.7 ml, 67.1 +/- 10.7% and 67.6 +/- 13.5%, 41 +/- 20.6 min and 49.7 +/- 25.3 min, 6.2 +/- 3.3 ml and 7.6 +/- 5.3 ml, and 38.1 +/- 12.2% and 40.7 +/- 14.5%, respectively. The differences between the two groups were statistically not significant. The corresponding values in patients with ED were 15.5 +/- 6.3 ml, 57.6 +/- 16.5%, 51.8 +/- 29.3 min, 6.1 +/- 3.2 ml, 44.1 +/- 17%, respectively. Compared with controls there was no statistically significant difference in these parameters, except the maximum percent of gallbladder emptied, which was significantly less than that in controls (57.6 +/- 16.5% vs. 67.1 +/- 10.7%; p less than 0.05). Therefore, we could not find that patients with IBS have any abnormality of gallbladder function; postprandially, patients with ED have submaximal contraction of the gallbladder.

Adolescent↗
PubMed1990

Pancreaticobiliary ductal union.

The main pancreatic duct and the common bile duct open into the second part of the duodenum alone or after joining as a common channel. A common channel of greater than 15 mm (an anomalous pancreaticobiliary duct) is associated with congenital cystic dilatation of the common bile duct and carcinoma of the gall bladder. Even a long common channel (greater than or equal to 8 mm) is associated with a higher frequency of carcinoma of the gall bladder. Gall stones smaller than the common channel and a long common channel predispose to gall stone induced acute pancreatitis. Separate openings for the two ductal systems predisposes to development of gall stones and alcohol induced chronic pancreatitis. The role of ductal union has also been investigated in primary sclerosing cholangitis and biliary atresia.

Cholangitis, Sclerosing↗
PubMed1990

Proximal versus distal carcinoma of the stomach. A clinicoendoscopic study.

During the period 1978 to 1988, 4619 upper gastrointestinal fibreoptic panendoscopies were carried out. There were 106 (2.2%) histologically confirmed cases of carcinoma of the stomach. The annual incidence was 9.6. The peak incidence was in the fifth decade. The mean age of these patients was 49.4 years and the male: female ratio was 3.6:1. The most frequent symptoms were weight loss (81%) and anorexia (72.9%). Dysphagia was present in 30% of patients. Thirty two percent of patients had proximal carcinoma, 63.2% had distal carcinoma and in 4.7% the whole stomach was involved. Patients with distal carcinoma had a longer history (P less than 0.01) and were more likely to present with weight loss (P less than 0.001), anorexia (P less than 0.005), abdominal pain (P less than 0.05) and abdominal lump (P less than 0.05), compared to proximal carcinomas. Dysphagia was, however, more likely to be present in patients with proximal carcinomas (P less than 0.001).

Adult↗
PubMed1990

Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites.

Adenosine deaminase was estimated in ascitic fluids of 49 patients with ascites (19 tuberculous, 20 cirrhotic, and 10 malignant). The adenosine deaminase concentration in tuberculous ascitic fluid was 98.8 +/- 20.1 U/L (mean +/- SD), which was significantly more than that noted in cirrhotic (14 +/- 10.6 U/L) or malignant (14.6 +/- 6.7 U/L) ascitic fluids (p less than 0.001 for each). At a cut-off value of greater than 33 U/L, the sensitivity, specificity, positive and negative predictive value, and the overall diagnostic accuracy for diagnosing tuberculous ascites were 100%, 96.6%, 95%, 100%, and 98%, respectively. We conclude that estimation of adenosine deaminase in ascitic fluid is an easy and reliable method for diagnosing tuberculous ascites.

Adenosine Deaminase↗