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Biomedical subjects

R K Tandon

Publications and source records attributed to R K Tandon.

At least 73 records · Page 4Linked to original sources
PubMed1994

Nonsurgical drainage for biliary obstruction.

Biliary obstruction is a common and potential fatal condition. Its pathological effects include depressed immunity, impaired phagocytic activity and reduced Kupffer cell function with consequent endotoxemia, septicemia and renal failure. Over the last decade however, non-surgical biliary drainage procedures performed with radiologic or endoscopic guidance emerged as alternative to surgical of therapy in many situations, particularly palliation of malignant strictures because of their lower morbidity and mortality rates. Endoscopic stent placement is preferred over percutaneous transhepatic catheter drainage in general. If endoscopic procedure is not possible or fails percutaneous transhepatic biliary drainage or combined radiological-endoscopic procedure should be employed. Surgery is currently reserved only for curative resection/palliative drainage in young and fit patients. Preoperative biliary drainage aimed at reducing post-operative morbidity and mortality is not universally accepted and needs further study. Benign strictures are increasingly being dilated non-surgically with temporary stenting, especially in patients with failed surgery, recurrent strictures, contraindication to surgery and pre-liver transplant strictures eg primary sclerosing cholangitis. A cohesive team consisting of a surgeon, a radiologist and an endoscopist is required to achieve the best possible results.

Cholestasis↗
PubMed1994

Biliary strictures on ERCP: a study in northern India.

Case records of 82 patients with biliary stricture diagnosed on endoscopic retrograde cholangiopancreatography (ERCP) during a 7-years period (1983-89) were analysed for its aetiology, clinical presentation, laboratory abnormalities and radiological characteristics. The aetiology was found to be benign in 59 and malignant in 23 patients. Forty seven percent of all strictures were post cholecystectomy strictures (PCS). Presence of mucosal irregularity and incomplete stricture were commoner with malignancy. Malignant biliary strictures (MBS) were commonly seen in males, occurred at older age, had short history, had higher alkaline phosphtase and serum bilirubin values when compared to patients with benign biliary strictures (BBS).

Adult↗
PubMed1994

Ketosis resistant diabetes of the young: a profile of its exocrine and endocrine pancreatic dysfunction.

A subset of insulin requiring diabetes in the young (IRDY) is ketosis resistant. Its pathogenesis and pathophysiology remain ill defined. The current study was done to evaluate the exocrine and endocrine dysfunction in ketosis resistant young diabetics. Fecal chymotrypsin (unit/G), basal & stimulated c-peptide levels (pmol/ml) and sonographic evaluation of the pancreas were done in 59 IRDY patients: 34 ketosis resistant (KR) and 24 ketosis prone (KP). Fecal chymotrypsin levels in KR (11.1 +/- 3.4) and KP (10.3 +/- 5.1) were lower than in controls (22.4 +/- 7.3) (P < 0.01). KR subjects had better endogenous insulin reserves than KP subjects: the basal and stimulated c-peptide levels in KR patients (0.12 & 0.17) were higher than in KP subjects (0.06 and 0.07) (P < 0.05). A strong correlation was noted between the exocrine and beta cell dysfunction in KR subjects (r = 0.7, P < 0.05). Pancreas was smaller in KR and KP patients than in controls (P < 0.05) on sonography. Thus the resistance to ketosis is a reflection of the better preserved beta cell reserves in the KR patients. Loss of the trophic effect of insulin and associated malnutrition is responsible for their exocrine dysfunction.

Adult↗
PubMed1993

Some toxicological issues in chemical safety and regulation in an Australian context.

This article considers the potential effects on the human body of toxic hazardous substances in general, along with advanced methods of detecting short- and long-term effects of exposure with reference to the results of recent research. In addition to occupational exposure, other contributors to an individual's overall toxic exposure load including environmental and home and lifestyle exposures are also considered in detail. Toxicological information (from diverse sources) and an awareness of the limitations of our present state of knowledge of toxicology are concluded to be important factors in developing chemical safety and regulatory criteria. Although there is some debate concerning the adequacy of the exposure standard-setting process, TWA measures are capable of giving reliable indications of the efficacy of control measures and procedures. Electroencephalogram (EEG) activity reflecting stimulus attention and decision time, electromyography measuring nerve conduction velocities, reaction time, and neuropsychological performance-using batteries of psychometric tests, may all be effective indicators of exposure, interaction with other factors, and long-term effects of exposure.

Australia↗
PubMed1993

Postoperative bile duct strictures: ultrasound and endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography evaluation.

