Browsing by Author "Amarapurkar, D N"

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    Abdominal pain and fever in cirrhotic patients.
    (1993-10-01) Amarapurkar, D N; Shah, S C
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    Acute pancreatitis in hepatitis A infection.
    (1996-01-01) Amarapurkar, D N; Begani, M M; Mirchandani, K
    A 13 year old boy who was admitted for acute viral hepatitis due to hepatitis A virus developed acute pancreatitis which resolved completely with conservative treatment. Extensive evaluation did not reveal any other cause of pancreatitis and it was presumed that hepatitis A may result in acute pancreatitis.
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    Alternate-day therapy with omeprazole for duodenal ulcer.
    (1993-10-01) Dhawan, P; Amarapurkar, D N; Kalro, R H
    BACKGROUND: Maximal acid suppression produced by a single dose of 20 mg omeprazole has been reported to persist for over 24 hours, with acid secretion returning to normal after 2 days. OBJECTIVES: (i) To study the effect of single oral dose of 20 mg omeprazole on maximal acid output (MAO) and peak acid output (PAO) in duodenal ulcer patients and healthy volunteers. (ii) To compare the efficacy of omeprazole 20 mg daily versus 20 mg on alternate days in the treatment of duodenal ulcer. STUDY DESIGN: Open randomized comparative trial. METHODS: MAO and PAO were estimated in five duodenal ulcer patients and five healthy volunteers before, and 24 hours and 48 hours after, a single 20 mg oral dose of omeprazole. Fifty eight consecutive uncomplicated duodenal ulcer patients were randomized to receive omeprazole 20 mg either daily (n = 30) or on alternate days (n = 28) for four weeks. The two groups were matched for age, sex, duration of ulcer symptoms, smoking, NSAID use, and ulcer size at entry. Symptom scores using a pre-defined scoring system and endoscopic ulcer healing rates were evaluated at 2 and 4 weeks. RESULTS: MAO and PAO showed significant reduction in both duodenal ulcer patients and healthy controls 24 hours after 20 mg omeprazole. Reduction at 48 hours was significant in duodenal ulcer patients but not in controls. Endoscopic healing rates of duodenal ulcer at 2 and 4 weeks were 80% and 93.3% respectively in the daily treatment group and 71.4% and 85.7% respectively in the alternate-day treatment group. These differences were not statistically significant. CONCLUSION: 20 mg omeprazole on alternate days is as effective as 20 mg daily (i) in suppressing MAO and PAO and (ii) in the treatment of duodenal ulcer.
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    Ascitic fluid protein and cellular changes during diuretic therapy in cirrhosis of liver.
    (1991-03-01) Parikh, S S; Amarapurkar, D N; Viswanath, N; Desai, H G; Kalro, R H
    Thirty four patients with peritoneoscopy and/or biopsy proven uncomplicated cirrhosis of liver with ascites were studied for the effect of diuretic therapy on ascitic fluid protein and cell count. Renal function tests, liver function tests, ascitic fluid protein concentration and cell count were estimated prior to diuretic therapy and once every week till the end of therapy. There was no change in mean total serum protein (5.71 +/- 0.58 g/dl to 5.72 +/- 0.63 g/dl). The rise in mean ascitic fluid protein from 1.55 +/- 0.77 g/dl to 1.76 +/- 0.79 g/dl was not significant (P greater than 0.05). Twenty one patients (Group I) showed a rise in ascitic fluid protein concentration while 13 patients (Group II) did not show a rise or showed a fall in protein concentration during diuretic therapy. The rise in ascitic fluid protein concentration in Group I from 1.62 +/- 0.69 g/dl to 2.05 +/- 0.67 g/dl was statistically significant (P less than 0.05). Group I patients had a mean weight loss of 6.21 +/- 3.66 kg as compared to 3.15 +/- 2.00 kg in Group II patients (p less than 0.05). There was no other difference between Group I and Group II patients. Only 5 patients showed a rise in ascitic fluid cell count (more than 50 cell/mm3). It is concluded that diuretic therapy alters ascitic fluid protein concentration in a majority of patients but has no significant effect on cell count.
