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Search Results: 1 - 10 of 1195 matches for " Rakesh Kochhar "
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Endoscopic balloon dilation for benign gastric outlet obstruction in adults
Rakesh Kochhar,Suman Kochhar
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: Gastric outlet obstruction (GOO) includes obstruction in the antropyloric area or in the bulbar or post bulbar duodenal segments. Though malignancy remains the most common cause of GOO in adults, a significant number of patients have benign disease. The latter include peptic ulcer disease, caustic ingestion, post-operative anastomotic state and inflammatory causes like Crohn’s disease and tuberculosis. Peptic ulcer remains the most common benign cause of GOO. Management of benign GOO revolves around confirmation of the etiology, removing the offending agent Helicobacter pylori (H. pylori), non-steroidal anti-inflammatory drugs, etc. and definitive therapy. Traditionally, surgery has been the standard mode of treatment for benign GOO. However, after the advent of through-the-scope balloon dilators, endoscopic balloon dilation (EBD) has emerged as an effective alternative to surgery in selected groups of patients. So far, this form of therapy has been shown to be effective in caustic-induced GOO with short segment cicatrization and ulcer related GOO. In the latter, EBD must be combined with eradication of H. pylori. Dilation is preferably done with wire-guided balloon catheters of incremental diameter with the aim to reach the end-point of 15 mm. While it is recommended that fluoroscopic control be used for EBD, this is not used by most endoscopists. Frequency of dilation has varied from once a week to once in three weeks. Complications are uncommon with perforation occurring more often with balloons larger than 15 mm. Attempts to augment efficacy of EBD include intralesional steroids and endoscopic incision.
Preliminary Investigation on the Effect of Lactobacillus and Epidermal Growth Factor on Tight Junction Proteins in Experimental Clostridium difficile Infection  [PDF]
Sukhminderjit Kaur, Chetana Vaishnavi, Pallab Ray, Rakesh Kochhar, Malkit Singh
Advances in Microbiology (AiM) , 2014, DOI: 10.4236/aim.2014.48047
Abstract: Clostridium difficile associated disease (CDAD) is the most common hospital acquired infection, due to exposure to various drugs. C. difficile toxins influence barrier function in intestinal epithelium. Biotherapeutic approaches, employing probiotic and epidermal growth factor (EGF) could help in barrier protein protection and aid in CDAD management. A preliminary investigation on the effect of Lactobacillus acidophilus and EGF on tight junction proteins in experimentally induced C. difficile infection was done. BALB/mice were divided into 5 groups. Group 1 was comprised of healthy controls, whereas animals in Groups 2 - 5 were sub-divided into 3 subgroups (a, b and c) each. Animals in Groups 2 - 5 received C. difficile inoculum either on day 1 (Group 2) or after pretreatment with ampicillin (Group 3), cyclosporine (Group 4) or lansoprazole (Group 5). Additionally animals in subgroups “b” and “c” also received L. acidophilus and EGF inocula respectively after C. difficile challenge. All animals were investigated for the presence of tight junction proteins (occludin, α-actinin and zonula occludens) in their colonic segments. Data were analyzed using the SPSS version 10 software. These three proteins were present in significantly less (P < 0.05) number of animals in the drug receiving animals, whereas
Surveillance for Antibiotic Resistance in Clostridium difficile Strains Isolated from Patients in a Tertiary Care Center  [PDF]
Meenakshi Singh, Chetana Vaishnavi, Safrun Mahmood, Rakesh Kochhar
Advances in Microbiology (AiM) , 2015, DOI: 10.4236/aim.2015.55034
Abstract: Clostridium difficile is the major etiological agent of nosocomial diarrhea primarily precipitated by antimicrobial therapy. We prospectively investigated the antibiogram profile of C. difficile strains isolated from patients reporting to a tertiary care hospital in North India. Fecal samples obtained from 1110 suspected cases of C. difficile infection were cultured for isolation of C. difficile. Colonies suspected as those of C. difficile were identified by phenotypic and molecular methods. Antimicrobial susceptibility of C. difficile isolates for different classes of antibiotics was determined using the Epsilon test for vancomycin, metronidazole, clindamycin and ciprofloxacin. The fecal samples cultured for C. difficile belonged to 709 (63.9%) males and 401 (36.1%) females. The mean age of the patients was 38.7 years. C. difficile was cultured from 174 (15.7%) of the total samples. Antibiotic resistance was largely observed towards clindamycin (57.5%) and ciprofloxacin (38.5%) but was significantly low towards metronidazole (1.72%) and nil (0%) towards vancomycin. C. difficile isolates had a high degree of resistance towards clindamycin and ciprofloxacin with low level of resistance to metronidazole and none towards vancomycin. Antibiogram surveillance of C. difficile will help for clinical practice and add to the epidemiological data of the organisms.
Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures
Rakesh Kochhar,Kuchhangi Suresh Poornachandra
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: Esophageal strictures are a problem frequently encountered by gastroenterologists. Dilation has been the customary treatment for benign esophageal strictures, and dilation techniques have advanced over the years. Depending on their characteristics and the response to treatment, esophageal strictures can be classified into two types: 1, simple (Schatzki rings, webs, peptic injury, and following sclerotherapy) - these are easily amenable to dilation, with a low recurrence rate after initial treatment; and 2, complex (caused by caustic ingestion, radiation injury, anastomotic strictures, and photodynamic therapy) - these are difficult to dilate and are associated with higher recurrence rates. Refractory strictures are those in which it is not possible to relieve the anatomic restriction successfully up to a diameter of 14 mm over five sessions at 2-weekly intervals, due to cicatricial luminal compromise or fibrosis; and recurrent strictures are those in which it is not possible to maintain a satisfactory luminal diameter for 4 wk once the target diameter of 14 mm has been achieved. There are no standard recommendations for the management of refractory strictures. The various techniques used include intralesional steroid injection combined with dilation; endoscopic incisional therapy, with or without dilation; placement of self-expanding metal stents, Polyflex stents, or biodegradable stents; self-bougienage; and endoscopic surgery. This review discusses the indications, technique, results, and complications of the use of intralesional steroid injections combined with dilation and endoscopic incisional therapy with dilation in refractory strictures.
Quality of life assessment with different radiotherapy schedules in palliative management of advanced carcinoma esophagus: A prospective randomized study
Mehta Shaveta,Sharma Suresh,Kapoor Rakesh,Kochhar Rakesh
Indian Journal of Palliative Care , 2008,
Abstract: Aim: To investigate the quality of life (QOL) of patients with advanced carcinoma esophagus treated with different palliative radiation schedules. Methods: Sixty-two consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions), Arm-B (external radiotherapy 30 Gy /10 fractions) and Arm-C (external radiotherapy 20Gy /five fractions). The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up. Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%). No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia. Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects.
Renal cell carcinoma metastasizing to duodenum: a rare occurrence
Alka Bhatia, Ashim Das, Yashwant Kumar, Rakesh Kochhar
Diagnostic Pathology , 2006, DOI: 10.1186/1746-1596-1-29
Abstract: We present the case report of a 55 year old male with duodenal metastasis of RCC. This patient presented with jaundice and abdominal lump one year after nephrectomy. On upper gastrointestinal endoscopy a submucosal mass lesion was noted in the duodenum, the biopsy of which revealed metastasis.In a nephrectomized patient presenting with jaundice and an abdominal mass, the possibility of metastasis should be suspected and a complete evaluation, especially endoscopic examination followed by biopsy, should be carried out.Renal cell carcinoma (RCC) has a potential to metastasize to almost any site. In descending order of frequency, the most common sites of metastasis are the lung, lymph nodes, liver, bone, adrenal glands, kidney, brain, heart, spleen, intestine, and skin [1]. It can involve any part of the bowel and accounts for 7.1% of all metastatic tumours to small intestine [2]. Duodenal