PubMed Health⌕ Search

Biomedical subjects

R Vasudeva

Publications and source records attributed to R Vasudeva.

At least 19 recordsLinked to original sources
PubMed2001

The effect of stimulant laxatives and polyethylene glycol-electrolyte lavage solution for colonoscopy preparation on serum electrolytes and hemodynamics.

We have previously shown that magnesium citrate or bisacodyl before polyethylene glycol electrolyte lavage solution (PEG-ELS) improves colonoscopy preparation. Patients prefer this to preparation with full-volume PEG-ELS alone. However, such combinations might cause undesirable changes in hemodynamics or serum electrolytes. This study examined the effects of these combinations on heart rate, blood pressure, and serum electrolytes. We randomized 68 consecutive patients undergoing colonoscopy to one of three preparations. Group 1 received 4 L of PEG-ELS, group 2 received 2 L of PEG-ELS with 20 mg bisacodyl, and group 3 received 2 L of PEG-ELS preceded by 296 mL of magnesium citrate. Heart rate, blood pressure, and serum electrolytes were measured before starting the preparation and immediately before colonoscopy. Mean serum magnesium fell by 0.01 mg/dL and 0.11 mg/dL in groups 1 and 2, respectively, and rose by 0.06 mg/dL in group 3 (p = 0.044). There were no other significant changes. Statistically significant changes in serum magnesium after preparation with PEG-ELS and a stimulant laxative are minor and probably of no clinical relevance. Two liters of PEG-ELS with a stimulant laxative is safe and effective for colonoscopy.

Cathartics↗
PubMed2000

Ultrasound-assisted direct percutaneous endoscopic jejunostomy (DPEJ) tube placement.

Direct percutaneous endoscopic jejunostomy (DPEJ) is an effective method of enteral feeding. However, failure rates with this procedure remain high due to various technical problems. We describe a case where modifications in the technique and ultrasound guidance assisted in a difficult DPEJ placement. This technique has the potential to improve the success rate of this procedure in selected cases.

Endoscopy↗
PubMed2000

Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey.

OBJECTIVE: Screening for colorectal cancer reduces its morbidity and mortality and is cost-effective. Screening is usually the responsibility of primary care physicians who may be unsure about its implementation. We aimed to assess primary care physicians' knowledge and practice regarding colorectal cancer screening, and to compare their responses with those of three national experts and with published guidelines. METHODS: We mailed a postal questionnaire to 2,310 primary care physicians regarding demographics, nature of practice, use of screening tests, and six hypothetical patients who may have been candidates for screening or surveillance. We used published national guidelines and the collective opinions of the three external experts as the so-called "gold standard." RESULTS: Of all respondents, 85.1% offered colorectal cancer screening. Most used suitable tests, starting at an appropriate age; 49.8% continued screening indefinitely irrespective of patients' age and 43.6% performed fecal occult blood testing without appropriate dietary advice to patients. Also, respondents frequently performed this test for inappropriate indications. Only 51.8% would follow a positive fecal occult blood test with colonoscopy. CONCLUSIONS: Colorectal cancer screening practices by primary care physicians vary considerably from those recommended. Many offer screening to individuals in whom it is not appropriate, and continue it into advanced age. Frequent, inappropriate use of fecal occult blood tests will produce many false positives. Primary care physicians often do not appropriately follow a positive test. Further educational efforts are needed in an attempt to improve practice and further reduce the morbidity and mortality from colorectal cancer.

Colorectal Neoplasms↗
PubMed2000

Changes in colorectal cancer over a 15-year period in a single United States city.

OBJECTIVE: The aim of this study was to identify colorectal cancer trends in different patient groups in one region. METHODS: We reviewed the records of all patients with colorectal cancer who were seen at two hospitals in Columbia, SC, between 1981 and 1995. Patients were divided into three 5-yr cohorts (cohort 1, 1981-1985; cohort 2, 1986-1990; and cohort 3, 1991-1995). We recorded demographic data, histological type, tumor stage, grade, and survival. RESULTS: A total of 1395 patients were diagnosed, of whom 1252 had adenocarcinoma. Mean age of diagnosis was 64.5 yr in black and 66 in white patients (p = 0.036). Adenocarcinoma proximal to the splenic flexure was found in 62% of women and 49% of men (p < 0.001), and in 51% of black and 44% of white patients (p = 0.08). Proximal cancers accounted for 61%, 48%, and 32% of cohorts 1, 2, and 3, respectively. The proportions of patients with advanced stage (III and IV) adenocarcinoma in the three cohorts were 54%, 47%, and 40%, respectively (p = 0.001). Median survival for adenocarcinoma was 23.7, 23.5, and 23.1 months in cohorts 1, 2, and 3 (p = 0.9). CONCLUSIONS: The prevalence and demographics of colorectal cancer have been fairly stable at this center. There has been a significant decrease in proximal cancers. Although adenocarcinoma is being diagnosed at an earlier stage, this has not affected survival. Colonoscopy may be the most appropriate screening method in women and in black patients, in whom proximal cancers are more often found.

