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Biomedical subjects

S K Mathur

Publications and source records attributed to S K Mathur.

At least 19 recordsLinked to original sources
PubMed2000

Extra-hepatic biliary-ductal necrosis in acute pancreatitis: a rare complication.

An 8-year-old male presented with an acute abdomen. Exploration revealed bilious ascites, oedematous pancreatitis with areas of necrosis, and omentum showing patches of fat necrosis. The common bile duct and almost all of the common hepatic duct were gangrenous and had sloughed, with bile leaking from the junctional stump of the right and left hepatic ducts. The patient was managed successfully by Roux-en-Y hepaticojejunostomy. This is a rare case showing necrosis and sloughing of the extrahepatic bile ducts in acute pancreatitis.

Acute Disease↗
PubMed2000

Role of biliary scintiscan in predicting the need for cholangiography.

BACKGROUND: Currently used predictors for bile duct calculi in patients undergoing cholecystectomy have low specificity resulting in unnecessary cholangiograms being performed. The role of biliary scintiscan in predicting the presence of bile duct calculi was assessed. METHODS: Seventy-five patients with symptomatic gallstone disease were studied prospectively regard- ing the value of a history of jaundice or acute pancreatitis, raised serum bilirubin and serum alkaline phosphatase levels, and visualization of stones or presence of dilated bile ducts on ultrasonography (standard criteria) in detecting bile duct calculi. Results of biliary scintiscan were evaluated against a combination of standard criteria. The 'gold standard' for evaluation was endoscopic or peroperative cholangiography. RESULTS: Biliary scintiscan had a higher sensitivity and specificity (93 and 94 per cent) than a combination of the above standard and modified predictors for biliary calculi (89 and 71 per cent). A combination of ultrasonography and selective use of scintiscan, in the absence of bile duct dilatation only, had higher values (96 and 98 per cent). CONCLUSION: A combination of ultrasonography and biliary scintiscan can accurately predict bile duct calculi and could be used as a guide for selective cholangiography.

Acute Disease↗
PubMed1999

Transabdominal extensive esophagogastric devascularization with gastroesophageal stapling for management of noncirrhotic portal hypertension: long-term results.

Outside Japan portosystemic shunts have been favored as the surgical procedure of choice for the management of portal hypertension of noncirrhotic etiology. Devascularization procedures have resulted in high rebleed rates probably owing to a limited extent of devascularization. We performed this study to assess the efficacy of our modification of Sugiura's procedure for long-term control of variceal bleeding in patients with noncirrhotic portal hypertension. Forty-six patients with extrahepatic portal venous obstruction (EHPVO) and 22 with noncirrhotic portal fibrosis (NCPF) were subjected to transabdominal extensive esophagogastric devascularization with esophageal or gastric stapled transection (modified Sugiura's procedure), 38 in an emergency situation and 30 electively. Follow-up endoscopies were performed every 6 months. Operative mortality, morbidity, variceal status, and causes of recurrent bleeding were evaluated. The postoperative mortality was 4%. Early procedure-related complications were seen in 6%, and esophageal strictures formed in 7 of 45 survivors undergoing esophageal transection (15%). Over a mean +/- SD follow-up of 53 +/- 34 months, 95% of patients were free of varices. Seven survivors (11%) had a rebleed, but only 5% were due to varices (two esophageal, one gastric). Six (9%) patients developed gastropathy. The 5-year survival was 88%. The modified Sugiura's procedure is safe and effective for long-term control of variceal bleeding especially in the emergency setting and in patients with anatomy unsuitable for shunt surgery or if surgical expertise for a shunt operation is not available.

Adolescent↗
PubMed1999

Incidence and fate of antral varices.

OBJECTIVE: To study the incidence of antral varices (AV) and their fate in patients with portal hypertension so as to formulate a management policy. DESIGN: Prospective cohort study. SETTING: Single surgical unit specializing in portal hypertension management in a tertiary level centre. PARTICIPANTS: Three hundred and seventy-one patients [cirrhosis 170, non-cirrhotic portal fibrosis (NCPF) 53, extrahepatic portal venous obstruction (EHPVO) 148] with history of bleeding from oesophageal varices were inducted in the chronic sclerotherapy programme. INTERVENTIONS: Protocol-based endoscopic sclerotherapy and management of bleeding for oesophageal varices. OUTCOME MEASURES: Development or disappearance of AV, bleeding from AV. RESULTS: No patient had AV on index endoscopy. Thirteen (3.5%) patients developed AV, in cirrhosis 2.9%, EHPVO 4.1%, NCPF 3.8% (P = 0.86). AV developed after a mean of 15 months. Oesophageal varices took a longer number of sessions to obliterate in patients with AV (11.1 vs 5.98 sessions, P<0.0001). Only one patient bled, having coexistent oesophageal varices and gastropathy. AV disappeared spontaneously in seven patients, recurring in only one. Of seven persisting AV, none have bled over a mean follow-up of 30 months (SD 23.2). CONCLUSIONS: AV are seen in a small proportion of patients, and are distributed equally amongst the aetiologies of portal hypertension. They rarely bleed and may be ignored during sclerotherapy of oesophageal varices.

