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Biomedical subjects

R K Tandon

Publications and source records attributed to R K Tandon.

At least 91 records · Page 5Linked to original sources
PubMed1991

Normal endoscopic pancreatogram in an Indian referral hospital.

A total of 101 normal pancreatograms were analysed in a major referral hospital in India in an attempt to establish normal standards of pancreatic ductal morphology in Indian population. Ductal position, course, caliber, length and variations of anatomy were analysed. Most often (39%) ampulla was seen at the level of second lumbar vertebra, commonly (54%) within 30-39 mm from the lateral margin of right side of corresponding vertebral body. Most common ductal course (21.78%) was ascending-horizontal-horizontal type. Mean ductal diameters in the head, body and tail of the pancreas were 2.63, 1.95, 0.99 mm in individuals aged less than or equal to 40 yr and 3.31, 2.34, 1.23 mm in those greater than 40 yr, respectively. A significant (r = 0.46; P less than 0.001) increase in ductal size was seen between less than or equal to 40 yr and after 40 yr of age. Mean ductal length was 16.10 and 16.58 cm in subjects less than or equal to 40 yr of age and greater than 40 yr respectively. Duct of Santorini was visualised in 6.6 per cent subjects.

Adolescent↗
PubMed1991

Pneumatic dilatation is a satisfactory first-line treatment for achalasia.

The results of 124 pneumatic dilatations done in 92 patients with achalasia cardia were assessed. Relief of dysphagia and other symptoms was obtained in 90 (97.8%) patients--in 68 (73.9%) after one dilatation, in 16 (17.8%) after two dilatations and in six (6.5%) after three dilatations. Two patients who did not obtain relief after three sittings of dilatation underwent surgery and both became totally asymptomatic thereafter. Most of the patients successfully treated with pneumatic dilatation remained asymptomatic during a follow up of 6 months--5 years. The few who did become symptomatic (8.01%) within a year after pneumatic dilatation responded well to the same procedure when repeated. Immediate and late complications of pneumatic dilatation occurred in 3.3% and 4.35% of patients respectively and were all medically manageable. In our assessment, pneumatic dilatation is a simple, quick, safe and effective method for treating achalasia. It should be used as the primary mode of treatment and surgery should be offered only to those patients who fail to respond to at least three attempts at pneumatic dilatation.

Adolescent↗
PubMed1991

Congenital biliary cysts in Indian adults.

Only one report of congenital biliary cysts has been described so far from India, and that was in children. We present our experience with 22 adult Indian patients with this condition. The main presenting symptoms were abdominal pain, icterus, and fever, and the classical triad of jaundice, pain, and abdominal mass was seen in only one patient. The mean age of presentation was 25.5 +/- 10.1 yr, and females predominated (82%). Type Ia cysts (fusiform choledochal cyst) were the commonest. Intrahepatic cysts were seen in four patients; three of these were associated with extrahepatic biliary ductal cysts (type IVa). Internal drainage procedures performed elsewhere in six patients were followed by recurrent cholangitis, necessitating excision of the cyst. Hence, the preferred operation for congenital biliary cysts is cyst excision and hepaticojejunostomy.

Adolescent↗
PubMed1990

Is solitary rectal ulcer a manifestation of a systemic disease?

In a prospective study of 22 patients with solitary rectal ulcer, we tried to define the features of this condition, especially the associated systemic features, that may give some clues to its etiopathogenesis. In 15 of these patients a single rectal ulcer was found, whereas in seven patients two ulcers were present in each. Of the total 29 ulcers in these patients, 19 were located on the anterior or anterolateral wall of the rectum and 10 were on the posterior or posterolateral wall. The sigmoidoscopic appearance of the ulcer was quite characteristic, yet a biopsy was considered essential to rule out other pathologic processes. Histological features of the solitary rectal ulcer comprised fibrous obliteration of the lamina propria with disorientation of the muscularis mucosa and extension of muscle fibers into the lamina propria. Evident rectal prolapse was present in only three patients. Recurrent oral ulcerations occurred in four (18.2%) patients and erythema nodosum in one of them (4.5%). Sacroiliitis was present in six of 19 (31%) patients studied radiologically, and human leukocyte antigen (HLA)-B27 occurred in four of the 20 patients (20%) tested for HLA class I antigens. All the four HLA-B27-positive patients had associated sacroiliitis and showed good response to sulfasalazine. These associations raise the possibility that solitary rectal ulcers may be a part of a systemic disease or of several diseases with varied etiology.

Adolescent↗
PubMed1990

Thoracic stomach: comparative evaluation of endoscopy, gastric aspirate analysis and hepatobiliary scintigraphy in the diagnosis of duodeno-gastric reflux.

Twenty patients with thoracic stomach were subjected to hepatobiliary scintigraphy for the diagnosis of duodenogastric reflux. The results of the radionuclide studies were correlated with those of endoscopy and biochemical estimation of total intragastric bile acid. Hepatobiliary scintigraphy was found to be more sensitive (91.6%) and accurate (95%) than endoscopy (25% and 55% respectively) and biochemical estimation of total intragastric bile acid content (66.6% and 80% respectively). Being noninvasive and physiological, radionuclide study appears suitable for routine clinical use in the diagnosis of duodeno-gastric reflux.

Adolescent↗
PubMed1990

Caroli's syndrome: a heterogeneous entity.

