PubMed Health⌕ Search

Biomedical subjects

S N Mehta

Publications and source records attributed to S N Mehta.

At least 37 records · Page 2Linked to original sources
PubMed1997

Magnetic resonance cholangiopancreatography.

Magnetic resonance cholangiopancreatography (MRCP) represents an important addition to conventional imaging of the pancreaticobiliary system. The main advantages of MR imaging of the biliary tract are that it combines the benefits of a cross-sectional imaging technique, providing the same type of information as ultrasonography and computed tomography, and the benefits of a projectional modality similar to endoscopic retrograde cholangiopancreatography. This article critically reviews the recent developments of this exciting technology and discusses the potential clinical role of MRCP in the evaluation of hepatobiliary and pancreatic diseases.

Bile Ducts↗
PubMed1997

Role of ERCP in the diagnosis of intraductal papillary mucinous neoplasms.

Mucinous cystic neoplasms of the pancreas may present in a "ductectatic" form, which parallels a distinct clinical presentation. We describe six patients with this entity termed mucinous ductal ectasia, or intraductal papillary mucinous neoplasm. All six patients presented with typical clinical and endoscopic findings and subsequently, almost all were found to have mucinous ductal cystadenocarcinomas. The endoscopic and pancreatographic findings associated with an intraductal papillary mucinous neoplasm are characteristic, unique, and yield a high diagnostic accuracy. It is important to recognize these features of intraductal papillary mucinous neoplasm since the tumor has a lower malignant potential than adenocarcinoma of the pancreas, and surgical resection is curative in many cases.

Aged↗
PubMed1996

Outpatient therapeutic ERCP: a series of 262 consecutive cases.

BACKGROUND: Because of possible complications, it has been common practice to admit most if not all patients undergoing therapeutic ERCP. Therefore, little descriptive data exist on the safety of outpatient therapeutic ERCP. METHODS: We assessed 262 consecutive ERCPs in 209 patients undergoing outpatient therapeutic ERCP over a 5-year period, with particular attention to the development of complications. All outpatient endoscopic sphincterotomies and stent placements performed over a 5-year period were prospectively entered into an ongoing data base that was used for the analysis. In addition, hospital and office records for all patients were retrospectively reviewed, including a 30 to 45 day follow-up in a private office setting. RESULTS: Suspected or documented choledocholithiasis was the most common indication for ERCP and was present in 132 (50%), followed by malignant obstruction in 77 (29%), type I sphincter of Oddi dysfunction (on the basis of symptoms, liver test abnormalities, and bile duct dilatation) in 36 (14%), chronic pancreatitis in 10 (3.8%), HIV cholangiopathy in 4 (1.5%), and other conditions in 3 (1.1%). Overall, 181 patients (69%) underwent a sphincterotomy. The 30-day post-ERCP complication rate was 5.7% (95% CI: 3.2% to 9.3%), occurring in 15 of 262 cases. Complications necessitating hospitalization developed in 9 of the 262 ERCPs for a rate of 3.4% (95% CI: 1.6% to 6.4%). The mean duration of hospital stay among patients admitted for a complication was 2.7 +/- 1.8 days (range, 1 to 7 days). All patients were discharged without permanent sequelae. No 30-day procedure-related fatalities were reported. CONCLUSION: In this selected series of 262 consecutive cases, endoscopic sphincterotomy and stent placement were safely performed in an ambulatory setting. Prior to recommending a generalized change in existing practice, however, this finding requires validation with larger series of cases, including the performance of other outpatient therapeutic ERCP techniques.

Adolescent↗
PubMed1996

Pneumatosis cystoides intestinalis: laparoscopic features.

Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cysts in the submucosa or subserosa of the gastrointestinal tract. PCI has been described by various radiographic methods but its laparoscopic features have not been previously described. We report a case of a 77-yr-old male with marked ascites and radiographic evidence of pneumatosis cystoides intestinalis of the ileum who underwent a laparoscopy to determine the cause of his ascites. The characteristic laparoscopic features of PCI are described, and its radiographic features are reviewed.