Cohort Studies↗
PubMed1999

Results of a modified sugiura's devascularisation in the management of "unshuntable" portal hypertension.

The results of a modified Sugiura devascularisation procedure were assessed in 14 patients with thrombosis of the portal and splenic vein requiring surgery for variceal hemorrhage, with no vein suitable for orthodox shunt surgery. The venous anatomy was determined by ultrasonography with Doppler studies and portovenography. Liver biochemistry as well as liver architecture on histopathology was normal in all. The surgery was elective in 9 cases for documented bleed from diffuse fundal gastric varices (FGV) and emergency in 5 cases, 3 having bleeding FGV and 2 for failure of emergency esophageal variceal sclerotherapy. All were subjected to a transabdominal extensive devascularisation of the upper two third of the stomach and lower 7-10cm of the esophagus. Stapled esophageal transection (n = 11) or esophageal variceal underrunning (n = 1) was performed in all with esophageal varices. FGV were underrun. Follow up endoscopies were done six monthly. There were 9 males and 5 females with a mean age of 17.2 years (SD 12.8). There was no operative mortality. Acute variceal bleeding was controlled in all patients. Over a mean follow up of 38 months, all but one remain free of recurrent bleeding. We conclude that a modified Sugiura devascularisation procedure is effective in the immediate and medium term control of variceal bleeding in patients with "unshuntable" portal hypertension.

Adolescent↗
PubMed1998

Heat shock response and protein degradation: regulation of HSF2 by the ubiquitin-proteasome pathway.

Mammalian cells coexpress a family of heat shock factors (HSFs) whose activities are regulated by diverse stress conditions to coordinate the inducible expression of heat shock genes. Distinct from HSF1, which is expressed ubiquitously and activated by heat shock and other stresses that result in the appearance of nonnative proteins, the stress signal for HSF2 has not been identified. HSF2 activity has been associated with development and differentiation, and the activation properties of HSF2 have been characterized in hemin-treated human K562 erythroleukemia cells. Here, we demonstrate that a stress signal for HSF2 activation occurs when the ubiquitin-proteasome pathway is inhibited. HSF2 DNA-binding activity is induced upon exposure of mammalian cells to the proteasome inhibitors hemin, MG132, and lactacystin, and in the mouse ts85 cell line, which carries a temperature sensitivity mutation in the ubiquitin-activating enzyme (E1) upon shift to the nonpermissive temperature. HSF2 is labile, and its activation requires both continued protein synthesis and reduced degradation. The downstream effect of HSF2 activation by proteasome inhibitors is the induction of the same set of heat shock genes that are induced during heat shock by HSF1, thus revealing that HSF2 affords the cell with a novel heat shock gene-regulatory mechanism to respond to changes in the protein-degradative machinery.

Animals↗
PubMed1998

Percutaneous pigtail catheter drainage of pancreatic pseudocysts.

AIM: To evaluate the efficacy of percutaneous pigtail catheter drainage (PCD) in the management of pancreatic pseudocysts otherwise meriting surgical intervention. METHODS: Fourteen consecutive patients with pancreatic pseudocysts (five following acute pancreatitis and nine with chronic pancreatitis) were subjected to PCD. For uncomplicated chronic pseudocysts, an algorithm using endoscopic retrograde pancreaticography to demonstrate ductal communication with obstruction was followed. Five patients had complicated pseudocysts and nine uncomplicated cysts persisting > 6 weeks and > 6 cm in size. RESULTS: All uncomplicated and two complicated pseudocysts resolved in 6-58 days (mean 19.7). No recurrences were seen. Three patients with complicated cysts had pancreatic fistulae; two of these were treated by surgery and one by pancreatic stenting. Sepsis required sump drainage in two patients. Four patients required early surgery: two for pancreatic fistula and one each for hemorrhage and residual cyst. Two patients were subjected later to pancreatico-jejunostomy for pain of chronic pancreatitis. CONCLUSIONS: Patients with acute pseudocysts and uncomplicated noncommunicating chronic pseudocysts respond to PCD. In complicated chronic pseudocysts, sepsis may be controlled by PCD.

