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Biomedical subjects

R Kochhar

Publications and source records attributed to R Kochhar.

At least 19 recordsLinked to original sources
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

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

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

A study of hepatitis delta virus infection in patients with acute and chronic liver disease from northern India.

To assess the prevalence of hepatitis delta virus (H delta V) in northern India, 204 adult patients with acute and chronic liver disease who were positive for hepatitis B virus (HBV) markers were screened for anti-H delta V antibody by enzyme-linked immunosorbent assay (ELISA). Anti-H delta V antibodies were positive in 29 (14.2%) patients. The incidence of H delta V infection was higher (21.4%) in patients with chronic liver disease when compared with those with acute viral hepatitis (10.7%) (P < 0.05). H delta V antibodies were positive in 16.6% of patients with fulminant hepatic failure (FHF) and in 25% of cases with hepatocellular carcinoma. Co-infections were significantly higher in acute hepatitis (80%), while superinfections predominated (66.7%) in chronic liver disease (P < 0.05). Our data show that H delta V is endemic in northern India and should be considered a major health problem.

Acute Disease↗
PubMed1995

Pancreatic ascites and pleural effusion treated by endoscopic pancreatic stent placement.

Usefulness of endoscopic pancreatic stents in the management of pancreatic ascites and pleural effusion has been evaluated only recently. We report a patient with alcoholic pancreatitis who presented with ascites and pleural effusion and had a pancreatic duct disruption in the body area on pancreaticography. A 5 F stent was placed across the disruption with rapid subsidence of both ascites and pleural effusion. The stent was removed after 12 weeks and there has been no recurrence during a follow-up period of 9 months.

Alcoholism↗
PubMed1995

Colovesical fistula complicating colonic diverticulosis.

Two cases of colovesical fistulae secondary to colonic diverticulosis are reported. Urinary symptoms were the prominent presenting features. Barium enema was helpful in documenting the fistulae, which cystoscopically was not localised. Definitive treatment included resection of the fistula and the diseased segment of the intestine. Both patients are well on follow-up. Diverticulosis coli should be considered in the differential diagnosis of colovesical fistulae even in tropical countries.

Aged↗
PubMed1994

Paraneoplastic cholestasis and hypercoagulability associated with medullary thyroid carcinoma. Resolution with tumor debulking.

The authors report a 69-year-old woman with a hypercoagulable state manifesting as superior sagittal sinus thrombosis, thrombocytosis, right lower extremity deep venous thrombosis, and subsequent pulmonary embolus. The liver enzyme values were elevated in a cholestatic pattern. Carcinoembryonic antigen level was markedly elevated. Evaluation revealed that her longstanding "goiter" had slowly enlarged during the past 6 years. The serum calcitonin level was markedly elevated. Subsequent biopsy revealed medullary thyroid carcinoma. Surgical debulking of the tumor and lymph nodes resulted in substantial reduction of the calcitonin and carcinoembryonic antigen levels in a matter of days. Long-term follow-up revealed normalization of cholestasis and resolution of the hypercoagulable state. Review of the literature revealed no previously reported cholestasis or hypercoagulable state associated with medullary thyroid carcinoma. The literature on paraneoplastic cholestasis, carcinoembryonic antigen production, and hypercoagulable states is reviewed.

Aged↗
PubMed1994

Oral sucralfate in acute radiation oesophagitis.

Eighty patients with carcinoma in the middle third of oesophagus and with acute radiation oesophagitis following external beam and intracavitary radiotherapy were managed by two different schedules. Group 1 (n = 40) received an antacid containing sodium alginate whereas Group 2 (n = 40) were given a 10% sucralfate suspension during 4 weeks. In Group 2, 32 patients had significant relief of symptoms within 7 days of treatment and most ulcers had healed by 12 days of treatment as seen on endoscopy. Patients in Group 1, on the other hand, showed little improvement of symptoms and had persistent ulcers even after 4 weeks of therapy. We conclude that sucralfate is useful in the management of acute radiation oesophagitis.

Administration, Oral↗
PubMed1994

Fungal colonization of untreated peptic ulcer.

