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Biomedical subjects

M Dwivedi

Publications and source records attributed to M Dwivedi.

At least 37 records · Page 2Linked to original sources
PubMed2000

A topographic study of Helicobacter pylori density, distribution and associated gastritis.

BACKGROUND AND AIMS: The topographic distribution and density of Helicobacter pylori and associated gastritis in the stomach were studied in order to determine which biopsy sites are likely to provide the maximum yield so as to reduce the fallacious results due to sampling error. METHODS: Fifty patients with upper gastrointestinal symptoms were studied. Eleven gastric biopsies from predetermined sites were obtained and subjected to ultra-rapid urease test, imprint cytology and histology. Haematoxylin and eosin stain was used for defining gastritis and other associated histopathological details. Loeffler's methylene blue stain was used to confirm the presence of H. pylori in imprint smears and histological sections. RESULTS: All 50 patients had H. pylori infection and evidence of chronic gastritis at one or more of the 11 biopsy sites. Maximum and minimum percentage positivity were observed at A3 (antral lesser curvature) and B4 (corpus greater curvature), respectively. Various sites in decreasing order of percentage positivity were A3 > A2 > A1 > A4 > B3 > B1 > A5 > B6 > B5 > B2 > B4. Among the biopsies obtained from the corpus, B3 (corpus lesser curvature) was the site with maximum positivity. A3 and B4 had a statistically significant difference in percentage positivity (P < 0.0001) for H. pylori and gastritis. The maximum and minimum density scores of H. pylori and gastritis were found in A3 and the B4, respectively. A3 had a significantly higher (P < 0.0001) mean density score than any other site in the stomach. The difference in the grading of H. pylori between A3 and B3 (sites of maximum positivity in antrum and corpus) was statistically significant (P < 0.0001). A statistically significant (P < 0.001) positive correlation between increasing grades of H. pylori and gastritis was observed at the site of maximum density. Eighty per cent of the patients had antral predominant gastritis and in 82%, H. pylori was predominantly observed in antral biopsies. CONCLUSION: It is concluded that two biopsies taken from A3 are sufficient for confirmation of presence of H. pylori and associated gastritis for initiation of treatment. However, additional biopsies from B3 will help in deciding the topographic pattern of gastritis.

Adult↗
PubMed2000

Clinical features and management of biliary ascariasis in a non-endemic area.

Biliary ascariasis is common in certain geographical areas of the world. In India, it is common in the Kashmir valley and only stray cases have been reported from other parts of the country. Between January 1995 and May 1997, 14 patients with biliary ascariasis were seen at our centre, which is more than 1000 km from the Kashmir valley. The mean (+/- SD) age of the patients was 31.7 (+/- 6.1) years and all were females. None of them had been to a place known to be endemic for biliary ascariasis. Four patients presented with acute cholangitis, eight with acute abdominal pain and vomiting, and the remaining two were diagnosed incidentally during surgery for gallstone disease. Barring these two patients, ultrasound examination of the abdomen diagnosed the condition accurately. In 10 patients, a part of the worm was visible outside the papilla of Vater. The roundworm was caught in a Dormia basket and could be extracted in nine patients. In one patient the worm migrated inside the bile duct while it was being caught in a Dormia basket. In this and two other patients, in whom the worm had migrated completely inside the bile duct, worms were removed with the help of a Dormia basket after endoscopic sphincterotomy. There were no complications of endoscopic therapy. In the two patients in whom biliary ascariasis was detected during surgery, the worms were removed after choledocholithotomy. On a mean follow-up of 13.8 months, only one patient had a recurrence of biliary ascariasis. It is concluded that biliary ascariasis is not an uncommon disease and must be considered as a possibility in patients presenting with acute cholangitis and biliary pain even in a non-endemic area. Ultrasonography is an excellent diagnostic tool and endoscopic management is very effective and safe in the treatment of these patients.

Abdominal Pain↗
PubMed2000

Clinical and ultrasonographic findings of carcinoma of gallbladder in Indian patients.

