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H S Himal

Publications and source records attributed to H S Himal.

At least 19 recordsLinked to original sources
PubMed1996

The role of ERCP in laparoscopic cholecystectomy-related cystic duct stump leaks.

BACKGROUND: Laparoscopic cholecystectomy has resulted in an increase in the incidence of cystic duct stump leaks. To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) a review of 14 cystic duct stump leaks following laparoscopic cholecystectomy was carried out. METHODS: A retrospective chart review of fourteen patients was carried out. There were 11 females and 3 males. Laparoscopic cholecystectomy was carried out without any difficulty. Three patients became very ill soon after surgery while 11 patients were minimally ill. All were still hospitalized after the cholecystectomy. RESULTS: Urgent ERCP on the 3 very ill patients demonstrated a cystic duct bile leak. In the 11 minimally ill patients, ultrasonography demonstrated intraabdominal fluid collections and initial treatment was percutaneous drainage. Only 2 of the 11 patients improved. The remaining nine patients developed a septic course. ERCP was carried out and demonstrated cystic duct bile leak in all 9 patients. Endoscopic papillotomy alone or endoscopic papillotomy plus stenting resolved the clinical picture. CONCLUSIONS: Patients who are ill post laparoscopic cholecystectomy should have urgent ERCP. Cystic duct bile leaks should be managed by endoscopic papillotomy and in select cases, stenting.

Adult↗
PubMed1996

Role of endoscopic sphincterotomy alone in patients with choledocholithiasis and cholelithiasis.

OBJECTIVE: To study the long-term effects of endoscopic sphincterotomy alone in elderly patients with choledocholithiasis and cholelithiasis. DESIGN: A chart review. SETTING: A university-affiliated hospital. PATIENTS: Twenty-one patients over 60 years of age, who presented with cholecystitis, jaundice or cholangitis. The follow-up ranged from 1 to 5 years (mean 3.51 years). INTERVENTION: Endoscopic sphincterotomy. MAIN OUTCOME MEASURES: The occurrence of postsphincterotomy pancreatitis, cholangitis and cholecystitis. RESULTS: In the early postsphincterotomy period, 3 of the 21 patients had pancreatitis, which was treated conservatively. One patient had cholangitis. In this patient the initial sphincterotomy did not clear the common bile duct of all stones, but a repeat procedure was successful and the cholangitis resolved. One patient had mild cholecystitis that responded to conservative therapy. In the long term, 9 of the 21 patients had cholecystitis. This was treated conservatively in six patients, but three required cholecystectomy. One patient had choledocholithiasis requiring exploration of the common bile duct. CONCLUSIONS: In elderly debilitated patients with cholelithiasis and choledocholithiasis, endoscopic sphincterotomy alone may be adequate therapy. However, patients presenting with cholangitis and cholelithiasis may eventually require cholecystectomy.

Age Factors↗
PubMed1992

Pancreatic pseudocysts: the role of percutaneous catheter drainage.

The case records of 69 patients who had pancreatic pseudocysts were reviewed retrospectively. All patients had abdominal pain and tenderness, 38 had nausea and vomiting, 9 had chills and fever and 5 had jaundice. Forty-eight patients had elevated body temperatures and 26 had elevated leukocyte counts. A history of alcoholism was obtained in 48 patients. Ultrasonography demonstrated 54 pseudocysts near the body of the pancreas, 8 near the tail and 7 near the head. Thirty-nine patients had internal drainage, 16 had laparotomy and external drainage and 14 had percutaneous catheter drainage. One of these 14 patients died of uncontrollable sepsis. Six of the 39 patients who had internal drainage had clinical evidence of sepsis (4 had septic complications postoperatively, and 2 died); the remaining 33 patients who had noninfected pseudocysts left hospital within 20 days of operation. However, only four of nine patients who had percutaneous drainage for noninfected pseudocysts left hospital within 20 days of the procedure. Thus, the authors recommend that infected pancreatic pseudocysts be managed by percutaneous catheter drainage and noninfected pseudocysts by internal drainage.