This retrospective study was undertaken to assess the role of ultrasound (US) and to compare it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of post-operative common bile duct (CBD) strictures. Seventy-four patients with postoperative CBD strictures were evaluated by ERCP and/or PTC. Of these, US scans were available in 52 patients. Ultrasound findings of CBD strictures were: proximal dilatation of CBD with smooth tapering stenosis (41%); abrupt cut off of CBD (18%); and echogenic nodule, without acoustic shadowing, in 16%. Of the remainder, mild proximal dilatation of the CBD was seen in 6%, and 19% of the patients had normal US scans.

Adult↗
PubMed1993

Workplace toxic incident notification: results of a survey of 16 factory sites in western Sydney.

Workers in the chemical industry are often employed where there is a potential for significant exposure to hazardous materials. Many of these events go unrecorded and are not notified to agencies charged with the responsibility of regulating the workplace. Therefore, a survey was conducted of factories covering a range of activities where poisonous chemicals are in use, aimed at proactively reviewing toxic incident reporting, including (i) underlying principles of notification, (ii) any relevant criteria used in the reporting of incidents, and (ii) compliance with existing legislation. Sixteen factories in the Western Sydney area were inspected by a government safety inspector over a 4-month period. Forty-eight employees were interviewed and data describing 46 exposure events were obtained covering a 12-month period. In all, 10 incidents were identified as significant exposure events, with 5 events (11% of total) at 5 different factories (31% of sites inspected) involving 8 workers (17% of workers interviewed) being definite breaches of statutory accident reporting requirements. The survey revealed a failure by employers to notify significant toxic exposure events due to reluctance or ignorance and or lack of clarity of occupational health and safety regulations. It also revealed that substantial numbers of workers are exposed to incidents involving poisonous materials, and that with this nonnotification, regulatory agencies are largely unaware of their magnitude.

Australia↗
PubMed1993

Renal functions in obstructive jaundice: a pre and post operative assessment.

Surgery in patients with surgical obstructive jaundice is known to be associated with increased risk of post-operative acute renal failure. A prospective study was carried out to evaluate the renal function in patients with obstructive jaundice. Renal functions of thirty two patients with jaundice secondary to mechanical obstruction of the biliary tract were evaluated pre-operatively and 7 days after surgical biliary decompression. Although no significant difference was seen in the mean values of pre and post operative renal function variables, two patients had overt renal failure, one with pre-operative cholangitis and acute tubular necrosis and another with carcinoma of the pancreas and postoperative acute renal failure. The overall satisfactory outcome in our obstructive jaundice patients may be related to pre-operative and intraoperative preparation with intravenous fluids and mannitol. It is concluded that patients with obstructive jaundice can be satisfactorily treated with special preoperative care including good hydration and mannitol therapy during anaesthesia and surgery.

Acute Kidney Injury↗
PubMed1992

Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial.

A prospective randomized double-blind study was conducted to evaluate the efficacy of sodium benzoate in the treatment of acute portal-systemic encephalopathy. Seventy-four consecutive patients with cirrhosis or surgical portasystemic anastomosis and hepatic encephalopathy of less than 7 days duration were randomized to receive lactulose (dose adjusted for 2 or 3 semiformed stools/day) or sodium benzoate (5 gm twice daily). Assessment of response included mental status, asterixis, arterial ammonia level, electroencephalogram and number-connection test. Each was given a score between 0 and 4+. A portal-systemic encephalopathy index was calculated with these scores. Visual, auditory and somatosensory evoked potentials and a battery of psychometric tests for intelligence and memory were also performed to assess improvement. Thirty-eight patients received sodium benzoate; 36 took lactulose. Thirty patients (80%) receiving sodium benzoate and 29 (81%) receiving lactulose recovered; the remaining patients died. Improvement in portal-systemic encephalopathy parameters occurred in both treatment groups and was similar (p greater than 0.1). Electroencephalogram and evoked potentials were not as helpful as mental status in assessing of recovery. Psychometric test scores remained abnormal after recovery of mental status (21 to 42 days) and were probably too sensitive for monitoring of these patients. The incidence of side effects was similar in the two treatment groups. The cost of lactulose for one course of therapy was 30 times that of sodium benzoate. We conclude that sodium benzoate is a safe and effective alternative to lactulose in the treatment of acute portasystemic encephalopathy.

Acute Disease↗
PubMed1992

Gastrointestinal endoscope disinfection practices in India: results of a national survey.

A questionnaire was sent to 435 endoscopy centers in the country to obtain information regarding current endoscopic disinfection practices. Of these, 133 (30.6%) centers responded. Adequate disinfection (a minimum exposure to 1% glutaraldehyde for 2 minutes) before the start of endoscopy sessions and between procedures was practised in 61 (46%) and 45 (34%) centers respectively. The proportion of centers practising adequate disinfection was similar among those performing < 1500 and > 1500 endoscopies/year (50% vs 36%; p = ns). Twenty two (17%) centers used some additional precautions in patients with hepatitis B virus infection or immunocompromised states. Two (1.5%) of the 133 centers performing upper GI endoscopies and eight (18%) of the 44 centers performing ERCP examinations reported occurrence of infections following these procedures. Allergic reactions to disinfectants were reported by five (4%) centers. We conclude that only about a third of the gastroenterology centers in the country are practising adequate endoscope disinfection routinely.

