Biomedical subjects

Rajiv Mehta

Publications and source records attributed to Rajiv Mehta.

10 recordsLinked to original sources

PubMed2006

Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study.

AIM: To evaluate predictors of neostigmine response in patients with acute colonic pseudo-obstruction. METHODS: Twenty-seven patients with acute colonic pseudo-obstruction were enrolled in the study. All patients had received initial conservative management such as nil orally, nasogastric suction, rectal tube placement and correction of electrolyte imbalance for the first 24 h. Those who did not resolve with conservative management received 2 mg neostigmine intravenously. The same dose was repeated after 24 h in patients who did not response to the first dose (initial non-responders), or in those patients who relapsed after an initial response (initial responders). All non-responders to neostigmine underwent colonoscopic decompression followed by 2 mg neostigmine infusion for 30 min. A sustained response was defined as the resolution of symptoms and colonic dilatation on a plain radiograph. RESULTS: The study enrolled 27 patients; 18 were male (67%), and the median age was 60 years (range 18-78 years). Eight (30%) patients had spontaneous resolution. Initial response with neostigmine was observed in 16 (84%) patients, of which 10 (63%) had a sustained response. Nine patients (three initial non-responders and six initial responders) had received a second dose of neostigmine. A sustained response was seen only in five initial responders. Four patients who did not respond to neostigmine underwent colonoscopic decompression followed by neostigmine infusion and had a sustained response. Neostigmine responders were more likely to be postoperative patients (11 of 15 (73%) vs one of four (25%), P = 0.07), less likely to have electrolyte imbalance and to be on antimotility agents (three of 15 (20%) vs four of four (100%), P = 0.009 and two of 15 (13%) vs four of four (100%), P = 0.003). CONCLUSIONS: Electrolyte imbalance and usage of anti-motility agents are factors associated with a poor response, while postoperative patients showing good response to neostigmine therapy.

Acute Disease↗

PubMed2004

Bulimia nervosa.

Although there is a lot of information coming up to explain the pathogenesis of anorexia nervosa, yet little is know about bulimia nervosa in Indian literature. This case report highlights the typical presentation of a case of bulimia nervosa in an adolescent girl, where bulimia symptoms were preceded by anorexic behavior. Our case showed clinical similarity with the diagnostic criteria of the available classification system. The absence of self-evaluation for body weight and shape in this case be explained on the basis of cultural factors. To some extent, initial anorexic behavior could have played a role in etiopathogenesis of bulimia nervosa.

Adolescent↗

PubMedDate not supplied

Idiopathic colonic varices.

Idiopathic varices of the colon are rare, with only a few reports in literature. We report 30-year-old man who presented with melena and had hepatic flexure varices detected at colonoscopy. Investigations for portal hypertension were negative. No treatment was given.

Adult↗

PubMedDate not supplied

Takayasu arteritis presenting as chronic mesenteric ischemia.

We report a 40-year-old man with Takayasu arteritis involving the abdominal aorta, who presented with chronic mesenteric ischemia. The diagnosis was made by aortogram, which showed tight superior mesenteric artery (SMA) stenosis. The patient underwent successful balloon angioplasty of the SMA following corticosteroid treatment. He is asymptomatic 9 months later; repeat aortogram showed no stenosis.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Natural course of asymptomatic pancreatic pseudocyst: a prospective study.

AIM: To study the natural course of asymptomatic pseudocysts of the pancreas. METHODS: Thirty patients (age range 18-68 years, mean 44; 24 men) with asymptomatic pseudocysts of the pancreas were enrolled between December 2001 and December 2003, and were followed up every month. Those who developed symptoms due to pseudocyst (increasing pain or features of obstruction such as vomiting or jaundice) were subjected to an endoscopic or surgical drainage procedure. End point of the study was either spontaneous resolution of pseudocyst or drainage procedure. RESULTS: Eighteen (60%) of 30 patients had resolution of the pseudocyst over an average duration of 5 months. Maximum diameter of less than 7.5 cm and cyst volume less than 250 mL were significantly more frequent in patients with resolution of pseudocyst than in those without (14/18 vs 2/12 [p=0.001] and 15/18 vs 2/12 [p=0.0003], respectively). Presence of internal debris was associated with non-resolution (9/12 vs 2/18; p=0.001). CONCLUSION: Pseudocysts with less than 7.5 cm diameter, volume less than 250 mL, and absence of internal debris were associated with spontaneous resolution within an average duration of 5 months.

