Eder-Puestow and Savary dilators.
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Dilatation↗
Biomedical subjects
B S Anand
Publications and source records attributed to B S Anand.
Pathogenesis of peptic ulcer in rheumatoid arthritis.
To assess the pathogenesis of the gastro-duodenal mucosal lesions in rheumatoid arthritis, 36 patients, consisting of 23 (group I) receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 13 (group II) on alternative forms of treatment, were examined by fibreoptic upper gastrointestinal endoscopy. Ten (43%) of 23 patients receiving NSAIDs showed mucosal damage in the form of erosions or a definite ulcer crater, compared to only one (8%) of 13 in group II (p less than 0.05). There was no correlation between the duration of illness and the incidence of mucosal lesions. These findings indicate that the high incidence of gastroduodenal mucosal abnormalities seen in rheumatoid arthritis is related to the use of NSAIDs and not to the underlying disease process.
Adult↗
Pyoderma gangrenosum in ulcerative colitis.
We present a patient with pyoderma gangrenosum, a rare complication of ulcerative colitis. The patient's disease was limited to the distal colon, was clinically mild and responded quickly to treatment, and yet it was associated with pyoderma gangrenosum and arthritis, complications generally associated with more severe and extensive ulcerative colitis.
Abdominal Muscles↗
Separate pancreatic and biliary ductal openings in alcoholic chronic pancreatitis.
Endoscopic retrograde cholangiopancreatograms of 49 patients with chronic pancreatitis (alcohol related 18; idiopathic 31) were assessed retrospectively. Thirteen (72%) of 18 patients with alcohol-related chronic pancreatitis had separate openings of the common bile duct and the main pancreatic duct into the duodenum. This was significantly more frequent (p less than 0.01) than in previously studied controls (37%). Although this finding was seen more frequently in patients with alcohol related chronic pancreatitis than in those with idiopathic chronic pancreatitis (14 of 31, 45%), the difference was not statistically significant. It is concluded that alcohol-related chronic pancreatitis, but not idiopathic chronic pancreatitis, is associated with the presence of separate openings of the common bile duct and main pancreatic duct into the duodenum.
Adolescent↗
Post-cholecystectomy syndrome due to a broken T-tube.
Breaking of a biliary T-tube during removal is unusual. One such case who presented with features of post-cholecystectomy syndrome is presented.
Adult↗
Development of carcinoma in chronic calcific pancreatitis.
Development of carcinomas of the pancreas over an underlying chronic pancreatitis is a rare event. Diminution of pancreatic calcification, following the development of carcinoma, has been previously reported only once. We report another such case.
Calcinosis↗
Aspirin concurrently administered with ranitidine does not delay healing of duodenal ulcer.
Sixty-nine patients with endoscopically diagnosed duodenal ulcer were randomised to either Group I or Group II. Group I patients (n = 35) received tablet ranitidine 150 mg twice daily along with tablet aspirin 600 mg three times a day while Group II patients received only tablet ranitidine 150 mg twice daily. Eight patients (four in each group) dropped out of the trial but were included in the final analysis as failure of treatment. At the end of four weeks 51.4% ulcers healed in Group I compared to 58.8% in Group II. The difference between the two groups was not significant. There was also no statistical difference in the time required for relief of pain, number of patients relieved of pain and the complication rate. It is concluded that aspirin concurrently administered with ranitidine is safe and does not delay the healing of uncomplicated duodenal ulcers.
Adult↗
Pancreatic duct abnormalities in gall stone disease: an endoscopic retrograde cholangiopancreatographic study.
This study was carried out to assess pancreatic duct abnormalities in gall stone disease. Endoscopic retrograde cholangiopancreatograms of 50 patients with gall stone disease were analysed and the results compared with those obtained in 33 patients investigated for cholestatic jaundice who were found to have a normal biliary tree (control group). Abnormal pancreatograms were obtained in 24 (48%) patients with gall stone disease and in only two (6%) in the control group; the differences were statistically significant (chi 2 = 14.3; p less than 0.001). The patients in the control group showed mild abnormalities as did those in the gall stone group. The frequency of various abnormalities were: mild 16 (32%), moderate five (10%), and severe three (6%). Pancreatic duct abnormalities were more severe and occurred more frequently in patients with gall stones who had stones in the biliary tree than in patients with a normal biliary tree (postcholecystectomy patients, 55% v 25%) but the difference between the two groups just failed to be significant (chi 2 = 3.34). In conclusion, nearly half of all patients with gall stone disease have pancreatic duct abnormalities and in 16% these were severe enough to be labelled as chronic pancreatitis.