OBJECTIVE: To determine the clinical and ultrasound appearances of carcinoma gallbladder in Indian patients. METHODS: The study included all patients suspected to have gallbladder malignancy, attending the gastroenterology department from January 1989 to February 1997. These patients underwent ultrasonographic examination with a grey scale sector scanner (Aloka SSD-630) with a 3.5 MHz transducer after an overnight fast. Histological confirmation was done at surgery, by US guided fine needle aspiration cytology or by direct biopsy/aspiration of the palpable mass. RESULTS: There were a total of 92 cases of cytologically and histologically proven carcinoma of gallbladder. A distinct female preponderance was seen with a male:female ratio of 1:3.6. The mean +/- SD age was 47.9 +/- 19.6 years (range 25-75 years). The histological confirmation was done at surgery in 10% of patients, by US guided fine needle aspiration cytology in 50 cases (54%) or by direct biopsy/aspiration of the palpable mass in 33 (36%) of cases. Pain in the right hypochondrium was the commonest presenting symptom (91%) followed by anorexia (88%) and weight loss (67%). Surgical obstructive jaundice was observed in 54% cases while 10.9% presented with biliary sepsis. A mass of mixed echogenicity protruding in the lumen of the gallbladder was seen in the majority of cases (52.8%). Less commonly infiltration of the gallbladder wall (33.7%) or a mass replacing the gallbladder (14.1%) was encountered. Gallstones were associated in 57% of patients with gallbladder malignancy. The elevated stone sign and peripancreatic nodal spread were important clues for gallbladder malignancy. CONCLUSION: A high index of suspicion of gallbladder malignancy in elderly Indian female patients presenting with features of choletithiasis, and awareness of the ultrasound findings may lead to early diagnosis and radical resection of this highly lethal malignancy.

Adult↗
PubMed1999

Colonic tuberculosis: clinical features, endoscopic appearance and management.

BACKGROUND: Although rare in the West, colonic tuberculosis is not an uncommon disease in developing countries. However, the clinical manifestations and radiological appearance of the disease are non-specific. In recent years, colonoscopy has been found to be very useful in diagnosing patients with colonic tuberculosis. METHODS: Clinical features, colonoscopic findings, histology and response to treatment were recorded in 50 patients with colonic tuberculosis. RESULTS: Abdominal pain, fever, anorexia, weight loss and diarrhoea were the common symptoms. The colonoscopic features consisted of ulcers (92%), nodules (88%), deformed caecum and ileocecal valve (42%), strictures (25%), multiple fibrous bands (8%) and polypoid lesions (6%). Segmental tuberculosis and lesions simulating carcinoma were seen in 22 and 16% of patients, respectively. Histological examination of the colonic biopsy specimens showed well-formed, non-caseating granulomas in 18%, collection of loosely arranged epithelioid cells in 40% and chronic non-specific inflammatory changes in 42% of the patients. Six patients needed surgical intervention. The other 44 patients responded well to anti-tuberculous therapy and became asymptomatic. CONCLUSIONS: It is concluded that colonoscopy is a useful method for diagnosing colonic tuberculosis. It is suggested that if the clinical picture and colonoscopic appearance are suggestive of tuberculosis and target biopsies reveal non-caseating granulomas, a collection of loosely arranged epithelioid cells, or even non-specific changes, then a therapeutic trial of anti-tuberculous drugs should be given and continued if there is clinical improvement.

Adult↗
PubMed1999

Effect of esophageal variceal sclerotherapy on hemorrhoids, anorectal varices and portal colopathy.

BACKGROUND AND STUDY AIMS: Endoscopic sclerotherapy (EST) results in an increase in the prevalence of portal hypertensive gastropathy (PHG). However, the effects of sclerotherapy on hemorrhoids, anorectal or colonic varices and portal hypertensive colopathy are not known. The aim of this study was to investigate these effects. PATIENTS AND METHODS: A total of 39 patients with portal hypertension were studied. Upper gastrointestinal endoscopy and full-length colonoscopy were carried out before the patients underwent EST for esophageal varices, and after obliteration of the varices following sclerotherapy. RESULTS: The obliteration of esophageal varices by EST did not significantly affect the prevalence of hemorrhoids (32 % before and after), anorectal varices (45% before and after) or portal hypertensive colopathy (60.5 % before and 66 % after, P > 0.05). CONCLUSION: Obliteration of esophageal varices does not affect the prevalence of hemorrhoids, anorectal varices, or portal hypertensive colopathy.

Adult↗
PubMed1999

Decreased sensitivity of the ultrarapid urease test for diagnosing Helicobacter pylori in patients with chronic renal failure.

Fifty patients with chronic renal failure and 50 asymptomatic healthy volunteers were studied to determine the prevalence of Helicobacter pylori in the two groups and to compare the results of ultrarapid urease test (URUT) and gastric histology for detecting H. pylori infection. Four gastric antral biopsy specimens were taken. Two specimens were used for the URUT and two were processed routinely. Sections were stained with H&E and Loeffler's methylene blue. Histological examination showed presence of H. pylori in 56% of patients with chronic renal failure (CRF) and in 78% of the controls. The difference was statistically significant (p < 0.05). The URUT was positive in only 16% of patients with CRF compared to 74% in the controls (p < 0.0001). The sensitivity and overall diagnostic accuracy of the URUT to diagnose H. pylori infection were 94.8 and 96%, respectively, in controls but were only 29 and 60%, respectively, in patients with CRF. It is concluded that the prevalence of H. pylori is significantly less in patients with CRF and that the URUT is less sensitive than gastric histology for diagnosing H. pylori infection in these patients.

