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Murli Krishna

Publications and source records attributed to Murli Krishna.

16 recordsLinked to original sources
PubMed2007

Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study.

BACKGROUND: Cystic neoplastic lesions of the pancreas (CNLP) are increasingly detected and are associated with a potential for malignant transformation. Diagnostic assessment of these lesions is often limited by the cystic nature and focality of neoplastic progression of these lesions. EUS-guided FNA (EUS-FNA) of cyst fluid and exfoliated cells is one of the most accurate methods of diagnosis but still has limited sensitivity. A new, through-the-needle cytologic brush system has recently been approved for use during EUS evaluation of cystic lesions of the pancreas. OBJECTIVE: To evaluate the cytologic yield and safety profile of the new cytobrush compared with conventional FNA in evaluating CNLP. DESIGN: Ten consecutive patients with CNLP were included. All cysts were sampled by standard EUS-FNA (0.5 of cyst volume) followed by brush cytology, then by aspiration of the remaining fluid. Fluid samples were separately submitted (standard FNA and cytobrushings FNA) but were read by the same pathologist. Complications were assessed during the immediate postprocedure period (2-3 hours) and by a telephone call conducted approximately 30 days after the procedure to inquire about any new symptoms, including abdominal pain, melena, hematochezia, hematemesis, fever, nausea, and vomiting. SETTING: High-volume EUS referral center. PATIENTS: Ten consecutive patients with CNLP that measured at least 20 mm in maximal dimension were included. MAIN OUTCOME MEASUREMENTS: Cellularity and presence of diagnostic cells on the FNA. RESULTS: In 7 of 10 cases, the EchoBrush specimen was superior to FNA in terms of cellularity and detection of diagnostic cells. Two cases had complications: 1 major and 1 minor intracystic bleed. No infection or pancreatitis was observed. LIMITATIONS: The interpreting pathologist for the case was not blinded to the results of either of the samples. In addition, this pilot study represents only a single-center experience. CONCLUSIONS: This study suggests that brush cytology specimens obtained at the time of EUS are superior to conventional FNA because of the higher yield of epithelial cells. It is unclear whether bleeding is more common after EchoBrush sampling; however, caution should be taken in patients who require anticoagulation until further data are available.

Aged↗
PubMed2006

Tudor, MBT and chromo domains gauge the degree of lysine methylation.

The post-translational modification of histones regulates many cellular processes, including transcription, replication and DNA repair. A large number of combinations of post-translational modifications are possible. This cipher is referred to as the histone code. Many of the enzymes that lay down this code have been identified. However, so far, few code-reading proteins have been identified. Here, we describe a protein-array approach for identifying methyl-specific interacting proteins. We found that not only chromo domains but also tudor and MBT domains bind to methylated peptides from the amino-terminal tails of histones H3 and H4. Binding specificity observed on the protein-domain microarray was corroborated using peptide pull-downs, surface plasma resonance and far western blotting. Thus, our studies expose tudor and MBT domains as new classes of methyl-lysine-binding protein modules, and also demonstrates that protein-domain microarrays are powerful tools for the identification of new domain types that recognize histone modifications.

Histones↗
PubMed2006

Clinicopathologic findings and outcomes of liver transplantation using grafts from donors with unrecognized and unusual diseases.

Despite certain strict criteria for suitable organ donors, some unrecognized and unusual diseases have been transmitted through liver transplantation to recipients. In the current series, we review our experience with 14 patients who underwent liver transplantation using donor grafts with unusual pathology, including amyloidosis (6), schistosomiasis (3), iron overload (2), and alpha-1 antitrypsin deficiency (3). One of 6 patients who received grafts with amyloidosis developed vasculitis associated with the presence of arterial amyloid. With proper management, patients with donor schistosomiasis, iron overload and alpha-1 antitrypsin deficiency appear to have outcomes comparable to liver transplantation using grafts without these findings. In conclusion, long-term follow-up is necessary to confirm these findings and understand the impact of using these grafts.

