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Biomedical subjects

N Kumar

Publications and source records attributed to N Kumar.

At least 559 records · Page 31Linked to original sources
PubMedDate not supplied

Ultrasound guided percutaneous fine needle aspiration cytology of pancreas: a review of 61 cases.

The study includes 61 cases which were subjected to ultrasound (US) guided fine needle aspiration cytology (FNAC) to find out the utility of this technique in the diagnosis of pancreatic lesions. Age of the patients ranged from 23 to 85 years with a median of 50 years. Male to female ratio was 36:25. One or more clinical diagnoses were offered in 16 and in 9 of these, the disease was related to pancreas. Subsequent to US, the lesions were localized to pancreas in 57 and the nature of pathology in the pancreatic lesion could be diagnosed in 31. By FNAC, 31 cases (50.8%) were diagnosed to have pancreatic malignancy which included adenocarcinoma (23 cases), papillary cystic tumour (1), muco-epidermoid carcinoma (1), acinic cell carcinoma (1), islet cell tumor (1), and non Hodgkin lymphoma (4). FNAC of liver in 2 cases and retroperitoneal lymph node in a case of pancreatic adenocarcinoma revealed metastasis. During follow up, 1 case of non Hodgkin's lymphoma showed CSF involvement. Three cases (4.9%) were suspected to have epithelial malignancy of which one was confirmed as an adenocarcinoma following surgery and histology. Four (6.6%) were benign lesions which included nonspecific inflammation (2 cases), tuberculous pancreatitis (1) and pseudopancreatic cyst (1). The remaining 23 cases (37.7%) had normal or inadequate cytology. Of these, FNAC of liver showed metastasis in 2 cases and one case each were diagnosed as adenocarcinoma and pseudopancreatic cyst respectively following surgery. None of the patients had any complication following FNAC. We recommend US guided FNAC to be routinely used for diagnosis of pancreatic lesion.

Adenocarcinoma↗
PubMedDate not supplied

A comparative study of double contrast barium enema and colonoscopy for evaluation of rectal bleeding in children.

In pediatric age group, rectal bleeding is both common and distressing. Unlike in adults, very few studies comparing diagnostic efficacy of double contrast barium enema (DCBE) and Colonoscopy are available in children. A prospective study was performed to compare the diagnostic accuracy of high quality DCBE against colonoscopy in children with overt rectal bleeding. Fourty four children underwent flexible colonoscopy and DCBE independently. The final diagnosis was made after considering all investigations. Against this gold standard, the sensitivity and specificity of DCBE were 66.66% and 100% while that of colonoscopy 74.35% and 100% respectively. When assessing polypoidal lesions of colon, diagnostic yield of enema study was 86.20% as compared to 72.41% with colonoscopy. In colitis cases, the similar figures for enema and endoscopy were 53.84% and 76.92% respectively. The observed differences were statistically insignificant. No significant preparation, premedication or procedure related complications were encountered. The study thus highlights the utility and complementary role of DCBE and colonoscopy for evaluation of children with rectal bleeding.

Barium Sulfate↗
PubMedDate not supplied

Clinical and endoscopic features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) in India.

Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant disease characterized by recurrent epistaxis and telangiectasia of the skin and mucous membranes. Most reports of HHT are from Europe and N. America. In this report of 7 patients from India we postulate that increased skin pigmentation in Asians and Negroids masks the cutaneous manifestations of the disease but without any discernible effect on mucosal lesions. The median hemoglobin value in these patients was 4 g/dl. Endoscopic lesions in the stomach or duodenum were detected in six patients. Most patients in our report (5/7) presented with a chronic iron deficiency anaemia. The treatment of HHT is mainly supportive although our preliminary data shows that low dose ethinyl estradiol therapy decreases transfusion requirement in these patients.

Aged↗
PubMedDate not supplied

Endoscopic treatment of bile duct stones: is stone extraction necessary after endoscopic sphincterotomy?