Adolescent↗
PubMed1999

Evaluation of the one-minute ultra-rapid urease test for diagnosing Helicobacter pylori.

To determine the diagnostic accuracy of the one-minute ultra-rapid urease test for diagnosing Helicobacter pylori infection, two biopsies were taken from both the gastric corpus and antrum from 1000 patients undergoing upper gastrointestinal endoscopy. All the biopsies were subjected to the one-minute ultra-rapid urease test before imprint smears were prepared from them. Thereafter, the biopsies were fixed in 10% formalin and histological sections were examined for the presence of H pylori by a pathologist who was not aware of the clinical details or the results of the urease test. The prevalence of H pylori in the gastric antrum and corpus was 86.7% and 53.3%, respectively. The sensitivity, specificity, positive and negative predictive value and the overall diagnostic accuracy of the ultra-rapid urease test to diagnose H pylori infection in the gastric antrum were 92%, 100%, 100%, 66%, and 93%, respectively. The corresponding figures for the gastric corpus were 83%, 100%, 100%, 85%, and 91%, respectively. It is concluded that the one-minute ultra-rapid urease test has a high sensitivity and specificity and may be used as a rapid and cheap method to diagnose H pylori infection.

Bacteriological Techniques↗
PubMed1999

Mallory-Weiss syndrome: clinical features and management.

OBJECTIVE: To report the clinical features, endoscopic appearance, management and outcome of patients with upper gastrointestinal bleeding due to Mallory-Weiss tear seen at our institution during the last seven years. METHODS: A retrospective study of all patients with upper gastrointestinal bleeding seen during the last seven years was performed. Patients who were bleeding from longitudinal non-perforating tear(s) of the gastro-oesophageal mucosa were included in the study and their clinical features, endoscopic appearance management and outcome were recorded. RESULTS: During the study period 426 patients with upper gastrointestinal bleeding were seen. Sixty-six (15.5%) of these were found to have bled or were bleeding from Mallory-Weiss tear(s). Twenty-seven (41%) patients with Mallory-Weiss tear had no antecedent nausea, retching, abdominal pain or vomiting. Two patients had portal hypertension and a solitary case bled from an iatrogenic tear induced during routine upper gastrointestinal endoscopy. Multiple bleeding episodes were seen in 12% of cases. Twenty (30%) patients needed endoscopic sclerotherapy. Haemostasis was achieved in all. Except retrosternal pain, no procedure related complications were seen. CONCLUSIONS: Mallory-Weiss tear is a common cause of upper gastrointestinal bleeding. Nearly half of the patients have no antecedent symptoms and presented for the first time with upper gastrointestinal bleeding. Endoscopic therapy is very effective and safe in producing haemostasis in these patients.

Adolescent↗
PubMed1998

Diagnosing Helicobacter pylori by imprint cytology: can the same biopsy specimen be used for histology?

Imprint cytology of the gastric mucosa has been found to be very simple, inexpensive, and rapid for diagnosing Helicobacter pylori infection. However, there is a fear that preparing imprint smears may damage the biopsy specimen for subsequent histologic examination. This study was planned to investigate whether this damage happens. Four antral biopsy specimens were obtained from each of the 100 patients undergoing upper gastrointestinal endoscopy. Imprint smears were made from two biopsy specimens, which were then fixed in 10% formal saline and sent for histologic study. The third and fourth biopsy specimens were directed fixed in 10% formal saline for histologic examination. Two pathologists examined the imprint smears. Agreement between the two observers was observed in 97% of cases. Beyond-chance agreement was good with a kappa index of 0.90. H. pylori organisms were seen in 82% of biopsy specimens from which imprint smears were prepared and in the same percentage of biopsy specimens that were processed directly. The pathologists could not identify the histologic sections form which imprints were made. It is concluded that imprint cytology is an excellent method of diagnosing H. pylori infection and that preparing imprint smears does not alter the quality of the tissue. The same biopsy specimen can be used for histologic studies.

Cytodiagnosis↗
PubMed1998

Fine-needle aspiration biopsy of colonic masses.

Between 1989 and 1996, fine-needle aspiration biopsy was performed in 22 patients with palpable colonic masses. In all of these patients colonoscopic examination was either not possible or could not be carried out successfully. The results of aspiration biopsy were confirmed by surgery and histopathological examination of the tissue. Aspiration biopsy correctly diagnosed all except one case. It identified all cases of colonic cancer. One patient with colonic tuberculosis was also diagnosed correctly. However, in another patient with colonic tuberculosis, aspiration biopsy showed only nonspecific changes in the form of inflammatory and epithelial cells. There were no false-positive results or complications from the procedure. It is concluded that fine-needle aspiration biopsy is a simple, rapid, and accurate method of diagnosing palpable colonic masses in patients in whom a colonoscopy is not possible or cannot be performed satisfactorily.

Adenocarcinoma↗