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Biomedical subjects

S K Sarin

Publications and source records attributed to S K Sarin.

At least 109 records · Page 6Linked to original sources
PubMed1991

Splenoportovenography: safety, success rate and hemodynamic changes, and incidence and natural history of splenic hematoma.

Forty-five non-cirrhotic patients undergoing splenoportovenography (SPV) were studied. SPV was performed successfully in 43 (95.5%) patients. Local pain was encountered in 12 (26.6%) and lasted for a mean (+/- SD) of 7 +/- 3.8 hours. Local tenderness was noted in 17 (37.7%) and lasted for 6.8 +/- 3.7 hours. The mean rise in the pulse rate after the procedure was 6.5 +/- 4.7 beats per minute and the fall in the systolic and diastolic blood pressures was 3.4 +/- 2.5 and 0.8 +/- 1.7 mmHg respectively. Post-SPV splenic hematoma was noted in 3 (6.6%) patients. All were subcapsular, at the site of puncture, and disappeared by the seventh day. There was no difference in the age, change in the pulse rate, and fall in systolic or diastolic blood pressures between those who developed and those who did not develop hematoma. One patient required one unit of blood transfusion. There were no deaths. SPV was noted to be a simple and safe procedure with a high success rate with minimal morbidity and no mortality.

Adolescent↗
PubMed1990

Splanchnic and systemic hemodynamics in mice using a radioactive microsphere technique.

Mice are commonly used for the study of human disease processes. However, techniques for measuring systemic and hepatic blood flow in mice have not been developed. We attempted the conventional technique of radiolabeled microsphere injection into the left ventricle, but difficulties were encountered, including unsuspected ventricular perforation and outflow obstruction in 68% of the animals. We therefore evaluated whether an injection into the carotid artery close to the aortic arch can fulfill the criteria (approximately or greater than 300 microspheres in femoral blood or tissues, adequate mixing of microspheres with blood, and no significant alteration of blood pressure during microsphere injection) required for accurate measurement of systemic and regional hemodynamics. Carotid artery injection resulted in adequate mixing and number of microspheres in tissues in 78 and 91% of the animals, respectively. Portal venous inflow was 1.8 +/- 0.3 ml.min-1.g liver tissue-1 and renal blood flow was 5.1 +/- 0.75 ml.min-1.g tissue-1. Compared per unit weight, these values are quite similar to those reported in rats. Cardiac output was 12.1 +/- 1.2 ml/min and cardiac index was 462 +/- 47 ml.min-1.kg body wt-1. The reliability of cardiac output determination is improved if whole body radioactivity is taken into account. Five of 22 animals had to be excluded because of either a low number of microspheres in tissues or inadequate mixing of microspheres with blood (shown by asymmetrical distribution of microspheres between left and right kidney). With modifications, the radioactive microsphere technique can be adapted to the hemodynamic study of mice.

Animals↗
PubMed1990

Feasibility spectrum for Doppler flowmetry of splanchnic vessels. In normal and cirrhotic populations.

The calculation of absolute blood flow by Doppler flowmetry requires adequate visualization of a vessel in both transverse and longitudinal planes and an insonating angle less than 60 degrees. The percentage of the splanchnic vessels in a given population in which these criteria could be fulfilled (ie, the feasibility spectrum) is not known. To identify this spectrum in our patient sample, 100 consecutive nonselected patients (58 female, 42 male) and 34 cirrhotics (31 male, three female) were prospectively studied. In addition, from the group of 42 nonselected patients, 31 males with no evidence of liver disease were matched for age, weight, and height with the 31 male cirrhotics. The echo-Doppler feasibility (EDF; success percentage) was determined for the hepatic, superior mesenteric, and splenic arteries and portal, superior mesenteric, and splenic veins. In the nonselected sample, the EDF varied from 86% for the portal vein to 60% for the superior mesenteric artery. In cirrhotics, the EDF ranged from 88% for portal vein to 29% in splenic artery. The total EDF for the nonselected sample (68%) was significantly higher than the EDF for cirrhotics (54%; P less than .001). Physical factors (weight, age, height, and sex) affected the EDF in the nonselected patient sample but not in cirrhotics. We conclude that analysis of EDF of splanchnic vessels in these groups clearly demonstrates that the composition of the patient sample has an important bearing on the feasibility spectrum of Doppler study. Female subjects who are thin, young, and short and lighter male patients are better candidates for abdominal Doppler flowmetry.

