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Biomedical subjects

V K Shukla

Publications and source records attributed to V K Shukla.

At least 37 records · Page 2Linked to original sources
PubMed2004

A trial to determine the role of placental extract in the treatment of chronic non-healing wounds.

OBJECTIVE: To investigate the effect of topical placental extract in the treatment of non-healing wounds. METHOD: One hundred patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks' duration were recruited. Fifty patients were treated with placental extract, and 50 were controls. Wound biopsy and swab culture and sensitivity were performed and the area surrounding the wound was X-rayed. Wound size was measured and the rate of epithelialisation assessed at weekly follow-ups. In nine cases biopsies were repeated after two weeks of treatment and sent for histopathological examination, including angiogenesis. RESULTS: Thirty patients dropped out, leaving 40 cases in the treatment group and 30 in the control group. Over an eight-week period, 27 patients (67.5%) in the treatment group showed more than 50% epithelialisation, compared with only seven patients (23.3%) in the control group. CONCLUSION: Placental extract has a beneficial role to play as a topical agent in the management of chronic non-healing wounds.

Adult↗
PubMed2004

An Indian community-based epidemiological study of wounds.

OBJECTIVE: To establish the prevalence of wounds in a community, with an emphasis on chronic lower extremity wounds, and to identify the various aetiological factors involved. METHOD: A cross-sectional study was conducted to screen the population of two nearby communities (one urban and one rural) in India for wounds. This involved conducting a door-to-door survey between July 2001 and February 2003. RESULTS: The prevalence of wounds in the population studied (n = 6917) was 15.03 per 1000. The prevalences of acute and chronic wounds were 10.55 and 4.48 per 1000 of the population respectively. CONCLUSION: The most common site for both acute and chronic wounds was the lower extremity. In contrast to Western studies, the most common aetiology for a chronic lower extremity wound was an untreated acute traumatic wound. This in turn highlights the need to establish community-based wound-care teams in India.

Acute Disease↗
PubMed2003

Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer.

Together with thyroid cancer, cancer of the gallbladder is the only non-sex hormone-related cancer displaying a female preponderance, with incidence being 3-4 times more common among women. We carried out this study to evaluate the role of menstrual, reproductive and lifestyle factors in gallbladder carcinogenesis. A case-control study involving 64 newly diagnosed cases of gallbladder cancer and 101 cases of cholelithiasis was carried out. A detailed menstrual and reproductive history was illustrated beside detailed lifestyle history, in particular consumption of betel nut, tobacco and alcohol and smoking, odds ratio was calculated. Mean age of the patients with cancer was 51+/-1.2 years while it was 40.9+/-1.2 years for gallstones; 69% of cancer patients and 90% of gallstones patients were females. More than half of the cancer patients (53%) and 43% of the gallstone patients were illiterate. A past history of typhoid was present in 22% of cancer patients and 13% of gallstone patients, while 35% of cancer and 25% of gallstone patients were chewers, 18.1 and 9.9% were smokers, and 10% of cancer and 2% of gallstone patients consumed alcohol. Mean age of menarche was 13.4+/-1.2 years among female patients with cancer while it was 14.0+/-1.4 years for gallstone patients. Higher age at menarche (>13 years, OR 2.48, 95% confidence interval (CI) 1.16-5.3), higher number of childbirths(>3 births, OR 3.92; 95% CI 1.4-10.3), higher number of pregnancies (>3 pregnancies, OR 6.66, 95% CI 1.8-23.4), and higher age at last childbirth (>25 years, OR 2.97, 95% CI 1.04-8.5) were found to have significantly higher risk of developing gallbladder cancer. In conclusion, tobacco chewing and smoking are associated with increased odds of gallbladder cancer. Similarly early menarche, late menopause, multiple pregnancies and childbirth increased the risk of gallbladder cancer.

Adult↗
PubMed2003

Nonhealing wounds--a therapeutic dilemma.

