Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of l... more Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as acalculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.
Keap1-Nrf2 pathway is continuously involved in the cytoprotection from oxidative stress generated... more Keap1-Nrf2 pathway is continuously involved in the cytoprotection from oxidative stress generated due to various factors either extrinsic or intrinsic in origin. This role of Nrf2 in the response to oxidative stress is well established. Following oxidative insult, Nrf2 mediates the regulation of the inducible expression of cytoprotective genes. The level and functional capacity of Nrf2 is regulated at the post-transcriptional level, mainly through its association with an actin-associated protein, Keap1. Various studies reported that any discrepancy from their routine may lead to promotion of tumor as well. So there is need to explore their role in cytoprotection and tumor promotion if any. This review is an attempt to critically analyze the available data that may lighten up the present knowledge and unveil the new regime for cancer prevention and treatment.
Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives i... more Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives include implantable venous ports with associated cost and complication of buried foreign body. In this pilot study, we created an arteriovenous fistula (AVF) at the wrist of cancer patients due for chemotherapy and then used the resultant enhancement of the peripheral veins of the hand and forearm for administering chemotherapy. The complications of this novel method are compared with our historical controls receiving chemotherapy through the peripheral veins without AVF. Ten patients were offered this new technique after prior informed consent and were followed prospectively for 1 year. Venous accessibility was excellent in the experimental arm with no incident of erythema, thrombophlebitis, or skin necrosis. No significant alteration was found in cardiac parameters at 1, 6, and 12 months post AVF surgery. The procedure proved economical and affordable for a majority of our patients.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Jul 1, 2009
Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be con... more Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be confused with gallbladder carcinoma. A 35-year-old lady presented with pain in the right upper abdomen, and was radiologically found to have a gallbladder mass. A provisional diagnosis of gallbladder carcinoma was made. Laparotomy revealed a 20 x 20 cm, exophytic, friable growth arising from the fundus of the gallbladder. It was excised with segment IVb and V of the liver and regional lymphadenectomy. Histopathological examination revealed it was a neuroendocrine carcinoma, atypical carcinoid of the gallbladder. Gallbladder carcinoid has a poor outcome, requires aggressive treatment, and should be considered as one of the rare but possible gallbladder lesions.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Oct 1, 2010
Background: Evidence exists of a link between chronic infection by Salmonella typhi (S. typhi) an... more Background: Evidence exists of a link between chronic infection by Salmonella typhi (S. typhi) and the development of gallbladder cancer (GBC), but several studies from endemic regions contradict its role in the etiopathogenesis of GBC. This study used various tools to assess the prevalence of S. typhi in patients with GBC and gallstone disease (GSD) in this region with a high incidence of GBC. Methods: S. typhi was detected in tissue and bile by PCR and culture and in serum by the Widal test and indirect hemagglutination assay (IHA). PCR with two pairs of S. typhi specific primers (flagellin gene H1d and SOP E gene) could detect 0.6 ng of S. typhi DNA. Fifty-four patients with GBC (cases) were matched with 54 patients with GSD (controls). Results: Of the 54 cases, 24 (44.44%) were positive on the Widal test and 12 (22.22%) on IHA, compared to 13 (24.07%) and 5 (9.26%) respectively in the controls. Eighteen (33.33%) cases showed a positive result on PCR (tissue) and 2 on PCR (bile) vs. none in the controls. Bile culture revealed no Salmonella colonies in either cases or controls. Only 3 cases were positive for Salmonella on tissue culture compared to none in the controls. The sensitivity of PCR (tissue) relative to the Widal test, IHA, culture (bile and tissue) and PCR (bile) was 100% vs. 66.67%, 11.11%, and 11.11%, and the specificity was 83.33% vs. 100%, 100%, and 100%, respectively. Conclusions: S. typhi is significantly associated with GBC compared to GSD (33% vs. 0%). PCR appears to be the most specific diagnostic tool, the gold standard for S. typhi in tissue samples.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Apr 1, 2010
Gallbladder cancer (GBC) is a rare disease but a leading cause of cancer-related death worldwide.... more Gallbladder cancer (GBC) is a rare disease but a leading cause of cancer-related death worldwide. A number of etiological factors have been implicated in the causation of GBC and pathogenic infection by bacteria is one of these. A PubMed search on "helicobacter", "gallbladder cancer", and "biliary tract malignancies" was done on the topic, and the relevant data were collected, reviewed, and analyzed. Helicobacter is an epsilon proteobacterium that infects the mucosal lining of the human gastrobiliary system. Infection with helicobacter is an important risk factor for the development of cancer and the bacterium has been categorized as a group-I carcinogen by the International Agency for Research on Cancer (IARC). These microbes enter the human body by means of contaminated food and water. Thereby they invade the tissues and produce chemical carcinogens that lead to DNA damage and subsequently a series of gene mutations transform normal cells into cancer cells. In this review, we focus our attention on the role of helicobacter in the causation of biliary tract malignancies. The review attempts to summarize the current available data on the role of helicobacter in the causation of GBC. There are accountable data available to suggest the role of helicobacter species in the causation of GBC although larger studies are urgently required for confirmation.
