Clinicopathological Correlation Of Gastric Endoscopic Biopsies In A Tertiary Care Hospital In Rural Area In Haryana

The study included gastric endoscopic biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 130 gastric biopsies were included in the study. The most common presentingcomplaint was pain abdomen. The neoplastic lesions commonly presented as carcinoma whereas thenon-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplastic lesions werefound to be common out of which gastritis was the most common lesion. Associated conditions werefound to be H. Pylori and intestinal metaplasia with gastritis. Majority of the lesions were nonneoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. The neoplasticlesions comprised of adenocarcinoma & signet ring cell carcinoma. 4 cases of signet ring cell carcinomawere noted. Percentage of concordance between endoscopic & histologic diagnoses was calculatedwherein cases of gastritis, ulcer, polyps & carcinoma showed 100%, 96.3%, 71.4% & 100%concordance respectively.The conclusion of the study was that histological examination in adjunct with endoscopy should beconsidered as much more valuable diagnostic tool rather than endoscopy alone.

Clinicopathological Correlation of Endoscopic Duodenal Biopsies in a Tertiary Care Hospital in Haryana

The study included endoscopic duodenal biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 44 biopsies were included in the study. The most common presenting complaintwas pain abdomen followed by diarrhea. The neoplastic lesions commonly presented as carcinomawhereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplasticlesions were found to be common with villous atrophy predominating the list. Majority of the lesionswere non-neoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. Theneoplastic lesions comprised of adenocarcinoma. A single case of ampullary carcinoma was alsonoted. Percentage of concordance between endoscopic & histologic diagnoses was calculated whereinduodenitis, scalloping, polypoidal & carcinomatous lesions showed 100%, 60.7%, 0% & 100%concordance between the two diagnostic modalities respectively. The conclusion of the study wasthat endoscopic examination alone might miss out in diagnosing majority of the lesions. So, histologicalexamination in adjunct with endoscopy should be considered as much more valuable diagnostic toolrather than endoscopy alone.

Endoscopic ultrasound-guided treatment of bleeding duodenal varix.

A 35-year-old man presented with recurrence of upper gastrointestinal bleed after eradication of esophageal varices. Upper gastrointestinal endoscopy revealed submucosal lesion in the duodenum and endoscopic ultrasound (EUS) demonstrated it to be a duodenal varix. Cyanoacrylate glue was injected into the duodenal varix and successful obliteration of the duodenal varix was demonstrated on a follow up EUS.

Celiac disease suspected at endoscopy in patients with chronic liver disease.

Endoscopic findings of celiac disease have high specificity and sensitivity. We evaluated records of 137 consecutive patients who had endotherapy for variceal hemorrhage, and who had features of celiac disease at endoscopy; patients who had such markers at endoscopy had undergone duodenal histology and serology. Thirty-one patients had changes of portal hypertensive vasculopathy in the duodenum, 8 had scalloping, and 6 had mosaic pattern; 3 patients also had decreased fold height or sparse folds in the descending duodenum. Six of these 8 patients had positive serology and histology suggestive of celiac disease. Endoscopic evaluation resulted in diagnosis of CD in 4.37% patients of chronic liver disease undergoing endotherapy.

Endoscopic jejunal biopsy culture: a simple and effective method to study jejunal microflora.

Background Jejunal fluid culture is the gold standard for assessing jejunal microflora. Aspiration of jejunal fluid is sometime difficult. As the microorganisms rests on the mucosal surface, culture of the mucosal biopsy may be a possible alternative method. Aim To study the role of jejunal mucosal biopsy culture to assess jejunal microflora and to compare it with jejunal fluid culture. Methods Thirty adult subjects with gastroesophageal reflux disease requiring endoscopy underwent enteroscopy. Jejunal fluid aspirate and mucosal biopsy were cultured. The procedure was repeated after omeprazole therapy in 18 patients. Results Forty-eight pairs (30 preomeprazole therapy and 18 postomeprazole therapy) of fluid and mucosal biopsies were cultured. In 45 of the 48 pairs (94%), both the culture of jejunal biopsy and jejunal fluid yielded similar results with respect to the presence (n=27) or absence of growth (n=18). In the remaining 3 pairs, the growth was present either in the biopsy culture (n=2) or in the fluid culture (n=1) only. Among those pairs in which growth was present, microorganisms isolated were identical in 53%, differed by ≤2 organism in 37% and different by >2 organisms in 10%. Ten of the 12 patients who were detected to have small intestinal bacterial overgrowth (SIBO) on fluid culture were also detected to have SIBO on biopsy culture. Sensitivity, specificity, positive and negative predictive value of biopsy culture in diagnosing SIBO was 83.5%, 97.2%, 94.7%, and 91.6%, respectively. Conclusion Culture of unwashed endoscopic jejunal mucosal biopsy is an effective and simple alternative to jejunal fluid culture for assessing jejunal microflora.