Aged↗
PubMed1996

Post transplant diabetes mellitus in live related renal allograft recipients: a single centre experience.

The incidence of post-transplant diabetes mellitus (PTDM) was evaluated in 250 patients who underwent live-related renal transplantation at our hospital between 1978 and 1992. Twelve (4.8%) patients developed PTDM requiring drug therapy. PTDM occurred in 4 of 197 (2%) patients on conventional prednisolone-azathioprine immunosuppression as compared to 8 of 53 (15.1%) patients receiving cyclosporine in addition (triple-therapy). Three patients (25%) developed PTDM during or immediately following anti-rejection therapy with intravenous methylprednisolone. Eight patients (66.6%) developed PTDM within six months of transplantation. Majority of our patients (66.6%) could be managed successfully with oral hypoglycemic agents. Two patients (16.6%) showed spontaneous resolution of hyperglycemia within six months of onset of PTDM. Eleven patients (91.6%) were symptomatic for their hyperglycemia with two patients presenting as 'pseudorejection' and one with diabetic ketoacidosis. Females were more predisposed to develop PTDM in our study (10% vs. 4.1%). HLA-B15 and DR 3 were the commonest phenotypes in our PTDM patients. No other known predisposing or triggering factors associated with PTDM were found in our patients. The current study suggests, that addition of cyclosporine to the conventional immunosuppression in live-related renal allograft recipients has contributed to an increased incidence of post-transplant diabetes mellitus. Close and regular blood sugar monitoring is thus recommended in post-transplant patients especially those on triple drug immunosuppression.

Adult↗
PubMed1995

Clinical profile and course and outcome of late acute rejection episodes in living-related-donor renal allograft recipients.

We prospectively monitored clinical data and renal function at monthly intervals in 165 patients who had received living-related-donor renal allografts in our institution between January 1981 and December 1991 and had a functioning allograft for 1 year or longer. During a mean follow-up period of 47.2 (range 13-155) months, 32 patients (17.2%) developed late acute rejections, of which 14 (43.7%) were asymptomatic. Amongst the symptomatic late acute rejections, worsening of hypertension was the commonest finding, being present in 11 (61.1%) patients, followed by oliguria in 8 (44.4%) and weight gain in 7 (38.8%) patients. Of these 32 late acute rejections, as many as 28 (87.5%) showed a response to antirejection therapy with high-dose steroids: 5 (15.6%) a complete response and 23 (71.9%) a partial response. The response rate was 100% if it was the first acute rejection (20% complete and 80% partial), 78.6% if it was the second (14.3% complete and 64.3% partial), and no or only a partial response to treatment if it was the third acute rejection episode. On long-term follow-up, patients who had responded to to antirejection treatment had a significantly better graft survival as compared with nonresponding patients: 76 and 27%, respectively. Our observations suggest that routine monitoring of the renal function at frequent intervals is essential for early diagnosis and treatment of acute rejections, even during the late posttransplant period. The chances of a response to antirejection therapy are higher during the first episode of late acute transplant rejection as compared with second or a third late rejection event.

Acute Disease↗
PubMed1994

Effect of panel reactive antibody on live related donor kidney transplantation: Indian experience.

Serum samples from 95 recipients, transplanted with kidneys from live related donors, were tested for the presence of panel reactive antibodies (PRA) in pre- and post-transplant serum samples by the extended microdroplet lymphocytotoxicity test. The immunoglobulin class of antibodies was tested by treatment of serum with dithiothreitol. A significant correlation was found between the high PRA found in the 75 pretransplant sera tested and the subsequent rejection episodes. In addition, the level of pretransplant PRA activity was associated with graft survival in that patients with low PRA had significantly superior graft survival than those with high PRA. Furthermore, the present data show that patients with historical high PRA, but current low PRA, had graft survival similar to that in recipients who had moderate PRA in their current sera. High PRA patients had more often a positive crossmatch than patients with low PRA. The PRA level was also associated with prolonged waiting period. Immunoglobulin class of antibodies was related to graft acceptance in that the presence of IgM antibodies was not detrimental to transplantation. The results in the present study suggest that PRA of < 10% is negligible, while more attention should be paid to patients with PRA > 10%.