Adenocarcinoma↗
PubMed1999

Prospective determination of distal colon findings in average-risk patients with proximal colon cancer.

BACKGROUND: Recent guidelines indicate that colonoscopy and sigmoidoscopy are both acceptable options for screening average-risk patients for colorectal cancer. Retrospective studies have found that a majority of patients with cancer proximal to the splenic flexure have a normal screening flexible sigmoidoscopy. METHODS: This was a multicenter, prospective description of colonoscopic findings and family history in consecutive patients with proximal colon cancer. RESULTS: Among 116 prospectively identified average-risk patients with cancer proximal to the splenic flexure, 40 (34.5%) had neoplasia distal to the splenic flexure. The prevalence of patients with adenomas greater than or equal to 1 cm, with only one tubular adenoma less than 1 cm, and with only hyperplastic polyps were 16.4%, 8.6%, and 6.9%, respectively. CONCLUSIONS: Most average-risk patients with cancer proximal to the splenic flexure will have a normal screening flexible sigmoidoscopy. These patients have an unexpectedly high prevalence of large distal adenomas, but the prevalence of both single small tubular adenomas and hyperplastic polyps alone is similar to that expected during screening of the general population. Clinicians and payers should continue to seek methods to improve the cost-effectiveness and availability of screening colonoscopy in average-risk persons.

Adenocarcinoma↗
PubMed1999

Examination of tissue distribution of Helicobacter pylori within columnar-lined esophagus.

H. pylori may colonize columnar-lined esophagus, although an etiologic role in esophageal adenocarcinoma is unproven. H. pylori can adhere to intestinal metaplasia in the stomach. This study was designed to examine if H. pylori adheres to specialized intestinal metaplasia in columnar-lined esophagus. Esophageal biopsies from patients with columnar-lined esophagus were reviewed. Patients with only gastric metaplasia were excluded. Sections with specialized intestinal metaplasia in at least one third of at least one gland were recut, stained using the Giemsa stain, and reexamined by two independent pathologists using strict criteria for adherence by H. pylori. The 209 esophageal biopsies with adequate specialized intestinal metaplasia from 58 patients were examined: H. pylori was only seen on gastric metaplasia in three patients-and never on specialized intestinal metaplasia. Within the esophagus, H. pylori adheres only to gastric metaplasia, which is not considered premalignant for esophageal adenocarcinoma.

Adenocarcinoma↗
PubMed1999

The effects on intragastric acidity of per-gastrostomy administration of an alkaline suspension of omeprazole.

BACKGROUND: It may be difficult to administer proton pump inhibitors via gastrostomy. Previous studies have examined the effect of intact proton pump inhibitor granules in orange juice. This study examined the effect of an alkaline suspension of omeprazole (simplified omeprazole suspension (SOS)) on 24-h intragastric acidity. METHODS: Six men with an established gastrostomy had a baseline 24-h intragastric pH study using methodology we have previously described. They then received 20 mg SOS o.d. for 7 days and had a repeat pH study at the end of this period. Four of the patients then received 20 mg SOS with 30 cc of liquid antacid (Mylanta) per gastrostomy o.d. for a further 7 days and then underwent a third pH study. RESULTS: SOS raised mean pH from 2.2 to 4.1. Intragastric pH was above 3, 4 and 5 for 35, 28 and 17% of the 24-h period at baseline, respectively; corresponding values after SOS were 63, 51 and 39%, respectively. Addition of liquid antacid to SOS did not further increase its pH-controlling effect. CONCLUSIONS: We found a statistically significant effect of o.d. SOS on intragastric pH when administered via gastrostomy. We found no additional benefit of administering SOS with liquid antacid.

Aged↗
PubMed1999

Simplified lansoprazole suspension--a liquid formulation of lansoprazole--effectively suppresses intragastric acidity when administered through a gastrostomy.

