Biomedical subjects

Rajesh N Keswani

Publications and source records attributed to Rajesh N Keswani.

7 recordsLinked to original sources

PubMed2006

A patient with abdominal pain and markedly elevated transaminase levels after cholecystectomy.

BACKGROUND: A 33-year-old white female with a history of cholecystectomy presented to the emergency department with intermittent severe abdominal pain radiating from the left upper quadrant to the right upper quadrant, associated with nausea and emesis. Three weeks previously the patient had presented to the emergency department with similar pain in the abdomen. Laboratory investigations had revealed elevated bilirubin, transaminase, and alkaline phosphatase levels. At that time, pain and liver chemistry test results improved and the patient was discharged on hospital day 3. She denied a history of alcohol use, new medications, or the ingestion of other toxins. INVESTIGATIONS: History and physical examination, liver chemistry tests, viral hepatitis serology tests, autoimmune serology tests, abdominal ultrasound, liver biopsy, and an endoscopic retrograde cholangiopancreatogram. DIAGNOSIS: Choledocholithiasis. MANAGEMENT: Endoscopic retrograde cholangiopancreatogram with sphincterotomy, removal of an 8 mm distal common bile duct stone, and pancreatic stent placement.

Abdominal Pain↗

PubMed2006

A family history of pancreatic cancer.

BACKGROUND: A 65-year-old white male with a family history of pancreatic cancer and a personal history of two episodes of acute pancreatitis was referred to our department in January 2005 by his primary-care physician for an assessment of his pancreatic cancer risk. INVESTIGATIONS: Physical exam, laboratory investigations, CT scan, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography. DIAGNOSIS: Familial pancreatic cancer. MANAGEMENT: Subtotal pancreatectomy, referral to genetic counselor, and continued surveillance.

Aged↗

PubMed2006

Factitious diarrhea masquerading as refractory celiac disease.

A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family. This case highlights the importance of considering factitious diarrhea in all patients admitted for refractory diarrhea, even those with documented underlying conditions.

Adult↗

PubMed2006

Clinical use of p53 in Barrett's esophagus.

Barrett's esophagus is an established precursor to esophageal adenocarcinoma. Whereas most patients with Barrett's esophagus do not progress to adenocarcinoma, patients with progression have a poor prognosis. Current management strategies use frequent endoscopic surveillance and multiple nontargeted biopsies. This approach, however, may miss dysplastic areas. Furthermore, given the relatively high prevalence of Barrett's esophagus but low incidence of progression, this invasive and expensive approach has not been shown to be cost-effective. Thus, there is intense interest in using biomarkers to identify patients at increased risk of progressing to adenocarcinoma. This has included examination of mutations in the tumor suppressor gene, p53. In this report, we discuss the biology of p53 and the incidence of p53 mutations in Barrett's esophagus and review relevant studies regarding the ability of p53 to predict neoplastic progression. Additionally, we report our results of the expression of p53 by immunohistochemistry in a group of 18 patients that have undergone endoscopic esophageal mucosal resection for dysplasia. Although the presence of a p53 mutation increases the risk of neoplastic progression, the absence of this mutation does not abrogate the risk. Continuing efforts, therefore, are needed to define and prospectively validate a panel of biomarkers to risk-stratify patients with Barrett's esophagus. Determination of p53 mutational status may ultimately be a component of such a panel.

Barrett Esophagus↗

PubMed2005

Postoperative management of ulcerative colitis and Crohn's disease.

Approximately 10% to 30% of patients with ulcerative colitis and up to 70% of patients with Crohn's disease will undergo surgery at some point during their lifetime. Although patients with ulcerative colitis are considered "cured" by surgery, patients who have undergone an ileal pouch anal anastomosis may develop pouchitis, cuffitis, pouch irritability, or even Crohn's disease. Various therapies have shown success, including probiotics, in the prevention of pouchitis onset or relapse. Crohn's disease historically recurs following surgery; prophylaxis against disease recurrence has been attempted with a variety of agents, with variable success. Innovative therapies holding promise for the future treatment or prevention of these conditions are under exploration.

Colitis, Ulcerative↗

PubMed2004

Older age and liver transplantation: a review.

Patients older than 60 are undergoing transplantation with increasing frequency. Reports from several transplant centers document that overall short-term patient survival rates in seniors undergoing liver transplantation are comparable to survival rates of younger adults. However, specific subgroups of older patients may not fare as well. Seniors with far-advanced end-stage liver disease are high-risk for liver transplantation and have poor survival rates. In addition, seniors older than 65 have worse outcomes than those who are 60 to 65, and studies have shown increased mortality with increasing age as a continuous variable. On the other hand, the majority of seniors who survive liver transplantation have full or only minimally limited functional status. Preoperative evaluation of older patients for transplantation requires careful screening to exclude cardiopulmonary disease, malignancy, and other diseases of the aged. Paradoxically, seniors may benefit from a senescent immune system, which results in decreased requirements for immunosuppressive drugs, and possibly a lower rate of acute allograft rejection. Despite good overall short-term survival in the elderly, long-term survival may be worse because of an increased rate of long-term complications, such as malignancy and heart disease. In conclusion, although advanced age is a negative risk factor, advanced age alone should not exclude a patient from liver transplantation; however, it mandates thorough pretransplant evaluation and careful long-term follow-up with attention to usual health maintenance issues in the elderly.

Aged↗

PubMed2003

Contour integration in peripheral vision reduces gradually with eccentricity.

Hess and Dakin reported that normally-sighted subjects using peripheral vision (beyond 10 degrees ) were unable to detect paths of alternating-phase Gabors embedded within randomly positioned Gabors, but could detect same-phase paths. This result led them to propose a "fundamental difference" between central and peripheral visual processing. While we were able to replicate many of their results, our normally-sighted observers could detect alternating-phase paths beyond 10 degrees. We found that path detection decreased monotonically as a function of eccentricity (0 degrees -30 degrees ) for both alternating-phase and same-phase stimuli. As with most visual functions the more difficult path detection condition (alternating-phase) declined slightly faster. The results for the normally-sighted observers could not be explained by poor fixation. Three people with substantial central vision loss (i.e. they can only use peripheral vision) could see both same- and alternating-phase stimuli with eccentric viewing of 13 degrees -17 degrees. Therefore central and peripheral vision appear to use similar visual mechanisms to perform the task, there being no fundamental difference.

Adult↗