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Biomedical subjects

M K Goenka

Publications and source records attributed to M K Goenka.

At least 19 recordsLinked to original sources
PubMed1997

Sclerotherapy in noncirrhotic portal fibrosis.

Endoscopic sclerotherapy has emerged as an effective and safe mode of treatment for long-term management of esophageal varices due to cirrhosis of liver and extrahepatic portal venous obstruction. There are few studies that have evaluated the role of sclerotherapy in the management of esophageal varices in patients with noncirrhotic portal fibrosis (NCPF). We report our results of long-term sclerotherapy in patients with NCPF. Seventy-two consecutive patients (men 29, women 43; age 32.9 +/- 11.8 years) with recurrent variceal bleeding due to NCPF were entered into the sclerotherapy program. Forty-eight patients received intravariceal absolute alcohol and 24 patients received intravariceal sodium tetradecyl sulfate (STD). Variceal obliteration was achieved in 65 (90.3%) patients with a mean of 5.7 +/- 3.0 (range 1-14) sessions. These patients were followed-up for a mean of 21.4 +/- 20.4 (range 1-96) months. Thirteen (17.3%) patients had episodes of upper gastrointestinal bleeding during sclerotherapy. Rebleed after obliteration was seen in 6 (9.2%) patients. Sclerotherapy was associated with a significant reduction in bleeding rate (bleeds per month per patient) during sclerotherapy and after obliteration of varices as compared to presclerotherapy period (P < 0.000001 for both). Recurrence of esophageal varices after obliteration was seen in 9 (13.9%) patients with reobliteration of varices in five patients in whom sclerotherapy was attempted. Complications including esophageal ulcer and stricture formation were seen in 18 (25%) and 4 (5.6%) patients respectively; strictures were restricted to patients who received absolute alcohol. Two (2.77%) patients died of massive upper gastrointestinal bleed during follow-up. We conclude that sclerotherapy is an effective and safe modality in the prevention of variceal bleeds in patients with NCPF.

Adult↗
PubMed1997

Transhiatal oesophagectomy for benign obstructive conditions of the oesophagus.

BACKGROUND: Transhiatal oesophagectomy is an accepted approach for the treatment of carcinoma of the oesophagus. However, experience of this technique in benign diseases is limited. METHODS: Transhiatal oesophagectomy was done in 29 patients for benign oesophageal conditions including corrosive stricture (21), achalasia of the cardia (four), tuberculosis (one), mediastinal fibrosis (one), Crohn's disease (one) and peptic stricture (one). Dysphagia was the predominant symptom in all patients; strictures had all previously been dilated repeatedly. The stomach was used as an oesophageal substitute in 24 patients; in five with a scarred stomach due to damage by a corrosive agent, oesophagocoloplasty was performed. Resection and reconstruction were done in one stage in 25 patients; four with poor nutritional status had a two-stage procedure. RESULTS: There was no perioperative death. Complications encountered were recurrent laryngeal nerve palsy (six patients) which was mostly transient, anastomotic leak (seven) and stenosis (eight). Postoperative function of the intrathoracic stomach was satisfactory. CONCLUSION: Transhiatal oesophagectomy is a safe and satisfactory procedure for benign obstructive conditions of the oesophagus.

Adolescent↗
PubMed1997

Transcriptional expression of gastrin mRNA in Helicobacter pylori infected patients.

In order to study the association between gastrin and H. pylori infection the density of antral G cells was evaluated by transcriptional expression of gastrin mRNA using a sensitive cold probe labelled with digoxigenin. the study group included 22 patients with symptomatic H. pylori positive gastritis and/or duodenal ulcer, 12 of whom were re-evaluated after eradication of H. pylori and 6 controls. The number of G cells per high power field in H.pylori positive patients (26.68 +/- 9.51) was significantly higher (P < 0.01) compared to controls (5.83 +/- 3.37). Among the 12 patients re-evaluated after H. pylori eradication, there was a significant decrease (P < 0.001) in the number of G cells (13.5 +/- 5.44) compared to pre-eradication value (26.25 +/- 8.0). The present study suggests that increased transcriptional expression of gastrin is directly related to H. pylori infection.

Adolescent↗
PubMed1997

Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India.

OBJECTIVE: To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL: Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS: The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION: PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.

Adolescent↗
PubMed1996

Candida overgrowth after treatment of duodenal ulcer. A comparison of cimetidine, famotidine, and omeprazole.

