Showing papers by "Pramod Kumar Garg published in 2008"

Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India.

Abstract: Context Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India. Objective To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis.

Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure?

Abstract: Objective:To define the magnitude, causes, risk factors, and consequences of hemorrhage in acute pancreatitis (AP).Methods:Consecutive patients with AP were studied for hemorrhagic complication and its impact on mortality. Patients with gastrointestinal (GI) hemorrhage or hemorrhage within the pancr

Cause and effect relationship of malnutrition with idiopathic chronic pancreatitis: prospective case-control study.

Abstract: Background and Aim: Patients with chronic pancreatitis are often malnourished. The role of malnutrition in the pathogenesis of chronic pancreatitis is unclear. The aim of the present article was to study prospectively the cause and effect relationship of malnutrition with idiopathic chronic pancreatitis in a case–control study. Methods: Consecutive patients with chronic pancreatitis underwent anthropometry, nutritional and dietary assessments. For dietary assessment, food frequency questionnaire and 24-hour dietary recall methods were used. Primary outcome measure was cause and effect relationship of malnutrition with idiopathic chronic pancreatitis. Results: Of 201 patients with chronic pancreatitis, 120 had idiopathic chronic pancreatitis (mean age 29.60 years, 74 males) who formed the study group. None of the patients consumed cassava. The nutritional status and dietary intake of the patients before the onset of chronic pancreatitis were comparable with those of controls with 20.6% of patients and 22.5% of controls being malnourished (body mass index [BMI] < 18.5). After the onset of chronic pancreatitis, 56.5% of patients lost weight and significantly more patients became malnourished compared with controls (45.8% vs 22.5%; P < 0.001). The causes of weight loss were diabetes, higher calories from proteins, and pseudocyst. Conclusion: Malnutrition was not a cause of idiopathic chronic pancreatitis and weight loss occurred as an effect of chronic pancreatitis. Cassava was not found to be a cause of idiopathic chronic pancreatitis.

Symptomatic outcome of laparoscopic cardiomyotomy without an antireflux procedure: experience in initial 40 cases.

Abstract: The aim of surgical treatment in achalasia cardia is symptom relief. Most studies have evaluated the results of laparoscopic cardiomyotomy with an antireflux procedure. However, data on the effectiveness of laparoscopic cardiomyotomy without an antireflux procedure is sparse. We describe our experience of laparoscopic cardiomyotomy without antireflux procedure in 40 consecutive patients with respect to symptom relief and complications. There was no mortality and 1 conversion. Preoperatively dysphagia, regurgitation, and heartburn were present in 40, 39, and 11 patients. At a mean follow-up of 26 months, there was a significant improvement in symptom scores. Two patients (5%) had persistent postoperative dysphagia. One improved on conservative therapy, whereas other was treated with relaparoscopic cardiomyotomy. Three patients (7.5%) developed heartburn in the postoperative period, which was well controlled with proton pump inhibitors. Laparoscopic cardiomyotomy without antireflux procedure results in excellent relief of dysphagia without producing significant symptomatic reflux in the follow-up.

Refining papillary balloon dilation: Less is better!

Abstract: and should therefore be interpreted as intriguing correlations which require validation in a larger cohort. The Exo1 SNP examined is an example of a variant which may impact disease outcome. In this study the rare TT genotype segregated with a significantly reduced patient survival (P = 0.002). The variant T allele results in a proline to leucine amino acid change and may alter the ability of the gene to facilitate DNA repair. Exo1 has been implicated as a predisposition gene for hereditary non-polyposis colorectal cancer, but this conclusion has been controversial. The present study should kindle further interest in the role Exo1 may play in CRC initiation and progression, which should now be tested in larger association and functional studies. Genomic medicine for the management of highly penetrant, hereditary colorectal syndromes is becoming routine in clinical practice. The utility of low-penetrance SNPs is still being evaluated in the research setting; however, preliminary findings certainly look promising. Whilst individual variants may confer only slightly altered risk, certain combinations of SNPs may synergize to significantly increase an individual’s lifetime risk. Assuming a multiplicative affect, Broderick and colleagues proposed that five susceptibility loci would be sufficient to warrant regular colonoscopic surveillance. An immediate goal is to identify SNPs which may modify CRC susceptibility, pathology, clinical course, and response to therapy. The greater challenges will be deciphering the mechanisms through which the SNPs impact disease progression, and formulating the complex algorithm necessary to calculate risk based on multiple low-penetrance variants which are also modulated by environmental influences. Whilst intelligent selection of patients requiring surveillance remains an economic necessity, we are now in an era where generation of a simple ‘SNP-Chip’ for routine presymptomatic patient evaluation seems a realistic and cost-effective goal. Ultimately, such a test will not only be utilized for risk assessment, but will be an invaluable routine tool for individualized patient therapy.

Pancreatic tuberculosis and its diagnosis by endoscopic ultrasonography : report of two cases and review of the literature

Abstract: Mass lesions in the head of the pancreas are generally malignant and it is difficult to diagnose benign lesions preoperatively. We describe two patients with pancreatic tuberculosis, who presented with abdominal pain, jaundice and a pancreatic head mass, mimicking cancer. The correct diagnosis could be made by endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (FNA) cytology in both patients, precluding the need for surgery. Both patients responded well to anti-tuberculosis treatment. We conclude that EUS with guided FNA is a useful modality to diagnose pancreatic tuberculosis.