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Biomedical subjects

R D Bapat

Publications and source records attributed to R D Bapat.

At least 73 records · Page 4Linked to original sources

The temporary effect of proximal gastric vagotomy on experimental duodenal ulcers and gastric secretion.

A proximal gastric vagotomy (PGV) prevented experimental duodenal ulcers in rats for only 5 days and thereafter all rats developed duodenal ulceration. In sham-operated rats the mean stimulated gastric acid output was 186 mumol/60 min. Immediately following a PGV there was a significant decrease in gastric juice volume and acidity (P less than 0.001) with a fall in the mean stimulated acid output to 12 mumol/60 min. On the seventh day after vagotomy the stimulated acid output (volume and concentration) significantly increased to 88 mumol/60 min (P less than 0.001). When the dose of gastric secretagogues was reduced by 50 per cent, a PGV on day 0 prevented any changes occurring in the duodenal mucosa, but when repeated at 4 weeks after a PGV the severity of duodenal ulcers in vagotomized rats was greater than in those having had a sham operation (P less than 0.05). This transient effect of a PGV on duodenal ulcerogenesis and gastric secretion may be due to recovery of the parietal cell mass.

Animals↗

Selective transplenic decompression of oesophageal varices by distal splenorenal and splenocaval shunt.

The usefulness of selective transplenic decompression of oesophageal varices by distal splenorenal shunt and splenocaval shunt was evaluated in the control of gastrointestinal haemorrhage in patients with portal hypertension of varied aetiology. (Decompression was successful in 69 out of 78 cases.) It was shown that it is superior to total portosystemic shunts, as the incidence of encephalopathy was very low compared with the data from our series of portocaval shunts. The operative mortality has been progressively lowered and has now reached levels comparable with portocaval shunt. Distal splenorenal shunt when performed as an emergency procedure to arrest bleeding has limited usefulness but when performed as an elective or prophylactic procedure its results are comparable with those of portocaval shunt without the untoward complications such as encephalopathy. A modified selective decompression of varices has been described in which the distal end of the splenic vein is anastomosed to the inferior vena cava. Though no long term follow-up studies are available, we believe that this shunt is likely to prove superior to distal splenorenal shunt as it has both the advantages of the distal splenoral and the haemodynamic advantage of end-to-side portocaval shunt. We conclude that in patients with portal hypertension of varied aetiology, who have not had a haemorrhagic episode but in whom varices have been demonstrated or who have had one episode of haemorrhage from varices, the splenocaval shunt when feasible or the distal splenorenal shunt offers the optimal method of management at present in India.

Adolescent↗

Ready-to-use pefloxacin infusion for surgical prophylaxis.

The efficacy of pefloxacin in preventing postsurgical infection was demonstrated in an open, comparative, randomized clinical trial. The 120 evaluable patients were divided into four groups of 30 each. Group A served as controls. Groups B, C, and D received one, two, and six doses, respectively, of pefloxacin 400 mg in 100-mL solution as an intravenous infusion. The majority of treated patients benefited from pefloxacin therapy, with only 3% to 7% developing infection. In contrast, 20% of the placebo group developed infection within 5 days after surgery. Two of the 90 treated patients experienced mild side effects. One to six doses of ready-to-use pefloxacin infusion may be administered safely to provide antibacterial coverage during surgery.

Adult↗

Thyroid abscess.

Thyroid abscess arising from Acute Suppurative Thyroiditis (AST) is a rare clinical disorder. The ability of the thyroid gland to resist infection is well known and infection in the thyroid gland is rare, particularly so with the advent of widespread usage of antibiotics. An internal pharyngeal fistula (Pyriform sinus fistula) is the most common underlying abnormality in patients with AST. We report a case of an adult male who presented with a thyroid abscess. The causal organism was found to be Staphylococcus aureus. Intravenous antibiotics and, incision and drainage of the abscess led to an uncomplicated recovery.

Abscess↗

Non-specific granulomatous inflammatory lesions of small bowel.

The entity of nonspecific granulomatous inflammatory lesions(NSGIL) of the small bowel is a diagnostic and therapeutic dilemma. Data of 52 histopathologically proven cases of NSGIL seen by us between 1986 and 1991 were analysed. All these patients presented with either intestinal obstruction or perforation. They were thoroughly evaluated and investigated for tuberculosis. Of the 52 patients, 6 patients received antitubercular therapy (ATT) before and after surgery and 32 patients only after surgery. Fourteen patients did not receive ATT. Surgical procedures undertaken included stricturoplasty, resection/anastomosis and simple suturing of perforation. No complications were seen in patients who received ATT; however, six of 14 patients who did not receive ATT developed wound sepsis and 2 developed partial wound dehiscence. Many of these NSGIL lesions could be tuberculous in etiology though typical caseating granulomas were not seen.

Adolescent↗

Detection of medullary carcinoma of thyroid, with liver metastasis, using 99mTc DMSA(V) scintigraphy.

A sixty year old female referred for thyroid and liver scintigraphy had a clinical history of progressive swelling in the neck with hepatomegaly. A large cold area was detected in the right thyroid lobe using 99mTc pertechnetate and in the right lobe of liver using 99mTc phytate. Subsequent whole body scan with 99mTC DMSA(V) showed avid tracer uptake in right lobe of thyroid and liver. Aspiration cytology of thyroid and liver showed medullary carcinoma of thyroid with its metastasis in liver. Histopathology following thyroidectomy confirmed the diagnosis. Thus 99mTc pentavalent DMSA contributes specificity to diagnose medullary carcinoma of thyroid and metastatic lesions.

Carcinoma, Medullary↗

Laparoscopic management of hydatid cyst of liver.

We describe the laparoscopic excision of a hydatid cyst in the liver. During the procedure, done after treatment with the scolicidal agents praziquantel and albendazole, care was taken to prevent spillage of scolices during evacuation of contents and to excise the entire germinal epithelium. The patient had no immediate or short-term complications and is asymptomatic 3 months later.

Adult↗