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Biomedical subjects

R Pradeep

Publications and source records attributed to R Pradeep.

15 recordsLinked to original sources
PubMed1996

Early carcinoma of the gallbladder: an elusive disease.

Prognosis of carcinoma of the gallbladder can be improved by diagnosing the disease in the early stages. Records of 14 patients with early (UICC AJCC TNM stages I and II) carcinoma of the gallbladder were analyzed. Clinical presentation in all these patients was like benign biliary disease. Ultrasonography could diagnose carcinoma of the gallbladder in only five patients; in the remaining nine patients, even the ultrasonographic diagnosis was benign biliary disease. All patients were operated; carcinoma of the gallbladder was diagnosed at operation in two more patients, but it was first detected only after histological examination in seven patients. All patients except four had associated gallstones. Preoperative diagnosis of early carcinoma of the gallbladder is difficult. The only way to diagnose early carcinoma of the gallbladder is by early surgical treatment of patients with clinical features of benign biliary disease.

Adult↗
PubMed1996

Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder.

The majority of patients with advanced carcinoma of the gallbladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. Intrahepatic segment III cholangiojejunostomy has been described for palliation of high biliary obstruction in these patients. Forty-one patients with stage IV gallbladder cancer underwent intrahepatic segment III cholangiojejunostomy. Subsequent jaundice, pruritus and cholangitis were documented; liver function tests and isotope hepatobiliary scans were performed. All patients had jaundice, 29 had pruritus and 12 had cholangitis. Postoperative complications included anastomotic leak in six patients and wound infection in six. Five patients died within 30 days of operation. Thirty-two patients were available for follow-up. The procedure failed to relieve jaundice, pruritus or cholangitis in four patients; 18 were free of jaundice, pruritus and cholangitis until death or last follow-up, and ten had recurrent jaundice or cholangitis. Isotope scanning was found to be useful to predict success of the procedure. Intrahepatic segment III cholangiojejunostomy provided excellent palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates in patients with advanced carcinoma of the gallbladder.

Adult↗
PubMed1995

Predictors of survival in patients with carcinoma of the gallbladder.

BACKGROUND: The role of resectional surgery in patients with advanced stages of gallbladder carcinoma has not been fully defined. It is generally believed that the survival depends on the stage of the disease, rather than on the treatment option. METHODS: Seventeen selected risk factors were analyzed using univariate and multivariate analyses to predict survival in 87 patients with gallbladder carcinoma who had undergone some form of surgical treatment. Similarly, a subset of 55 patients with American Joint Committee on Cancer Stage IV disease also was analyzed separately. RESULTS: Palpable mass, tumor (T) status, local infiltration, lymph node involvement, distant metastasis, TNM stage, and the type of surgical treatment (laparotomy alone, bypass, or resection) were significant risk factors by univariate analysis. In addition to palpable mass and the type of surgical treatment, age was also a significant predictor of survival by multivariate analysis. Multivariate analysis of patients with Stage IV disease revealed the same three factors to be significant. In this subset of patients, the median survival after resectional surgery was 16.3 months; after biliary and/or gastric bypass, 4.8 months; and after laparotomy alone, 1.6 months. CONCLUSIONS: The type of surgical treatment significantly influenced survival. Resectional surgery was associated with better survival compared with biliary and/or gastric bypass or laparotomy alone for patients with all stages of the disease, including those with advanced carcinoma of the gallbladder.

Adult↗
PubMed1994

Appraisal of surgical and endoscopic management of choledocholithiasis.

One hundred and ten patients with common bile duct (CBD) stones were treated in the Department of Surgical Gastroenterology at SGPGIMS, Lucknow, India between January 1989 and December 1992. The primary modality of treatment was surgery in 62 patients (group I) and endoscopic sphincterotomy (ES) in 48 (group II). The two groups were well matched with respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; group Ia). Four patients (7%) had retained stones following surgery (group Ib). In group II, the CBD was cleared by endoscopic means in 20 out of 48 patients (42%) and was categorized into group IIa. In the remaining patients ES was followed by CBD exploration (group IIb). Significantly higher morbidity was seen in patients needing CBD surgery following attempted endoscopic clearance, because of ES-related complications, such as bleeding, cholangitis, septicaemia and numerous others. Use of ES to treat CBD stones on a routine basis was therefore not found to be any better than one-time surgical exploration.

Adult↗
PubMed1994

Palliative surgical treatment of malignant obstructive jaundice.

One-hundred-and-forty-five cases of malignant obstructive jaundice were seen from January 1989-December 1992. Carcinoma gallbladder (74/145) and carcinoma pancreas (67/145) were the two common causes. Fifty patients underwent a palliative surgical biliary bypass procedure. Jaundice was present in all the patients. Pruritus (40/50), cholangitis (17/50) and gastric outlet obstruction (11/50) were the other predominant symptoms which required palliation. Surgical palliation was achieved with a morbidity and mortality of 38% and 8%, respectively. Jaundice, pruritus and cholangitis were relieved in 92%, 88% and 88%, respectively. All patients with gastric outlet obstruction had complete relief. The mean hospital stay was 18.5 days. The mean survival was 6.5 months and 8.6 months for carcinoma gallbladder and carcinoma pancreas, respectively.

Adult↗
PubMed1990

Highly selective vagotomy in the treatment of peptic ulcer diathesis.