Abdomen↗
PubMed1992

Bleeding gastric and duodenal ulcers: endoscopic therapy versus surgery.

From a retrospective review of 156 patients with actively bleeding peptic ulcers, 61 patients had gastric ulcers and 95 patients had duodenal ulcers. Patients presented with hematemesis or melena or a combination of the two. Forty patients with gastric ulcers and 53 patients with duodenal ulcers were in shock. Twenty-five patients with gastric ulcers underwent surgery. Bleeding was controlled in all patients, but in the postoperative period five patients died of myocardial infarction, pulmonary embolism or septic multisystem organ failure. Of 36 patients who underwent endoscopic epinephrine sclerosis of the bleeding gastric ulcer, hemorrhage was controlled in 34. Two patients required reoperation for bleeding after surgery; both survived. Fifty patients with duodenal ulcers had surgery. Bleeding was controlled in all patients, but in the postoperative period 10 died of myocardial infarction and multisystem organ failure. Of 45 patients who underwent endoscopic sclerosis, bleeding was controlled in 40. Five patients required reoperation for bleeding after surgery; all survived. The authors conclude that endoscopic sclerosis should be the initial treatment for actively bleeding gastric and duodenal ulcers. If bleeding continues or recurs then surgery should be carried out.

Adult↗
PubMed1991

Anastomotic recurrence of carcinoma of the colon and rectum. The value of endoscopy and serum CEA levels.

The early diagnosis of anastomotic recurrence after surgery for carcinoma of the colon and rectum is difficult. Whether repeat colonoscopy and serial serum CEA measurements were useful in diagnosing early anastomotic recurrence was examined. A total of 112 patients with carcinoma of the colon and rectum who had undergone resection and anastomosis were followed with frequent colonoscopy and serum CEA measurements. Seventeen patients developed anastomotic recurrence. Fourteen patients had elevated serum CEA levels, and 15 patients had endoscopic evidence suggesting recurrence at the anastomotic site. CT scans of the abdomen and pelvis demonstrated metastatic disease in seven patients, localized anastomotic disease in six patients, and no evidence of disease in four patients. Laparotomy was then carried out in 10 patients. In eight of 10 patients, it was possible to resect localized disease. In a 3-year follow-up study, eight patients were alive, four without any evidence of recurrent disease. Repeat colonoscopy and serum CEA measurements are recommended as postoperative surveillance for carcinoma of the colon and rectum. In select cases laparotomy and resection may prolong survival.

Abdominal Neoplasms↗
PubMed1991

The role of endoscopic papillotomy in ascending cholangitis.

The role of endoscopic papillotomy in calculous cholangitis is unclear. A retrospective review of 41 patients admitted to hospital with calculous cholangitis was carried out. There were 30 women and 11 men and their ages ranged between 49 and 98 years (mean age 77). All patients presented with abdominal pain, tenderness, chills, and fever. Clinical jaundice was present in 95 per cent of the patients. Initial endoscopic papillotomy was successful in 17 of the 41 patients. In 24 patients cholangitis persisted or recurred and further therapy was carried out. Surgery was successful in controlling sepsis in ten of the 24 patients. Repeat endoscopic papillotomy was successful in four of 13 patients. Surgery was successful in one of nine patients who had failed repeat endoscopic papillotomy. Nasobiliary drainage and percutaneous transhepatic drainage of the common bile duct after failed repeat endoscopic papillotomy was successful in only two of nine patients. Six patients died after failed repeat endoscopic papillotomy. We conclude that initial endoscopic papillotomy should be attempted in patients with calculous cholangitis. Surgical exploration of the common bile duct should then be carried out if initial endoscopic papillotomy fails to control cholangitis.

Aged↗
PubMed1990

Ventilatory responses to hypercapnia and hypoxia in patients with eucapnic morbid obesity before and after weight loss.