We report our experience with nine adult patients (six females, three males) with Caroli's syndrome. Most of these patients were young (mean age 27.0 yr), and had presented at a mean interval of 12.1 yr after the onset of symptoms. Recurrent abdominal pain was the most common symptom, present in eight of nine patients. Mild jaundice (serum bilirubin 1.8-4.2 mg/dl) and raised serum alkaline phosphatase (18-36 King-Armstrong units) were the only other significant findings. Ultrasound proved to be a good screening test. However, the diagnosis was confirmed on cholangiography. Six of nine patients had associated extrahepatic biliary cysts (type IVa). The operative management was directed mainly at excising the extrahepatic cysts and draining the biliary tree, and was met with satisfactory results.

Abdominal Pain↗
PubMed1990

Management of retained common bile duct stones in patients with T-tube in situ: role of endoscopic sphincterotomy.

Retained common bile duct stones in postcholecystectomy patients who have a T-tube in situ should be treated, preferably, by nonoperative means. Thus, we treated seven such patients with common bile duct perfusion (through T-tube) of methyl tertiary butyl ether, and 10 patients with perfusion of monooctanoin. However, successful dissolution was achieved in only one and three patients, respectively. Hence, endoscopic sphincterotomy (ES) was performed in the patients in whom solvent perfusion had failed, and in other subsequent patients with T-tube in situ. Of 28 patients thus treated, bile duct clearance could be achieved in 27 (96.5%) patients; minor bleeding occurred in only three patients. After sphincterotomy, the stones passed out spontaneously in 20 patients while the T-tube was still in situ, but in two patients, only after the T-tube was removed. Similarly, basketing of the stones could be done in four patients with the T-tube in position, but in one patient whose ductal stones were above the T-tube, the tube had to be removed to make basketing successful. Endoscopic sphincterotomy is an efficient method of treating retained common bile duct stones in patients with T-tube in situ. However, in those patients whose ductal stones are above or astride the T-tube, the T-tube may have to be removed to attain bile duct clearance.

Adolescent↗
PubMed1989

Primary sclerosing cholangitis in India.

Six patients with PSC have been diagnosed and followed up at a centre in Northern India for periods up to 4 years. They all presented with cholestatic jaundice and cholangitis, but one of them subsequently presented with variceal haemorrhage. Cholangiographic features were the most characteristic and included irregular narrowing and segmental dilatation of the biliary radicles giving them a beaded appearance. Treating them was most frustrating. Two of them died of hepatic encephalopathy, others have also continued to be sick during the follow-up.

Adrenal Cortex Hormones↗
PubMed1989

Gall bladder and common bile duct stones--when is direct cholangiography indicated.

The medical records of 277 consecutive patients who underwent cholecystectomy for benign gall stone disease, were reviewed to determine the incidence and cause of biliary tract obstruction. Obstructive jaundice (icteric obstructive biliopathy) was present in 38 cases. This was due to choledocholithiasis in 22. Mirizzi's Syndrome in two, biliobiliary fistula in eight and biliary stricture in five patients. Preoperative direct cholangiography (ERCP/PIC) was helpful. Anicteric patients were classified on the basis of a history of jaundice serum alkaline phosphatase, sonography and operative findings. Anicteric patients with evidence of biliary tract pathology (anicteric obstructive biliopathy) had a significant incidence of choledocholithiasis (33.3%). Biliary complications were uncommon in this group (4.3%). Peroperative cholangiography was carried out and was valuable in these patients but was normal in all 83 patients who had no evidence of biliary obstruction.

Cholangiography↗
PubMed1989

Poor response to long-term albendazole therapy of hydatid liver cysts.

Seven patients with uncomplicated hepatic hydatid cysts (Echinococcus granulosus) were treated with albendazole 10 mg/kg/day for 2-6 months (mean 4 months). Serial sonographic evaluation showed reduction in cyst size in only 1 patient (the anteroposterior diameter decreased from 16.5 cm to 4.9 cm). Therapy in this patient was discontinued after 4 months due to development of jaundice. Albendazole appears to have a limited role in the treatment of hydatid disease of the liver.

Adult↗
PubMed1989

Radiologic approach to choledochal cysts.

Choledochal cysts, being uncommon and having a nonspecific presentation, require a high index of suspicion for their diagnosis. In this series of 11 patients, the correct diagnosis was established in all using a combination of real-time ultrasound (US) scanning (9 positive) and endoscopic retrograde cholangiopancreatography (ERCP; 10 positive). Real-time US is suitable as the initial imaging modality and ERCP is complementary.

Adolescent↗
PubMed1989

Duodenoscopic sphincterotomy in a northern Indian hospital.

In a 36-month period, 154 duodenoscopic sphincterotomies (DS) were performed on 120 patients in a Northern Indian hospital. The major indication for DS was choledocholithiasis (95.8%), the rest being done for indications like papillary stenosis, periampullary carcinoma and the sump syndrome. Seven patients (5.8%) had significant associated medical illnesses. An adequate sphincterotomy was achieved in 91.6% of patients, with successful stone extraction in 95.3% of them. Overall clearance of the common bile duct (CBD) was thus achieved in 87.5% of the patients subjected to DS. Two patients (1.7%) died after undergoing DS, and six (5%) experienced early complications that necessitated emergency operation in two of them (1.7%). DS appears to be the treatment of choice for the management of choledocholithiasis in the postcholecystectomy patient as well as in the patient with gallbladder in situ who has cholangitis or jaundice or associated medical illness that may constitute a high risk for surgery.

Cholangiopancreatography, Endoscopic Retrograde↗