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Biomedical subjects

G Sachdev

Publications and source records attributed to G Sachdev.

12 recordsLinked to original sources
PubMed1988

Endoscopic sclerotherapy in the treatment of gastric varices.

Of 309 patients with portal hypertension, gastric varices were found in 48 (16 per cent). While the majority (88 per cent) of the patients had gastric varices in association with oesophageal varices, 6 (12 per cent) patients had 'isolated' gastric varices. Gastric varices were seen significantly (P less than 0.01) more often with grade 4 than with grade 3 varices. In 11 (28 per cent) of the 40 patients who completed sclerotherapy for oesophageal varices, gastric varices disappeared concurrently on eradication of oesophageal varices or during the following 6 months. Of the initial five patients with gastric varices who received direct intravariceal injections, four rebled; this technique was therefore replaced by combination (paravariceal + intravariceal) gastric variceal sclerotherapy. Emergency combination sclerotherapy successfully controlled bleeding from gastric varices in six of the eight treated patients. Thirty-two patients entered a programme of elective combination gastric variceal sclerotherapy. Variceal obliteration was achieved in 12 cases (38 per cent) and reduction in size was noted in another 7 patients (22 per cent) after a minimum of four courses. There were 11 (23 per cent) deaths, 8 due to uncontrolled bleeding from gastric varices and 3 due to hepatic coma. The other complications of gastric variceal sclerotherapy were minor and included retrosternal pain, fever and dysphagia. It is concluded that gastric varices often coexist with large oesophageal varices. If they persist for 6 months after eradication of oesophageal varices, a combination of paravariceal and intravariceal sclerotherapy should be attempted for their obliteration.

Emergencies↗
PubMed1988

Pattern of psychiatric morbidity and alcohol dependence in patients with alcoholic liver disease.

Fifty-six male patients with alcoholic liver disease were evaluated for the presence and severity of alcohol dependence and psychiatric illness using a severity of alcohol dependence questionnaire and research diagnostic criteria, respectively. Forty-three (76.7%) patients were found to be dependent; 26 (46.4%) moderately, and 17 (30.3%) severely. Patients with alcoholic hepatitis were significantly (P less than 0.05) more often found to be dependent than patients with alcoholic cirrhosis. Psychiatric morbidity was observed in 42 (75%) of the patients with alcoholic liver disease and 15 (26.7%) of the nonalcoholic cirrhotics. The difference was highly significant (P less than 0.01). The commonest disorders in patients with alcoholic liver disease were neuroses (33.0%), followed by affective disorders (26.8%). It was, however, not possible to ascertain whether psychiatric disorders antedated alcoholism or were secondary to it. Detection of moderate to severe dependence on alcohol and psychiatric morbidity in about three-fourths of the patients with alcoholic liver disease warrants an increased awareness and a multidisciplinary approach for the management of these patients.

Adult↗
PubMed1988

Bumetanide, spironolactone and a combination of the two, in the treatment of ascites due to liver disease. A prospective, controlled, randomized trial.

There are few studies available comparing the efficacy of loop and distal diuretics and a combination of the two groups, in the treatment of ascites due to liver disease. Thirty-seven nonazotemic cirrhotic patients with ascites were randomly allocated to receive for 2 weeks bumetanide (group A, n = 13), spironolactone (group B, n = 12) or a combination of the two drugs (group C, n = 12) after a 5-day stabilization period. The response to the treatment was 69, 42 and 83% in groups A, B and C, respectively; the difference was not significant. Hypokalemia was seen in 4 patients of group A and mild hyperkalemia in 2 patients of group B. Electrolyte disturbances were minimal in patients of group C. The response to diuretic treatment was prompt in groups A and C. It can be concluded that a combination of loop and distal diuretics is superior to a one-drug regimen in achieving a rapid and better diuretic response with fewer side effects.

Administration, Oral↗
PubMed1987

Relative efficacy and safety of absolute alcohol and 50% alcohol as variceal sclerosants.