Abdominal Pain↗

PubMedDate not supplied

Incidental detection of tubular esophageal duplication in gastric cardia malignancy.

Congenital esophageal duplications represent about 15% of digestive tract duplications. We report a 38-year-old man who presented with longstanding heartburn and recent dysphagia. Endoscopy showed communicating tubular duplication of lower esophagus with ulceroproliferative growth at the gastric cardia extending into the lower esophagus. Histology of radical esophagogastrectomy specimen showed poorly differentiated adenocarcinoma of gastric cardia without evidence of Barrett's esophagus.

Adenocarcinoma↗

PubMedDate not supplied

Infiltrating Strongyloides stercoralis presenting as duodenal obstruction.

Small intestinal obstruction due to Strongyloides stercoralis is rare and has not been reported in an immunocompetent patient. We describe a 70-year-old immunocompetent man presenting with duodenal obstruction secondary to severe S. stercoralis infestation, as documented on duodenal biopsy. He was treated with ivermectin, with which he recovered remarkably.

Aged↗

PubMedDate not supplied

Skeletal infections in cirrhotics.

There are few reports of skeletal infections in patients with cirrhosis. We present two such cases, both with alcoholic liver disease, seen over a period of one year. The first, a 46-year-old man, presented as pyrexia of unknown origin, and was found to have pyogenic discitis; he responded to antibiotic and surgery. The second, a 42-year-old man, presented with chest wall abscess and was diagnosed to have tubercular osteomyelitis; he expired despite treatment with non-hepatotoxic anti-tubercular drugs.

Adult↗

PubMedDate not supplied

Factors determining successful outcome following pneumatic balloon dilation in achalasia cardia.

BACKGROUND: Pneumatic balloon dilation is a popular method of treating patients with achalasia cardia. It may be useful to know the factors that predict response to this treatment. AIM: To determine predictors of outcome following pneumatic balloon dilation in patients with achalasia cardia. METHODS: Records of 62 patients who had undergone pneumatic dilation using Rigiflex balloon dilators (Boston Scientific, Boston, MA, USA) were reviewed. Follow-up data were available for 52 patients. Data from patients with and without improvement in symptoms were compared. RESULTS: Of the 52 patients (age mean 44 [range 11-68] years; 27 male; median symptom duration 20 [4-90] months], 42 (81%) patients had response in symptoms after balloon dilatation. On univariate analysis, the responders more often had age> 40 years (26/42 [62%] versus 1/10 [10%], p=0.003), and less often had lower esophageal sphincter pressure> 50 mmHg (8/10 [80%] versus 10/42 [24%], p=0.0007) and mid-esophageal body hypocontraction (7/10 [70%] versus 12/24 [29%] p=0.01) than the non-responders. On multivariate analysis only age <or= 40 years (p=0.02) was associated with poor outcome. CONCLUSION: Younger age may predict non-response to balloon dilation using Rigiflex balloon dilators in patients with achalasia cardia.

Adolescent↗

PubMedDate not supplied

Thyrotoxicosis co-existing with ulcerative colitis.

A 32-year-old lady was admitted with complaints of recurrent episodes of vomiting and loose stools associated with tenesmus and blood and mucus. She also had a neck swelling since 11 years of age, and had features of thyrotoxicosis for five to six months. She responded to balsalazide only after her thyroid status was controlled with carbimazole.

Adult↗