Adult↗
PubMed2006

Oral mesalamine and clinical remission are associated with a decrease in the extent of long-standing ulcerative colitis.

OBJECTIVE: To compare colonoscopy alone with surveillance biopsy for the determination of anatomic extent in long-standing ulcerative colitis (UC). To assess the influences of mesalamine use and clinical disease activity on the change of histologic extent with time. MATERIALS AND METHODS: Disease extent (proctosigmoiditis, left-sided colitis, or pancolitis) measured by colonoscopy and surveillance biopsy was compared among 212 consecutive patients with long-standing UC. Among the 102 patients who had 2 consecutive colonoscopies with surveillance biopsies, the following influences on change in histologic extent were determined: disease activity, mesalamine use, age at disease onset, folic acid, corticosteroid and azathioprine/6-mercaptopurine use, and time between colonoscopies. RESULTS: Agreement between gross and microscopic findings was poor (kappa = 0.39). Colonoscopy underestimated and overestimated extent in 25.9% and 8.5%, respectively. Microscopic distribution between consecutive colonoscopies remained the same in 60.8%. Where distribution changed, an increase was twice as common as a decrease in extent. There was no difference in age at onset, time between colonoscopies, or disease duration among those with an increase, decrease, or no change in extent. Clinical remission and oral mesalamine were independently associated with 10.7 and 5.8 times the odds of a decrease in disease extent, respectively. Folic acid, topical mesalamine, corticosteroids, and immunomodulators did not influence change in extent. CONCLUSIONS: UC extent is best determined by surveillance biopsy. Among patients with long-standing UC, histologic extent fluctuates with time. Disease remission and oral mesalamine were independently associated with decreases in disease extent.

Administration, Oral↗
PubMed2006

Disseminated Bartonella infection following liver transplantation.

Bartonella henselae has not only been identified as the causative agent of cat scratch disease, but it is also associated with other significant infectious syndromes in the immunocompromised population. We describe two cases of B. henselae associated diseases in liver transplant recipients who both had contact with cats. The first recipient developed localized skin manifestation of bacillary angiomatosis in association with granulomatous hepatitis. He tested positive for Immunoglobulin G (IgG) antibodies against B. henselae. The second patient developed axillary lymphadenopathy, with biopsy showing necrotizing granulomatous inflammation and polymerase chain reaction studies were positive for B. henselae DNA. Her serology for bartonellosis showed a fourfold rise in antibody titers during her hospitalization. Both patients responded to treatment with Azithromycin in combination with Doxycycline. These were the only cases within a series of 467 consecutive liver transplants performed in 402 patients performed during a 4-year period. Although bartonellosis is a rare infection in liver transplantation recipients, it should always be included in the differential diagnosis of patients presenting with fever, central nervous system (CNS) symptoms, skin lesions, lymphadenopathy, and hepatitis especially if prior contact with cats is reported.

Angiomatosis, Bacillary↗
PubMed2006

Barrett's esophagus is common in older men and women undergoing screening colonoscopy regardless of reflux symptoms.

BACKGROUND: Although Barrett's esophagus (BE) is the precursor of esophageal adenocarcinoma (ACA), most patients with ACA present outside of a BE surveillance program. This could be due to undiagnosed symptomatic GER and BE or BE/ACA occurring in patients without reflux symptoms. We have, therefore, studied the prevalence of BE and symptom status in older patients referred for colonoscopy. METHODS: All patients referred for outpatient colonoscopy were eligible if they were at least 65 yr old and had not previously undergone esophagoscopy. After informed consent, the patients completed detailed GER questionnaires. During the research endoscopy, the endoscopist recorded the squamocolumnar junction (SCJ) as either long-segment BE (LSBE), short-segment BE (SSBE), or normal. If the SCJ was felt to be "irregular" the endoscopist was asked to predict, in their judgment, if BE was present. All patients had biopsies below the SCJ, which were examined by a gastrointestinal pathologist who was blinded to the endoscopic findings. RESULTS: BE esophagus was present in 50 of the 300 patients studied (16.7%). BE was more common in men (35 of 161, 21.7%) than in women (15 of 139, 10.8%) (p < 0.025). GERD symptoms were reported in 106 patients (35%) and BE was present in 19.8% of symptomatic and 14.9% of asymptomatic cases (NS). The majority of the BE in this study was less than 3 cm in length (92%). The questionnaires did not predict the presence of BE. CONCLUSIONS: BE is common in unscreened male and female patients at least 65 yr of age who are referred for colonoscopy. Men were more likely than women to have BE although it occurred in both sexes. Reflux symptoms were fairly common but a poor predictor of BE.

