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M P Sharma

Publications and source records attributed to M P Sharma.

At least 55 records · Page 3Linked to original sources
PubMed1991

Case report: unusual CT appearances in a case of Budd-Chiari syndrome.

We describe a case of Budd-Chiari Syndrome due to hepatic venous blockage in which there were multiple space-occupying lesions on CT simulating tumour deposits. Ultrasound directed liver biopsy and laparoscopy proved these to be areas of haemorrhagic necrosis consistent with Budd-Chiari Syndrome without any evidence of malignancy. The CT finding of multiple large focal non-enhancing areas in liver does not always indicate tumour deposits in a patient suspected to have Budd-Chiari Syndrome.

Adult↗
PubMed1991

Constrictive pericarditis masquerading as Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) and constrictive pericarditis (CP) share many common clinical features. Over the last year we encountered three patients in whom CP clinically mimicked BCS. Two of the three did not even have raised jugular venous pressure. One patient with severe jaundice and hepatic coma ultimately died. Liver biopsy features were not discriminating. The final diagnosis of CP was established by echocardiography, chest computed tomography (CT), or cardiac catheterization. We conclude that in all patients with apparent BCS and atypical features, a noninvasive test like echocardiography or chest CT should be done to rule out treatable illness like CP before embarking on such invasive procedures as liver biopsy for diagnosis.

Adolescent↗
PubMed1991

Gallbladder abnormalities in acute viral hepatitis: a prospective ultrasound evaluation.

We carried out a prospective case controlled study to evaluate the temporal sequence of sonographic abnormalities in acute viral hepatitis (AVH) and their resolution patterns. Correlations were established between the sonographic abnormalities and the clinical and biochemical profiles. Fifty-six patients within 2 weeks of onset of illness (37 within 1 week and 19 between 1 and 2 weeks) underwent real-time ultrasound at weekly intervals until clinical and biochemical resolution. Abnormal sonographic patterns were found in 55 of 56 (98.2%) patients. The wall thickness was abnormal (6.1 +/- 4.3 mm) in 55 (98.2%) cases, luminal abnormalities observed in 33 (58.9%) cases, and alterations in volume in 14 (25%) cases. Complete resolution took place in 53 (96.4%) cases by 12 weeks. A wall thickness of greater than 7 mm and abnormal luminal contents were more frequent in patients studied within 1 week of illness than later (p less than 0.05). No other correlations could be established between the different sonographic patterns and the clinical and biochemical profiles at any stage of the illness. We conclude that sonographic abnormalities are common in patients with AVH, with resolution as the rule with clinical recovery.

Acute Disease↗
PubMed1991

Control of variceal bleed with metoclopramide.

The efficacy of parenteral metoclopramide in the control of active variceal bleeding was assessed in a prospective, randomized, double blind, placebo controlled trial. Patients with portal hypertension due to different etiologies (cirrhosis, non cirrhotic portal fibrosis and extrahepatic portal venous obstruction) with endoscopically documented active variceal bleeding entered the study. Forty nine consecutive patients were randomized after pre-entry stratification for Child's scores. Intravenous metoclopramide (20 mg) or 2 ml dextrose was administered in all patients while the first endoscopy documented an active variceal bleeding. All patients were subjected to a second endoscopy 15 minutes later to determine control of bleeding. Rebleeding rate, transfusion requirement, adverse effects and mortality were analysed. Twenty of the 25 patients treated with metoclopramide stopped bleeding compared to 5 of 24 in the control group (p less than 0.05). Rebleeding occurred in 4 of 20 in the metoclopramide group and 4 of 5 in the control group within 72 hours (p less than 0.05). The number of patients requiring blood transfusion (10 vs 16) and the transfusion requirement (1.8 +/- 2.2 vs 3.6 +/- 2.1 units) were significantly lower (p less than 0.01) in the metoclopramide group than in the control group. Mortality was similar and there were no complications due to therapy. We conclude that intravenous metoclopramide is a safe and effective agent for the control of acute esophageal variceal bleeding.

Adolescent↗
PubMed1990

Metabolic labeling of Entamoeba histolytica antigens: characterization of a 28-kDa major intracellular antigen.