Successful resolution of bronchobiliary and biliocutaneous fistula by prolonged endoscopic transpapillary biliary drainage.

Bronchobiliary fistula is a rare condition that has been usually treated surgically. We report successful resolution of a rare case of combined bronchobiliary and biliocutaneous fistula by prolonged endoscopic transpapillary biliary drainage. The patient developed these fistulae following right hepatectomy for blunt trauma to the abdomen. Although endoscopic biliary drainage has been reported to be effective in healing of post-traumatic and post-surgical bile leaks, there are limited reports describing the efficacy of endoscopic drainage in complex biliary fistulas. This case report describes the successful closure of complex biliary fistula by prolonged endoscopic drainage.

Effect of different doses of carotenoids in isoniazid-rifampicin induced hepatotoxicity in rats.

AIM: Isoniazid (INH) and Rifampicin (RIF) are hepatotoxic drugs. Oxidative stress has been reported as one of the mechanisms of INH+RIF induced hepatotoxicity. METHODS: Intragastric administration of INH and RIF (50 mg/kg body weight/day each) for 28 days in Wistar rats is hepatotoxic, indicated by raised transaminases and histology. Carotenoids have antioxidant properties. Therefore, different doses of carotenoids (2.5, 5, 10 and 20 mg/kg body weight/day) were administered to study the hepatoprotective effect against INH+RIF. RESULTS: The higher doses of carotenoids i.e.10 and 20 mg/kg body weight/day showed partial hepatoprotection indicated by return to normal of liver transaminase level and of liver histology in 33.3% of rats. There was no further protective effect seen by increasing the dose of carotenoids from 10 to 20 mg/kg body weight/day. Lower doses of carotenoids, i.e., 2.5 and 5 mg/kg body weight/day were not effective. CONCLUSION: Thus, a minimum dose with maximum hepatoprotection (10 mg/kg b.wt/ day) was selected as the optimum dose in the present study. The hepatoprotective nature of carotenoids in INH+RIF treated rats may be attributed to their antioxidative property.

Morphological and functional outcome after pancreatic necrosectomy and lesser sac lavage for necrotizing pancreatitis.

BACKGROUND: Immediate outcomes after pancreatic necrosectomy have improved in recent years. This study reviews our short-term to medium-term experience of structural and functional changes in the pancreas after necrosectomy. METHODS: Ten patients (8 males, median age 35 years), discharged after pancreatic necrosectomy for acute necrotizing pancreatitis between 1996 and 1998 were reviewed after a median period of 22 months. Clinical evidence of pancreatic dysfunction was documented at follow-up interview. Patients underwent computed tomography of the abdomen, endoscopic retrograde pancreatography, oral glucose tolerance test, fecal fat estimation and fasting serum C-peptide estimation (CPE). RESULTS: No patient had repeat episodes of pancreatitis during the follow-up period. Three patients developed de-novo diabetes after discharge. No patient had symptoms of steatorrhea. Five patients showed severe changes on CECT. ERCP showed marked changes in six patients, the commonest being an abrupt cut-off of the main pancreatic duct. Glucose tolerance was abnormal in three patients and impaired in two patients while fecal fat excretion was abnormal in 8 patients. CONCLUSIONS: Severe acute pancreatitis and necrosectomy are associated with significant structural and functional changes on medium-term follow-up.

Modification of small bowel microflora in chronic alcoholics with alcoholic liver disease.