BACKGROUND: The current treatment for stones in the biliary tree is endoscopic sphincterotomy (ES) followed by stone extraction with the help of balloon catheters or metal baskets. Stone extraction techniques are often associated with complications. Moreover, the balloon catheters break easily which aids to the cost of the procedure. The present study was designed to examine the effectiveness of endoscopic sphincterotomy (ES) alone in allowing spontaneous expulsion of bile duct stones and to determine the circumstances which warrant stone extraction. METHODS: Endoscopic retrograde cholangio-pancreatography (ERCP) was attempted in 68 patients with stones in the common bile duct. The stone size was determined by ultrasound, cholangiography in post cholecystectomy patients with a T-tube or by ERCP. Patients with stone size of 15 mm or less in diameter were treated with ES alone without stone extraction. Patients were discharged from the hospital within 24 hrs and returned for reassessment every week or earlier, if symptomatic, until complete clearance of stones was demonstrated. RESULTS: Endoscopic sphincterotomy was successfully performed in 63 (93%) patients, the procedure was abandoned in the remaining 5 patients for technical reasons. Spontaneous clearance of stones was observed in 55 (87%) patients, usually without any accompanying pain (47.85%). Persistent stones were seen in 8 (13%) patients; extension of the ES resulted in spontaneous stone expulsion in 6 of these patients. Thus, 61 (97%) of the 63 patients with stones of 10 mm or less in size cleared the stones spontaneously and all 8 patients who failed the initial ES, had stones > 10 mm in size. COMMENT: The present study shows that all small stones (< 10 mm) and most of those < 15 mm are expelled spontaneously after an adequate ES. These finding if substantiated by larger studies will reduce considerably the cost of the procedure as well as the morbidity associated with mechanical stone extraction.

Adolescent↗
PubMedDate not supplied

Course of severe ulcerative colitis in northern India.

Thirty patients with severe ulcerative colitis were studied prospectively. Sixty percent (18/30) of severe ulcerative colitis were in remission after mean duration of 9.2 days (range 2-20 days) of intensive intravenous therapy without major side effects of steroids. Factors predicting poor response to medical therapy on admission are: stool frequency > or = 9 per day, pulse rate > or = 120/minute, temperature > or = 38 degrees C, Albumin < or = 2 gm, mucosal tags on plain x-ray abdomen and pancolitis.

Adult↗
PubMedDate not supplied

Spectrum of gastrointestinal malignancy over a period of 10 years at a tertiary referal center of India.

We studied the frequency of different gastro intestinal malignancies (GIM) diagnosed in a given year, among patients attending gastroenterology department, and changing pattern of their occurrence over a period of 10 years (1984-1993). The records of all patients with histologically confirmed GIM were screened. Out of 83380 outdoor patients registered in the department over 10 years, there were a total of 1751 (2.1%) patients with GIM. The relative distribution of malignancy according to site was esophagus 36.0%, stomach 19.9%, liver secondaries 13.9%, colon 9.8%, periampullary 5.6%, gall pladder 4.5%, duodenum 3.0%, malignant ascites 2.6%, HCC 2.3% and pancreas 1.1%. Mean age for cancer of esophagus was 53.5 +/- 11.4 year, stomach 51.8 +/- 12.9, colon 49.1 +/- 16.7, duodenum 45.3 +/- 11.4, malignant ascites 51.8 +/- 13.1, pancreas 46.9 +/- 15.3 and HCC 52.5 +/- 12 years with an overall mean age of all GIM being 49.7 +/- 13.4 years. All malignancies were common in males except for cancer of gall bladder. The annual distribution of GIM did not confirm to a rising or declining trend with reference to the frequency of occurrence or age and sex distribution over the last decade.

Adolescent↗
PubMedDate not supplied

Intestinal metaplasia--its association with gastric cancer.

Endoscopic gastric biopsies from 230 patients and post gastrectomy specimens of 18 patients were evaluated for the presence of intestinal metaplasia (IM) and its association with the gastric lesions. There were a total of 78 malignant and 170 benign lesions. IM was present in 53% of patients with gastric carcinoma (GC) and in 10.6% with benign lesions of the stomach. The IM in association with GC was of type 1 (Small Intestinal) in 58.8%; type II (mixed gastric and small intestinal) in 11.8% and type III (Colonic) in 29.4%. In patients with benign lesions the IM was predominantly of type I (94.5%) except in 1 patient who had type III metaplasia. Our findings indicate that type III IM was significantly more frequent in patient with GC than with benign lesions (29.4% Vs 5.5%; p < .005). Therefore we conclude that patients with type III IM should be kept on surveillance for GC.

Biopsy↗
PubMedDate not supplied

Tandem use of PCR and synthetic peptides to map helper T-cell epitopes on 27-kDa sexual stage antigen of Plasmodium falciparum.