Adolescent↗
PubMed1990

Sclerosants for variceal sclerotherapy: a critical appraisal.

Endoscopic sclerotherapy is a well-accepted technique for the treatment of variceal bleeding. It is carried out by injecting a sclerosant into or around a varix. Sclerosants are oily or aqueous chemicals which produce sclerosis, depending on their necroinflammatory and thrombotic properties. The safety and efficacy of various sclerosants has been evaluated in experimental and human studies. However, due to the presence of a large number of variables, conflicting results have been reported. Based primarily on anecdotal experiences, sodium tetradecyl sulfate, ethanolamine oleate, polidocanol, and alcohol appear to be potent and safe sclerosants. There is great need to perform double-blind trials to identify ideal sclerosant(s) with optimum thrombogenic and minimum necroinflammatory properties.

Animals↗
PubMed1990

Ulcers after intravariceal sclerotherapy: correlation of symptoms and factors affecting healing.

Esophageal variceal ulcers have been held responsible for most postsclerotherapy complaints. To investigate a possible relation between these ulcers and symptoms, we followed for 4 weeks 40 patients with portal hypertension who had received a single course of intravariceal sclerotherapy. All 40 patients were found to have mucosal variceal ulcers on the day after sclerotherapy. One or more symptoms were given by 26 (65%) patients; dysphagia by 53% (mean duration 4.6 +/- 2.2 days), retrosternal pain by 28% (mean duration 3.0 +/- 2.5 days), and fever by 15% (mean duration 2.1 +/- 0.4 days). A gastric variceal ulcer was responsible for bleeding in one (2.2%) patient. We found no correlation between the occurrence and duration of symptoms and the presence of variceal ulcers. While symptoms were transient, ulcers persisted for several days to weeks in most patients. Patients who had received a higher amount of sclerosant developed larger ulcers (greater than 1 cm) with more symptoms and healing was more delayed than in those who had received lesser amounts and developed smaller ulcers (less than 1 cm). In patients with a serum albumin level greater than 3.0 g/dl, ulcers healed more often than in those with a less than 3.0 g/dl albumin (72 versus 18%, p less than 0.05). Development of mucosal ulcers is a natural consequence of intravariceal sclerotherapy and it appears unrelated to symptoms. The chemical nature and the volume of the injected sclerosant are probably responsible for the symptoms after sclerotherapy. Further, postsclerotherapy ulcers heal spontaneously, more often in patients with good nutritional status.

Esophageal Diseases↗
PubMed1990

Comparative evaluation of visual, somatosensory, and auditory evoked potentials in the detection of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis.

To objectively determine the incidence of subclinical hepatic encephalopathy (SHE) and the relative sensitivity of different evoked potentials for its detection, 22 nonalcoholic cirrhotics without clinically detectable neurological abnormality and an equal number of matched healthy controls were studied. Of the three evoked potentials, visual evoked potential (VEP) studied by the pattern shift reversal method was not found to be abnormal in any patient. Short latency somatosensory evoked potential (SSEP) was abnormal in one (4.5%) and brain stem auditory evoked potential (BAEP) in nine (41%) patients. There was little advantage of performing both BAEP and SSEP in a patient, since the two together were abnormal in 10 (45.5%) patients, with SSEP adding only one more patient. Interpeak latencies I-III, III-V, and I-V in BAEP test were found to be the most sensitive parameters for the detection of SHE. Our results argue in favor of BAEP as the single investigation of choice for the objective assessment of SHE in patients with cirrhosis of the liver.

Adult↗
PubMed1989

Endoscopic sclerotherapy for esophago-gastric varices: a critical reappraisal.

