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Biomedical subjects

V K Shukla

Publications and source records attributed to V K Shukla.

155 records · Page 9Linked to original sources
PubMedDate not supplied

Cholecystosonographic evaluation of the prevalence of gallbladder diseases. A university hospital experience.

Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gallbladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.

Adult↗
PubMedDate not supplied

Magnetic resonance cholangiopancreatography in obstructive jaundice.

GOALS: To determine the ability of magnetic resonance cholangiopancreatography (MRCP) to diagnose the level and cause of obstruction in patients with obstructive jaundice. BACKGROUND: The limitations of available imaging modalities have led to the increasing use of MRCP, which is a noninvasive and highly accurate technique in evaluating patients with biliary obstruction. STUDY: Thirty patients were included in this study. MRCP was done using a fat suppressed, heavily T2 weighted fast spin echo sequence. The MRCP findings were confirmed on surgical exploration or clinical follow-up. RESULTS: MRCP could correctly identify ductal dilatation and the level of obstruction in all cases, except one. All causes of obstruction, except three, were detected. It failed to detect a common bile duct calculus in a minimally dilated ductal system and misdiagnosed a case of focal chronic pancreatitis as carcinoma head pancreas and a small pancreatic head mass as cholangiocarcinoma. It had a sensitivity of 94.44%, specificity of 81.81%, positive predictive value of 89.47%, and negative predictive value of 90% for the detection of malignant causes. The overall diagnostic accuracy for detection of level and cause of obstruction was 96.3% and 89.65%, respectively. CONCLUSION: The high diagnostic accuracy of MRCP in evaluating patients with obstructive jaundice indicates that it has the potential to become the diagnostic modality of choice in such patients.

Adult↗
PubMedDate not supplied

Design of potent and selective dynorphin A related peptides devoid of supraspinal motor effects in mice.

Dynorphin A-(1-13)-Tyr-Leu-Phe-Asn-Gly-Pro (Dyn Ia) was previously shown to be a highly potent and selective kappa opioid peptide. Four analogs of Dyn Ia are synthesized by the solid-phase procedure, introducing pseudo CH2NH linkage between positions 6 and 7 as follows: analog 1, [6 psi 7 (CH2NH)]Dyn Ia; analog 2, [6 psi 7 (CH2NH), D-Leu8]Dyn Ia; analog 3, [N(Me)-Tyr1, 6 psi 7 (CH2NH)]Dyn Ia; and analog 4, [N(Me)-Tyr1, 6 psi 7 (CH2NH), D-Leu8]Dyn Ia. The purified peptides are compared in vitro with Dyn Ia for their ability to compete with the binding of selective kappa, mu, and delta opioid ligands using membrane preparations of guinea pig cerebellum (kappa) and rat brain (mu and delta). The synthetic compounds are also compared in vivo in mice (intracerebroventricularly administered) for their analgesic activity against acetic acid induced writhing and their ability to produce motor dysfunction. All compounds display a high affinity (Ki = 0.5-1.8 nM) and a good selectivity for the kappa opioid receptor, and their rank order of potency on the kappa site (analog 2 > analog 1 > analog 3 > analog 4) closely parallels their potency (AD50 = 1.57-5 nmol/mouse) in inhibiting acetic acid induced writhing in mice (analog 2 > analog 1 > analog 4 > analog 3). On the other hand, all the synthetic analogs are less potent than Dyn Ia in producing motor effects, analog 2 being the least potent (CD50 = 15.4 nM as compared with 2.9 nM for Dyn Ia).(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMedDate not supplied

Ultrasound-guided fine needle aspiration cytology of malignant gallbladder masses.

OBJECTIVE: To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. STUDY DESIGN: We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. RESULTS: After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. CONCLUSION: US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Sonographic and colour doppler morphology in carcinoma gallbladder.