The bacterial flora of the gastrointestinal tract plays an essential role in human physiology. Our aim was to study the pattern of change in bacterial microflora in the small intestines of patients with chronic alcoholic liver disease (ALD). Patients of ALD made up the test group and nonalcoholics served as controls. Duodenal (D2) biopsies were obtained by upper gastrointestinal endoscopy and processed immediately for microbiological analysis. Marked qualitative and quantitative alterations of small intestinal microflora was documented in chronic alcoholics. There was increased bacterial growth of both gram-positive cocci and gram-negative bacilli in the ALD group.

Evaluation of an in-house rapid diagnostic method for detection of Salmonella enterica serovar Typhi in fecal specimens.

Salmonella enterica serovar Typhi is the etiological agent of typhoid fever. Laboratory diagnosis requires isolation and identification of the organism from the patient's blood or feces. Feces is the specimen most commonly submitted to laboratories. Detection of bacterial antigens is an important adjunct to laboratory diagnosis. We carried out an in-house diagnostic method by preparing test reagents comprising of latex beads coated with specific antisera to detect Vi, O9 and H-d antigens of S. typhi. Fecal specimens from one hundred patients with diarrhea and fever as well as from twenty healthy controls were incubated for enrichment in Selenite F broth for 6 hours or overnight. Latex agglutination tests to detect antigens of S. typhi were carried out on centrifuged broth supernatants. Parallel cultures on media selective for S. typhi were also set up. Nine of the supernatants were positive for two or more specific antigens and S. typhi grew in three of the corresponding cultures. None of the samples from 20 healthy controls were positive by either the diagnostic method or by culture. The result of the in-house diagnostic assay can be obtained overnight and may help in directing immediate antimicrobial therapy.

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Clostridium perfringens type A & antibiotic associated diarrhoea.

BACKGROUND & OBJECTIVE: Clostridium perfringens type A (CPA) isolates produce lethal necrotizing antigens and the heat resistant forms of the organism are associated with pathogenic outcome in humans. CPA has also been implicated in antibiotic associated diarrhoea (AAD). We therefore undertook this study to investigate the presence of CPA in stool samples of patients with AAD in a tertiary care setting in north India. METHODS: A total of 285 stool samples obtained from patients suspected for Clostridium difficile aetiology were examined for the presence of CPA antigens. Four sets of reagents (CP-I, CP-II, CP-III and CP- IV) comprising latex beads coated with polyvalent immune sera to 17 serotypes of heat resistant CPA were used in the study. Agglutination reaction was carried out using the reagents with the stool supernatants. RESULTS: Of the 285 stool samples tested, 25 (8.77%) were positive for at least one or more of the four polyvalent sets. Briefly, 48 per cent were positive for all the four sets, 12 per cent for 3 sets, 28 per cent for 2 sets and 12 per cent for only one set, indicating the prevalence of multiple serotypes of CPA. Twenty three (92%) of the 25 positive samples came from patients who were on antibiotics. C. difficile toxin was also present in 9 of 25 (36%) of the samples positive for CPA antigens. INTERPRETATION & CONCLUSION: In our setting, CPA could thus be associated with AAD either by itself or in synergy with C. difficile infection. Assessment of true burden of CPA associated AAD would be required to take appropriate steps for its control in our country.

Bacteriuria in patients with gallbladder and biliary tract diseases.

Urinary tract infections (UTI) are important hospital acquired entities, resulting in bacteriuria indicated by the presence of significant numbers of bacteria in the urine. This study examined the prevalence of bacteriuria in our patients with gallbladder diseases. Three hundred and forty eight patients with various gallbladder (GB) diseases were enrolled in our study. Routine bacteriological cultures of midstream urine specimens were done. Significant bacteriuria was defined as the growth of 105 or more organisms in pure culture per milliliter of urine. Forty four (12.6%) of the patients (18 symptomatic; 26 asymptomatic) showed bacteriuria. Escherichia coli was the predominant isolate followed by Klebsiella pneumoniae, Enterobacter, Pseudomonas aeruginosa, Enterococci and several others. Thus UTI is also a frequent concomitant of gall bladder diseases and is a sign of the fact that kidneys are in a condition endangered by pyelonephritis.