Adult↗
Long term behaviour of healed duodenal ulcer with and without maintenance therapy.
Seventy six patients who showed complete ulcer healing at endoscopy were treated within 48 hr with either placebo (41 patients) or cimetidine 400 mg nocte (35 patients) as a maintenance therapy for a period of one year in a double blind controlled study. Patients were reviewed every month and an endoscopy was performed every 3 months after starting the treatment or earlier if there was recurrence of symptoms. During the first three months of treatment the relapse rate in the two treatment groups were similar. The difference between the two first became obvious at 4 mo, but statistically significant difference appeared only at 6 mo: 70.7% in the placebo group suffered a relapse compared to 42.9% in the cimetidine group (x2 = 6.01; p less than 0.02). The difference remained significant until the 10th mo (78.1% vs 48.6%; x2 = 7.16; p less than 0.01). At 12 mo, the difference was not significant (80.5% vs 62.9%; x2 = 2.93). The age, sex, duration of illness, previous treatment and blood group status did not influence ulcer relapse. However, two factors had an influence on the relapse rate: a) in patients receiving placebo the relapse rate was significantly greater in smokers compared to non smokers; no such difference was observed in the cimetidine group. Moreover, smokers on cimetidine had a significantly lower relapse rate at 6.9 and 12 mo compared to smokers on placebo (50% vs 88.9%, 50% vs 94.4% and 53.3% vs 94.4%; p less than 0.01 for each).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Conventional versus on-demand therapy for duodenal ulcer: results of a controlled therapeutic trial.
To compare the efficacy of conventional versus on-demand (symptomatic) treatment of duodenal ulcer, 81 patients were randomized into two groups. Group A (n = 40) patients were treated with ranitidine 150 mg twice daily until complete ulcer healing was achieved. Group B (n = 41) received a similar dose of ranitidine until complete relief of pain was achieved, irrespective of ulcer healing. Recurrence of ulcer in group A was treated with a full course of treatment until complete healing of the ulcer was achieved again, whereas, in group B, treatment was given only until pain recurrence was symptomatically controlled. Endoscopic examination was performed each month. Analysis of the results at 8 wk and 28 wk showed that 1) ulcer healing in group A was significantly superior to that in group B up to 24 wk, but at 28 wk the difference was no longer statistically significant (95% vs 70%), 2) the number of painful days were similar in the two groups, 3) group A patients took treatment for a significantly longer period than those in group B, 4) the cost of treatment per patient in group A was significantly greater than that in group B, 5) the recurrence rate assessed in patients followed for 28 wk after complete ulcer healing was similar in the two groups, and 6) the ulcer-related complications were not significantly different in the two groups. These findings indicate that, although on-demand treatment results in slower ulcer healing, it is not associated with an increase in the duration of pain and incidence of complications. A major advantage of this approach was a significant reduction in the cost of treatment. It is concluded that on-demand treatment is an attractive alternative therapeutic approach in the management of duodenal ulcer disease.
Adult↗
Colonoscopic polypectomy. North Indian experience.