Conventional radiography has limitations in accurate diagnosis of gallbladder cancer (GBC). Ultrasonography (USG) allows correct diagnosis in 70-80% advanced and 23% early GBC. Present study was initiated to identify morphology and flow characteristics in GBC using conventional USG and Colour Doppler USG (CD-USG). In 100 patients, USG assessed morphology of mass lesion/wall thickening together with associated features. Of these, 60 cases were studied using CD-USG for intralesional/perilesional vascularity, peak systolic flow velocity (V max), resistive index (RI) and pulsatility index (PI). USG identified GB with mass lesion in 44% cases (Group-I) and only mass in GB fossa in 56% cases (Group-II). Findings identified calculi (73%), liver infiltration (74%), intrahepatic ductal dilatation (IHDD) (52%), lymphadenopathy (19%) and ascites (5%). CD-USG revealed vascularity, mainly pulsatile flow, in 78.3% cases (in 91.3% Group-I cases). Mean Vmax was 0.3037 m/sec (0.109 - 0.646 m/sec.), mean RI was 0.6621 (0.526 - 1.000) and PI was 1.282 (0.772 -2.140), Mean Vmax and PI were higher in Group-I compared to Group-II. Presence of calculus in 73% cases suggests a high association between calculus and malignancy. As flow signals were seen in 78% of all cases and 91.3% Group-I cases undergoing CD-USG, USG and CD-USG together can improve pickup rate of GBC.

Adenocarcinoma↗
PubMedDate not supplied

Silent gallstones: a therapeutic dilemma.

Asymptomatic gall stones are defined as stones that have not caused biliary colic or other biliary symptoms. Nearly two-third of patients with gall stones are asymptomatic. Studies of the natural history of asymptomatic gall stones suggest that the cumulative probability of developing biliary colic after 10 years ranges from 15% to 25%. The incidence of other complications is much less. The operative mortality of elective cholecystectomy is <0.5% but increased mortality is seen in elderly persons (>60 year of age), particularly in those with complications such as acute cholecystitis. Most decision analysis studies do not favour prophylactic cholecystectomy for asymptomatic cholelithiasis. Nonetheless, many studies have listed certain criteria for carrying out elective cholecystectomy in asymptomatic patients. The authors, from their own experience and after reviewing the literature, propose the following criteria for cholecystectomy: life expectancy >20 years, calculi >3 cm in diameter, particularly in individuals in geographical regions with a high prevalence of gall bladder cancer or calculi <3 mm, chronically obliterated cystic duct, non-functioning gallbladder and calcified (porcelain) gallbladder. The widespread use of diagnostic abdominal ultrasonography has led to the increasing detection of clinically unsuspected gall stones. This, in turn, has given rise to a great deal of controversy regarding the optimal management of asymptomatic or 'silent' gall stones. While cholecystectomy is the undisputed gold standard treatment for symptomatic gall stones, the natural history of silent gall stones is not known well enough to recommend a definitive therapeutic strategy for such patients. The treatment options for asymptomatic or silent gall stones range from no treatment to selective cholecystectomy in at-risk group to elective cholecystectomy in all patients. There are a large number of proponents for each of these options so that each merits careful consideration. In this article, the authors examine the evidence for and against treating silent gall stones with the aim of providing more specific guidelines for the management of patients found to have asymptomatic gall stones.

Cholecystectomy↗
PubMedDate not supplied

Management of polypoidal lesions of gallbladder in laparoscopic era.

UNLABELLED: The detection of polypoidal lesion of gallbladder (PLG) has increased particularly with widespread use of ultrasonography (US) as a diagnostic modality. Most of the PLG are diagnosed incidentally during scanning. Differentiation of benign from malignant PLG is a major concern and further management is based on this differentiation. DATA SOURCE: A Pubmed database search was performed. Abstract and articles were reviewed in detail. Other references were extracted by cross-reference. CONCLUSION: The risk factors for malignancy in PLG are identified. The newer investigative procedures may differentiate benign from malignant PLG. Follow up of the asymptomatic patient and indication for surgery is established in PLG.

Algorithms↗
PubMedDate not supplied

Effect of venoruton on hypoxic stress-induced neurotoxicity in mice and oxygen free radical generation by human neutrophils.

Venoruton offers a protection against hypoxic stress-induced neurotoxicity (convulsions and death) in mice. It also inhibits free radical generation, since it produces a concentration-dependent (5-160 micrograms/10(6) cells/ml) decrease of chemiluminescence response from human neutrophils. The maximum inhibition was observed at 140 micrograms/10(6) cells/ml. The in vivo protective effect against hypoxic stress-induced neurotoxicity has been correlated to the inhibitory action of venoruton on oxygen free radical generation.

Animals↗