Adolescent↗
PubMed1994

Clinicopathologic course of hepatitis B infection in surface antigen carriers following living-related renal transplantation.

We present the clinical course, serology, and histopathology of 17 living-related renal allograft recipients who were hepatitis B surface antigen (HBsAg) positive at the time of transplantation. Although 14 patients were hepatitis B e antigen (HBeAg) positive, none had clinical hepatitis at the time of transplantation. All patients were receiving moderate doses of prednisolone and azathioprine only. At the mean short-term follow-up of 70 months (range, 6 to 132 months), none of the patients had seroconversion to antibody to HBsAg. Four patients died due to extrahepatic complications between 16 and 50 months following transplantation. Of these, three had normal liver function at the time of death and one had portal tract infiltration by chronic inflammatory cells. One patient died due to fulminant hepatitis at 6 months after transplantation. Of the remaining 12 patients, although 11 were HBeAg positive, only two developed chronic active hepatitis. Our short-term follow-up data suggest that chronic liver disease is not a frequent complication following living-related renal transplantation in HBsAg carriers. In addition, the presence of HBeAg at the time of transplantation does not predict a bad prognosis. Thus, in a living-related renal transplant program, asymptomatic carriers of HBsAg with positive HBeAg are not a contraindication for renal transplantation.

Actuarial Analysis↗
PubMed1992

Renal artery stenosis caused by nonspecific arteritis (Takayasu disease): results of treatment with percutaneous transluminal angioplasty.

Renovascular hypertension is common in nonspecific aortoarteritis (Takayasu disease). The utility of percutaneous transluminal renal angioplasty in managing this disease has been reported infrequently, and technical problems in using this treatment method have not been described. We retrospectively evaluated the results of renal angioplasty in treating 33 stenoses in 20 patients. Each patient's diagnosis was based on the criteria established by the Aortitis Syndrome Research Committee of Japan. Criteria for selection of patients for angioplasty were (1) severe hypertension uncontrolled by single-drug therapy, (2) angiographic evidence of at least 70% stenosis of the renal artery with a pressure gradient of more than 20 mm Hg, and (3) a normal sedimentation rate. The transfemoral route was used to treat all 33 stenoses. Follow-up examinations included blood pressure and medication evaluation 1 day, 1 week, and 4-6 weeks after treatment, and thereafter at 6-month intervals. Technical success was obtained in 28 lesions (85%) in 17 patients (85%). All failures occurred in the presence of coexistent abdominal aortic disease and tight, proximal stenosis of the renal artery. Technical difficulties were attributed to the tough, noncompliant nature of the stenoses, which were difficult to cross and resisted repeated, prolonged balloon inflations. These patients experienced backache and a fall in systemic blood pressure during balloon inflation. In one patient, the ipsilateral renal vein was injured during angioplasty and required surgery. Clinical success was obtained in 14 (82%) of the 17 patients in whom technical success was achieved and included cure in six patients and improvement in eight others. Follow-up 1-18 months (mean, 8 months) after treatment showed restenosis in six (21%) of 28 lesions. We conclude that renal angioplasty in nonspecific arteritis is associated with technical difficulties; however, the short-term results are good and the complication rate is acceptable.

Adolescent↗
PubMed1991

Flexion osteotomy of the femur for genu recurvatum after poliomyelitis.

We report the results of 21 femoral osteotomies performed in 18 patients for genu recurvatum and flattening of the femoral condyles after poliomyelitis. Before operation the average angle of recurvatum was 31 degrees and all the limbs required bracing. After a mean follow-up of four years there has been partial recurrence in only one case. Nine patients (10 limbs) needed no orthosis and the others had less discomfort and an improved gait. Complete remodelling of the femoral and tibial epiphyses was noted in two of the younger patients.

Adolescent↗