Acid-reducing drugs can cause increased growth of microbes, including fungus, because of high gastric pH. Our purpose was to evaluate the occurrence of mycotic infection in patients with duodenal ulcer on anti-ulcer therapy and to compare the effects of cimetidine, famotidine, and omeprazole. Eighty patients with duodenal ulcer (62 males and 18 female patients, 16-65 years old) were evaluated for mycotic infection before and after 6 weeks of therapy (cimetidine, 20 patients; famotidine, 40 patients; omeprazole, 20 patients). Mycotic infection was diagnosed by endoscopic biopsy from the ulcer edge subjected to smear, culture, and histopathology and by endoscopic brush samples and gastric aspirate. On the basis of these studies, patients were categorized as having no fungal growth, saprophytic growth, or significant fungal growth. Thirty-five (43.8%) patients had evidence of fungus before ulcer therapy, and 16 of the 35 (20%) had significant fungal growth. The fungal isolation rate was higher in older patients (> and = 45 years of age) and in those with an ulcer size > and = 2 cm. While there was no significant increase in the total number of patients with evidence of fungus after therapy (n = 36), there was a significant increase in those with significant growth (n = 27, p < 0.05) compared with pretreatment status. We found that posttreatment gastric pH of > and = 4 was associated with a higher fungal positivity rate (59.4%) than pH values < 4 (32.4%, p < 0.05). However, neither the type of drug used nor the response in terms of ulcer healing correlated with the presence of fungus. Regardless of the type of drug used, acid-reducing therapy is associated with increased significant fungal growth.

Adult↗
PubMed1996

Hepatic amyloidosis presenting with severe intrahepatic cholestasis.

Systemic amyloidosis presenting with jaundice is rare. A case of primary amyloidosis presenting with severe intrahepatic cholestasis is reported. The patient had hepatomegaly, ascites, and a markedly elevated serum alkaline phosphatase level. He had a rapid downhill course resulting in death. Autopsy showed evidence of amyloidosis involving multiple organs, including the liver, kidney, and heart.

Adult↗
PubMed1996

Primary lymphoma of the esophagus.

Primary esophageal lymphoma is very rare. We report a patient with non-Hodgkin's lymphoma involving the lower one-third of the esophagus. Presenting with dysphagia, he was treated successfully by transhiatal esophagectomy along with combination chemotherapy. We review the relevant literature.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Primary sclerosing cholangitis: an experience from India.

Primary sclerosing cholangitis (PSC) is considered to be rare in India. The aim of the present study was to investigate the incidence, clinical profile and outcome of PSC seen in a tertiary care centre. Over a period of 10 years (July, 1984-June, 1994) 18 patients of PSC were diagnosed at cholangiography (14 patients by endoscopic retrograde cholangiopancreatography, two patients by percutaneous transhepatic cholangiography and two patients by both methods). The presence of secondary causes, such as choledocholithiasis, biliary tract surgery, congenital biliary tract anomalies, cholangiocarcinoma and pancreatic diseases, were excluded. These patients were evaluated retrospectively with respect to their clinical presentation, radiological findings, presence of associated idiopathic ulcerative colitis (IUC), treatment instituted and outcome. The mean (+/- s.d.) age at diagnosis of PSC was 39.0 (+/- 16.1) years with a male:female ratio of 1.57:1. Nine (50%) patients had associated IUC. The diagnosis of the IUC preceded that of PSC in all but one case. Fifteen (83.3%) patients had cholestatic jaundice at presentation, while three (16.7%) patients had asymptomatic rise of alkaline phosphatase. Three (16.7%) patients had recurrent cholangitis and five (27.8%) patients developed portal hypertension during the course of the disease. At cholangiography, intrahepatic radicles were involved in all and extrahepatic radicles in 12 (66.6%) cases. Patients were managed with steroids (n = 7), colchicine (n = 3), ursodeoxycholic acid (UDCA; n = 2) and methotrexate (n = 1), along with symptomatic measures. Mean duration of follow up available in 11 (61%) patients was 20.1 months (range: 1 month-8 years). Four (36.4%) patients died. Steroids and colchicine did not have any effect while the one patient on UDCA and one on methotrexate showed improvement. In conclusion, in India PSC does not seem to be a rare entity. Its clinical profile and outcome are somewhat similar to those seen in Western countries.

Adult↗
PubMed1996

Chloroquine for mild to moderately active ulcerative colitis: comparison with sulfasalazine.