Chronic wounds of the lower extremity are a therapeutic dilemma. In India, chronic wounds are caused by factors other than impaired circulation and diabetes, which account for most of this clinical problem in Western societies. A study of 2 topical agents, placental extract and phenytoin powder, is presented in this paper. One hundred fifty patients were randomly assigned to these treatments or to saline dressings (control). It was observed that patients receiving active topical treatments responded better than those in the control group. The importance of this finding should be viewed with the perspective that these topical treatments are inexpensive and easily available in India. The study also piloted measurements of angiogenic responses in 1 group, and the findings encourage further exploration with the technique and topical agent.

Journal Article↗
PubMed2003

Management of plantar ulcers in Hansen's disease.

Plantar ulcers occur in patients with Hansen's disease not because of the disease but because of its neuropathic effects on the skin over the feet. This enhances the risk of trauma to patients' feet, leading to the development of ulcers. This short article reviews the current management of leprosy on the basis of World Health Organization guidelines and the complexities of plantar ulceration in such patients. A guide to its management and prevention is also discussed.

Journal Article↗
PubMed2002

Diet and gallbladder cancer: a case-control study.

Cancer of the gallbladder is rare but fatal, and has an unusual geographic and demographic distribution. Gallstones and obesity have been suggested as possible risk factors. As diet is known to influence both these factors, we carried out the present study to evaluate the possible role of diet in gallbladder carcinogenesis. A case-control study involving 64 newly diagnosed cases of gallbladder cancer and 101 cases of gallstones was carried out. The dietary evaluation was carried out by the dietary recall method based on a preset questionnaire developed specifically for the present study, keeping in mind the common dietary habits prevailing in this part of the world. Odds ratios (OR) and 95% confidence interval (CI) were calculated for various dietary items. A significant reduction in odds ratio was seen with the consumption of radish (OR 0.4; 95% CI 0.17-0.94), green chilli (OR 0.45; 95% CI 0.21-0.94) and sweet potato (OR 0.33; 95% CI 0.13-0.83) among vegetables, and mango (OR 0.4; 95% CI 0.16-0.99), orange (OR; 0.45; 95% CI 0.22-0.93), melon (OR 0.3; 95% CI 0.14-0.64) and papaya (OR 0.44; 95% 0.2-0.64) among fruits. A reduction in odds was also seen with the consumption of cruciferous vegetables, beans, onion and turnip, however the difference was not statistically significant. On the other hand, an increase in the odds was observed with consumption of capsicum (OR 2.2), beef (OR 2.58), tea (OR 1.98), red chilli (OR 1.29) and mutton (OR 1.2), however the difference was statistically not significant. In conclusion, the results of the present study show a protective effect of vegetables and fruits on gallbladder carcinogenesis, but red meat (beef and mutton) was found to be associated with increased risk of gallbladder cancer.

Adult↗
PubMed2001

Carcinoma of the gallbladder: a retrospective review of 99 cases.

Since the first description of the carcinoma of the gallbladder, about two centuries ago, this disease has evaded all attempts at early detection and a potential cure. There are only a few studies involving the Indian population, which has a high incidence of gallbladder cancer. Indians are ethnically and culturally different from their Western counterparts, for whom the incidence of this disease is comparatively low. The present study was conducted prospectively on 99 consecutive cases of carcinoma of the gallbladder of 736 patients with biliary diseases admitted to one surgical unit at the University Hospital. The staging, histological type, and grade were correlated with the clinical outcome. Abdominal pain (82.8%) and abdominal mass (73.7%) were the main presenting features. The diagnosis was obtained by ultrasonography (USG) in 93 of 99 cases and confirmed by fine-needle aspiration cytology (FNAC) in 70 patients. Ultrasonography, however, was found to be inadequate for accurate staging of the disease. Based on the TNM classification, 3 (3.0%), 12 (12.1%), 14 (14.1%), 12 (12.1%), and 58 (58.6%) patients had stage 0, I, II, III, and IV disease, with a corresponding mean survival of 28.3, 13.8, 7.5, 5.2, and 3.7 months, respectively. Carcinoma of the gallbladder is difficult to diagnose early due to its vague symptomatology. A high index of suspicion and health education seem to be the only answers available for early detection and improvement of survival.