The in vivo incorporation of radiolabeled amino acids into antigens of Entamoeba histolytica, HM-1:IMSS, is reported. Immunoprecipitation with sera from patients with invasive amebiasis revealed a 28-kDa antigen present in whole cell lysates of E. histolytica. This antigen was of cytoplasmic origin, as indicated by cell fractionation and Triton X-114 detergent-phase separation. Immunoprecipitation, using sera from patients with invasive amebiasis and symptomless cyst passers, revealed the 28-kDa antigen as the major antigen recognized by the sera tested. Immunoprecipitation analysis using radiolabeled-released proteins instead of whole cell lysates showed a number of bands, including the 28-kDa antigen. The data suggest that the 28-kDa antigen is of cytoplasmic origin or is released from the cytoplasmic compartment.

Amebiasis↗
PubMed1990

Gallstone disease in north India: clinical and ultrasound profile in a referral hospital.

We studied the prevalence of gallstones in patients with upper abdominal pain, heaviness, or discomfort by ultrasound examination of the gallbladder. The actual ultrasound examination was performed by a clinical gastroenterologist blinded to the symptoms. Of 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The gallbladder was contracted in 450 (91.2%), normal-size in 36 (7.2%), and distended in 8 (1.6%). Biliary colic was more frequently the presenting complaint in patients with a contracted gallbladder than in those with normal size gallbladder (p less than 0.001). Dyspepsia was more frequent in the presence of a normal size gallbladder than a contracted one (p less than 0.001). We conclude that ultrasonography of the gallbladder by the clinician has a high diagnostic yield, and the symptom complex has an excellent correlation with the sonographic appearance.

Adolescent↗
PubMed1990

Clinical profile of multiple amoebic liver abscesses.

Of 70 consecutive patients with amoebic liver abscess admitted over a 3 year period, 15 (21.4%) had multiple abscesses. This condition, like solitary abscess, was a disease of the 2nd to 5th decade with a male preponderance. Multiple abscesses were more frequently associated with fever, jaundice, upper abdominal pain, pneumonitis and tender hepatomegaly. The left lobe of the liver was always enlarged in patients with multiple abscesses and 86% of patients required drainage of an abscess cavity. The presence of more severe clinical course, jaundice and left lobe hepatomegaly should raise the suspicion of multiple abscesses. After confirmation of the diagnosis by imaging technique, the abscess cavity should be aspirated for quick relief and cure.

Adolescent↗
PubMed1990

Zollinger Ellison syndrome.

ZES is an uncommon disease with clinical manifestations akin to patients with peptic ulcer. Marked gastric acid hypersecretion can be checked but cause of death in the patients is usually metastasis. An early diagnosis and hence a possible surgical cure is very important and one must have high index of suspicion for diagnosis. As many as 50% of patients may have non diagnostic serum gastrin levels and hence need provocative tests to establish the diagnosis. Hypersecretion of acid should be controlled by antisecreting drugs followed by tumor localization with contrast CT, selective angiography and portal venous sampling for gastrin levels in doubtful cases. In MEN-I and metastatic patient, major surgery should be avoided. All pancreatic and extra pancreatic tumors should be resected if there is no metastasis.

Female↗
PubMed1990

Etiology of liver abscess with special reference to anaerobic bacteria.

Specimens of pus from 78 patients with liver abscesses were cultured using anaerobic culture techniques in an attempt to ascertain the etiologic role of anaerobes. Bacteria were isolated from 28 of the 78 specimens, 9 with anaerobes and or microaerophilic streptococci. Two pus specimens yielded mixed growth. Fourteen liver abscess pus specimens were subjected to direct gas liquid chromatography for detection of volatile and nonvolatile fatty acids (VFA/NVFA). Two of the 3 specimens positive for multiple VFA were bacteriologically sterile--an indirect evidence of the presence of anaerobic bacteria at the site of infection bringing the number of patients with anaerobic infection to 11 (14.1%).

Adult↗
PubMed1989

Needle aspiration of amoebic liver abscess.

OBJECTIVE: To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN: Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING: Referral based gastroenterology clinic. PATIENTS: 39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION: Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES: Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS: Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS: Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.

Adult↗