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Biomedical subjects

R Patankar

Publications and source records attributed to R Patankar.

8 recordsLinked to original sources
PubMed1999

Quality of life in stoma patients.

BACKGROUND: Patients with stomas face many difficulties both physical and psychological. Little is known about the long-term problems and the impact on patient lifestyle of a permanent stoma. This study was designed to address the problems faced by patients with stomas. METHODS: Patients were identified from the Stoma Care Department records for the years 1985 to 1992 and were contacted by mail. A questionnaire was designed to assess postoperative care, quality of life issues, and equipment problems. Responses were recorded on either a visual analog scale, a choice of yes-or-no alternatives, or by selection from a list of responses. RESULTS: A total of 542 eligible patients were contacted, and 391 replies were received. Major stomal problems included rashes (51 percent), leakage (36 percent), and ballooning (90 percent of patients with ileostomy). The majority of patients experienced some change in lifestyle (80 percent), and more than 40 percent of patients had problems with their sex lives. CONCLUSION: Many patients cope extremely well with a stoma; however, some patients experience considerable difficulty and distress. Improved preoperative assessment and counseling with longer follow-up by the stoma department would be helpful in the management of these patients and probably would contribute to improvement in the quality of their lives.

Adaptation, Psychological↗
PubMed1999

Treatment of pancreatic exocrine insufficiency after pancreatic resection. Results of a randomized, double-blind, placebo-controlled, crossover study of high vs standard dose pancreatin.

BACKGROUND: Steatorrhea following major pancreatic resection can be difficult to control, requiring high doses of pancreatic enzyme supplements. The aim of this study was to demonstrate equivalent efficacy of high-dose and standard-dose pancreatin in treating steatorrhea after pancreatectomy. METHODS: A randomized, double-blind, crossover study was conducted with a 2-wk run-in period for stabilization on a suitable dose of standard-dose pancreatin and two 14-d treatment periods using either high-dose or standard-dose pancreatin at this dosage. Parameters used to demonstrate efficacy of treatment were stool fat excretion, stool volume, and clinical symptoms. RESULTS: Thirty-nine patients who had undergone total or partial pancreatectomy were randomised; 37 completed all parts of the study. During stabilization, the mean daily capsule intake was 19.4 (range 9-54); even so, 22 (56%) patients had stool fat excretion > 7 g/d. There were significant correlations between stool fat excretion and stool volume (p < 0.0001) and stool frequency (p < 0.01), but not with indices of abdominal pain and global symptoms. Both high-dose and standard-dose pancreatin demonstrated statistically similar efficacy in the treatment period. CONCLUSION: The use of high-dose pancreatin for the treatment of pancreatic insufficiency in patients following pancreatectomy should significantly reduce capsule intake with increased convenience and greater compliance rate. Our results, however, indicate that further progress is needed to resolve steatorrhea following pancreatic resection.

Adult↗
PubMed1996

Effect of cisapride on gallbladder emptying and plasma CCK in normal and vagotomized human subjects.

Previous studies have provided conflicting results of cisapride on gallbladder emptying in response to a meal. We studied six volunteers and six patients after a truncal vagotomy in a double-blind, placebo-controlled, prospectively randomized study using 10 mg cisapride four times a day for three days. Gallbladder volume was quantitated using ultrasonography, and plasma CCK levels were measured with a sensitive and specific radioimmunoassay using the DINO antibody before and for 90 min after a fatty, mixed meal. Plasma effect was observed on the gallbladder either in normal subjects or vagotomized patients. Paradoxically, residual volume (RV) was increased in the vagotomized patients after treatment with cisapride: RV cisapride 7.1 (4.1-15.9) ml, RV placebo 5.1 (3.8-14) ml, P < 0.05. Further work is required to clarify the mechanisms of action of cisapride on the gallbladder and the sphincter of Oddi. The use of cisapride during litholytic therapy may impair gallbladder emptying and delay stone clearance.

Adult↗
PubMed1996

Standardization of a technique for BrIDA cholescintigraphy.

Calculation of ejection fraction by cholescintigraphy is a well-established technique to quantify motor function of the gallbladder. All previous cholescintigraphic studies of gallbladder emptying have exclusively used the anterior projection for gallbladder visualization. This may lead to inaccuracies because attenuation of gamma rays may vary depending on the state of gallbladder filling and body habitus. The use of geometric means may prevent these errors. In this study, 7 health volunteers were examined after the administration of 150 MBq 99Tcm-bromotrimethyl-IDA (99Tcm-BrIDA) without any stimulus and 9 volunteers ingested a maxied, fatty meal 35-40 min after BrIDA injection. Imaging was done using a dualheaded camera in a dynamic study of 140 one-minute frames. A plateau of activity was reached between 70 and 90 min post-injection of BrIDA and between 55-60% of maximal counts were achieved in the gallbladder region of interest (ROI) between 35 and 40 min. Significant emptying was seen in all nine subjects after the meal. No significant difference in ejection fraction was seen between the anterior projection and the geometric mean of the data from the anterier and posterior projections. The slope of the gallbladder filling curve from the anterior camera data was different from that obtained from the geometric mean, but the correlation coefficient was not significantly different. In conclusion, adequate counts are achieved in the gallbladder ROI 35-40 min after BrIDA injection, when the stimulus can be administered to study gallbladder emptying. There is no advantage to imaging in the anterior and posterior projections and data obtained from the anterior projection alone are adequate for gallbladder emptying studies.

Adult↗
PubMed1995

Gallbladder motility, gallstones, and the surgeon.

Cholecystectomy is one of the commonest surgical procedures in the Western world, with more than half a million procedures performed annually in the United States alone. In recent years, studies of gallstone pathogenesis and gallbladder disease have increasingly focused on abnormal gallbladder motility in the pathogenesis of some, if not all, gallbladder conditions. The control of gallbladder motility is complex and depends on an intricate interplay of neural and hormonal factors. An understanding of the control of gallbladder motility is crucial to the understanding of the mechanisms of gallstone formation and may help to explain the failure to cure symptoms after cholecystectomy in up to one third of patients. The purpose of this article is to outline mechanisms controlling gallbladder motility, examine recent developments in our understanding of this complex process, and relate changes in motility to common disease conditions of the gallbladder. The role of altered motility in the pathogenesis of gallstones is discussed and the effects of commonly performed surgical procedures such as truncal vagotomy and cholecystectomy on upper gut physiology are reviewed.

Cholecystectomy↗