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    The classification of chronic gastritis.
    (1994-03-01) Amarapurkar, D N; Desai, H G
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    Coagulation abnormalities in non-cirrhotic portal fibrosis and extra hepatic portal vein obstruction.
    (1996-11-01) Sheth, S G; Deo, A M; Bichile, S K; Amarapurkar, D N; Chopra, K B; Mehta, P J
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    Epidermolysis bullosa with esophageal web.
    (1996-05-01) Amarapurkar, D N; Amarapurkar, A D; Vora, I M
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    Frequency of hepatitis B, C and D and human immunodeficiency virus infections in multi-transfused thalassemics.
    (1992-04-01) Amarapurkar, D N; Kumar, A; Vaidya, S; Murti, P; Bichile, S K; Kalro, R H; Desai, H G
    Of forty multi-transfused thalassemia patients (26 males, 14 females; mean age 8.1 +/- 5.3 years, range 1-35) with no clinical or biochemical evidence of liver disease, HBsAg, anti-hepatitis C virus and anti-human immunodeficiency virus antibodies were present in 18 (45%), 7 (17.5%) and 1 (2.5%) cases respectively. Three of the 18 (16.7%) HBsAg positive patients were anti-delta antibody positive. Our results indicate that more than 50% of multi-transfused thalassemia patients show serological evidence of one or more of hepatitis B, C and D and human immunodeficiency virus infection.
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    Gastric antral vascular ectasia (GAVE) syndrome.
    (2004-09-21) Amarapurkar, D N; Patel, N D
    Gastric antral vascular ectasia (GAVE) syndrome is an uncommon cause of chronic gastrointestinal bleeding and iron deficiency anaemia. We describe two cases of GAVE, one pernicious anaemia related and the other portal hypertension related. In both the cases, progressive mucosal changes, which lead to development of GAVE, were documented. Those changes were progression of multiple antral erythematous spots into linear configuration and lastly to watermelon stomach. One of the cases was treated with tranexamic acid with good response.
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    Genotype III - HCV infection.
    (2007-04-07) Amarapurkar, D N; Choksi, Mehul
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    Helicobacter pylori in normal gastric mucosa.
    (1994-11-01) Prabhu, S R; Ranganathan, S; Amarapurkar, D N
    Since the discovery of Helicobacter pylori (H. pylori) in 1983 several studies have established relationship of H. pylori with gastritis, duodenal ulcer disease and gastric carcinoma. H. pylori infection is widely prevalent and exposure occurs at younger age in our country. Several Western studies have shown prevalence of H. pylori in normal gastric mucosa to range from 0-25%. As similar information is not available from our country we estimated the prevalence of H. pylori in histologically normal gastric mucosa. Of the 50 asymptomatic volunteers studied, 33 showed histological evidence of gastritis and 28 of these were H. pylori. We conclude that histological gastritis is very common in young asymptomatic Indians and H. pylori infection is noticed in almost 25% subjects with histologically normal gastric mucosa.
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    Hepatic sarcoidosis.
    (2003-05-04) Amarapurkar, D N; Patel, N D; Amarapurkar, A D
    We describe six cases of hepatic sarcoidosis. Clinical presentation was with weight loss, hepatomegaly and abnormal liver function tests. In addition there was fever, itching, splenomegaly and abdominal lymphadenopathy in some. CT scan revealed mediastinal lymphadenopathy in all. Liver biopsy showed noncaseating epithelioid granulomas. Serum angiotensin converting enzyme was elevated in four cases. All patients had received anti-tuberculosis treatment with clinical diagnosis of hepatic tuberculosis. None of them improved, while some showed clinical deterioration. All patients responded to corticosteroids with disappearance of symptoms and normalization of liver function tests.