OBJECTIVE: Lansoprazole suppresses intragastric acidity when given as nonencapsulated intact granules. Because the administration of granules via small-bore tubes may still be problematic, we studied the effect of a liquid formulation of lansoprazole obtained by suspending the contents of a standard 30-mg capsule in 10 cc of 8.4% NaHCO3. METHODS: Six men with an established gastrostomy had a baseline 24-h intragastric pH study. Through the gastrostomy, they then received 7 days of once-daily dosing with 30 mg lansoprazole as intact granules in orange juice. After a 7-day washout period, they then received 7 days of once-daily dosing with the liquid formulation. Intragastric pH monitoring was repeated after each dosing period. RESULTS: Baseline mean intragastric pH was 1.8 +/- 0.5 (SD). This increased to 4.5 +/- 0.5 with lansoprazole granules in orange juice, and to 5.1 +/- 1.1 after the liquid formulation. At baseline, intragastric pH was >3, 4, and 5 for 19.5%, 12.7%, and 8.1%, respectively, of the 24-h recording period. Corresponding values after lansoprazole granules in orange juice were 77.5%, 67%, and 49.6% (p < 0.01 for each comparison with baseline). After the liquid formulation, the corresponding values were 84%, 77.9%, and 65.9% respectively (p < 0.01 for each comparison with baseline; p > 0.05 for each comparison with lansoprazole granules in orange juice). CONCLUSIONS: A liquid formulation of lansoprazole suppressed intragastric acidity when given through a gastrostomy. The degree of suppression was comparable to that obtained with intact nonencapsulated granules in orange juice.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1999

A survey of gastroenterologists' perceptions and practices related to Helicobacter pylori infection.

OBJECTIVE: The aim of this study was to assess the current practice of gastroenterologists in the United States concerning Helicobacter pylori (H. pylori) infection. METHODS: We mailed a structured questionnaire to 1000 gastroenterologists chosen at random from a national database. We asked about personal and practice demographics and practices relating to testing for, and treating, H. pylori infection. RESULTS: A total of 922 questionnaires were delivered, from which we received 286 responses (31%). Respondents used many different tests for H. pylori infection, but only 10% each had used either the 13C- or 14C-urea breath test. Testing for H. pylori infection was usually for appropriate reasons, although 21% indicated that they might not treat a patient with a positive test result. Different multiple treatment regimens were used; the most frequent were combinations of a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. Estimates of the prevalence of antibiotic resistance were highly variable and often inaccurate. Most respondents would not check asymptomatic individuals for the infection; however, in the absence of symptoms, 38% would personally undergo testing and treatment if positive. CONCLUSIONS: Gastroenterologists usually test for H. pylori infection in appropriate conditions, but may not always treat the infection based on a positive test result. Most use efficacious regimens to treat the infection although many have inaccurate information on resistance rates, which may adversely influence prescribing. Many would have testing and, if positive, treatment in the absence of symptoms or a specific diagnosis, but do not recommend this for their patients.

Amoxicillin↗
PubMed1998

Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation.

BACKGROUND: Laxative pretreatment decreases the volume of polyethylene glycol electrolyte lavage solution (PEG-ELS) required for colonoscopy without compromising preparation quality. We compared the use of 4 L of PEG-ELS with the use of 2 L plus a laxative. METHODS: One hundred fifty consecutive patients (148 men) undergoing outpatient colonoscopy were randomly selected for one of three preparations (Prep 1: 4 L PEG-ELS; Prep 2: 2 L PEG-ELS plus 296 mL magnesium citrate 1 hour prior; Prep 3: 2 L PEG-ELS plus bisacodyl 20 mg). Endoscopists were blinded as to the type of preparation. RESULTS: Colonoscopy times were 37, 33, and 29.5 minutes (p = 0.02). Satisfaction scores (0 to 11) during preparation were 2.75, 1.84, and 2.54 (p = 0.05). Preparation times were 519, 397, and 379 minutes (p < 0.001). Preparation satisfaction scores (0 to 10) were 6.2, 7.7, and 7.4 (p < 0.001). Endoscopists' scores of preparation quality (1 to 10) were 7.3, 7.8, and 8.1 (p = 0.03). Volumes of liquid stool aspirated were 181, 103, and 90 mL (p < 0.001). Twenty-four patients receiving Prep 2 and 16 receiving Prep 3 had previous colonoscopy using full volume PEG-ELS; 88% who received Prep 2 and 56% who received Prep 3 preferred the newer preparation (p = 0.006). CONCLUSIONS: Two liters of PEG-ELS plus laxative improved preparation quality and patient satisfaction and reduced preparation time. Magnesium citrate pretreatment had fewer symptoms and was preferred to bisacodyl. PEG-ELS in 2 L quantities could reduce costs, and consideration should be given to making it available commercially.

Adult↗
PubMed1998

The pharmacodynamics of lansoprazole administered via gastrostomy as intact, non-encapsulated granules.