Absolute alcohol and 50% alcohol were compared as sclerosants in 79 patients who underwent sclerotherapy for esophageal varices every 3 weeks with either of the solutions. Active variceal bleeding could be controlled more often (p less than 0.05) with absolute alcohol (93.3%) compared with 50% alcohol (53.8%). Variceal eradication could be achieved with absolute alcohol in a significantly shorter time with smaller amounts and fewer sclerotherapy sessions than with 50% alcohol. Except for a higher incidence of retrosternal pain and fever noted with the use of absolute alcohol, there was no significant difference in the incidence of various complications, rebleeding rate, or mortality between the two sclerosants. Absolute alcohol is a more effective and equally safe sclerosant compared with 50% alcohol.

Adolescent↗
PubMed1987

Intravariceal versus paravariceal sclerotherapy: a prospective, controlled, randomised trial.

Fifty four consecutive patients with oesophageal variceal bleeding were randomised to undergo intravariceal (28 patients) or paravariceal (26 patients) sclerotherapy, every three weeks. Intravariceal technique was found significantly (p less than 0.01) more effective in controlling active variceal bleeding than the paravariceal technique (91% v 18.7% respectively). The mean (+/- SD) time taken for variceal eradication by intravariceal sclerotherapy (15.4 +/- 5.3 weeks) was significantly (p less than 0.001) less than paravariceal (26.8 +/- 6.6 weeks) technique. The number of sclerotherapy sessions needed with intravariceal technique were also significantly less. Rebleeding was seen in 38.5% patients after para and 14.3% after intravariceal injections (NS). Except for retrosternal pain, which occurred more often (p less than 0.01) with paravariceal technique, there was no difference in the incidence of other complications or mortality between the two groups. Variceal recurrence was seen in seven patients (25%) in the intra and one (3.9%) patient in the paravariceal group (p less than 0.01) after a mean follow up of 29.4 +/- 9.1 weeks. Intravariceal sclerotherapy was superior to paravariceal in the control of active variceal bleeding and for total variceal obliteration, but was associated with a higher variceal recurrence.

Adolescent↗
PubMed1986

Follow-up of patients after variceal eradication. A comparison of patients with cirrhosis, noncirrhotic portal fibrosis, and extrahepatic obstruction.

One hundred one patients, 54 with cirrhosis of liver, 31 with noncirrhotic portal fibrosis (NCPF), and 16 with extrahepatic obstruction (EHO), were followed up at monthly intervals for a mean (+/- SD) period of 17.9 +/- 4.8 months after achieving total variceal eradication with endoscopic sclerotherapy. Recurrence of esophageal varices was seen in 19 (18.8%) patients, 12 with cirrhosis and seven with NCPF, within a mean (+/- SD) period of 5.7 +/- 1.6 months. No patient with EHO showed recurrence. Three (2.9%) patients rebled from the recurred varices. Mean (+/- SD) number of sclerotherapy sessions and the amount of absolute alcohol required for eradication of recurred varices were 1.6 +/- 0.8 and 3.6 +/- 1.8 ml, respectively. Dysphagia and esophageal stricture were present in 15 (14.9%) patients with nearly similar frequency in patients with cirrhosis, NCPF, and EHO. Dysphagia in four patients with stricture improved without dilatation. While there were no deaths in patients with NCPF and EHO, 11 patients with cirrhosis died. There was significant (p less than 0.01) improvement in the liver status of surviving patients with cirrhosis after variceal eradication. It can be concluded that variceal recurrence and rebleeding are not major problems after sclerotherapy. Sclerotherapy probably helps in spontaneous improvement of the liver status of surviving cirrhotics and reduces long-term morbidity and mortality of patients with NCPF and EHO.

Adult↗
PubMed1986

Comparison of the two time schedules for endoscopic sclerotherapy: a prospective randomised controlled study.