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    Hepatitis C virus infection in chronic liver disease in Bombay.
    (1992-10-01) Amarapurkar, D N; Kumar, A; Parikh, S S; Chopra, K B; Murti, P; Kalro, R H; Desai, H G
    To find out the prevalence of antibody of hepatitis C virus (anti-HCV) in patients with chronic liver disease in Bombay, sera from 126 patients (93 men, 33 women; aged 9-70 years, mean 39.7) with chronic liver disease (cirrhosis 103, cirrhosis with hepatocellular carcinoma 3, chronic active hepatitis 20) were tested for HBsAg and anti-HCV antibody. HBsAg positive sera were tested for anti-delta antibody and IgM anti-HBc. All the tests were carried out by ELISA. Of 126 patients, 51 (40.5%) were HBsAg positive, 49 (38.8%) alcoholic and 21 (16.6%) anti-HCV positive. The prevalence of anti-HCV in HBsAg positive, alcoholic and cryptogenic (HBV negative and no alcohol) liver disease patients was 13.7%, 14.7% and 20.5% respectively. Of 21 anti-HCV antibody positive patients, 8 (38%) had received blood transfusions previously. HCV is present in 15-20% of patients with chronic liver disease in Bombay.
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    Histological spectrum of lymphoid follicles and aggregates in Helicobacter pylori gastritis.
    (1997-01-01) Amarapurkar, A D; Prabhu, S R; Amarapurkar, D N
    Seventy three patients of non ulcer dyspepsia underwent upper gastrointestinal endoscopy with biopsy from antrum and body of stomach. The tissue was stained with hematoxylin eosin and warthin starry stain. The severity of gastritis was correlated with the presence of Helicobacter pylori and lymphoid follicles and aggregates. The incidence of chronic atrophic gastritis and Helicobacter pylori were found to be 97% and 64.1% respectively. Lymphoid follicles and aggregates were seen in 32.9% of chronic atrophic gastritis. Severity of gastritis with activity correlates with Helicobacter pylori colonisation and the presence of lymphoid follicles and aggregates. We have found that there is no difference between presence of lymphoid follicles and aggregates in Helicobacter pylori positive and negative gastritis. The development of lymphoid follicles probably represents an immune response to the colonisation of gastric mucosa by Helicobacter pylori.
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    HIV infection in patients of liver cirrhosis.
    (1992-07-01) Amarapurkar, D N; Kumar, A; Murti, P; Kalro, R H; Desai, H G
    A total of 130 patients of liver cirrhosis (97 males, 33 females; aged 9-70 yr) of various etiologies were subjected to anti HIV antibodies testing by ELISA and supplementary Western Blot (WB) tests. Eleven patients were positive by ELISA. Of these 11 patients, 5 were WB positive, 4 were WB negative and 2 were indeterminate. Of the 5 WB positive patients none had received blood transfusions and one was a homosexual. These results indicate that HIV infection was present in 3.8 per cent patients of liver cirrhosis. Further studies are required on a large number of patients to recommend HIV testing routinely in cirrhotic patients.
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    HLA genotyping in type-I autoimmune hepatitis in Western India.
    (2003-10-15) Amarapurkar, D N; Patel, N D; Amarapurkar, Anjali D; Kankonkar, S R
    OBJECTIVES: To analyze association of different HLA genotypes for predisposition to type-I autoimmune hepatitis in Western India. METHODS: This study was undertaken on patients of type-I autoimmune hepatitis (defined by international criteria by IAHG, 1999). HLA genotyping for class I and II was done in 20 patients of autoimmune hepatitis and 100 healthy controls. Statistics were done using Halden's modification of Woolfs formula. RESULT: Significant association of autoimmune hepatitis was found amongst class I antigens--HLA B27 [20 vs. 0 %] & HLA cw4 [40 vs. 15 %] and amongst class II antigens--DRBI*01XX [25 vs. 2%], DRB1*14XX [30 vs. 12%], DRB1*15XX [40 vs. 25%] and DRB1*07XX [20 vs. 9 %] at DRB1 locus. Stronger association was found with HLA B27, cw4 & HLA DRB1 *01XX. CONCLUSION: Our data indicate that predisposition to autoimmune hepatitis is different in Indian patients and not associated with HLA DRB1*03XX or *04XX, as seen in Western world.
