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Biomedical subjects

M Dwivedi

Publications and source records attributed to M Dwivedi.

At least 55 records · Page 3Linked to original sources
PubMed1998

Malignancy is the most common cause of gastric outlet obstruction even in a developing country.

BACKGROUND AND STUDY AIMS: It has recently been reported that in developed countries gastric outlet obstruction now predicts gastric malignancy. The aim of this study was to find out if this is the case in a developing country like India. PATIENTS AND METHODS: Seventy-four patients with gastric outlet obstruction underwent upper gastrointestinal endoscopy and biopsy specimens were obtained from any suspicious looking lesions or from the most distal point at which the endoscope could be positioned. RESULTS: In 56 patients (76%) the cause of the gastric outlet obstruction was malignant. On clinical and endoscopic appearance three patients were wrongly diagnosed as having malignancy when the cause, on endoscopic biopsy, was benign (tuberculosis n = 2, and immunoproliferative small intestinal disease n = 1). Twelve of the 18 patients with benign gastric outlet obstruction were managed conservatively with drugs and endoscopic balloon dilatation. CONCLUSION: Even in a developing country like India, malignancy is the commonest cause of gastric outlet obstruction and endoscopic biopsy specimens should be obtained in all patients with gastric outlet obstruction because the occasional benign lesions can be managed conservatively.

Adenocarcinoma↗
PubMed1998

Thickened gastric mucosal capillary wall: a histological marker for portal hypertension.

To evaluate whether the diameter or thickness of the wall of mucosal capillaries in the stomach could be a useful histological marker of portal hypertension, gastric mucosal biopsies were taken from the fundus and antrum of 73 patients with cirrhosis of the liver and 64 healthy volunteers. The mean +/- SD diameter of mucosal capillaries in the fundus of patients was not significantly different from that in the control group (59.4 +/- 16.8 microns vs 53.5 +/- 16.5 microns, respectively; P = NS). However, the mean +/- SD diameter of the antral mucosal capillaries was significantly greater in patients compared to controls (61.3 +/- 18.1 microns vs 47.6 +/- 12.7 microns, respectively; P < 0.001). The mean +/- SD thickness of the fundal and antral capillary wall in the patients group (6.8 +/- 2.4 microns and 7.2 +/- 2.4 microns, respectively) was significantly greater than that in the control group (3.5 +/- 1.5 microns and 3.3 +/- 1.5 microns, respectively) (P < 0.001 for each). The overall diagnostic accuracy of antral mucosal capillary diameter to diagnose portal hypertension was 50%, while that of thickened fundal and antral mucosal capillary wall was 84% and 85%, respectively. It is concluded that the gastric mucosal capillary walls are thicker in patients with portal hypertension and that this is a more reliable histological marker of portal hypertension than dilated gastric mucosal capillaries.

Adult↗
PubMed1998

Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis.

Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesophageal mucosa in 2% of controls and 66% of patients with oral submucosal fibrosis (p < 0.0001). In the control group, acanthosis was seen in one patient, while in the patient group atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and papillomatosis and mild dysplasia in 2% patients. Subepithelial collagenization was seen in 32 (64%) patients. The oesophageal abnormalities were seen more frequently in patients who had consumed Pan masala, Gutka, betel nut, tobacco or a combination of some or all of these, with or without betel leaf, for > or = 5 years compared to those consuming them for a shorter period of time (91% vs 46%, p < 0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oesophagus may also be involved in about two-thirds of patients.

Adult↗
PubMed1998

Endoscopic injection therapy for bleeding peptic ulcer using absolute alcohol.

The injection of sclerosants and adrenaline in a bleeding peptic ulcer is known to arrest bleeding in the majority of patients. However, there are very few studies from India on this subject. Injection therapy was carried out using absolute alcohol in 21 patients with bleeding gastric ulcer and 55 with bleeding duodenal ulcer. Injection therapy successfully controlled bleeding in all 76 patients. Bleeding recurred in two patients who were successfully managed with a second injection of absolute alcohol. Post-injection blood transfusion was required in 16 (76%) patients with gastric ulcer compared with only 12 (22%) of those with a duodenal ulcer. The difference was statistically significant (P < 0.001). No complication of injection therapy was noted. It is concluded that injection therapy using absolute alcohol is a safe and effective therapy for managing patients with bleeding peptic ulcer.

Adolescent↗
PubMed1998

Spider angiomas are not found in the retina of patients with cirrhosis.

To determine the prevalence of spider angiomata in patients with cirrhosis, the factors influencing them and whether or not they are present in the retina of patients with cirrhosis, 93 cirrhotics were studied. Cutaneous spider angioma were seen in 19 (20%) patients. All patients with spiders had at least one episode of variceal bleeding and had grade III or IV oesophageal varices. Spiders were seen more commonly in patients with alcoholic cirrhosis than in those with non-alcoholic cirrhosis (53.5% vs 6%, p < 0.001), in patients with Child's C cirrhosis than those with Child's A and B cirrhosis (67% vs 4%, p < 0.001). However, although spiders were seen more often in patients undergoing sclerotherapy than those not, the difference was statistically not significant (23% vs 19%, p = NS). Spiders had no association with presence or absence of portal hypertensive gastropathy or gastric varices. None of the patients showed any abnormality or presence of spiders in the retina. It is concluded that spider angiomas are seen more commonly in patients with alcoholic cirrhosis, those with more severe liver disease and patients having large oesophageal varices and they are not seen in the retina of patients with cirrhosis.

