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Biomedical subjects

M Dwivedi

Publications and source records attributed to M Dwivedi.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1989

Accuracy of abdominal ultrasonography and the role of a second investigation in surgical obstructive jaundice.

The diagnostic accuracy of ultrasonography (US) was evaluated in delineating the site and cause of biliary obstruction in 59 patients of surgical obstructive jaundice (SOJ). A final analysis of the ultrasonographic data was carried out in 42 patients on whom laparotomy or endoscopic papillotomy with removal of common bile duct stones, confirmed the diagnosis. Evaluation of the role of second investigation following ultrasound in 28 patients (side-viewing endoscopy in 13, ERCP in 12 and PTC in 3) was also done to determine whether they provide any additional information over ultrasonography in delineating the exact level and etiology of biliary obstruction. US was done by the clinician who interpreted the findings in conjunction with the clinical profile of the patient. US correctly diagnosed SOJ in all 42 patients. In 26 of the 28 patients with distal CBD block (specificity 87.5%; sensitivity 100%) and in 14 out of 16 patients with proximal CBD block (specificity 100%; sensitivity 87.5%) US provided and accurate diagnosis of the site of obstruction. US was correct in diagnosing a malignant etiology in 26 out of 27 malignant cases whereas it accurately indentified the benign nature of biliary obstruction in 14 of the 15 patients of SOJ due to benign obstruction (specificity and sensitivity range 93.3% to 96.3%). A second investigation could correctly change the etiology and site of biliary obstruction in only 5 patients (17.9%) whereas in the remaining 23 patients (82.1%) it did not add any additional information over the US findings. Six out of fifteen patients (40%) who underwent cholangiography had cholangitis and in one severe septicemia led to death.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1989

The ultrasonographic "common channel" sign: a characteristic feature of malignant obstruction of the lower end of common bile duct.

We describe an ultrasonographic "common channel" sign as the characteristic sonographic feature of malignant distal common bile duct (CBD) obstruction. Of 24 patients with obstructive jaundice due to distal CBD obstruction (pancreatic carcinoma 8, periampullary cancer 5, choledocholethiasis 10, CBD stricture due to pancreatitis 1) in whom the final diagnosis was proven at laparotomy, ultrasonography revealed 11 patients to have a thin-walled distended gallbladder continuous with a dilated CBD, which was termed the "common channel" sign. In all 11 patients, the cause of obstruction of the lower end of CBD proved to be malignant (pancreatic carcinoma 6, periampullary 5). In contrast, only 2 of the other 13 patients with obstructive jaundice with distal CBD obstruction, but without the "common channel" sign, had a malignant lesion at the lower end of CBD. The positive and the negative predictive values of the common channel sign were 100% and 85%, respectively. Thus, the ultrasonographic common channel sign is a reliable and characteristic feature of distal CBD obstruction due to malignant pathology.

Cholestasis↗
PubMed1989

Lipids changes in alcoholic & non-alcoholic cirrhotics.

Fasting plasma samples from 29 patients of cirrhosis were analysed for cholesterol and triglycerides and their lipo-protein fractions. The patients included 11 alcoholic cirrhotics consuming over 130 g/day of absolute ethanol and 18 non-alcoholic cirrhotics. The difference in lipid values between the two patient groups was not significant except that VLDL cholesterol was raised in alcoholic cirrhotics (P less than 0.05). However, in comparison to normal healthy controls, the values were significantly altered. The dietary intake, in the two groups showed no difference, except that non-alcoholic cirrhotics consumed more animal proteins. Low intake of exogenous fat and reduced synthesis of endogenous cholesterol in cirrhotic patients seemed to influence the total lipid values.

Adult↗