Amongst the many non-surgical techniques for the treatment of variceal bleeding, endoscopic sclerotherapy (EST) has shown great promise. EST can successfully obliterate esophageal varices and prevent variceal rebleeding. It is also very effective in the control of active bleeding from esophageal varices. The technique of EST is simple and can be carried out with a conventional, forward viewing, flexible endoscope and a teflon injector. Weekly intravariceal injections of an aqueous sclerosant are preferable. Though complications of EST in experienced hands are low, prophylactic EST at present should be advocated only to patients at high risk of bleeding. While controversy exists, most reports indicate that EST improves survival of patients with portal hypertension who have bled from esophageal varices. With regular follow-up endoscopies, recurrence of varices and bleeding from them can be substantially reduced. Sclerotherapy may successfully obliterate gastric varices in some patients either following EST for esophageal varices or by direct gastric variceal injections. For the long-term management of portal hypertension, combination of pharmacotherapy before as well as after eradication of esophageal varices, needs proper evaluation.

Endoscopy↗
PubMed1989

Predictors of variceal bleeding: an analysis of clinical, endoscopic, and haemodynamic variables, with special reference to intravariceal pressure.

To assist in the prediction of variceal bleeding we examined 12 clinical, endoscopic and haemodynamic variables in 126 patients with portal hypertension (72 bleeders and 54 non-bleeders). Multiple regression and discriminant analysis were utilised for 101 patients. Stepwise regression among the 12 variables explained only 54% of the variability existing between bleeders and non-bleeders. Six of the 12 variables accounted for 51% of the total bleeder/non-bleeder variability. A predicting equation was evolved [Yp = -0.60 + 0.19 X1 (colour of varices) + 0.16 X2 (cherry red spots) + 0.03 X3 (red wale, markings) + 0.01 X4 (haematocystic spots) + 0.15 X5 (Conn's grading of variceal size) + 0.03 X6 (intravariceal pressure)]. Of the six variables used, variceal size indicated 35%, and intravariceal pressure accounted for 12%, of the explained variability between bleeders and non-bleeders. The presence of the three red colour signs and the colour of the varices accounted for only 3% and 1% respectively of the total explained variation. Using the discriminant function analysis, we were able to correctly identify 85% of the bleeders and 81% of the non-bleeders. Additional studies are required to detect the variables responsible for the unexplained variability (46%) between bleeders and non-bleeders.

Adolescent↗
PubMed1989

Gastric varices: profile, classification, and management.

Development of gastric varices is an important manifestation of portal hypertension. In segmental portal hypertension, gastric varices originate from short gastric and gastroepiploic veins. In generalized portal hypertension, intrinsic veins at cardia participate in the formation of gastric varices. Endoscopy and/or splenoportovenography and a high index of suspicion are required for the diagnosis of gastric varices. The incidence of gastric varices in patients with portal hypertension has been variably reported (2-70%), probably due to difficulties in diagnosis. In a small proportion of patients with gastric varices, chronic portal-systemic encephalopathy or significant variceal bleeding develops. Gastric varices can be classified, depending on their anatomical location, into gastroesophageal varices (a continuation of esophageal varices) or "isolated" gastric varices (fundal or ectopic varices). This distinction is necessary for management. Whereas surgery is recommended for bleeding fundal varices, in acute bleeding from gastroesophageal varices, sclerotherapy could be attempted successfully. In more than a quarter of patients, gastric varices disappear after obliteration of esophageal varices. Prophylactic sclerotherapy of gastric varices is not recommended.

Catheterization↗
PubMed1989

Comparative efficacy of psychometric tests in detection of subclinical hepatic encephalopathy in nonalcoholic cirrhotics: search for a rational approach.

To compare the efficacy of various psychometric tests in the detection of subclinical hepatic encephalopathy (SHE), cerebral functions were studied in 20 nonalcoholic cirrhotics without overt encephalopathy and in 18 matched healthy controls. Wechsler Adult Intelligence Scale (WAIS) indicated that verbal ability was preserved in all cirrhotics. Of the WAIS performance tests, block design test (BDT) was abnormal in 11 (55%), picture arrangement in 10 (50%), object assembly in eight (40%) and digit symbol in six (30%) patients. Taken together, these tests diagnosed SHE in 14 (70%) patients. Number connection test (NCT) alone, on the other hand, was abnormal in 13 (65%) patients. A combination of NCT and BDT yielded the diagnosis of SHE in 15 (75%) patients. An important measure of the reliability of the diagnosis of SHE was that NCT and BDT were independently abnormal in 10 of these patients. Both NCT and BDT were found easy and quick to administer. In conclusion, our results argue in favor of using a combination of NCT and BDT for a rapid and accurate diagnosis of SHE in patients with cirrhosis of the liver.