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    Intrinsic factor antibody negative atrophic gastritis; is it different from pernicious anaemia.
    (2010-10) Amarapurkar, D N; Amarapurkar, A D
    Introduction: H. pylori gastritis and autoimmune gastritis are the two main types of chronic atrophic gastritis. Parietal cell antibody (PCA) and intrinsic factor antibody (IFA) are characteristic of autoimmune gastritis, of which IFA is more specific. Patients who are IFA negative are considered under the category of chronic atrophic gastritis. Aim: To differentiate IFA positive from IFA negative chronic atrophic gastritis. Methods: Fifty consecutive patients of biopsy proven chronic atrophic gastritis were included in this study. All patients underwent haematological and biochemical tests including serum LDH, vitamin B12 and fasting serum gastrin levels. PCA and IFA antibodies were tested in all patients. Multiple gastric biopsies from body and antrum of the stomach were taken and evaluated for presence of intestinal metaplasia, endocrine cell hyperplasia, carcinoid and H. pylori infection. Patients were grouped as group A (IFA positive) and group B (IFA negative). The mean laboratory values and histological parameters were compared between the two groups using appropriate statistical methods. Results: Eighteen patients were in group A (mean age 55.5±13 years, male: female = 16:2) and thirty-two in group B (mean age 49.7±13 years, male: female = 25:7). There was no statistically significant difference between median values of haemoglobin, MCV, LDH, Vitamin B12 and serum gastrin in both the groups. None of the histological parameters showed any significant difference. Conclusion: There was no statistically significant difference in haematological, biochemical and histological parameters in IFA positive and negative gastritis. These may be the spectrum of the same disease, where H. pylori may be responsible for initiating the process.
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    Is maintenance therapy required for duodenal ulcer disease?
    (1990-09-01) Kalro, R H; Amarapurkar, D N
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    Management of large hepatocellular carcinoma.
    (2004-04-08) Amarapurkar, D N
    Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. There is increasing incidence of HCC in India. More than 70% of HCC are not suitable for curative treatment. Majority of the HCCs are large when diagnosed all over the world. There is no standard treatment for large HCCs. Different palliative treatments like arterial embolization/chemoembolization, intraarterial lipoidol chemotherapy, hormonal compounds like tamoxifene, octerotide systemic chemotherapy, immuno therapy with interferon, internal radiation with 131I or 99Yttrium. Arterial chemoembolization is the treatment of choice with proved efficacy in selected group of patients. The newer modalities and strategies need to be tried in controlled randomized trials.
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    New H2-receptor antagonist--roxatidine acetate--in treatment of duodenal ulcer.
    (1993-08-01) Amarapurkar, D N; Parikh, S S; Desai, H G
    A double blind randomised trial, comparing a new H2-receptor antagonist, Roxatidine acetate, with Cimetidine was carried out in 47 patients of uncomplicated, endoscopically proven duodenal ulcer. Twenty seven patients were treated with Roxatidine 75 mg twice daily and 20 patients were treated with Cimetidine 200 mg 3 times a day and 400 mg at bed time for 4 weeks. At the end of 4 weeks, total pain relief was obtained in 74% and 70% patients receiving Roxatidine and Cimetidine respectively. Complete endoscopic healing at the end of 4 weeks was observed in 92.3% patients receiving Roxatidine and 85% patients receiving Cimetidine. These differences were statistically not significant. No significant side effects were observed in either group. We conclude that Roxatidine acetate is comparable to cimetidine in relieving pain and endoscopic healing of duodenal ulcer and has an excellent safety profile.