To compare the efficacy and safety of one week versus three weeks interval treatment schedules of endoscopic sclerotherapy, injections were carried out in a prospective manner in 96 patients with variceal bleeding; 47 on a one week and 49 on a three weeks treatment schedule. Weekly endoscopic sclerotherapy eradicated oesophageal varices significantly (p less than 0.01) earlier (mean +/- SD 7.1 +/- 2.43 weeks) as compared with the three weeks regimen (mean +/- SD 14.86 +/- 4.86 weeks). The rebleeding rate was also significantly less (p less than 0.05) with weekly endoscopic sclerotherapy (8.5%) as compared with three weeks endoscopic sclerotherapy treatment (26.5%). The amount of alcohol and the number of endoscopic sclerotherapy courses required for complete variceal eradication did not differ significantly between the two groups. Patients undergoing weekly injections were seen to have significantly more oesophageal ulcers (p less than 0.01) as compared with the three weeks group, necessitating at times (23%) postponement of the procedure. There was, however, no difference between the two groups in the frequency of oesophageal stricture formation, dysphagia, retrosternal pain, and fever. Mortality was also similar in the two groups. It can be concluded that a weekly schedule of endoscopic sclerotherapy appears superior to a three weeks schedule.

Adult↗
PubMedDate not supplied

Biochemical characterization of ketosis-resistant young diabetics of northern India. In vivo effects of i.v. glucose, s.c. epinephrine and i.v. glucagon and in vitro effects of anti-insulin serum on adipose tissue lipolysis.

Epinephrine (10 micrograms/kg body weight) s.c., glucagon (1 microgram/kg body weight) i.v. and glucose (0.5 g/kg body weight) i.v. were injected in groups of ketosis-prone young diabetics, ketosis-resistant young diabetics, maturity-onset diabetics, young and mature controls, each group comprising 8 subjects. Samples were drawn at timed intervals and analyzed for glucose, FFA, acetone, citrate and plasma free insulin. FFA and glycerol release by the adipose tissue in vitro was studied in 6 of each of the following groups: young diabetics and young controls in the presence of norepinephrine, anti-insulin serum or both. Failure of the adipose tissue of ketosis-resistant young diabetics to respond to lipolytic and ketogenic hormones has been suggested by others as the basis for the clinically observed resistance to ketoacidosis. The present data do not confirm any failure of the liver or adipose tissue to respond to glucagon, epinephrine or norepinephrine in these diabetics. The ketosis-resistant young diabetics have some endogenous insulin secretory capacity still preserved as evident from their basal and post-glucose free insulin levels and effects of anti-insulin serum on in vitro lipolysis by their adipose tissues. The available endogenous insulin though adequate in preventing excessive lipolysis and ketogenesis, appears insufficient to check hyperglycemia.

Adipose Tissue↗
PubMedDate not supplied

Characterization of peripheral blood lymphocytes in patients with non-cirrhotic portal fibrosis: a comparison with cirrhotics and healthy controls.

Non-cirrhotic portal fibrosis (NCPF) is a common cause of portal hypertension in India. Its aetiopathogenesis is not well understood. To investigate the possibility of an immune mediated injury, phenotypes of peripheral blood lymphocytes were studied in 15 NCPF patients and were compared with an equal number of compensated cirrhotics and matched healthy controls. The population of total peripheral T lymphocytes (T1) and suppressor/cytotoxic phenotype (T8) was significantly (P less than 0.01) decreased in NCPF patients compared with controls. The sub-populations of helper/inducer lymphocytes (T4) and total B lymphocytes, however, were comparable with controls. The ratio of T4 to T8 lymphocytes was significantly (P less than 0.01) increased in NCPF patients in comparison with controls. Similar changes in the lymphocyte population were also observed in cirrhotic patients. Further investigations are required to identify whether the cellular alterations seen in NCPF have a pathogenetic basis or are secondary to the disease process itself.

Adult↗