metastasis from RCC is very uncommon and only few cases have been described in the English literature (table 1) [3-18]. Also duodenal metastasis generally occurs when there is widespread nodal and visceral involvement and evidence of metastatic disease elsewhere in the body. Here we present the case report of a patient with duodenal and liver metastasis who presented with jaundice and right sided abdominal lump one year after nephrectomy. Duodenal biopsy performed revealed metastasis in the duodenum.The patient was a 55 years old male who came to gastroenterology out patient department with complaints of jaundice and an abdominal mass. He had a history of RCC in the left kidney and had undergone left radical nephrectomy one year ago in our institute. The tumour was present in the lower pole and measured 7 × 5 × 6 cm. Microscopically, it was a conventional clear cell carcinoma (Furhman grade III) involving the renal sinus with tumour emboli in the renal vein. The adrenal gland and ureter were free. This time the patient had jaundice and an abdominal lump. An upper gastrointestinal end
Asymptomatic ulcerative colitis and pyoderma gangrenosum
Nanda Arti,Kumar Bhushan,Radotra Bishan,Kochhar Rakesh
Indian Journal of Dermatology, Venereology and Leprology , 1990,
Abstract: A Total of 11 patients of pyoderma gangrenosum (PG); 5 males and 6 females were observed over 8 years. The ages ranged between 35-72 years. Nine patients were associated with ulcerative colitis, one with chronic renal failure, and one was labelled idiopathic. Three of the 9 patients of PG, who had ulcerative colitis presented first with skin lesions and had clinically silent, but acute, ulcerative colitis, diagnosed only after colonoscopy and rectal biopsy. This highlights the need for investigation including colonoscopy and biopsy even in asymptomatic patients of PG. Most of the cases benefitted from medical treatment (Corticosteroids + Salazopyrin).
Aberrant promoter methylation of p16 in colorectal adenocarcinoma in North Indian patients
Pooja Malhotra,Rakesh Kochhar,Kim Vaiphei,Jai Dev Wig
World Journal of Gastrointestinal Oncology , 2010,
Abstract: AIM: To investigate p16 gene methylation and its expression in 30 patients with sporadic colorectal adenocarcinoma in a North Indian population.METHODS: Methylation specific polymerase chain reaction was used to detect p16 gene methylation and immunohistochemistry was used to study the p16 expression in 30 sporadic colorectal tumors as well as adjoining and normal tissue specimens.RESULTS: Aberrant promoter methylation of p16 gene was detected in 12 (40%) tumor specimens, whereas no promoter methylation was observed in adjoining and normal tissue. Immunohistochemistry showed expression of p16 protein in 26 (86.6%) colorectal tumors whereas complete loss of expression was seen in 4 (13.3%) and reduced expression was observed in 12 (40%) tumors. In the adjoining mucosa, expression of p16 was in 11 (36.6%) whereas no clear positivity for p16 protein was seen in normal tissue. There was a significant difference in the expression of p16 protein in tumor tissue and adjoining mucosa (P < 0.001). The methylation of the p16 gene had a significant effect on the expression of p16 protein (P = 0.021). There was a significant association of methylation of p16 gene with the tumor size (P = 0.015) and of the loss/reduced expression of p16 protein with the proximal site of the tumor (P = 0.047). Promoter methylation and expression of p16 had no relation with the survival of the patients (P > 0.05).CONCLUSION: Our study demonstrated that promoter hypermethylation of the p16 gene results in loss/reduced expression of p16 protein and this loss/reduced expression may contribute to tumor enlargement.