BACKGROUND: Because of its acid-labile nature, lansoprazole is usually administered as encapsulated enteric-coated granules. The gelatin capsule and acid-resistant coating of the granules have been considered essential for effective drug absorption and optimal bioavailability. Lansoprazole may attain effective plasma levels when given as non-encapsulated intact granules, but effects on intragastric acidity are unknown. AIM: To test the effectiveness of non-encapsulated. intact lansoprazole granules in suppressing intragastric acidity when administered through a gastrostomy. METHODS: Eight men, each with an established gastrostomy, underwent baseline 24 h intragastric pH monitoring while off any acid-suppressing medication. Via the gastrostomy, they then received 7 days of once-daily dosing with 30 mg lansoprazole as intact granules in 3 fl. oz. of orange juice. Intragastric pH monitoring was repeated on day 7. RESULTS: Mean intragastric pH pre-dosing was 1.96+/-0.5 (s.d.). This increased to 4.7+/-0.6 on day 7 (P < 0.0001). Median intragastric pH rose from 1.5 to 5.2 (P < 0.0001). Before lansoprazole, the proportions of time when intragastric pH was above 3, 4 and 5 were 23.2, 13.5 and 7.5%, respectively. Corresponding values after 7 days of lansoprazole were 81.1, 70.2 and 52.3% (P < 0.0001 for each comparison). CONCLUSION: Lansoprazole can effectively suppress intragastric acidity when given through a gastrostomy as intact, non-encapsulated granules in orange juice.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

A study of the prevalence of Helicobacter pylori infection and other markers of upper gastrointestinal tract disease in patients with rosacea.

OBJECTIVE: Recent reports have suggested that patients with rosacea, a chronic inflammatory skin disorder of unknown etiology, have an increased prevalence of Helicobacter pylori infection. However, no causal relation has been identified. This study was designed to determine the prevalence of H. pylori infection and upper gastrointestinal symptoms in rosacea patients and in subjects without chronic skin disorders. METHODS: Forty-five patients with rosacea and 43 healthy subjects underwent serological testing for H. pylori infection. Demographics, gastrointestinal symptoms, and medication use were recorded using a structured questionnaire. RESULTS: There was no significant difference in the seroprevalence of H. pylori infection between rosacea patients and healthy subjects (26.7% vs 34.9%; p = 0.40). Significantly more patients with rosacea complained of indigestion (66.7% vs 32.6%; p = 0.001) and used antacids (60% vs 32.6; p = 0.01). There was no significant difference in the prevalence of H. pylori infection between symptomatic and asymptomatic rosacea patients, or in those using antacids. There were no differences in the frequency of heartburn, history of peptic ulcer disease, family history of peptic ulcer disease, use of H2-receptor antagonists, or use of nonsteroidal antiinflammatory drugs. CONCLUSIONS: Patients with rosacea have similar rates of H. pylori infection as healthy subjects. Rosacea patients complain significantly more frequently of "indigestion" and use more antacids unrelated to H. pylori infection.

Adult↗
PubMed1998

Changing trends in esophageal cancer: a 15-year experience in a single center.

OBJECTIVE: Esophageal adenocarcinoma is increasing in white men. We sought to identify trends in esophageal cancer in different patient groups in our region. METHODS: We reviewed the records of all patients with esophageal cancer seen at two hospitals in Columbia, SC between 1981 and 1995. Patients were divided into three cohorts (1981-1985, 1986-1990, and 1991-1995). Demographic data, histological type, tumor stage, grade, and survival were recorded. RESULTS: Histology was available in 371 of 386 patients (cohort 1, 113 patients; cohort 2, 144; and cohort 3, 114). Adenocarcinoma accounted for 24%, 27%, and 49% of esophageal cancer in white men in cohorts 1, 2, and 3, respectively (p = 0.03). Corresponding figures for African-Americans were 10%, 7%, and 3% (p = 0.22). Women comprised 8%, 14%, and 22% of patients with squamous carcinoma in the three cohorts (p = 0.03). Median survival for esophageal cancer was 6.0, 6.8, and 10.4 mo in cohorts 1, 2, and 3 (p = 0.0002). CONCLUSION: Adenocarcinoma is increasing in whites. Squamous carcinoma remains the predominant type in this region, seen mainly in African-Americans. Esophageal squamous carcinoma is increasing in women. The mean age at diagnosis of squamous carcinoma has decreased in whites. There is a trend toward improved survival in patients with esophageal cancer.

Adenocarcinoma↗
PubMed1997

Candida splenic abscess in the absence of obvious immunodeficiency.

