Biomedical subjects
Publications and source records attributed to V K Thorat.
Development of carcinomas of the pancreas over an underlying chronic pancreatitis is a rare event. Diminution of pancreatic calcification, following the development of carcinoma, has been previously reported only once. We report another such case.
To compare the efficacy of conventional versus on-demand (symptomatic) treatment of duodenal ulcer, 81 patients were randomized into two groups. Group A (n = 40) patients were treated with ranitidine 150 mg twice daily until complete ulcer healing was achieved. Group B (n = 41) received a similar dose of ranitidine until complete relief of pain was achieved, irrespective of ulcer healing. Recurrence of ulcer in group A was treated with a full course of treatment until complete healing of the ulcer was achieved again, whereas, in group B, treatment was given only until pain recurrence was symptomatically controlled. Endoscopic examination was performed each month. Analysis of the results at 8 wk and 28 wk showed that 1) ulcer healing in group A was significantly superior to that in group B up to 24 wk, but at 28 wk the difference was no longer statistically significant (95% vs 70%), 2) the number of painful days were similar in the two groups, 3) group A patients took treatment for a significantly longer period than those in group B, 4) the cost of treatment per patient in group A was significantly greater than that in group B, 5) the recurrence rate assessed in patients followed for 28 wk after complete ulcer healing was similar in the two groups, and 6) the ulcer-related complications were not significantly different in the two groups. These findings indicate that, although on-demand treatment results in slower ulcer healing, it is not associated with an increase in the duration of pain and incidence of complications. A major advantage of this approach was a significant reduction in the cost of treatment. It is concluded that on-demand treatment is an attractive alternative therapeutic approach in the management of duodenal ulcer disease.
Colonoscopic snare polypectomy was carried out in 70 patients (40 children, 30 adults). There was a male preponderance in both the groups with a combined male: female ratio of 4.4:1. The majority of patients (85%) were aged 20 years or below. All patients presented with intermittent bleeding per rectum, ranging from 2 months - 6 years (mean 1.2 +/- 1.1 years) in children and 1-14 years (1.9 +/- 2.3) in adults. The majority of patients polyps were located in the rectum (73%) or in the rectosigmoid region (21%). Polyps were significantly more common in the rectum (80% vs 63%; P less than 0.01) and less frequent in the rectosigmoid (15% vs 30%; p less than 0.01) in children as compared to adults. A single polyp was present in 49 (70%) patients; 17 (24%) had 2-10 polyps, while 4 patients (2 children, 2 adults) had more than ten polyps. Most patients (94%) had polyps of less than 2 cm size. Histologically, the most polyps (91.5%) were of the juvenile variety; 39 (97.5%) children and 25 (83%) adults had this variety of polyp. The remaining 5 (17%) adults and one (2.5%) child had adenomatous polyps. The difference in the polyp histology between the two age groups was statistically significant (p less than 0.05). Only one patient (1.4%) had excessive bleeding following polypectomy. The present study suggests two important differences in the nature of polyps as compared to the West: 1) our patients were much younger, and polyps were rare after 40 years; and (2) histologically, the commonest polyps were of the juvenile variety (91.5%) while adenomatous polyps were rare (8.5%).
To examine the long-term management of irritable bowel syndrome we conducted a two-part controlled therapeutic trial on 28 patients who had recovered completely after four to six weeks of treatment with ispaghula husk and propantheline. In part I patients were randomly divided into two groups. Group A received a placebo capsule while Group B continued with treatment as before. After six months the response to treatment was assessed according to a scoring system. The overall relapse rate in Group B was 46 per cent compared to 82 per cent in group A. With continued treatment patients in Group B became asymptomatic from the fourth month while patients in Group A continued to deteriorate. In part II, patients who had relapsed whilst on placebo received active treatment. Six of the seven who agreed to continue with the study became asymptomatic within four weeks. However, all the patients who were asymptomatic while on active treatment relapsed on discontinuation and again recovered on reinstitution of active treatment. We conclude that irritable bowel syndrome is a chronic relapsing disorder and that treatment with a combination of ispaghula husk and propantheline is effective, both in relieving symptoms and in the maintenance of remission.
To assess whether the anatomy of the pancreaticobiliary ductal drainage into the duodenum has any relationship with biliary diseases we analyzed 259 endoscopic retrograde cholangiopancreatograms. These included 102 normal examinations (control group), 95 patients with gallstone disease, and 21 patients with carcinoma of the gallbladder. In the control group, 64 (63%) subjects had a common channel and 38 (37%) had separated openings for the common bile duct and the main pancreatic duct. By contrast, the prevalence rate of a common channel was significantly lower in gallstone disease [28 (30%); p less than 0.001]. No such difference, compared with controls, was observed in patients with carcinoma of the gallbladder. The length of the common channel in the control group (mean +/- SD, 4.7 +/- 2.5 mm) was similar to that in gallstone disease (4.6 +/- 2.6 mm). However, patients with carcinoma of the gallbladder had a significantly longer common channel (8.3 +/- 4 mm; p less than 0.001) compared with the control group. An abnormally long common channel (greater than or equal to 8 mm) was seen more frequently in carcinoma of the gallbladder (8 of 21; 38%) compared with normal subjects (3 of 102; 3%) and patients with gallstones (1 of 95; 1%); the difference was highly significant (p less than 0.001 for each). These observations suggest a close association between the anatomy of the distal ends of the common bile duct and main pancreatic duct and the development of gallstones and carcinoma of the gallbladder.
We report a case of spontaneous expulsion of a lipoma in a 32 year old male patient who presented with recurrent attacks of subacute intestinal obstruction. During one such episode the patient developed unusually severe abdominal pain and expelled a fleshy mass per rectum which, on histopathology, was found to be a lipoma attached to a necrosed portion of the small intestine. The pain disappeared immediately; a subsequent barium meal examination revealed normal appearances and the patient has remained completely symptom free 10 months after the incident.
In order to test the hypothesis that increased basal vagal tone causes basal acid hypersecretion in duodenal ulcer (DU), the effect of sham feeding on gastric acid secretion was studied in 26 patients with DU and 20 healthy controls. Basal acid output (BAO), sham feeding-stimulated acid output (SAO) and peak histamine-stimulated acid output (PAO) were significantly higher in DU patients compared with healthy controls (P less than 0.01). The BAO/PAO ratio in DU patients (0.28 +/- 0.03) was not significantly different from that of healthy subjects (0.19 +/- 0.03), indicating that the higher BAO in DU patients group, as a whole, was due to a higher parietal cell mass. The basal subtracted response to sham feeding expressed as a fraction of secretory capacity [(SAO-BAO)/PAO], which correlates inversely with the basal vagal tone, was not significantly different in the patients and control subjects (0.27 +/- 0.03 versus 0.3 +/- 0.03; P greater than 0.05). Based on the data from the healthy controls, a ratio of BAO/PAO greater than 0.44 was defined as abnormal (using 95% confidence limits) and it indicated marked basal acid hypersecretion. Four of 26 DU patients had basal acid hypersecretion (that is, BAO/PAO greater than 0.44), but only two of them did not show an increase over their basal rate of secretion in response to sham feeding. All other DU patients, including two with marked basal acid hypersecretion, and all healthy controls showed an appreciable increase in their acid secretion in response to sham feeding.(ABSTRACT TRUNCATED AT 250 WORDS)