Embolization of Cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report
Kirti Gupta, Rakesh K Vasishta, Usha Dutta, Rakesh K Kochhar, Kartar Singh
Diagnostic Pathology , 2009, DOI: 10.1186/1746-1596-4-45
Abstract: A 77 year-old lady presented four years back with upper gastrointestinal bleed. On examination, she had splenomegaly and grade three esophageal and fundal varices. Ultrasound abdomen had revealed a shrunken liver with coarse echotexture, portal vein (15 mm), splenomegaly, ascites and collateral formation at gastrohepatic ligament. Viral markers [anti-Hepatitis C virus (anti-HCV) and hepatitis B surface antigen (HBsAg)] were negative. Ascitic fluid examination revealed a total cell count of 80 (all lymphocytes), protein 300 mg/dL, sugar 134 mg/dl, SAAG 2.5. She was diagnosed as a case of decompensated cirrhosis with portal hypertension, ascites, upper gastrointestinal bleed, and hepatic encephalopathy. She was discharged on oral hematinics, Propranolol, diuretics and Lactulose. She underwent several sessions of variceal ligation, endoscopic sclerotherapy for esophageal varices. She also underwent 2 sessions of cyanoacrylate glue injection (1.5 ml each time) for large fundal varices. A year later, she developed persistent pruritis. Autoimmune work-up revealed anti-nuclear antibody (ANA) 3+, other autoimmune markers [(anti-smooth muscle autoantibody (SMA), anti-liver/kidney microsome antibody (LKM) and anti-mitochondrial antibody (AMA)] were negative. The liver biopsy was deferred in view of persistent deranged coagulation profile. She was started on Azathioprine (50 mg) which had to be stopped after 9 months because of persistent elevation of liver enzymes (aspartate aminotransferase (AST) - 100 IU/L, alanine transaminase (ALT) - 56 IU/L and alkaline phosphatase (ALP) - 622 IU/L) suggestive of Azathioprine induced cholestatic hepatitis. On subsequent follow up, her AST and ALT values normalized on stoppage of the drug.She was now hospitalized, after 4 years, with symptoms of pleuritic chest pain for 2 weeks, with associated dyspnoea and orthopnea. She also had malena for two days about a week ago. She had pallor, icterus, peripheral cyanosis and bilateral pedal edema
NSAIDs-Related Pyloroduodenal Obstruction and Its Endoscopic Management
Mohd Talha Noor,Pankaj Dixit,Rakesh Kochhar,Birinder Nagi,Usha Dutta,Kartar Singh,Kuchhangi Suresh Poornachandra
Diagnostic and Therapeutic Endoscopy , 2011, DOI: 10.1155/2011/967957
Abstract: Endoscopic balloon dilatation (EBD) has important role in the management of benign gastric outlet obstruction. Although there are many reports on the role of EBD in the management of corrosive-induced and peptic benign GOO, there is scanty data on its role in the management of NSAID-induced GOO. We report 10 cases of NSAID-induced pyloroduodenal obstruction and their endoscopic management. The most common site of involvement was duodenum (5/10) followed by both pylorus and duodenum (4/10) and pylorus (1/10). Most of the strictures were short web-like, and the mean (SD) number of stricture was 2.0 (0.94). Endoscopic balloon dilatation was successful in 90% (9/10) cases requiring mean (SD) of 2.0 (1.6) sessions of dilatation to achieve target diameter of 15?mm and mean (SD) of 5.3 (2.7) sessions to maintain it over a treatment period of 4.5 months (IQR 2–15 months). There was no procedure-related complication or mortality. 1. Introduction Peptic ulcer disease and corrosive ingestion are the leading causes of benign gastric outlet obstruction [1]. Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with various forms of gastrointestinal injuries including peptic ulcer disease, diaphragm disease of the bowel, and protein losing enteropathy [2]. NSAIDs are one of the most commonly prescribed medications, and they are often used for long period of time. Chronic NSAID consumption is a rare cause of gastric outlet obstruction [3–5]. There are case reports of duodenal web-like strictures associated with long-term NSAID use [6]. Gastric outlet obstruction (GOO) includes obstruction in the antropyloric area or in the bulbar or postbulbar duodenal segments [1]. With the advent of EBD, endoscopic therapy has become the cornerstone of management of benign gastric outlet obstruction. A number of reports have reported the safety and efficacy of the procedure [7, 8]. The initial experience of EBD was under fluoroscopic guidance; subsequently it has been shown that EBD can be performed under endoscopic guidance only [9]. We here report our experience on gastric outlet obstruction caused by NSAIDs. 2. Methods Between January 2004 and December 2010, all consecutive patients with symptomatic NSAID-induced GOO were evaluated. Details of NSAID intake were noted in terms of type, amount, and duration of intake. All patients underwent upper gastrointestinal endoscopy, barium meal follow through, and contrast-enhanced computed tomography to note the site and length of gastric and duodenal stricture(s) and to rule out presence of jejunal and ileal
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