Adenocarcinoma↗
PubMed2001

Choledochal cyst: a changing pattern of presentation.

BACKGROUND: The aim of the present paper was to study the spectrum of choledochal cysts and analyse the results of various surgical procedures. METHODS: A prospective study was undertaken, at University Hospital, Varanasi, India, of 10 patients with choledochal cyst who presented between January 1996 and June 2000. The patients had a median age at presentation of 16.0 years (interquartile range (IQR): 13.75 years). All patients underwent ultrasonography and endoscopic retrograde cholangiopancreaticography for confirmation of diagnosis. Cyst excision was performed in eight patients followed by reconstruction by hepaticoduodenostomy and Roux-en-Y hepaticojejunostomy in four patients each. Two patients underwent cystoduodenostomy. RESULTS: One patient who underwent hepaticoduodenostomy had a minor leak that responded to conservative management. All patients were asymptomatic at a median follow up of 36.5 months (IQR: 31 months). CONCLUSIONS: There is a changing trend in the commonest mode and age of presentation; fewer patients are presenting with the classical triad and the mean age of presentation is higher. Reconstruction by hepaticoduodenostomy is equally effective, more physiological and less time consuming as compared to hepaticojejunostomy, if the anastomosis can be achieved without tension.

Adolescent↗
PubMed2001

Pentoxifylline in perforated peritonitis: results of a randomised, placebo controlled trial.

OBJECTIVES: To evaluate the role of pentoxifylline as an adjuvant to operation and routine antibiotic treatment for perforated peritonitis. DESIGN: Randomised controlled clinical trial. SETTINGS: University hospital, India. SUBJECTS: 36 patients with clinically diagnosed and radiologically confirmed perforated peritonitis. 22 (61%) had typhoid enteric perforations, 11 (31%) had duodenal ulcer perforations while 3 (8%) had perforated gastric ulcers. INTERVENTION: Laparotomy with closure of perforation and lavage together with routine antibiotic treatment (ciprofloxacin and metronidazole), and random allocation to pentoxifylline 200 mg/day for 3 days in 500 ml of saline over 3-4 hours or saline alone (n = 18 in each group). MAIN OUTCOME MEASURES: Hospital stay, APACHE II scores, and the condition of the wound during the postoperative period. RESULTS: The baseline characteristics of the two groups were essentially similar. However, their preoperative APACHE II scores differed significantly (mean (SD) 12 (3) in the pentoxifylline group compared with 10 (2) in the saline group; p <0.01). The outcome was better in the pentoxifylline group in terms of significantly reduced hospital stay (median 8, range 6-17, compared with 11, 7-27, p=0.02) improved postoperative APACHE II scores (mean (SD) 8 (2) compared with 9 (2), p=0.02), and reduced incidence of wound infection (6/18 compared with 12/18, p=0.02). CONCLUSION: The addition of pentoxifylline to our standard management protocol for patients with perforated peritonitis helped to improve their outcome significantly compared with a placebo-treated group.

APACHE↗
PubMed2001

Organochlorine pesticides in carcinoma of the gallbladder: a case-control study.

Carcinoma of the gallbladder is the third most common malignancy of the gastrointestinal tract in the Eastern Uttar Pradesh and Western Bihar regions of India. The main source of drinking water in this region is the river Ganges, which is heavily polluted with agricultural pesticides. Organochlorine pesticides were estimated in bile by gas liquid chromatography in 60 patients (30 carcinoma of the gallbladder and 30 cholelithiasis) to observe its association with aetiopathogenesis of carcinoma of the gallbladder. The mean biliary concentration of benzene hexachloride (BHC) was found to be significantly higher in carcinoma of the gallbladder (0.0471 ppm) than in cholelithiasis (0.0352 ppm) (P < 0.04). The mean biliary concentration of dichlorodiphenyltrichloroethane (DDT) was also significantly higher in carcinoma of the gallbladder (0.418 ppm) than in cholelithiasis (0.0103 ppm) (P < 0.03). Biliary aldrin and endosulfan concentrations were higher in carcinoma of the gallbladder (0.0008 and 0.00132 ppm) than in cholelithiasis (0.0005 and 0.0126 ppm) but the difference was statistically not significant (P < 0.06 and P < 0.9). The levels of pesticides in blood did not show significant differences in either carcinoma of the gallbladder or cholelithiasis. Significantly high biliary BHC and DDT concentrations suggest that these pesticides might be associated with gallbladder carcinogenesi.

