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Biomedical subjects

R K Tandon

Publications and source records attributed to R K Tandon.

At least 109 records · Page 6Linked to original sources
PubMed1988

Common bile duct obstruction by portal cavernoma.

Obstructive jaundice occurring in a patient with portal hypertension is a rare association. In this report, a 24-year-old patient is described who had biliary obstruction due to a portal cavernoma compressing the common bile duct and in whom surgical decompression of the portal system resulted in relief of the biliary obstruction, thus proving that the dilated portal vein collaterals were compressing the biliary tract and producing jaundice. Although biliary obstruction due to a portal cavernoma has been described earlier, this is, to the best of our knowledge, the first case described in which improvement followed shunt surgery.

Adult↗
PubMed1988

Spontaneous massive gastrointestinal hemorrhage in patients with pancreatitis.

Spontaneous massive gastrointestinal hemorrhage occurring in patients with pancreatitis is an uncommon and difficult clinical problem, especially in a tropical third world country where the underlying causes of pancreatitis and facilities for its diagnosis and management are different from those in the developed West. Of 7 such cases seen by us in 3 years, 2 were due to hemosuccus pancreaticus, 2 were due to gastric variceal hemorrhage consequent to splenic vein obstruction, and one each due to contiguous pancreatic inflammation involving the duodenum, an aneurysmal bleed from the left gastric artery and a pseudocyst rupturing into the transverse colon. A fiberoptic endoscopic examination was helpful in all the 7 cases and delineated the cause of bleeding, whereas angiography, performed in 4 patients contributed little to management. The mortality rate was 14%. It is suggested that a timely endoscopic examination during active bleeding, which may be repeated if necessary, is extremely rewarding in the diagnosis and management of such patients and often obviates the necessity of angiography which is a time-consuming and cumbersome investigation in a critically ill patient and facilities for which are usually not available in most third world country hospitals.

Adult↗
PubMed1988

Chronic calcific pancreatitis: clinical profile in northern India.

Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.

Adolescent↗
PubMed1988

Biliobiliary fistula: review of nine cases.

We have reviewed nine cases of biliobiliary fistula operated during 1983-85. Two of these patients also had a high hepatic duct stricture, an association not highlighted before. Eight of these patients had jaundice. A classical cholecystectomy in the presence of biliobiliary fistula entails grave risk to the integrity of the upper biliary tract. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography can detect these rare fistulae. It is proposed that all patients with cholelithiasis associated with jaundice be screened by sonography for evidence of biliobiliary fistula. They should then have an ERCP to detect and delineate the biliobiliary fistula. At surgery, all of these patients have a fused gall bladder with obliteration of the Calot's triangle. Both retrograde and antegrade cholecystectomy is hazardous in these cases. Instead, the gall bladder should be opened inferiorly and evacuated of all stones, followed by a partial cholecystectomy and common hepatic duct repair over a T-tube. In the presence of an associated high or low biliary stricture, a suitable bilioenteric anastomosis may be required.

Adult↗
PubMed1987

Biliary lipid composition in patients with non-cirrhotic portal fibrosis--a comparison with compensated cirrhosis of the liver.

Patients with non-cirrhotic portal fibrosis (NCPF) are known to have mild hepatic functional abnormalities. To study the biliary lipid composition in these patients, duodenal bile was collected from 18 patients with NCPF, 15 patients with non-alcoholic compensated cirrhosis of the liver and 18 matched, non-obese, healthy control subjects. There were no significant differences in the mean (+/- SD) concentrations of cholesterol, phospholipids and bile acids in patients with NCPF and healthy controls. On the other hand, patients with cirrhosis had significantly lower concentrations of all the three biliary lipids as compared with the NCPF patients and controls (p less than 0.05). The cholesterol solubilizing capacity of the bile was the same in NCPF patients, cirrhotics and controls. It is concluded that the relative proportions of the three biliary lipids remain unchanged in patients with NCPF despite mild hepatic derangement.

Adolescent↗
PubMed1986

Toxic and genotoxic action of electric-arc welding fumes on cultured mammalian cells.

Welding fumes generated by manual metal arc welding (MMAW) with an automatic welding machine were extracted with water and both the soluble and insoluble fractions were investigated for mitotic delay and for sister chromatid exchange (SCE) induction in cultured Chinese hamster lung (Don) cells. Five flux-coated electrodes of varying composition were chosen as representative of those available. In general, water-soluble and water-insoluble fractions induced SCE in proportion to their chromium(VI) content, and any contribution from chromium(III), fluorides, nickel, manganese or other fume constituents was minor. However, mitotic delay could not be explained in terms of the chromium(VI) concentration alone. This indicated that other components of both the soluble and insoluble fractions of the fumes were capable of inducing mitotic delay. The activity of insoluble fume fractions, either in mitotic delay- or in SCE-induction, was markedly less than that of soluble fractions. This was presumably because of the lower, though still significant, bioavailability of 'insoluble' components of the fume particles.

Air Pollutants, Occupational↗
PubMed1986

Cholesterol and pigment gallstones in northern India. A prospective analysis.

Two hundred one consecutive patients with gallstone disease who had undergone cholecystectomy were analyzed to determine the relative frequency of occurrence of cholesterol and pigment gallstones and to identify distinguishing features of the two stone types. Cholesterol stones (CS) formed the majority (94%) of gallstones. There were no distinctive clinical, biochemical, or radiological features of CS or pigment stones (PS). However, CS were found significantly more often than PS (P less than 0.05) in multiparous women leading a sedentary life-style. Although multiplicity of gallstones was somewhat commoner with CS (P less than 0.05) and radiopacity with PS (P less than 0.05) as compared with the other stone type, these differences were certainly not discriminatory between CS and PS.

Adult↗