Adenocarcinoma↗
PubMed2006

Enhanced magnification-directed biopsies do not increase the detection of intestinal metaplasia in patients with GERD.

BACKGROUND: The diagnosis of Barrett's esophagus (BE) requires histologic confirmation of specialized intestinal metaplasia (SIM) through biopsy, a technique prone to sampling error. One method designed to improve the yield of biopsy uses acetic acid with magnification endoscopy: enhanced magnification endoscopy (EME). This technique identifies several mucosal surface patterns, and of these, pattern types III and IV have been associated with SIM. METHODS: We conducted a prospective, randomized trial to compare EME-directed biopsies and standard endoscopy with random biopsies in patients with symptoms of gastroesophageal reflux disease. Patients in the standard endoscopy group with evidence of BE had four-quadrant random biopsies taken every 2 cm. If there was no BE, four-quadrant biopsies were taken at the SCJ. Patients in the EME group had the mucosa at the SCJ classified as type I-IV based on published criteria. Biopsies targeted to type III and IV were compared to random biopsies. RESULTS: One hundred thirty-seven patients enrolled (68 randomized to EME, 69 to standard endoscopy). Fifty-six (41%) had endoscopic evidence of BE (20 standard endoscopy [29%] vs 36 EME [53%]). Of the patients with apparent BE, standard endoscopy with random biopsies confirmed SIM in 12 (60%) compared to 11 of 18 (61%) patients with EME targeted biopsies of patterns type III or IV (p = 1.0). Patients without apparent BE (N = 81) had SIM of the SCJ confirmed in 16% (8 of 49) with standard endoscopy and random biopsies compared with 8% (1 of 12) using EME-directed biopsy of pattern III or IV (p = 0.67). CONCLUSIONS: Random biopsies of endoscopically apparent BE and a normal SCJ yield SIM at the same rate as targeted biopsies with EME in patients with pattern types III or IV. This calls into question the utility of this technique in reducing sampling error to identify SIM.

Barrett Esophagus↗
PubMed2004

Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C.

BACKGROUND: The use of liver allografts from an older donor (OD) (age>50 years) is a widespread strategy to manage the disparity between supply and demand of organs for liver transplantation. This study determines the effect of OD allografts on fibrosis progression and graft survival after liver transplantation in patients with and without infection caused by hepatitis C virus (HCV). METHODS: All patients undergoing liver transplantation at our center from March 1998 to December 2001 were analyzed. Protocol liver biopsies were performed at 1, 16, and 52 weeks after transplantation and yearly thereafter. One liver pathologist scored all biopsy specimens for modified hepatic activity index (0-18) and fibrosis (0-6). RESULTS: A total of 402 patients (167 with HCV and 235 without HCV) underwent liver transplantation during the study period. Among patients with HCV, baseline characteristics of OD recipients were similar to younger donor (YD) (age<50 years) recipients. In patients with HCV, graft survival was shorter in OD graft recipients than in YD recipients (P<0.001). In patients without HCV, graft survival was independent of donor age. In patients with HCV, a fibrosis score of 3 or greater was present in 17% of OD recipients at 4 months and in 26% at 12 months after transplantation, compared with 8% of YD recipients at 4 months and 13% at 12 months (P<0.001). CONCLUSIONS: Liver transplantation with OD grafts is associated with rapid progression of fibrosis and decreased graft survival in patients with HCV, but not in patients without HCV. OD grafts should be considered preferentially for patients without HCV.