North Kerala is a high risk area for carcinoma stomach. Therefore, &a... more North Kerala is a high risk area for carcinoma stomach. Therefore, 'intestinal type' carcinoma of Lauren is more prevalent here and the disease occur even in people below the age of 40. An attempt is made to analyse various risk factors in 70 patients who had undergone gastrectomy for carcinoma stomach in Medical College Hospital, Calicut. The population study revealed no relationship between the disease and the various religious communities. Diet is found to be the most important potential environmental influence. Even though both males and females share the same type of diet, males are found to be more affected by the disease. The high frequency of female population in North Kerala with a low frequency of carcinoma stomach in them, suggests the possible role of smoking and alcohol abuse in males. The blood group profile of healthy population in North Kerala and that of the patients show that people with blood group A have a differential susceptability to gastric carcinoma. Age and chewing of tobacco were the other factors involved.
A total 17 cases of carcinoma oesophagus were studied in a period of 2 years. Ten patients (58.82... more A total 17 cases of carcinoma oesophagus were studied in a period of 2 years. Ten patients (58.82%) were males and rest were females. Maximum cases (64.70%) were seen in 5th and 6th decades. Majority of the patients belonged to low socio-economic group (47.05%) followed by middle socio-economic group (41.17%). Dysphagia was present in all cases, followed by weight loss 52.94% and other symptoms. Cancer was equally distributed in middle third and lower third of the oesophagus (41.18% in each group) only in 3 cases it was in upper third of the oesophagus. Histologically 70.5% tumours were squamous cell carcinoma, 17.64% were adenocarcinoma and 11.76% were undifferentiated carcinoma. Surrounding epithelium in 17.64 per cent cases showed chronic oesophagitis, 4 cases (23.52%) showed acanthosis and dysplasia, and two cases revealed carcinoma in situ. Hence findings of oesophagitis, acanthosis, dysplasia, carcinoma in situ suggest that oesophagitis and acanthosis may be considered as precancerous lesions.
Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of l... more Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as acalculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.
Keap1-Nrf2 pathway is continuously involved in the cytoprotection from oxidative stress generated... more Keap1-Nrf2 pathway is continuously involved in the cytoprotection from oxidative stress generated due to various factors either extrinsic or intrinsic in origin. This role of Nrf2 in the response to oxidative stress is well established. Following oxidative insult, Nrf2 mediates the regulation of the inducible expression of cytoprotective genes. The level and functional capacity of Nrf2 is regulated at the post-transcriptional level, mainly through its association with an actin-associated protein, Keap1. Various studies reported that any discrepancy from their routine may lead to promotion of tumor as well. So there is need to explore their role in cytoprotection and tumor promotion if any. This review is an attempt to critically analyze the available data that may lighten up the present knowledge and unveil the new regime for cancer prevention and treatment.
Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives i... more Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives include implantable venous ports with associated cost and complication of buried foreign body. In this pilot study, we created an arteriovenous fistula (AVF) at the wrist of cancer patients due for chemotherapy and then used the resultant enhancement of the peripheral veins of the hand and forearm for administering chemotherapy. The complications of this novel method are compared with our historical controls receiving chemotherapy through the peripheral veins without AVF. Ten patients were offered this new technique after prior informed consent and were followed prospectively for 1 year. Venous accessibility was excellent in the experimental arm with no incident of erythema, thrombophlebitis, or skin necrosis. No significant alteration was found in cardiac parameters at 1, 6, and 12 months post AVF surgery. The procedure proved economical and affordable for a majority of our patients.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Jul 1, 2009
Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be con... more Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be confused with gallbladder carcinoma. A 35-year-old lady presented with pain in the right upper abdomen, and was radiologically found to have a gallbladder mass. A provisional diagnosis of gallbladder carcinoma was made. Laparotomy revealed a 20 x 20 cm, exophytic, friable growth arising from the fundus of the gallbladder. It was excised with segment IVb and V of the liver and regional lymphadenectomy. Histopathological examination revealed it was a neuroendocrine carcinoma, atypical carcinoid of the gallbladder. Gallbladder carcinoid has a poor outcome, requires aggressive treatment, and should be considered as one of the rare but possible gallbladder lesions.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Oct 1, 2010