Adult↗
PubMed1998

Endoscopic management of choledocholithiasis: to cut, stretch or relax?

Since it was first described in 1974, endoscopic sphincterotomy has been the procedure of choice for management of choledocholithiasis, especially for retained common bile duct stones. However, it has the dubious distinction of being the most hazardous of all endoscopic retrograde cholangiopancreatographic procedures and carries an immediate complication rate of 8-10%. Concern has also been voiced about the long-term complications of sphincterotomy, as the sphincter of Oddi is cut during the procedure. To prevent, or at least lessen, the short- and long-term complications of endoscopic sphincterotomy, an alternative in the form of balloon dilatation of the papilla, has been advocated. However, the procedure of balloon dilatation is cumbersome, time consuming and, more importantly, a recent multi-centre study from the US comparing endoscopic sphincterotomy with balloon dilatation observed higher complications with balloon dilatation. The use of nitrites to relax the papilla is another novel method used for removal of common bile duct calculi. So how should a therapeutic endoscopist decide which method is to be used? The advantage of endoscopic sphincterotomy is that it has been around for more than two decades and most endoscopists are familiar with the technique as well as its complications. It can be accomplished quickly and with the advent of wire-guided and balloon-mounted sphincterotomes, the time taken for the procedure to be completed has been reduced further. The complications of the procedure are less when it is employed for removal of common bile duct stones and when used by experts. It, therefore, still appears to be the procedure of choice for endoscopic management of choledocholithiasis. The other two methods may, however, be useful in patients with coagulopathy.

Animals↗
PubMed1998

Helicobacter pylori-induced lymphonodular hyperplasia: a new cause of gastric outlet obstruction.

A 30-year-old female was seen with symptoms and radiological evidence of gastric outlet obstruction. Endoscopic examination revealed findings suggestive of gastric outlet obstruction with nodularity of the antral mucosa leading to deformity of the pylorus. Endoscopic biopsies from the nodular antral mucosa showed presence of Helicobacter pylori-induced lymphonodular hyperplasia without evidence of mucosa-associated lymphoid tissue lymphoma. Anti-H. pylori therapy resulted in eradication of the H. pylori infection and the signs and symptoms of gastric outlet obstruction. The case demonstrates that H. pylori-induced lymphonodular hyperplasia can also cause gastric outlet obstruction. We believe this is the first such case to be reported.

Adult↗
PubMed1997

Helicobacter pylori in areas of intestinal metaplasia in gastric antral mucosa.

Colonization of areas of intestinal metaplasia by Helicobacter pylori is rare and there is only one report in the literature of this organism colonizing areas of intestinal metaplasia in the antral mucosa. We report two more cases where H. pylori were seen in the gastric pits with intestinal metaplastic changes in the antral biopsy specimens.

Adolescent↗
PubMed1997

Histomorphometric study of portal hypertensive enteropathy.

Histopathologic features of duodenal and jejunal mucosal biopsy specimens obtained from 58 patients with portal hypertension and 30 healthy volunteers were studied. Dilated mucosal vessels with thickened walls were seen in duodenal and jejunal biopsy specimens from 39 (67%) and 41 (71%) of the patients, respectively, compared with corresponding biopsy specimens from 8 (27%) and 6 (2%) of the control subjects. The difference between the two groups was statistically significant. Other important histologic features in the patient group included edema of the lamina propria, fibromuscular proliferation, a decreased villous/crypt ratio, and thickened muscularis mucosae. The mean +/- SD thickness of capillary wall and diameter were significantly more in the patient group compared with those in the control subjects. We conclude that thick-walled dilated vessels along with edema of the lamina propria, fibromuscular proliferation, a decreased villous/crypt ratio, and thickened muscularis mucosae form a characteristic picture of portal hypertensive enteropathy. These changes seem to be a part of the changes seen in the gastrointestinal tract of patients with portal hypertension without any meaningful clinical implication except the increased chance of occult gastrointestinal blood loss.

Adolescent↗
PubMed1997

Emergency endoscopy in patients with portal hypertension having upper gastrointestinal bleeding.

During the last 4 years, 147 patients suffering from portal hypertension with acute upper gastrointestinal bleeding were subjected to emergency endoscopy soon after they were resuscitated. Seventeen (11.5%) patients were referred to us with a clinical diagnosis other than portal hypertension. The causes of bleeding as seen during endoscopy were: oesophageal varices (n = 130; 88%), gastric varices (n = 11), gastric ulcer (n = 2) portal hypertensive gastropathy (n = 2) and erosive gastritis and duodenal ulcer in one patient each. All patient bleeding from oesophageal varices except one underwent emergency endoscopic sclerotherapy. One hundred and twenty-one (94%) stopped bleeding immediately. Rebleeding was seen in 11% and was effectively controlled by a second session of sclerotherapy in all but one patient. Twenty (14%) patients died. It is concluded that emergency endoscopy has a definite role in the management of patients with portal hypertension complicated by gastrointestinal bleeding.

Adolescent↗