1. To examine the relationship between eucapnic morbid obesity and ventilatory responsiveness to chemical stimuli, we measured hypercapnic and hypoxic ventilatory responses in 29 patients (26 women, three men) before and 3-6 months after gastroplasty. No subject demonstrated resting awake hypercapnia and non suffered from sleep-disordered breathing. 2. Mean weight fell significantly (122.8 +/- 21.4 vs 102.2 +/- 22.8 kg, P less than 0.0001) and functional residual capacity rose slightly but significantly (1.94 +/- 0.58 vs 2.18 +/- 0.64 litres; P less than 0.05) after weight loss. 3. The hypercapnic ventilatory response slope fell significantly after weight loss (2.88 +/- 2.27 vs 2.24 +/- 1.06 litres min-1 mmHg-1, P less than 0.05) with a significant shift of the ventilatory response curve to the right. There were no statistically significant changes in the patterns of ventilatory response. 4. In addition, isocapnic hypoxic ventilatory response slopes, measured at two levels of carbon dioxide partial pressure, fell significantly after weight loss. These changes were accompanied by significant shifts of the ventilatory response curves to the left, such that, for a given oxygen saturation, mean ventilation was significantly lower in the less obese state. Similarly to hypercapnic responses, there were no statistically significant changes in ventilatory pattern despite the changes in overall ventilatory response. 5. We conclude that ventilatory responsiveness to chemical stimuli is increased in obese subjects who maintain adequate alveolar ventilation while awake.

Adult↗
PubMed1990

Investigation of obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) or CT scan of the abdomen.

Investigation of the cause of obstructive jaundice usually involves a myriad of blood tests and x rays. The recent development refinement and availability of new techniques--ultrasonography, computed tomographic scans (CT), and endoscopic retrograde cholangiopancreatography (ERCP), have significantly improved the diagnostic accuracy of establishing the cause of obstructive jaundice. What is not clear is whether all investigations should be carried out on all patients presenting with jaundice. Recently the authors have had experience with 14 patients who presented with obstructed jaundice. This report compares the accuracy rate between CT scans and ERCP.

Aged↗
PubMed1990

Ascending cholangitis: surgery versus endoscopic or percutaneous drainage.

A retrospective review of 61 patients with calculous cholangitis was carried out. There were 31 men and 30 women and their mean age was 75.8 years. All patients had abdominal pain, 87% had chills and fever, 65% had clinical jaundice, 23% were in shock, and 54% had positive blood cultures. Because intravenous hydration and antibiotics did not help, 33 patients underwent surgery, 25 patients underwent endoscopic papillotomy (EP), and three patients underwent percutaneous transhepatic drainage of the common bile duct (PTD). Morbidity in the surgery group included two wound infections, one respiratory failure, and one renal failure. Morbidity in the EP-PTD group was one case of arterial bleeding requiring surgery and one of pancreatitis treated conservatively. Two patients (6%) died in the surgery group, one of sepsis and the other of cardiorespiratory arrest. In the EP-PTD group nine patients (32%) died of sepsis and multisystem organ failure. These patients were considered too ill to undergo surgery and thus repeat EP-PTD was carried out. Cholangitis persisted, and retained common bile duct stones with sepsis was the cause of death. Thus when initial EP or PTD is unsuccessful, surgical exploration of the common bile duct should be carried out to control sepsis.

Adult↗
PubMed1989

Benign cecal ulcer.

Benign cecal ulceration, generally presenting as a right lower abdominal mass or lower gastrointestinal bleeding in older patients, is often associated with typhoid fever, cytomegalovirus, and ingestion of nonsteroidal anti-inflammatory drugs. Diagnosis is generally made during surgery, but conservative treatment often leads to complete healing. In elective patients, repeated X-ray examinations of the colon, especially with air contrast barium enema and colonoscopy, are recommended to distinguish benign cecal ulceration from a malignancy.

Cecal Diseases↗
PubMed1989

Retained common bile duct stones. Endoscopic papillotomy is the preferred approach.