Agriculture↗
PubMed2000

Carcinoma of the gallbladder: role of sonography in diagnosis and staging.

PURPOSE: In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology. Patients and Methods Patients with proven gallbladder cancer presenting to a single surgical unit between 1991 and 1995 were identified through a records search. All patients underwent sonographic examination followed by fine-needle aspiration (FNA), biopsy, or laparotomy for establishing the diagnosis. RESULTS: A mass in the gallbladder and gallbladder wall thickening (> 12 mm) were cardinal sonographic findings of carcinoma. Liver infiltration was correctly identified in all patients who had it. Sonography was highly accurate for detecting mass lesions, gallstones, liver infiltration, metastasis, and ascites. However, visualization of lymph nodes, common bile duct infiltration, and peritoneal dissemination was poor. CONCLUSIONS: Sonography was found to be a good diagnostic tool for carcinoma of the gallbladder; however, its sensitivity was poor for staging nodal spread of the disease.

Adenocarcinoma↗
PubMed2000

Carcinoma of the gallbladder--is it a sequel of typhoid?

Gallbladder diseases, including carcinoma, are common in the northern part of India and so are Salmonella typhi infection and typhoid carrier state. This study was aimed to find out the association of typhoid carrier state in patients with cholelithiasis, carcinoma of the gallbladder, and controls. The three groups are comparable in age and sex composition. This is the first study of its kind from an area of high endemicity for both typhoid infection and carcinoma of the gallbladder. A case-control study was carried out to detect typhoid carrier state among the patients with biliary diseases and healthy controls, using indirect haemagglutination assay measuring antibodies against highly purified S. typhi Vi polysaccharide antigen. A significantly high Vi positivity was observed in patients with gallbladder carcinoma (29.4%) compared to controls (5%) (chi2 = 6.325, P < 0.004, OR = 7.19) and patients with cholelithiasis (10.7%) (chi2 = 5.066, P < 0.01, OR = 3.86). There is 8.47 times more risk of developing carcinoma of the gallbladder in culture-positive typhoid carriers than the noncarriers. The present study suggests the typhoid carrier state to be one of the possible mechanisms of gallbladder carcinogenesis.

Adult↗
PubMed2000

Quality of life in patients with early and advanced carcinoma of the breast.

AIM: Emotional disturbances are known to occur in patients suffering from malignant diseases even after treatment. This is mainly because of a fear of death which modifies quality of life (QOL). QOL has gained an important place in the management of cancer in industrialized nations, with the increase in survival. However, in developing countries like India, very little attention has been paid to this issue. Developing countries have poor infrastructure and lack proper treatment facilities at most centres, this leads to poor survival rates and hence much emphasis is on attaining quantity of life rather than quality. This study was carried out to assess the quality of life determinant in patients with breast cancer and the impact of treatment on quality of life indices. METHODS: We carried out QOL assessment in 50 patients with breast cancer using the modified linear analogue scale for self assessment (LASA). RESULTS: Significant deterioration was seen in health-related parameters in terms of recreation (P=0.01), social life (P=0.002), mobility (P=0.03), physical activity (P=0.4) and sleep and appetite (P=0.05). Treatment related parameters deteriorated in both early and advanced carcinoma. Similarly, weight loss was seen in both the groups, however, this was not statistically significant. Self-care and recreation were found to be the most important parameters influencing the QOL in breast cancer patients. CONCLUSIONS: Breast cancer detection programs, health education and better awareness among women in industrialized nations has helped in downstaging of the disease, thus improving overall survival. It has not been so in developing countries, where the majority of patients present with advanced disease (T3 and T4). These are usually managed with surgery and adjuvant chemotherapy, which duly interferes with general health-related parameters and the social life of these patients, thereby adversely affecting the QOL.