Focal hepatosplenic candidiasis has been increasingly recognized as a variant of disseminated candidiasis in immunocompromised patients. It rarely presents as Candida splenic abscess. Its occurrence in non-leukemic patients is quite rare. A patient with diabetes mellitus and previously undiagnosed sickle cell trait presented with upper gastrointestinal bleeding. Candida splenic abscess was diagnosed. She was successfully treated with percutaneous drainage and fluconazole. The clinical presentation, diagnosis, and treatment of Candida splenic abscess is reviewed, and its relationship to diabetes mellitus and sickle cell disease without major immunodeficiency is discussed.

Abscess↗
PubMed1997

Randomized, controlled comparison of two forms of preparation for screening flexible sigmoidoscopy.

OBJECTIVE: There is a paucity of data regarding the optimal form of bowel preparation for flexible sigmoidoscopy. Most endoscopists recommend enemas. A simpler preparation that is easy, acceptable, and that reduces patient encounter time would be desirable, and might be cost-effective. Our objective in this study was to evaluate a simple oral form of preparation for screening flexible sigmoidoscopy. METHODS: In this randomized, single-blind, controlled trial, we compared two forms of preparation in consecutive male patients referred for screening flexible sigmoidoscopy. The oral preparation consisted of one bottle of magnesium citrate and two "Dulcolax" tablets on the evening before flexible sigmoidoscopy. This was compared with the standard form of preparation, namely, two Fleet's enemas given on arrival at the endoscopy suite. Thirty-seven patients received the oral preparation [mean age, 62.8 +/- 8.9 (SD) yr]; 33 received enemas (mean age, 65.2 +/- 7.3 yr). Endoscopists were blinded to the preparation. RESULTS: Mean time between arrival and starting flexible sigmoidoscopy was 36 +/- 22 (SD) min for patients on oral preparation, and 62 +/- 25 min for patients receiving enemas (p < 0.0001). Mean times performing flexible sigmoidoscopy were 10 +/- 3 min and 13 +/- 4 min, respectively (p = 0.004). Mean patient satisfaction score (range 0-13) was higher for patients given the oral preparation (11.4 +/- 1.8) than for patients receiving enemas (9.6 +/- 2.4) (p = 0.001). Fifteen patients randomized to receive the oral preparation had previous flexible sigmoidoscopy with an enema preparation; all preferred the oral form. Mean technical difficulty (range 1-10) was 3 +/- 2.2 for patients given the oral preparation and 4.9 +/- 3.1 for patients receiving the enema preparation (p = 0.01). Polyps were identified in 10/37 patients who received the oral preparation and in 3/33 patients who received enemas (p = 0.05). Quality of colon preparation was judged "good" in 29, "fair" in four, and "poor" in four, among the 37 patients given the oral form; corresponding values for 33 patients given enemas were 16, 10, and 7 (p = 0.03). CONCLUSION: Patient acceptance, encounter time, technical ease, and quality of colon preparation were significantly better with the oral form of colon preparation than with the standard Fleet enema preparation.

Administration, Oral↗
PubMed1997

Nonencapsulated, intact omeprazole granules effectively suppress intragastric acidity when administered via a gastrostomy.

UNLABELLED: Because of its acid-labile nature, omeprazole is usually administered as encapsulated enteric-coated granules. The gelatin capsule and acid-resistant coating are essential for effective drug absorption and optimal bioavailability. OBJECTIVE: This study tested the effectiveness of nonencapsulated, intact omeprazole granules in suppressing intragastric acidity when administered through a gastrostomy. METHODS: Fourteen male patients with established gastrostomies underwent a baseline 24-h intragastric pH monitoring study while off any acid-suppressing medication. Via the gastrostomy, they then received 7 days of dosing with 20 mg omeprazole as intact granules in orange juice. Twenty-four-hour intragastric pH monitoring was repeated on the seventh day. RESULTS: Mean intragastric pH during the baseline study was 1.8 (+/- SD 0.7). This pH increased to 4.9 +/- 0.8 with omeprazole granules (p < 0.0001). Median intragastric pH rose from 1.3 to 5.3 (p < 0.0001). During the baseline study, intragastric pH was above 3 for 21.2 +/- 14.1%, above 4 for 14.9 +/- 11.0%, and above 5 for 9.5 +/- 8.4% of the 24-h recording period. Corresponding values after 7 days of omeprazole were 80 +/- 15.1%, 72.5 +/- 16.3%, and 59.1 +/- 16.6% (p < 0.0001 for each comparison with pretreatment values). CONCLUSION: Omeprazole effectively suppresses intragastric acidity when given through a gastrostomy tube as nonencapsulated, intact granules.

Aged↗