Acute Disease↗
PubMed1997

Transabdominal extensive oesophagogastric devascularization with gastro-oesophageal stapling in the management of acute variceal bleeding.

BACKGROUND: Operation is required for patients with portal hypertension who have failed to respond to emergency sclerotherapy for control of acute variceal bleeding. This study evaluates the role of transabdominal extensive oesophagogastric devascularization combined with gastro-oesophageal stapling for control of acute variceal bleeding in patients with portal hypertension of different aetiologies. METHODS: Transabdominal extensive oesophagogastric devascularization combined with gastrooesophageal stapling was performed in 65 patients (28 with cirrhosis, 17 with non-cirrhotic portal fibrosis and 20 with extrahepatic portal venous obstruction) in whom emergency endoscopic sclerotherapy, and/or pharmacotherapy and balloon tamponade had failed. The Sugiura procedure was modified to minimize operating time and to reduce the operative difficulties due to oesophageal wall necrosis after sclerotherapy. RESULTS: The operative mortality rate was higher in patients with cirrhosis (P = 0.0003); sepsis was the leading cause of death (in nine of 18). A high mortality rate (12 of 15) was seen in patients with Child grade C cirrhosis. Control of bleeding was achieved in all patients. The procedure-related complication rate was 17 per cent with a 6 per cent oesophageal leak rate; four of 47 surviving patients developed oesophageal stricture. During a mean follow-up of 33 months, residual varices, recurrent varices and rebleeding were seen in three, two and three of 47 survivors. CONCLUSION: Transabdominal extensive oesophagogastric devascularization combined with gastrooesophageal stapling is an effective and safe procedure for control of acute variceal haemorrhage with satisfactory long-term control, especially in patients without cirrhosis and low-risk patients with cirrhosis.

Acute Disease↗
PubMed1996

Regulatory differences in the stress response of hippocampal neurons and glial cells after heat shock.

During periods of stress, cells depend on a transient, highly conserved, and regulated response to maintain homeostasis. This "heat shock response" is mediated transcriptionally by a multigene family of heat shock factors (HSF). The presence of multiple HSF suggests that activation of a given HSF is stress-specific. Using Western blot analysis, we have demonstrated the inability of primary cultured rat hippocampal neurons to induce a heat shock response after hyperthermia. In contrast, secondary cultured rat glial cells demonstrated a robust response. Examination of whole-cell extracts from the two cell types with gel shift mobility analysis and Western blot analysis revealed that although glial cells express HSF1 and HSF2, hippocampal neurons only express HSF2. Incubation of whole-cell extracts with monoclonal antisera raised against HSF1 and HSF2 before gel shift mobility analysis demonstrated HSF1 DNA-binding activity in glial cells and HSF2 DNA-binding activity in neurons. HSF1 has been shown to be the principal mediator of heat-induced heat shock gene expression. These results suggest that the deficient heat shock response of hippocampal neurons at this developmental stage is attributable to a lack of HSF1 expression. Furthermore, these results suggest that considerations of selective neuronal vulnerability to environmental stress should include the principal mediators of the stress response, the HSF.

Animals↗
PubMed1996

Cementless total knee arthroplasty in obese patients. A comparison with a matched control group.

The heaviest 45 patients (50 knees) who underwent cementless total knee arthroplasty were compared with a matched control group of 45 total knee arthroplasty patients (50 knees) with respect to clinical and radiographic data. Surgery was performed over a 10-year period (1980-1989) and follow-up evaluation averaged 7 years (range, 2-11 years). The control group consisted of nonobese patients matched to the obese group with respect to age, sex, diagnosis, preoperative deformity, and length of follow-up evaluation. Clinical evaluation was made using the Knee Society rating scale as well as an analysis of multiple other clinical parameters. Radiographically, each patient was evaluated with long-standing anteroposterior views, lateral and patellar views, and spot fluoroscopic views of the involved knee. This evaluation included an analysis of lucencies, bead shedding, and prosthetic alignment. The final average clinical score in the obese group was 88 points with four revisions, and that for the control group was 91 points with two revisions. There were no significant differences in the combined percentage of good and excellent results between the two groups. On the basis of the results of this study, it is believed that weight as a factor by itself should not compromise the early (7-year average follow-up period) results of total knee arthroplasty.