Monoclonal antibodies recognizing two overlapping linear epitopes (amino acid residues 10 to 25) on the 27-kDa sexual stage antigen of Plasmodium falciparum (Pfg 27) effectively reduce the infectivity of the parasites to mosquitoes. Although malaria transmission-blocking immunity is largely antibody-mediated, T cells play critical roles in the regulation of antibody-secreting B cells. In order to facilitate the development of a malaria transmission-blocking subunit vaccine, studies were undertaken to map epitopes on Pfg 27 recognized by T-helper lymphocytes. Pfg27-specific T-cell hybridoma clones were produced from rPfg27-immunized BALB/c (H-2d) and C57BL/6 (H-2b) mice, and used in studies to map antigenic determinants using PCR-generated Pfg27 gene fragments expressed in E. coli and synthetic peptides based on the Pfg27 sequence. We identified and mapped five distinct T-cell epitopes that are recognized by major histocompatibility complex (MHC) class II-restricted T-cell hybridoma clones. A single peptide (21 residues) was shown to contain two tandem or partially overlapping epitopes recognized by T-cell hybridomas in the context of I-Ad and I-Ab, respectively. Synthetic peptides representing epitopes recognized by T-cell hybridoma clones elicited strong IgG responses in immunized mice, suggesting that T-cells of the helper phenotype were stimulated in vivo by these peptides. These studies represent the first detailed T-cell epitope analysis of a malaria sexual-stage antigen.

Amino Acid Sequence↗
PubMedDate not supplied

Percutaneous catheter drainage in pancreatic pseudocysts.

Percutaneous catheter drainage (PCD) was performed in 12 pancreatic pseudocysts in 11 patients. The procedure was performed under realtime ultrasound guidance adopting a direct transperitoneal approach in all cases. Complete cure was achieved in 9 (75%) of the Pseudocysts drained. Success rate was higher in pseudocysts not communicating with the main pancreatic duct (MPD), 7 of 8 (87.5%) as compared to those with ductal communication, 2 of 4 (50%). The mean duration of catheter drainage was 14.2 days in the first group while it was significantly longer, (42.5 days) in the latter group. No death or major complication related to the procedure was encountered in the study. A single pseudocyst got infected after catheter insertion but it was treated successfully with antibiotics. The follow up period was 3-18 months with a mean of 6.8 months. PCD failed in 2 pseudocysts communicating with MPD and associated strictures in the MPD. In one case having no communication with MPD the procedure failed because the cyst had thick debris which could not be drained properly. PCD may be a safe and effective therapy in the management of pseudocysts with best results in those not communicating with the MPD. Communicating pseudocysts, also having strictures in MPD, should not be subjected to PCD.

Adult↗
PubMedDate not supplied

Pharmacokinetics of 7 alpha-methyl-19-nortestosterone in men and cynomolgus monkeys.

Testosterone and its esters are widely used for androgen replacement therapy. In the prostate, testosterone ins 5 alpha-reduced to dihydrotestosterone (DHT), which leads to an amplification of its stimulatory activity in this and other tissues that have significant 5 alpha-reductase activity. While this amplification is essential during fetal development, it has potentially undesirable consequences during adult life. 7 alpha-Methyl-19-nortestosterone (MENT) is a potent synthetic androgen that does not undergo 5 alpha reduction and is therefore being investigated for long-term clinical use because it is expected to be less stimulatory to the prostate. Since we anticipate using MENT acetate (MENT Ac) rather than MENT as the form of this androgen in humans, the bioavailability of MENT following the administration of MENT and MENT Ac was investigated in cynomolgus monkeys. Equimolar concentrations of MENT or MENT Ac were administered as a continuous subcutaneous infusion via Alzet osmotic pumps. Serum MENT levels were measured by radioimmunoassay (RIA) in blood samples collected daily for 4 days during steady state. The serum MENT levels were not significantly different in the two groups (11.3 +/- 1.6 vs. 13.1 +/- 1.2 nmol/L). This suggested that MENT Ac was rapidly converted to MENT in circulation. The hydrolysis of MENT Ac to MENT was confirmed by the in vitro incubation of MENT Ac with blood or plasma and the demonstration of MENT in products following separation by high-performance liquid chromatography (HPLC). Following the demonstration of the safety of MENT Ac in subchronic toxicity studies in rats and rabbits, a pharmacokinetic study was performed in men. In normal men, a single intravenous bolus of 500 micrograms of MENT led to peak serum MENT levels at 3 minutes after dosing (when the first samples were collected), followed by an exponential decline, reaching undetectable levels by 180 minutes. The average terminal half-life and the metabolic clearance rate (MCR) were calculated to be 40 minutes and 2,360 L/day, respectively. The results of the pharmacokinetic studies show that in both men and monkeys, the MCR of MENT is much faster than the values reported for testosterone. The faster MCR can be attributed, in part, to the finding that, in contrast to testosterone, MENT showed no binding to sex hormone binding globulin (SHBG).

Adult↗