Colonoscopic snare polypectomy was carried out in 70 patients (40 children, 30 adults). There was a male preponderance in both the groups with a combined male: female ratio of 4.4:1. The majority of patients (85%) were aged 20 years or below. All patients presented with intermittent bleeding per rectum, ranging from 2 months - 6 years (mean 1.2 +/- 1.1 years) in children and 1-14 years (1.9 +/- 2.3) in adults. The majority of patients polyps were located in the rectum (73%) or in the rectosigmoid region (21%). Polyps were significantly more common in the rectum (80% vs 63%; P less than 0.01) and less frequent in the rectosigmoid (15% vs 30%; p less than 0.01) in children as compared to adults. A single polyp was present in 49 (70%) patients; 17 (24%) had 2-10 polyps, while 4 patients (2 children, 2 adults) had more than ten polyps. Most patients (94%) had polyps of less than 2 cm size. Histologically, the most polyps (91.5%) were of the juvenile variety; 39 (97.5%) children and 25 (83%) adults had this variety of polyp. The remaining 5 (17%) adults and one (2.5%) child had adenomatous polyps. The difference in the polyp histology between the two age groups was statistically significant (p less than 0.05). Only one patient (1.4%) had excessive bleeding following polypectomy. The present study suggests two important differences in the nature of polyps as compared to the West: 1) our patients were much younger, and polyps were rare after 40 years; and (2) histologically, the commonest polyps were of the juvenile variety (91.5%) while adenomatous polyps were rare (8.5%).
Adolescent↗
Endoscopic sphincterotomy--experience with 110 patients.
During the last two years, 116 endoscopic sphincterotomies (ES) were attempted in 110 patients. The indication for ES was choledocholithiasis in 102 (93%) patients, including 37 (36.2%) with gallbladder in situ and 65 (64%) post-cholecystectomy patients; the other 8 (7%) were performed for stricture of the lower end of the common bile duct (CBD) with cholangitis (2), insertion of nasobiliary drain (2), restenosis after previous sphincterotomy (1), stone in the cystic duct stump causing cholangitis (1), papillary stenosis (1) and post-cholecystectomy cholangitis with no obvious cause (1). ES was achieved in 113 (97.4%) attempts in 107 (97%) patients and was overall successful in 81% of patients. Of the 95 patients with choledocholithiasis in whom ES could be performed and a follow-up was available, 79 (83%) cleared their CBD. Of 98 patients with choledocholithiasis, 79 (80.6%) finally cleared their CBD of stones. Three patients developed complications, one needing emergency operation. There were no deaths. ES was found to be effective in patients with retained stones and also in patients with choledocholithiasis with gallbladder in situ, especially those who were poor surgical risk.
Adult↗
Long-term treatment of irritable bowel syndrome: results of a randomized controlled trial.
To examine the long-term management of irritable bowel syndrome we conducted a two-part controlled therapeutic trial on 28 patients who had recovered completely after four to six weeks of treatment with ispaghula husk and propantheline. In part I patients were randomly divided into two groups. Group A received a placebo capsule while Group B continued with treatment as before. After six months the response to treatment was assessed according to a scoring system. The overall relapse rate in Group B was 46 per cent compared to 82 per cent in group A. With continued treatment patients in Group B became asymptomatic from the fourth month while patients in Group A continued to deteriorate. In part II, patients who had relapsed whilst on placebo received active treatment. Six of the seven who agreed to continue with the study became asymptomatic within four weeks. However, all the patients who were asymptomatic while on active treatment relapsed on discontinuation and again recovered on reinstitution of active treatment. We conclude that irritable bowel syndrome is a chronic relapsing disorder and that treatment with a combination of ispaghula husk and propantheline is effective, both in relieving symptoms and in the maintenance of remission.
Adult↗
Pancreaticobiliary ductal union in biliary diseases. An endoscopic retrograde cholangiopancreatographic study.
To assess whether the anatomy of the pancreaticobiliary ductal drainage into the duodenum has any relationship with biliary diseases we analyzed 259 endoscopic retrograde cholangiopancreatograms. These included 102 normal examinations (control group), 95 patients with gallstone disease, and 21 patients with carcinoma of the gallbladder. In the control group, 64 (63%) subjects had a common channel and 38 (37%) had separated openings for the common bile duct and the main pancreatic duct. By contrast, the prevalence rate of a common channel was significantly lower in gallstone disease [28 (30%); p less than 0.001]. No such difference, compared with controls, was observed in patients with carcinoma of the gallbladder. The length of the common channel in the control group (mean +/- SD, 4.7 +/- 2.5 mm) was similar to that in gallstone disease (4.6 +/- 2.6 mm). However, patients with carcinoma of the gallbladder had a significantly longer common channel (8.3 +/- 4 mm; p less than 0.001) compared with the control group. An abnormally long common channel (greater than or equal to 8 mm) was seen more frequently in carcinoma of the gallbladder (8 of 21; 38%) compared with normal subjects (3 of 102; 3%) and patients with gallstones (1 of 95; 1%); the difference was highly significant (p less than 0.001 for each). These observations suggest a close association between the anatomy of the distal ends of the common bile duct and main pancreatic duct and the development of gallstones and carcinoma of the gallbladder.
