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Biomedical subjects

S C Kadakia

Publications and source records attributed to S C Kadakia.

At least 37 records · Page 2Linked to original sources
PubMed1993

Esophageal dilation with polyvinyl bougies, using a marked guidewire without the aid of fluoroscopy: an update.

One hundred thirty-eight patients with esophageal stricture underwent polyvinyl bougie dilations whereby American Endoscopy dilators were passed over a marked guidewire that had been placed endoscopically. Fluoroscopy was not utilized during the dilations. The dilations were performed only after the guidewire was properly placed, with 60-cm markings at the incisors, which ensured that the tip of the guidewire was in the antrum. One hundred fourteen patients had benign strictures and 24 had malignant strictures. There were 197 sessions of dilations for a total of 748 individual dilations. In 97 of 138 patients, the guidewire was placed in the antrum under direct vision. The remaining 41 patients had significant esophageal stenosis which prevented passage of the endoscope into the stomach; therefore, the guidewire was placed by advancing it blindly through the stenosis. There were no procedure-related complications. During this period, eight patients were dilated without complications, using fluoroscopic placement of guidewire because endoscopic placement of the guidewire was not considered safe. We conclude that esophageal strictures can be safely dilated in most patients by means of the American Endoscopy dilator system and the marked guidewire without the aid of fluoroscopy.

Adult↗
PubMed1993

Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia.

Pneumatic dilation is the initial therapy for primary esophageal achalasia. Recently, polyethylene balloon (Rigiflex) dilators have been used with varying success and complication rate. We performed a total of 47 dilations in 29 consecutive patients with achalasia using the Rigiflex dilators. The 3.0-cm balloon was always used first. If there was no symptomatic response, a 3.5-cm balloon was used after 4-8 wk. If there was still no symptomatic response after 4-8 wk, a 4.0-cm dilator was used. Eighteen (62%) patients were successfully dilated with a 3.0-cm balloon only. Of 11 patients not responding to a 3.0-cm balloon, five were dilated successfully with a 3.5-cm balloon. Of six patients not responding to a 3.5-cm balloon, four were successfully dilated with a 4.0-cm balloon dilator. Two patients eventually required surgery. The overall success with Rigiflex balloon dilator was achieved in 27 of 29 (93%) patients. There were no complications. We conclude that pneumatic dilation for esophageal achalasia performed in a graded fashion starting with Rigiflex 3.0-cm balloon dilator has a high success rate without complications in patients with achalasia.

Adolescent↗
PubMed1992

Serum and tissue zinc concentrations in patients with endoscopic esophagitis.

Because zinc is an important metabolic requirement for growth and repair of squamous tissue, we questioned whether changes in serum and esophageal tissue zinc were present in patients with reflux esophagitis. To investigate this question, we prospectively studied 49 patients undergoing upper gastrointestinal endoscopy for symptoms of abdominal pain and discomfort; 19 patients were taking H2 antagonists at the time of the study. Blood was obtained to measure serum zinc concentrations prior to endoscopy and tissue zinc levels were obtained from esophageal biopsies from the distal, middle, and proximal esophagus in patients who were either endoscopically normal or who exhibited endoscopic esophagitis. Serum zinc concentrations were significantly lower in patients with endoscopic esophagitis compared to the endoscopically normal group (77 +/- 3.8 micrograms/dl vs 88 +/- 2.4 micrograms/dl, P less than 0.02). Distal esophageal tissue concentrations were significantly higher in patients with endoscopic esophagitis compared to the endoscopically normal group (200 +/- 30 micrograms/liter vs 135 +/- 15 micrograms/liter, P less than 0.05); whereas there were no differences between values obtained in the proximal or middle esophagus. Serum and tissue zinc concentrations in patients with esophagitis receiving H2 antagonists were more similar to values obtained in patients who were endoscopically normal than to patients with endoscopic esophagitis without treatment. This study suggests that in endoscopic esophagitis: (1) greater amounts of zinc are concentrated in the rapidly proliferating distal esophageal epithelium, (2) the serum zinc pool may serve as a major zinc source, and (3) decreasing esophageal mucosal inflammation with H2 antagonists may decrease zinc loss via the esophageal epithelium.

Adult↗
PubMed1992

Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients.