Adult↗
PubMed1996

Intraoperative custom press-fit and standard press-fit femoral components in total hip arthroplasty. A comparison of surgery, charges, and early complications.

A consecutive group of 60 patients who had intraoperative custom press-fit total hip arthroplasties (67 hips; Identifit, Thackray, London, United Kingdom) was compared with a similar group of 60 patients who had standard press-fit arthroplasties (66 hips; McCutchen, Wright Medical Technologies, Arlington, Tennessee) to determine if there were differences in operative time and charges, as well as early complications and early radiographic results. The unilateral intraoperative custom group had an average anesthesia time of 3 hours, 39 minutes, an operating time of 2 hours and 26 minutes, and a blood loss of 725 mL. The averages for the standard group included an anesthesia time of 2 hours, 19 minutes, a surgical time of 1 hour, 25 minutes, and a blood loss of 480 mL. By 6 months after surgery, 49 (73%) in the custom group had subsidence of 2 mm or more, compared with 10 hips (15%) in the standard group. The custom group had 17 early postoperative complications versus 3 in the standard group. The charge for the hospital stay averaged $19,950 for the custom group and $14,322 for the standard group. At the present time, the high incidence of complications and the increased charges make the intraoperative custom hip replacement an unlikely first choice of recommendation.

Adult↗
PubMed1996

Percutaneous sump drainage of pancreatic abscess.

Pigtail drainage often falls to drain thick, infected collections. Percutaneous wide-bore sump drainage has been successfully used in such cases. We report one such case of pancreatic abscess which was successfully managed using an indigenously made percutaneous sump drain.

Abscess↗
PubMed1995

Effect of nitrendipine, nimodipine and nisoldipine on experimentally induced myocardial infarction in rats.

Cardiac necrosis was produced in rats by administering isoproterenol sulphate (85 mg/kg, sc for 4 days). The myocardial damage was proved by observing the elevated levels of serum aspartate aminotransferase, ++alanine aminotransferase and lactate dehydrogenase and the changes were confirmed by his topathology. Nitrendipine, nimodipine and nisoldipine (10 mg/kg, ip) significantly reduced the elevated levels of these enzymes. The average degree of cardiac necrosis in these rats when observed microscopically and histologically was also found to be significantly reduced on pretreatment with these drugs. Nisoldipine was more effective in preventing cardiac necrosis as compared to nitrendipine and nimodipine.

Animals↗
PubMed1995

Protection of CCL4-induced liver damage in rats by some calcium channel blockers.

Liver necrosis was produced in rats by administering 3 doses o a mixture o carbon tetrachloide+olive oil, 2 ml/kg, ip. The liver damage was evidenced by the elevated levels serun aspartate aminotrans ferase (AST), alanine aminotransferase (AIT) and gamma glutamyl transpeptidase (gamma-GT) and by histopathological observations of liver sections. Nitrendipine, nimodipine and nisoldipine (1 mg/100 g of rat, ip) significantly reduced these elevated levels of AST, AIT and gamma-GT. Carbon tetrachloride induced liver necrosis was also found to be significantly reduced in nitrendipine, nimodipine and nisoldipine pre-treated animals as observed macroscopically and histologically.

Alanine Transaminase↗
PubMed1994

Deficient induction of human hsp70 heat shock gene transcription in Y79 retinoblastoma cells despite activation of heat shock factor 1.

One of the basic features of the inducible heat shock response is the activation of heat shock factor which results in the rapid transcriptional induction of the heat shock genes. Although it is widely considered that the heat shock response is ubiquitous, several reports have indicated that the transcriptional response can vary in both intensity and kinetics and often in a tissue-specific manner. Of interest have been studies on the expression of heat shock genes in the brain, particularly observations that certain cultured neuronal cells exhibit a diminished heat shock response. We demonstrate that transcription of the gene encoding a 70-kDa heat shock protein (hsp70) is diminished upon heat shock in Y79 human retinoblastoma cells (which are of neuronal origin) despite both the activation of heat shock factor 1 and induced transcription of another heat shock gene, hsp90 alpha. This uncoupling of stress-induced transcription of the hsp70 and hsp90 alpha genes, which are typically coordinately regulated in response to stress, appears to be due to the selective inability of trans-acting factors, including heat shock factor 1, to bind in vivo to the hsp70 promoter as the result of a chromatin-mediated effect.

DNA-Binding Proteins↗