Adult↗
PubMed2000

An ultrasonographic evaluation of gallbladder emptying in patients with cholelithiasis.

Impaired gallbladder emptying producing biliary stasis may provide potent carcinogen, which comes in contact with gallbladder mucosa for a prolonged period, inducing carcinogenesis. The aim was to study gallbladder emptying pattern in cholelithiasis. Postprandial gallbladder emptying was measured ultrasonographically in terms of fasting volume (FV), postprandial residual volume at 30 minutes (PP30), 60 minutes (PP60), and 90 minutes (PP90), residual fraction, and ejection volume (EV) in 58 patients with gallstones. Patients were divided into two groups of poor and good contractors on the basis of 50% maximal postprandial gallbladder emptying. Malonaldehyde level was estimated in 15 patients with cholelithiasis. Twenty-nine patients (50%) were poor contractors. The FV in patients with cholelithiasis (mean, 30.08 mL) was larger than the controls (mean, 17.55 mL) and the difference was statistically significant (p < 0.02). The FV in the cholelithiasis group correlated significantly with the PP30 (r = 0.85, p < 0.001), PP60 (r = 0.85, p < 0.001), PP90 (r = 0.78, p < 0.001), and EV (r = 0.65, p < 0.001). Ejection volume was significantly less in poor contractors (p <0.001). Residual fraction was significantly higher in poor contractors (p < 0.001). The biliary malonaldehyde in poor contractors (2.27 micromol/mL) was higher than in good contractors (1.78 micromol/mL), but the difference was statistically not significant. Significantly larger volumes of PP30, PP60, PP90, and residual fraction and a low EV indicate poor contraction leading to biliary stasis.

Cholelithiasis↗
PubMed2000

Biliary lipid peroxidation products in gallbladder cancer: increased peroxidation or biliary stasis?

Gallbladder cancer is a common malignancy among women in India. The aetiology of gallbladder carcinoma is still obscure and although numerous factors have been implicated, none has stood the test of time. This study was carried out to evaluate the role of lipid peroxidation product 4-hydroxynonenal (HNE) in gallbladder carcinogenesis. High-performance liquid chromatography (HPLC) analysis was carried out in 30 bile samples obtained during laparotomy from patients with gallbladder cancer (n = 10), cholelithiasis (n = 10) and age- and sex-matched controls (n = 10). A significantly high concentration of HNE and lower concentration of biliary pH and electrolyte was observed in patients with carcinoma of the gallbladder compared with controls and patients with cholelithiasis. A significant correlation was also observed between biliary Na+ and K+ (r = 0.72), biliary Ca2+ and Na+ (r = 0.69) among controls. However, there was no correlation between HNE, electrolytes and pH among cancer patients. An increased concentration of biliary HNE and decreased concentration of electrolytes suggest biliary stasis rather then increased peroxidation in cancer patients.

Aldehydes↗
PubMed2000

A clinico-epidemiological profile of non-healing wounds in an Indian hospital.

One hundred patients with non-healing wounds of more than six weeks' duration were studied for clinico-epidemiological factors and their correlation with healing time. The majority of subjects were aged 30-59 years; those aged 50 and over had significantly delayed healing. Most of the subjects were farmers and physical labourers. Leprosy was the most common cause of non-healing wounds, followed by diabetes, trauma and venous ulcers; the lower limbs were the most common site of involvement. Diabetic wounds were more common in those aged 40 years and above. Diabetic wounds were slower to heal than others. The time to healing was calculated from the day subjects received treatment advice at the wound clinic. Seventy-five of the study group were included for calculation of healing time. The others were lost to follow-up or excluded for other reasons.

Adolescent↗