Chloroquine and hydroxychloroquine have been used successfully in a number of immunological diseases because of their immunomodulatory effect. Preliminary studies have shown them to be effective in the treatment of idiopathic ulcerative colitis. We assessed the efficacy or oral chloroquine in the treatment of idiopathic ulcerative colitis of mild to moderate severity in a randomized, controlled, blinded trial. Forty patients were assigned to receive chloroquine phosphate (500 mg/day) or sulfasalazine (3 g/day). The outcome of therapy was monitored at the end of 2 wk and 4 wk by symptom assessment and sigmoidoscopic examination. An objective scoring system was used for the evaluation, and patients were categorized into those showing complete remission, partially responding, and nonresponders. There was a sequential improvement in the individual scores as well as total activity score in both groups at 2 wk and 4 wk. With chloroquine, 12 patients (60%) showed complete remission at 4 wk, whereas six (30%) had a partial response. With sulfasalazine, 11 patients (55%) had complete remission at 4 wk, and eight (40%) showed partial response. There was no significant difference in the response to the two drugs (p > 0.05). Five (25%) patients in the chloroquine group had side effects, compared with eight (40%) in the sulfasalazine group (p > 0.05). All side effects were minor and transient, not requiring withdrawal of the drug. We conclude that short-duration chloroquine therapy is a safe and effective alternative to sulfasalazine in the treatment of mild to moderately active ulcerative colitis.

Adjuvants, Immunologic↗
PubMed1996

Angioimmunoblastic lymphadenopathy: an etiology for gastrointestinal lymphomatous polyposis.

We describe a case of angioimmunoblastic lymphadenopathy with multiple polyps of the gastrointestinal tract. The patient presented with fever, abdominal mass, ascites, diarrhea, generalized lymphadenopathy, anemia, and marked peripheral eosinophilia. She had multiple polyps in the colon, as well as in the stomach and duodenum. Histology of a colonic polyp showed involvement by angioimmunoblastic lymphadenopathy. The patient responded initially to combination chemotherapy, with total disappearance of polyps. However, she succumbed later to infections. Angioimmunoblastic lymphadenopathy, although rare, should be included as a cause of lymphomatous polyposis of the gastrointestinal tract.

Adult↗
PubMed1996

Helicobacter pylori eradication--evaluation of triple therapy containing omeprazole.

BACKGROUND: There is a need to develop alternative regimen(s) for treating Helicobacter pylori infection because of problems of drug compliance, side-effects and resistance with the conventional regimen consisting of bismuth, metronidazole and an antibiotic. AIMS: To compare prospectively the efficacy of conventional triple therapy (bismuth subcitrate 120 mg QID, amoxycillin 500 mg QID and metronidazole 400 mg TID for 2 weeks with one containing omeprazole (20 mg OD), bismuth subcitrate and amoxycillin (regimen B). METHODS: Sixty two consecutive patients with H pylori infection associated with antral gastritis and/or duodenal ulcer were randomized to two treatment groups and re- evaluated after completion of 2 weeks of therapy and then after a further 4 weeks for eradication of H pylori, ulcer healing and drug side-effects. RESULTS: Regimen B resulted in higher H pylori eradication rate as compared to regimen A (76.7% vs 63.3%, better ulcer healing rate (90.9%, vs 70.6%), lesser side-effects (10.0% vs 36.7%) and better drug compliance (100% vs 93.3%). The difference between the two regimens was significant (p < 0.05) only in respect to side-effects. CONCLUSION: For H pylori eradication, omeprazole, bismuth and amoxycillin combination for 2 weeks is as effective as the conventional therapy and is better tolerated.

Adult↗
PubMed1996

Pancrease divisum: five years' experience in a teaching hospital.

AIM: To study the frequency and significance of pancreas divisum. METHODS: Retrospective analysis of all pancreatograms carried out between July 1989 and June 1994. RESULTS: The 809 pancreatograms performed included 207 in patients with pancreatitis (acute 74, chronic 133), 330 with biliary disease, 238 with obscure abdominal pain and 34 with pancreatic malignancy. Of these, 30 patients (3.7%) were diagnosed to have pancreas divisum - 26 had type I variant, one had type II variant and three had type III variant. Accessory papillary cannulation was attempted in 10 patients; 8 were successful, with dorsal ductography confirming pancreas divisum in all of them. Two of these 8 patients had changes of chronic pancreatitis in the dorsal duct. The frequency of pancreas divisum in patients with pancreatitis (19 of 207, 9.2%) was significantly higher than in patients with biliary diseases and those with obscure abdominal pain (11 of 568, 1.9%; p < 0.001). CONCLUSIONS: Pancreas divisum is not an uncommon condition in India and its frequency in patients with idiopathic pancreatitis is higher than that in patients with other abdominal conditions. It should be looked for in any case of idiopathic pancreatitis.

Biliary Tract Diseases↗
PubMed1995

Hepatic involvement culminating in cirrhosis in a child with disseminated cryptococcosis.

A 7-year-old child had unusual manifestation of cryptococcosis; liver and lymph node involvement predominated. There was evidence of cryptococcal hepatitis, extrahepatic biliary obstruction, and subsequent cirrhosis of the liver. Despite widespread dissemination, underlying immune disturbance was not evident. The patient was treated with two courses of amphotericin and 5-flucytosine.

Amphotericin B↗