Biomedical subjects
Publications and source records attributed to N M Gupta.
Primary esophageal lymphoma is very rare. We report a patient with non-Hodgkin's lymphoma involving the lower one-third of the esophagus. Presenting with dysphagia, he was treated successfully by transhiatal esophagectomy along with combination chemotherapy. We review the relevant literature.
OBJECTIVE: To evaluate morbidity, mortality and cure rate after transhiatal oesophagectomy for carcinoma of the oesophagus. DESIGN: Prospective audit. SETTING: University hospital, India. SUBJECTS: From December 1986 to June 1993 a total of 250 consecutive patients underwent one stage transhiatal oesophagectomy with cervical oesophagogastrostomy for carcinoma of the oesophagus. INTERVENTIONS: Transhiatal oesophagectomy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The mortality was 6% (14/250) and complications included recurrent laryngeal nerve palsy (n = 35, 14%), anastomotic leak (n = 38, 15%), respiratory failure (n = 8, 3%), anastomotic stenosis (n = 44, 18%) and anastomotic recurrence (n = 3, 1%). The actuarial survival at one year was 45% and at five years was 5%. CONCLUSIONS: Transhiatal oesophagectomy is safe and well tolerated for the treatment of carcinoma of the oesophagus when done with care. Avoidance of thoracotomy, adequate longitudinal clearance, cervical anastomosis, and a short operating time are its main advantages.
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Twelve patients who had previously undergone preliminary pelvic loop colostomy were treated by conversion of loop colostomy to end colostomy by alternative technique ie without dismantling of loop and conversion to end stoma. The results of this technique were compared with those of conventional procedure which was performed in ten patients. The new technique results in a 'mature' end colostomy in situ with little pain at the stoma site, no risk of retraction and lower risk of peristomal infection. We therefore recommend this procedure for all patients needing such conversion.
Isolated esophageal tuberculosis is very rare. We report a patient who presented with history of retrosternal pain and dysphagia and on investigation was found to have a smooth esophageal mass. Endoscopic biopsy showed epitheloid cell granuloma with necrosis suggestive of tuberculosis. CT scan of the thorax showed no involvement of adjacent structures. The patient responded to antitubercular therapy.
A case of spontaneous esophageal perforation occurring in a healthy esophagus without any predisposing factor is reported. The problem of delayed diagnosis has been discussed.
We describe placement of a double pigtail cystogastric stent in 5 patients with pancreatic pseudocyst using real-time ultrasonography and fluoroscopy as guidance techniques. This was done as a two-step procedure. First, a transgastric drainage catheter was placed for a period of six days. All the patients continued to have high drainage output and the cyst size decreased, as seen sonographically. Simultaneous barium meal and sinogram were then done to measure the distance between the posterior gastric wall and the cyst. A polyurethane double pigtail stent of appropriate size was then introduced to achieve cystogastric drainage. The cyst resolved in all the patients by four weeks to six weeks, when the stent was removed endoscopically. There was no recurrence of pseudocyst during follow-up for 6 months to 13 months. None of the patients suffered any complication. Cystogastric drainage using a double pigtail stent is an easy and safe alternative to surgical cystogastrostomy.
Ultrasound-guided fine needle aspiration cytology (FNAC) of carcinoma of the intra-abdominal oesophagus was attempted on 21 patients with a 21 G spinal needle using a percutaneous anterior epigastric approach. The results were compared with those of endoscopic biopsy and brush cytology. The ultrasound-guided FNAC had a positive yield in 20/21 (95.2%) compared with 18/21 (85.7%) for endoscopic biopsy and 18/21 (85.7%) for brush cytology (P greater than 0.59). The combination of US-guided FNAC with endoscopic biopsy and the brush cytology achieved a positive yield in 21/21 (100%) whereas combining endoscopic biopsy and brush cytology produced a positive yield of 19/21 (90.5%). Two patients developed temporary epigastric pain. We recommend US-guided FNAC as a safe and effective technique that can be used alone or as an adjunct to endoscopic procedures for the diagnosis of carcinoma of the intra-abdominal oesophagus.
In contrast to reports from Western countries, the incidence of colorectal carcinoma among patients with idiopathic ulcerative colitis is considered to be low in the Indian subcontinent. In order to assess the risk of carcinoma in Indian patients, a retrospective analysis of 436 cases of idiopathic ulcerative colitis seen by us over a period of 12 years was carried out. Eight cases of colitis carcinoma (1.8%) were encountered during the study period. Pancolitis was present in six of them while colitis was of limited extent in two cases. The mean duration of colitis prior to development of carcinoma was 12.1 (range 7-25) years. While four of these patients were on our follow-up list and were diagnosed to have carcinoma at the time of a medical or surgical complication, four others first presented to us with a surgical complication of colitis carcinoma. We conclude that colitis carcinoma is not a rare entity among Indian patients with idiopathic ulcerative colitis. We feel that until proved otherwise, patients with idiopathic ulcerative colitis from the Indian subcontinent should not be denied the benefits of a cancer surveillance programme.
The study evaluated 48 patients with carcinoma of the oesophagus to assess the optimal number of biopsy specimens required to obtain the highest yield. Eight specimens were obtained from each patient and two specimens were placed serially in each of four vials. The first vial provided a positive diagnosis in 95.8% of cases. The addition of two more specimens (second vial) increased the yield to 97.9% and the fifth and sixth specimens increased the positive yield to 100%. There was no statistically significant difference in the yield according to the site and the type of growth.
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We have studied fibrinolytic activity of 12 cases of infiltrating duct carcinoma of breast (7 metastatic and 5 non-metastatic) and ten cases of adenocarcinoma of gastrointestinal tract (5 each of metastatic and nonmetastatic), and compared with some of their normal tissue counterparts. Both metastatic and non-metastatic tumors of breast and gastrointestinal tract had significantly higher levels of fibrinolytic activity as compared to normal tissues. Though mean fibrinolytic activity (expressed as ug/ml of urokinase activity) of metastatic tumors of breast and gut had higher values as compared to non-metastatic counterparts, however it did not reach statistical significance.
A case of haemoperitoneum and haemobilia due to tearing of the cystic artery following rupture of the gall bladder during acute cholecystitis in a pregnant women is reported. The relevant literature is reviewed.
An interesting manifestation of carcinoma of the esophagus, hitherto undescribed is reported. The patient at the time of diagnosis had presented with an esophagocutaneous fistula. He was treated by feeding jejunostomy and local palliative radiotherapy and showed good clinical improvement. The extreme rarity of such a presentation is highlighted.
Over a period of eleven years, eight patients were treated for duodenal ulcer perforation measuring more than one centimetre in diameter. In five of these patients, the perforation was sealed using a jejunal loop as serosal onlay patch; one patient underwent gastrectomy and in two patients catheter duodenostomy was done. Two patients died, both due to renal failure. The six surviving patients were discharged with the advice for a subsequent 'ulcer-curing' operation after six months. Two patients developed life threatening complications during this waiting period and one of these died. Giant perforations of duodenal ulcer can safely be closed using a jejunal loop as serosal patch. Delay in doing the second stage definitive surgery for the ulcer may be dangerous.