In six patients who had undergone cholecystectomy and common bile duct exploration, the postoperative T-tube cholangiogram demonstrated stones. Endoscopic cholangiography demonstrated a normal common bile duct in 2 patients and stones in 4 patients. In the latter group, endoscopic papillotomy and stone extraction were successful.

Adult↗
PubMed1988

Proliferative activity of rectal mucosa and soluble fecal bile acids in patients with normal colons and in patients with colonic polyps or cancer.

Rectal biopsies and fecal collections were obtained from a consecutive series of 34 outpatients prior to colonoscopy at a gastroenterology clinic. Subsequently, 14 were found to have no colonic pathology, 13 had adenomatous polyps, (3 of those had a previous history of colon cancer) and 7 were diagnosed with colon cancer. In confirmation of earlier studies the tritiated thymidine labelling index was higher in patients with tumors than in those without pathology (7.9% vs. 5.8% with P = 0.06). The patients with colonic tumors also had significantly higher levels of deoxycholic acid (P = 0.01) and lithocholic acid (P = 0.005) in the aqueous extract of their feces. This study shows that these biochemical measures may indicate colon cancer risk.

Bile Acids and Salts↗
PubMed1987

Endoscopy in patients undergoing gastroplasty for morbid obesity.

Fifty patients underwent gastroplasty for morbid obesity. The follow-up regimen included both nutritional and weight assessment and gastroscopy. Weight loss was satisfactory in patients with gastric stomas less than 9 mm in diameter. Stomal obstruction was endoscopically diagnosed in 5 patients. Endoscopic dilatation was successful in 4 patients. Gastroscopy should thus be a routine postoperative procedure in patients undergoing gastric partitioning for morbid obesity.

Female↗
PubMed1987

Endoscopic vs surgical gastrostomy for enteral nutrition.

A retrospective review of 78 patients who had undergone endoscopic gastrostomy and 22 patients who had undergone Stamm gastrostomy was carried out. The mean operative time for the Stamm gastrostomy group was 63 min, while that for the endoscopic gastrostomy group was 26 min. One operative complication--bleeding--requiring reoperation occurred in the Stamm gastrostomy group. The incidences of aspiration, pneumonia, wound infection, and mortality were significantly higher in the Stamm gastrostomy group. We conclude that percutaneous endoscopic gastrostomy is the preferred technique for long-term enteral nutrition.

Adolescent↗
PubMed1986

Therapeutic endoscopy.

The development of flexible endoscopic instruments has altered the surgical approach to many disease processes. Endoscopic treatment of gastrointestinal polyps, common bile duct stones and foreign bodies of the gastrointestinal tract has now become the preferred method of treatment. Endoscopic gastrostomy is replacing surgical gastrostomy for the patient who requires long term enteral nutrition. Sclerosis of esophageal varices has now become the preferred method of managing patients with portal hypertension and bleeding esophageal varices. As newer endoscopic instruments are developed, more and more operative procedures will be carried out by endoscopic methods.

Ampulla of Vater↗
PubMed1985

Endoscopic control of upper gastrointestinal bleeding.

One important objective in managing patients with upper gastrointestinal hemorrhage is to control the bleeding until the patient's condition is stable and definitive therapy can be carried out. Endoscopic techniques are now available to attain this goal. Endoscopic sclerosis has become an accepted treatment for bleeding esophageal varices, especially in patients with Child's class B or C cirrhosis. Control of nonvariceal bleeding by endoscopic techniques is now feasible and involves laser photocoagulation and electrocoagulation. Clinical experience with endoscopic laser photocoagulation has demonstrated that it can successfully arrest bleeding in gastric and duodenal ulcers. Endoscopic electrocoagulation has been successful in stopping bleeding from Mallory-Weiss tears, acute gastric erosions, and gastric, duodenal and stomal ulcers. Use of an endoscopic heater probe, now in the development stage, to control bleeding gastric and duodenal ulcers will be an important addition.

Adult↗