Adult↗
PubMed1988

Endoscopic sclerotherapy in the treatment of gastric varices.

Of 309 patients with portal hypertension, gastric varices were found in 48 (16 per cent). While the majority (88 per cent) of the patients had gastric varices in association with oesophageal varices, 6 (12 per cent) patients had 'isolated' gastric varices. Gastric varices were seen significantly (P less than 0.01) more often with grade 4 than with grade 3 varices. In 11 (28 per cent) of the 40 patients who completed sclerotherapy for oesophageal varices, gastric varices disappeared concurrently on eradication of oesophageal varices or during the following 6 months. Of the initial five patients with gastric varices who received direct intravariceal injections, four rebled; this technique was therefore replaced by combination (paravariceal + intravariceal) gastric variceal sclerotherapy. Emergency combination sclerotherapy successfully controlled bleeding from gastric varices in six of the eight treated patients. Thirty-two patients entered a programme of elective combination gastric variceal sclerotherapy. Variceal obliteration was achieved in 12 cases (38 per cent) and reduction in size was noted in another 7 patients (22 per cent) after a minimum of four courses. There were 11 (23 per cent) deaths, 8 due to uncontrolled bleeding from gastric varices and 3 due to hepatic coma. The other complications of gastric variceal sclerotherapy were minor and included retrosternal pain, fever and dysphagia. It is concluded that gastric varices often coexist with large oesophageal varices. If they persist for 6 months after eradication of oesophageal varices, a combination of paravariceal and intravariceal sclerotherapy should be attempted for their obliteration.

Emergencies↗
PubMed1988

Pattern of psychiatric morbidity and alcohol dependence in patients with alcoholic liver disease.

Fifty-six male patients with alcoholic liver disease were evaluated for the presence and severity of alcohol dependence and psychiatric illness using a severity of alcohol dependence questionnaire and research diagnostic criteria, respectively. Forty-three (76.7%) patients were found to be dependent; 26 (46.4%) moderately, and 17 (30.3%) severely. Patients with alcoholic hepatitis were significantly (P less than 0.05) more often found to be dependent than patients with alcoholic cirrhosis. Psychiatric morbidity was observed in 42 (75%) of the patients with alcoholic liver disease and 15 (26.7%) of the nonalcoholic cirrhotics. The difference was highly significant (P less than 0.01). The commonest disorders in patients with alcoholic liver disease were neuroses (33.0%), followed by affective disorders (26.8%). It was, however, not possible to ascertain whether psychiatric disorders antedated alcoholism or were secondary to it. Detection of moderate to severe dependence on alcohol and psychiatric morbidity in about three-fourths of the patients with alcoholic liver disease warrants an increased awareness and a multidisciplinary approach for the management of these patients.

Adult↗
PubMed1988

Ulceration after esophageal and gastric variceal sclerotherapy--influence of sucralfate and other factors on healing.

Forty-five consecutive patients underwent sclerotherapy with absolute alcohol. Post-sclerotherapy ulcers were detected in all of them (100%) on the following day. In order to evaluate its influence on ulcer healing, 20 patients were given sucralfate (1 g QID before meals), while 25 patients received identical-looking placebo, in a double-blind randomised manner. Endoscopy done at weekly intervals revealed healing of ulcers in 25%, 55%, 95% and 100% in the sucralfate, and 24%, 40%, 72% and 84% in the placebo group at 1, 2, 3, and 4 weeks, respectively. Differences between the two groups were not significant. Gastric variceal ulcers healed better with sucralfate (7 out of 7) than placebo (0 out of 2). Healing was influenced by the size of the ulcer. At two weeks, 63% of ulcers less than 1 cm, 43% of ulcers 1-2 cm, and only 16.6% of ulcers greater than 2 cm had healed. The size of the ulcer also correlated with the amount of the sclerosant injected. Our results show that (a) mucosal ulcers universally develop after adequate sclerotherapy, (b) most ulcers heal spontaneously, (c) sucralfate does not hasten ulcer healing, with the exception of gastric variceal ulcers, (d) a larger amount of sclerosant produces larger ulcers that take longer to heal.

Adult↗