Adolescent↗
PubMed2004

Hepatitis C recurrence is not associated with allograft steatosis within the first year after liver transplantation.

The natural history of allograft steatosis in hepatitis C (HCV)-infected patients after liver transplantation (LT) is poorly understood. The aim of our study was to determine the relationship of allograft steatosis to HCV recurrence after LT. All patients undergoing LT at our center from March 1998 to December 2001 were included in the study. Explanted liver tissue and liver biopsies performed at 1 week, 4 months, and 12 months were scored for degree of allograft steatosis (0-4), fibrosis (0-6), and modified histological activity index (0-18). One hundred sixty-seven HCV and 235 non-HCV-infected patients (control group) underwent LT. Of these patients, 122 HCV and 154 non-HCV patients had a viable graft at 1 year and were analyzed. Allograft steatosis was present in 40% of HCV patients at 4 months and 36% at 1 year. The incidence of allograft steatosis after LT was similar in HCV-infected and non-HCV-infected patients (P not significant). Age of the donor (P =.041), or higher recipient body mass index (BMI) at the time of LT (P =.015) or at 12 months after LT (P =.041) predicted a higher degree of allograft steatosis at 12 months in the HCV group. Degree of allograft steatosis was not associated with higher fibrosis or necroinflammatory score. In conclusion, there is a similar high incidence of allograft steatosis in HCV and non-HCV-infected patients after LT. A high BMI of the HCV-infected recipient is the best predictor for high degree of allograft steatosis after LT. Allograft steatosis does not predict the severity of HCV recurrence in the first 12 months after LT.

Age Factors↗
PubMed2004

Bisalbuminemia in chronic kidney disease.

Hereditary and acquired bisalbuminemia, in which the serum contains an albumin variant differing from albumin A by single amino-acid substitutions, have been reported in different races or ethnic groups and in association with various pathologic states. The importance of this rare condition in the pathophysiology of established diseases is uncertain. We evaluated a 68-year-old woman with chronic kidney disease who presented with worsened serum creatinine concentration despite lack of dietary or medical changes. Serum protein electrophoresis was performed with an automated rapid electrophoresis system. Bisalbuminemia was noted as an incidental finding on serum protein electrophoresis. The serum creatinine level stabilized with dietary protein restriction and a beta-blocking agent/diuretic combination for blood pressure control. Although the possibility that some physiologic or pharmacologic substances may not bind to abnormal albumin variants as well as they bind to normal albumin should not be discounted, the finding of bisalbuminemia did not influence the diagnosis, management, course, or prognosis of chronic kidney disease. The role of persistent bisalbuminemia in renal disease is uncertain.

Acute Kidney Injury↗
PubMed2004

Recurrent pancreatitis due to a cystic pancreatic tumor: a rare presentation of acinar cell carcinoma.

CONTEXT: Acinar cell carcinoma is an uncommon malignancy of the pancreas. It has characteristic histomorphology, immunohistochemistry profile, and clinicopathological behavior. CASE REPORT: We report a rare case of recurrent pancreatitis secondary to acinar cell carcinoma of the pancreas. We describe the endoscopic ultrasound characteristic, treatment and the surgical outcome. CONCLUSIONS: Acinar cell carcinoma should be considered in the differential diagnosis of cystic pancreatic tumors presenting with recurrent pancreatitis.

Aged↗
PubMed2003

Jaw claudication in primary amyloidosis: unusual presentation of a rare disease.

We describe two patients with temporal artery biopsy-proven amyloidosis presenting with symptoms of jaw claudication, visual disturbance, and proximal muscle stiffness suggestive of giant cell arteritis (GCA) and polymyalgia rheumatica. At the onset of disease, neither patient had other characteristic symptoms to suggest primary amyloid. We point out similarities between GCA and primary amyloid that can lead to confusion in diagnosis.

Aged↗