Adult↗
Sucralfate in ulcerative colitis.
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Colitis, Ulcerative↗
Young v adult cirrhotics: a prospective, comparative analysis of the clinical profile, natural course and survival.
In order to assess the frequency and profile of cirrhosis in the young, 169 consecutive patients with cirrhosis were studied. Sixty three (37%) patients of less than or equal to 35 years age were defined as young and the remaining 106 (63%) patients (greater than 35 years) as adult cirrhotics. Men predominated significantly (p less than 0.01) in the young cirrhotic group. The aetiology, the frequency of positive hepatitis B markers and initial clinical presentation were similar in the two groups. During the follow up period (30.6 +/- 29.7 months for the young and 25.8 +/- 21.7 months for the adult group), except for abdominal distension and pedal oedema which occurred significantly more often in the adult compared with the young cirrhotics, no difference was noted in the two groups. Twenty seven (39.7%) deaths (40% as a result of hepatic failure and 52% due to variceal bleeding) occurred in the young and 47 (44.3%) deaths (63.8% because of hepatic failure and 26% because of variceal bleeding) occurred in the adult cirrhotics during the follow up (difference NS). The five year survival (61.9% v 55.7%) and the probability of survival within the same Child's grade of liver disease were comparable. In both the groups, however, the probability of survival was significantly higher in Child's A compared with Child's B and C and in Child's B compared with Child's C grade of liver disease. Survival was not influenced by sex of the patient and aetiology of cirrhosis. Results of this prospective study indicate that cirrhosis is not uncommon in young adults. The aetiology, clinical presentation, natural history of the disease and the survival rates in young cirrhotics do not differ significantly from adult cirrhotics.
Adolescent↗
Response of tuberculous stricture to antituberculous treatment.
Tuberculous infection of the gastrointestinal tract results in a variety of histopathological lesions. Some patients develop intestinal strictures and present with subacute intestinal obstruction. The treatment is controversial and vary from a trial of antituberculous drugs to early surgery:the response to medical therapy is not clear. To examine this issue the present prospective therapeutic trial was carried out on 39 patients with symptoms of bowel obstruction and radiological evidence of intestinal stricture. All patients were treated with conventional antituberculous drugs (streptomycin, rifampicin, and isoniazid) under close supervision. Thirty four (87%) patients completed the trial, five were lost to follow up. Thirty one (91%) of these showed significant clinical improvement:26 became completely symptom free, while the remaining five complained of only vague abdominal discomfort. Only three (8%) patients failed to respond to treatment and were subjected to surgery. Barium series were repeated in 23 of 31 who completed the treatment; the remaining eight refused further investigations. Complete resolution of the radiological abnormality was seen in 16 (70%) patients. In the remaining seven (30%) the stricture persisted; in two of these the treatment was continued for another year and both showed substantial radiological improvement. It is concluded that most patients with tuberculous strictures respond well to medical treatment and surgery should be resorted to only if drug therapy fails.
Adolescent↗
Spontaneous expulsion per rectum of an ileal lipoma.
We report a case of spontaneous expulsion of a lipoma in a 32 year old male patient who presented with recurrent attacks of subacute intestinal obstruction. During one such episode the patient developed unusually severe abdominal pain and expelled a fleshy mass per rectum which, on histopathology, was found to be a lipoma attached to a necrosed portion of the small intestine. The pain disappeared immediately; a subsequent barium meal examination revealed normal appearances and the patient has remained completely symptom free 10 months after the incident.
Adult↗