Cross Infection↗
PubMed1992

A study of Helicobacter pylori in north Indian subjects with non-ulcer dyspepsia.

A prospective case control study was conducted in 50 patients with non-ulcer dyspepsia (NUD) and 10 age and sex matched controls to determine the prevalence of Helicobacter pylori in patients with NUD and to correlate symptoms, histology and presence of H pylori in gastric biopsies. Endoscopic biopsies from antrum and fundus were subjected to urease test and histological examination. On histology, H pylori was identified in 27 (54%) NUD patients and in one of 10 controls. Urease test was positive in 31 (62%) antral and 21 (42%) fundal biopsies in patients with NUD and in only one (10%) of 10 antral biopsies in the control group. On histology, gastritis was present in the antrum in 46 (92%) NUD patients and in the fundus in 40 (80%) cases; of these, 27 (54%) and 15 (30%) had H pylori in antral and fundal biopsies respectively. The severity of antral gastritis correlated with the density of H pylori (p < 0.05).

Adolescent↗
PubMed1992

A prospective randomized study of the injurious effects of aspirin and naproxen on the gastroduodenal mucosa in patients with rheumatoid arthritis.

A prospective double-blind randomized placebo-controlled study was conducted to compare the injurious effects of aspirin and naproxen on the gastroduodenal mucosa. Patients with rheumatoid arthritis attending the immunology clinic of a tertiary care center were included in the study. Ninety consecutive patients were randomized to receive aspirin, naproxen, or placebo. Clinical evaluation was done every 2 wk. Upper gastrointestinal endoscopy, biopsies from the gastric antrum and duodenum for histological examination, and Helicobacter pylori studies were done at entry and after 2 months. The number of patients with dyspeptic symptoms was similar in the aspirin (12) and naproxen (9) groups. In both cases, however, it was higher (p less than 0.01) than in the placebo group (none). Naproxen was associated with a higher score of endoscopic abnormalities in the gastric body (0.6 +/- 1.3) than aspirin (0.2 +/- 0.6) or placebo (0.03 +/- 0.18). H. pylori was present in a similar proportion of patients in the three groups (33-43%). A greater fall in hemoglobin was observed with aspirin (0.35 +/- 0.48 g%) and naproxen (0.44 +/- 0.53 g%) than with placebo (0.09 +/- 0.4 g%). The present study suggests that aspirin and naproxen produce a similar degree of injury to the gastroduodenal mucosa.

Adult↗
PubMed1991

Treating bleeding peptic ulcer with sustained achlorhydria.

A controlled randomized study and a subsequent prospective therapeutic trial have demonstrated the efficacy of an intensive therapy comprising hourly intravenous injections of 100 mg of cimetidine along with a continuous nasogastric infusion of a liquid antacid at the rate of 0.5 ml per minute in achieving achlorhydria and controlling bleeding in patients with bleeding peptic ulcer. We recommend that this regimen should be routinely employed for treating patients with bleeding peptic ulcer, at least in center that do not practise topical therapeutic modalities for control of bleeding.

Adult↗
PubMed1991

The role of sustained achlorhydria in bleeding peptic ulcer.

Twenty-five patients with bleeding peptic ulcers were randomized to receive either ranitidine 50 mg 8 hourly i.v. (control group) or a continuous nasogastric antacid infusion at the rate of 0.5 ml/min along with an i.v. injection of cimetidine 100 mg/h (treatment group). Twelve patients were included in the control group and 13 in the treatment group. The mean gastric pH on therapy was significantly higher in the treatment group (7.88 +/- 0.37) than in the control group (5.00 +/- 0.55) (p less than 0.001), and the gastric pH was noted to be greater than 7 on 95% of the occasions in the treatment group and on 8.6% of the occasions in the control group. An overall control of bleeding was achieved in 92.3% of the patients in the treatment group and 50% of the patients in the control group (p less than .05). Thus, the failure of therapy was significantly more common in the control group than in the treatment group (p less than 0.05), and more patients of the control group had to undergo emergency surgery than that in the treatment group. None of the patients in the treatment group, but 16.6% of the patients in the control group, died during the study period in the hospital stay. We conclude that in patients with bleeding peptic ulcer an intensive medical therapy comprising hourly injections of cimetidine (or presumably of other H2 blockers) and continuous nasogastric antacid infusion can achieve sustained achlorhydria, better control of bleeding, and reduce the need for emergency surgery.

Adult↗