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ) are well-accepted procedures for long-term enteral alimentation. PEG has replaced surgical gastrostomy at many institutions because of its safety and ease. This study was undertaken to evaluate the indications for PEG and PEJ, as well as their success rates, complications with special attention to aspiration, and long-term follow-up. We were specifically interested in reviewing the problem of aspiration in patients with PEG and PEJ. A retrospective review of 79 patients at Brooke Army Medical Center over a 3-year period was done. PEG or PEJ was successful in 79 of 81 patients (97%). The most common indications were neurologic disorders in 46 patients (58%) and cancer in 20 (25.3%). Complications other than aspiration occurred in 11 patients (14%). Aspiration occurred in nine patients after PEG or PEJ (11.4%); six patients had experienced aspiration prior to PEG or PEJ. Six patients had a jejunostomy tube placed through the PEG for prevention of aspiration, and three died of continued aspiration. We conclude that aspiration is not prevented by PEJ, continues to be a major problem after PEJ, and becomes manifest for the first time after PEG.

Adolescent↗
PubMed1992

Endoscopic removal of colonic leiomyoma.

Most gastrointestinal leiomyomas are found in the stomach, only 3% of them arising in the colon. Surgical resection of the leiomyoma is usually necessary owing to its submucosal location. We describe a patient with a 1.5 cm pedunculated leiomyoma of the colon successfully removed by colonoscopic snare electrocauterization. We believe this to be the first report of a colonic leiomyoma of this size removed endoscopically without complication. We review the literature regarding gastrointestinal leiomyomas with special attention to pedunculated leiomyomas and their endoscopic management.

Aged↗
PubMed1992

Foley feeding catheter migration into the small bowel.

Percutaneous endoscopic gastrostomy provides a non-surgical alternative to enteral feeding. The tube may deteriorate or be expelled accidentally from the stomach and require replacement. We report a patient in whom the replacement Foley catheter migrated into the jejunum, resulting in impaction of the hub into the abdominal wall with resultant localized infection and impaction at the stoma site. We review this problem and suggest a simple technique to prevent the complication.

Catheterization↗
PubMed1992

Gastrointestinal Kaposi's sarcoma as the first manifestation of acquired immunodeficiency syndrome.

Gastrointestinal Kaposi's sarcoma can occur in HIV-infected patients without previously diagnosed AIDS. Gastrointestinal symptoms in such patients should be thoroughly investigated because of the possibility of gastrointestinal Kaposi's sarcoma, despite the absence of the cutaneous form. The discovery of gastrointestinal Kaposi's sarcoma establishes the diagnosis of AIDS, as it did in our two patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Metastatic tumors to the upper gastrointestinal tract: endoscopic experience.

Metastatic tumors to the upper gastrointestinal tract were identified by esophagogastroduodenoscopy in 14 patients. Malignant melanoma, breast cancer, and lung cancer were the most common primary cancers in four, three, and three patients, respectively. Osteogenic sarcoma, renal cell carcinoma, Meckel cell carcinoma of the skin, and germ-cell tumor were the primary cancer in the remaining four. The esophagus was involved in three patients, the stomach in 13, duodenum in four, and papilla of Vater in one. Upper gastrointestinal bleeding and anemia were the most common presenting features. There was correlation between symptoms and endoscopic findings in all patients. Involvement of gastrointestinal tract at endoscopy was the initial and only evidence of metastases in all patients without evidence of metastases elsewhere, as evidenced by other diagnostic tests in any of these patients. Endoscopic biopsies and/or brush cytology provided histologic diagnosis in all 14 patients. The endoscopic and nonendoscopic literature regarding metastases to the upper gastrointestinal tract is reviewed.

Adenocarcinoma↗
PubMed1992

Prospective evaluation of Foley catheter as a replacement gastrostomy tube.

Percutaneous endoscopic gastrostomy provides a nonsurgical alternative to enteral feeding. However, the percutaneous endoscopic gastrostomy tube may deteriorate, malfunction, or be accidentally expelled from the stomach, requiring replacement. This prospective study was performed to evaluate the use of an all silicone Foley catheter (Foley) as a replacement feeding gastrostomy in 28 patients requiring replacement gastrostomy. A plastic ring and a retention disc were always placed over the Foley prior to replacement. Foley functioned well without replacement in 19 (68%) patients for a mean of 167 days. It needed to be replaced in nine (32%) patients due to malfunction after a mean of 138 days. Lack of migration of Foley was the most striking finding of our study, in contrast to case reports in the literature. These data suggest that Foley can be safely used as replacement gastrostomy tube. A randomized controlled trial comparing the Foley catheter as a replacement tube with other commercially available devices is needed.