The results of highly selective vagotomy in 174 Indian patients have been analysed. Compared to other procedures on the stomach, HSV has a definite advantage both on long term as well as on short term basis. HSV has therefore become the procedure of choice in the treatment of duodenal ulcer disease provided the expertise is available locally. HSV has also been used now in the treatment of ulcer complications and benign gastric ulcer disease.

Duodenal Ulcer↗
PubMed1988

Benign disease of the common bile duct.

The incidence of common bile duct (CBD) pathology in a group of patients with benign biliary disease (n = 505) was found to be 23.2 per cent. The spectrum included 111 patients (90.2 per cent) with CBD stones, 37 of whom (33.3 per cent) had no symptoms or findings pre-operatively indicating CBD involvement. Five patients had papillary stenosis, three had postoperative CBD strictures, one had a choledochal cyst and one had an external biliary fistula. Of the 100 CBDs measuring more than 10 mm in diameter, 90 harboured calculi. In the remaining 23 CBDs measuring less than 10 mm, calculi were present in 21. The presence of CBD calculi was demonstrated by intra-operative cholangiography in 49 patients. In the remaining patients (n = 74), the diagnosis of CBD pathology was made either by percutaneous transhepatic cholangiography, endoscopic retrograde cholangio-pancreatography, T-tube cholangiography or peroperative palpation. The surgical procedures performed included choledochotomy and T-tube drainage (n = 74), transduodenal sphincteroplasty (n = 27) and choledochoduodenostomy (n = 18). The overall mortality and morbidity of CBD exploration was 3.3 per cent and 24.4 per cent respectively, which was significantly greater than that for cholecystectomy alone (0.3 per cent and 8.6 per cent respectively). Transduodenal sphincteroplasty carried a much higher mortality (11 per cent) and morbidity (52 per cent) when compared with other procedures.

Cholangiography↗
PubMedDate not supplied

Nelson's syndrome due to an intracavernous corticotropin-secreting adenoma.

OBJECTIVE: To report the first case of Nelson's syndrome due to an ectopic intracranial corticotropin-secreting tumor arising entirely within the cavernous sinus. METHODS: We present a case report of Nelson's syndrome with clinical, laboratory, and radiologic features throughout a 25-year period. RESULTS: A 54-year-old woman had been treated for Cushing's disease with bilateral adrenalectomy in 1971. Subsequently, Nelson's syndrome developed, and she had severe generalized hyperpigmentation and substantially increased plasma corticotropin levels. In 1976, she underwent a transsphenoidal hypophysectomy. Postoperatively, despite the development of panhypopituitarism and diabetes insipidus, she remained hyperpigmented and had persistently increased plasma corticotropin levels. Throughout the years, efforts to identify the site of the corticotropin-secreting tumor were unsuccessful until 1988, when magnetic resonance imaging revealed a mass in the right cavernous sinus; subsequently, petrosal sinus cannulation corroborated the intracavernous source of excess corticotropin. Cobalt-60 gamma knife radiotherapy in 1992 was followed by a clinical and hormonal response 4 1/2 years later. CONCLUSION: This report describes only the second reported case of an intracranial corticotropin-secreting tumor arising entirely within the cavernous sinus and the first such case associated with Nelson's syndrome. Although rare, the possibility of an ectopic intracranial or extracranial pituitary adenoma should be considered in patients with pituitary hypersecretion without clear-cut intrasellar abnormalities or those with no response to surgical resection of the pituitary gland.

Journal Article↗
PubMedDate not supplied

Capsule endoscopy in obscure gastrointestinal bleeding--an Indian experience.

BACKGROUND: Obscure gastrointestinal bleeding (OGIB) is a common indication for capsule endoscopy (CE). Reports on diagnostic yield of CE in this situation show a wide variation. We evaluated the diagnostic yield and clinical impact of CE in patients with OGIB. METHODS: We reviewed the medical records of patients with OGIB who underwent CE at our institution between June 2002 and October 2005. RESULTS: 154 patients (mean age 47 [SD 17] years; 117 men), including 74 with overt OGIB and 80 with occult OGIB, underwent CE. CE yielded positive findings in 57 of 74 patients (77%) with overt OGIB and 22 of 80 (27%) of those with occult OGIB (p < 0.0001); the overall positive diagnostic yield was 52%. NSAID-induced lesions (15%), angiodysplasias (14%) and aphthous ulcers (12%) were the most frequent findings. CE helped in planning further management in 79% of patients with overt OGIB and 26% of those with occult OGIB. CONCLUSION: CE is a useful diagnostic technique in patients with OGIB, especially those with overt OGIB.

Adult↗
PubMedDate not supplied

Carcinoma gallbladder: atypical presentations and unusual associations.

Patients with carcinoma of the gall bladder (CaGB) may have atypical presentations and unusual associations. Out of 324 patients with CaGB seen at a tertiary referral center in northern India, 26 (8%) had atypical clinical presentations and 34 (10%) had unusual associations. The atypical presentations were empyema (5), acute cholecystitis (3), post-cholecystectomy benign biliary stricture (3), carcinoma of the head of pancreas (3), gastric outlet obstructions (2) and liver abscess (1). Unusual associations were common bile duct stones (18), left supraclavicular lymph node metastasis (11), Mirizzi's syndrome (3), inguinal lymph node metastasis (1) and umbilical metastasis (1). Majority of these patients had advanced disease and curative resection was not possible; a worthwhile palliation was however possible in the majority.

Acute Disease↗