AIM: To evaluate the relationship between Candida and peptic ulcer. METHODS: One hundred consecutive patients with untreated peptic ulcer (81 with duodenal ulcer and 19 with gastric ulcer) were studied using histopathology, culture and fungal serology. Twenty subjects with non-ulcer dyspepsia were taken as controls. RESULTS: Forty seven patients (47%) with peptic ulcer were colonized by Candida as compared to 3 patients (15%) with non ulcer dyspepsia (p < 0.05). Confluent growth of Candida on culture of gastric aspirate or biopsy from ulcer edge was a more sensitive method for diagnosis of peptic ulcer-associated candidiasis than histological examination. There was no significant difference in the prevalence of Candida isolation in relation to age or sex of the patients, smoking habit and alcoholism. Large ulcers (> 2 cm) were, however, more often colonized by Candida (75%) than smaller ones (43%) (p < 0.05). Candida albicans was the commonest species isolated (60%). Invasive candidiasis was associated with Candida agglutinin titer of 1:128 in 81% of cases. CONCLUSION: Candida colonization rate in peptic ulcer is significantly higher than in non-ulcer dyspepsia.

Adolescent↗
PubMed1994

Esophageal candidiasis after renal transplantation: comparative study in patients on different immunosuppressive protocols.

OBJECTIVES: The incidence of esophageal candidiasis (EC) in renal allograft recipients has not been well documented. The present study was done to determine the incidence of EC in renal allograft recipients receiving different forms of immunosuppressive therapy and to identify patients at a high risk of developing Candida esophagitis. METHODS: We conducted a retrospective study of 265 live related renal allograft recipients and compared three groups: patients given azathioprine and prednisolone (group I), those given cyclosporine, azathioprine, and prednisolone (group II), and those given cyclosporine and prednisolone (group III). EC was diagnosed by esophagogastroduodenoscopy. RESULTS: The overall incidence of EC was 10.5%. Group II patients had a significantly higher incidence (28.6%) than those in group I (10.4%) and group III (3.8%). EC was noted earlier in patients in groups II and III, who were on higher doses of steroids than group I patients. Dysphagia (57.1%) was the most common presenting symptom of EC, but 21.4% of patients were asymptomatic. Oral thrush was present in 42.9%. The entire esophageal mucosa was affected in six (46.1%) patients in group II and one (20%) in group III. No correlation was found between fungal serology or daily dose of steroids and extent of esophageal involvement. Treatment included nystatin in seven, nystatin and ketoconazole in 10, ketoconazole alone in eight, amphotericin B in one, and ketoconazole and amphotericin B in two episodes. Treatment failure occurred in seven (25%). Three patients died of disseminated candidiasis. Serology and biopsy were poor predictors of dissemination. CONCLUSIONS: In this retrospective study of renal allograft recipients, patients on triple drug immunosuppression, diabetics, and those with myelosuppression had an increased risk of developing EC. This high incidence calls for prophylactic use of antifungal agents in selected renal transplant recipients.

Adult↗
PubMed1994

Colonic diverticulosis in India: the changing scene.

BACKGROUND: The prevalence of colonic diverticulosis has a wide geographic and ethnic variation and has been considered to be quite low in India. This study was aimed at determining the prevalence of colonic diverticulosis in northern India based on barium enema examination in symptomatic patients. METHODS: All barium enema examinations performed between January 1985 and December 1991 were reviewed for the presence of colonic diverticulosis. Clinical data of such patients were retrieved. RESULTS: 51 (3.2%) of 1610 barium enema studies showed colonic diverticulosis. The frequency of diverticulosis in barium studies increased from 0.3% among subjects in the third decade to 32.4% in patients above 60 years. Most patients were city dwellers, vegetarians and belonged to the upper socio-economic stratum. Twenty patients (39.2%) presented with a complication; the spectrum of such patients was no different from that reported from the West. While the sigmoid colon was the commonest site of diverticuli, there was a relative preponderance of right sided diverticuli as compared to the Western experience. Seven patients with complications required surgical treatment, while the rest were managed conservatively. CONCLUSION: Colonic diverticulosis and its complications are not rare in India and should be considered in the differential diagnosis of abdominal disorders.

Adult↗