Adult↗
PubMed1992

Tortilla corn chip-associated esophageal perforation: an unusual presentation of achalasia.

Laceration of the esophagus related to ingestion of tortilla corn chips has been described in the past. However, no cases of perforation of the esophagus are known to be associated with tortilla corn chip ingestion. We describe a case of previously undiagnosed achalasia in a patient who presented with an esophageal perforation after ingestion of tortilla corn chips.

Adolescent↗
PubMed1986

Gastrointestinal blood loss associated with running a marathon.

Gastrointestinal bleeding has been observed in long-distance runners. We prospectively studied participants of the Eighth Annual Marine Corps Marathon to determine the incidence of gastrointestinal blood loss associated with long-distance running. Of 600 runners contacted, 125 (21%) returned a questionnaire as well as pre- and postmarathon stool specimens. Stool specimens converted from Hemoccult negative to positive in 29/125 (23%) of the participants, indicating that running the marathon was associated with gastrointestinal blood loss (P less than 0.001). The incidence of this conversion (negative to positive) was significant for both males (N = 68, P less than 0.001) and females (N = 57, P less than 0.05). Gastrointestinal bleeding appeared to be independent of age, race time, abdominal symptoms, and the recent ingestion of aspirin, vitamin C, or steak.

Adult↗
PubMedDate not supplied

Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases.

We retrospectively compared the efficacy and complications of 10 F biliary stents with 11.5 F stents in the management of malignant and benign biliary tract diseases. Thirty-three patients treated with 10 F stents inserted on 46 occasions and 30 patients with 11.5 F stents inserted on 43 occasions were evaluated. The success of insertion, relief of jaundice, decline in total bilirubin, stent survival, and complications due to stents were compared. Patients with multiple stents, preoperative biliary drainage, stents smaller than 10 F, larger than 11.5 F, nasobiliary catheter drainage, and percutaneous biliary drainage were excluded. When comparing 10 F stents to 11.5 F stents, the success of insertion was 85% vs. 79% (p = 0.52), relief of jaundice was 88% vs. 90% (p = 0.79), and the decline in total bilirubin was 7.4 mg/100 ml vs. 8.3 mg/100 ml (p = 0.67). The complications, including stent clogging, cholangitis, stent migration, and pancreatitis occurred on seven occasions in patients with 10 F stents and on six occasions in patients with 11.5 F stents. This difference was statistically not significant (p = 0.87). We conclude that 10 F stents have the same success rate and complication rate as 11.5 F stents in the management of biliary tract diseases, and offer no significant advantage.

Aged↗
PubMedDate not supplied

Serum electrolyte, mineral, and blood pH changes after phosphate enema, water enema, and electrolyte lavage solution enema for flexible sigmoidoscopy.

Hypertonic sodium phosphate (Fleet) enema is a commonly used preparation for fiberoptic flexible sigmoidoscopy. Unfortunately, Fleet has been associated with complications in children and adults. The purpose of this study was to compare the serum electrolytes, mineral, and blood pH changes before and after the administration of Fleet with water and polyethylene glycol electrolyte lavage solution (Golytely) as enemas in an adult population undergoing flexible sigmoidoscopy. Sixty-six patients were randomized in a double-blind fashion to receive two enemas of either Fleet (N = 22), water (N = 20), or Golytely (N = 24). The cleansing ability was graded from 1 to 4 (1 = poor, 4 = excellent). The Fleet had significantly better optimal cleansing efficacy compared with water (p < 0.05) but not to Golytely (p > 0.05). There was a significant increase in the serum phosphorus in the Fleet group compared with water (p < 0.001) or Golytely (p < 0.001). However, absolute serum phosphorus values after Fleet enema always remained within normal range in all but one patient. The changes in other electrolytes, minerals, and venous pH were insignificant.

Calcium↗