Background: Evidence exists of a link between chronic infection by Salmonella typhi (S. typhi) an... more Background: Evidence exists of a link between chronic infection by Salmonella typhi (S. typhi) and the development of gallbladder cancer (GBC), but several studies from endemic regions contradict its role in the etiopathogenesis of GBC. This study used various tools to assess the prevalence of S. typhi in patients with GBC and gallstone disease (GSD) in this region with a high incidence of GBC. Methods: S. typhi was detected in tissue and bile by PCR and culture and in serum by the Widal test and indirect hemagglutination assay (IHA). PCR with two pairs of S. typhi specific primers (flagellin gene H1d and SOP E gene) could detect 0.6 ng of S. typhi DNA. Fifty-four patients with GBC (cases) were matched with 54 patients with GSD (controls). Results: Of the 54 cases, 24 (44.44%) were positive on the Widal test and 12 (22.22%) on IHA, compared to 13 (24.07%) and 5 (9.26%) respectively in the controls. Eighteen (33.33%) cases showed a positive result on PCR (tissue) and 2 on PCR (bile) vs. none in the controls. Bile culture revealed no Salmonella colonies in either cases or controls. Only 3 cases were positive for Salmonella on tissue culture compared to none in the controls. The sensitivity of PCR (tissue) relative to the Widal test, IHA, culture (bile and tissue) and PCR (bile) was 100% vs. 66.67%, 11.11%, and 11.11%, and the specificity was 83.33% vs. 100%, 100%, and 100%, respectively. Conclusions: S. typhi is significantly associated with GBC compared to GSD (33% vs. 0%). PCR appears to be the most specific diagnostic tool, the gold standard for S. typhi in tissue samples.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Apr 1, 2010
Gallbladder cancer (GBC) is a rare disease but a leading cause of cancer-related death worldwide.... more Gallbladder cancer (GBC) is a rare disease but a leading cause of cancer-related death worldwide. A number of etiological factors have been implicated in the causation of GBC and pathogenic infection by bacteria is one of these. A PubMed search on "helicobacter", "gallbladder cancer", and "biliary tract malignancies" was done on the topic, and the relevant data were collected, reviewed, and analyzed. Helicobacter is an epsilon proteobacterium that infects the mucosal lining of the human gastrobiliary system. Infection with helicobacter is an important risk factor for the development of cancer and the bacterium has been categorized as a group-I carcinogen by the International Agency for Research on Cancer (IARC). These microbes enter the human body by means of contaminated food and water. Thereby they invade the tissues and produce chemical carcinogens that lead to DNA damage and subsequently a series of gene mutations transform normal cells into cancer cells. In this review, we focus our attention on the role of helicobacter in the causation of biliary tract malignancies. The review attempts to summarize the current available data on the role of helicobacter in the causation of GBC. There are accountable data available to suggest the role of helicobacter species in the causation of GBC although larger studies are urgently required for confirmation.
North Kerala is a high risk area for carcinoma stomach. Therefore, &a... more North Kerala is a high risk area for carcinoma stomach. Therefore, 'intestinal type' carcinoma of Lauren is more prevalent here and the disease occur even in people below the age of 40. An attempt is made to analyse various risk factors in 70 patients who had undergone gastrectomy for carcinoma stomach in Medical College Hospital, Calicut. The population study revealed no relationship between the disease and the various religious communities. Diet is found to be the most important potential environmental influence. Even though both males and females share the same type of diet, males are found to be more affected by the disease. The high frequency of female population in North Kerala with a low frequency of carcinoma stomach in them, suggests the possible role of smoking and alcohol abuse in males. The blood group profile of healthy population in North Kerala and that of the patients show that people with blood group A have a differential susceptability to gastric carcinoma. Age and chewing of tobacco were the other factors involved.
A total 17 cases of carcinoma oesophagus were studied in a period of 2 years. Ten patients (58.82... more A total 17 cases of carcinoma oesophagus were studied in a period of 2 years. Ten patients (58.82%) were males and rest were females. Maximum cases (64.70%) were seen in 5th and 6th decades. Majority of the patients belonged to low socio-economic group (47.05%) followed by middle socio-economic group (41.17%). Dysphagia was present in all cases, followed by weight loss 52.94% and other symptoms. Cancer was equally distributed in middle third and lower third of the oesophagus (41.18% in each group) only in 3 cases it was in upper third of the oesophagus. Histologically 70.5% tumours were squamous cell carcinoma, 17.64% were adenocarcinoma and 11.76% were undifferentiated carcinoma. Surrounding epithelium in 17.64 per cent cases showed chronic oesophagitis, 4 cases (23.52%) showed acanthosis and dysplasia, and two cases revealed carcinoma in situ. Hence findings of oesophagitis, acanthosis, dysplasia, carcinoma in situ suggest that oesophagitis and acanthosis may be considered as precancerous lesions.
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Papers by Hari Shukla