Browsing by Author "Harbans Singh"

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Carcinoma of the gallbladder - Is it a sequel of typhoid?
(2000) Vijay K. Shukla; Harbans Singh; Manoj Pandey; S.K. Upadhyay; Gopal Nath
Gallbladder diseases, including carcinoma, are common in the northern part of India and so are Salmonella typhi infection and typhoid carrier state. This study was aimed to find out the association of typhoid carrier state in patients with cholelithiasis, carcinoma of the gallbladder, and controls. The three groups are comparable in age and sex composition. This is the first study of its kind from an area of high endemicity for both typhoid infection and carcinoma of the gallbladder. A case-control study was carried out to detect typhoid carrier state among the patients with biliary diseases and healthy controls, using indirect haemagglutination assay measuring antibodies against highly purified S. typhi Vi polysaccharide antigen. A significantly high Vi positivity was observed in patients with gallbladder carcinoma (29.4%) compared to controls (5%) (χ2 6.325, P < 0.004, OR = 7.19) and patients with cholelithiasis (10.7%) (χ2 = 5.066, P < 0.01, OR = 3.86). There is 8.47 times more risk of developing carcinoma of the gallbladder in culture-positive typhoid carriers than the non-carriers. The present study suggests the typhoid carrier state to be one of the possible mechanisms of gallbladder carcinogenesis.
Cardiff repair of incisional hernia: A University hospital experience
(1998) Vijay K. Shukla; Anurag Gupta; Harbans Singh; Manoj Pandey; Amitabh Gautam
Objective: To analyse our results of the 'Cardiff' (far and near) repair in incisional hernias. Design: Prospective study. Setting: University hospital, Varanasi, India. Subjects: 50 patients who presented with incisional hernias between January 1990 and December 1994. Intervention: Interrupted far-and-near sutures inserted after excision of the sac. The contents were pushed into the abdomen and the peritoneum sutured with non- absorable polypropylene (prolene). Main Outcome Measures: Early and late morbidity. Six patients developed postoperative complications (wound infection, n = 3; flap necrosis, n = 2; and wound sinus, n = 1). No patient has been lost to follow up and there have been no signs of recurrence after a mean follow up of 52 months. Conclusion: The meticulous application of this simple surgical technique has low morbidity and is cost effective. We recommend it for small and medium size defects.
Combined augmentation ileo-cystoplasty and ileal replacement of ureter in advanced genitourinary tuberculosis: Modified technique
(2002) P.B. Singh; Harbans Singh; Arif Hamid; Gopi Kishore; U.S. Dwivedi
An advanced case of genitourinary tuberculosis presenting with small capacity bladder, left ureteric stricture and nonfunctioning right kidney was managed with modified technique of combined augmentation ileo-cystoplasty and ileal replacement of left ureter. This complex and extensive reconstruction can be done easily and successfully in a short time with our modified technique.
Filarial chyluria: Long-term experience of a university hospital in India
(2004) Vipul Tandon; Harbans Singh; U.S. Dwivedi; Mufti Mahmood; P.B. Singh
Background: Filariasis is an endemic problem in various Indian states. We evaluated the results of long-term follow up (10-20 years) of patients with filarial chyluria. Methods: We conducted a retrospective analysis of 160 patients treated for filarial chyluria who presented to the Banaras Hindu University Hospital from 1982 to 1992. Eighty-four patients (52.5%) were treated using diethylcarbamazine (DEC) and a fat restricted diet and 76 patients (47.5%) underwent surgery. To examine the long-term effects of filarial chyluria we analysed data on post-treatment recurrence, weight gain, dietary freedom, chyluria free period and a number of other associated factors. Results: Previous history of filariasis or its complication was documented in 19% of patients. In 71% of cases, cystoscopy showed that chylous efflux was predominant in the left ureteric orifice. The long-term remission rate was 62% in the conservatively managed group (DEC + fat restricted diet), whereas 90% of patients in the operated group were cured. Postoperative recurrence rate was 10%. There was more weight gain and dietary freedom along with a longer chyluria free period in the operated group relative to the conservatively managed group. Conclusions: Definitive surgical ablation of lymphatic urinary fistula is better than conservative medical management because it has a higher success rate, more dietary freedom and, therefore, better patient acceptability.
Serum p53 and bladder cancer: Can serum p53 be used as a tumor marker?
(2004) Vibhav Malviya; Harbans Singh; U.S. Dwivedi; Usha; P.B. Singh
The aim of this study was to find the correlation between serum p53 and carcinoma of the bladder and to investigate whether serum p53 protein can be used as a tumor marker for p53 gene alteration. The study included patients with carcinoma of the bladder and controls. Serum p53 protein estimation was done with an ELISA kit. There were 23 patients with superficial and 17 with invasive carcinoma. The median serum p53 was 31.5 U/ml in superficial and 41 U/ml in invasive cancer. This was significantly higher than the mean value (16.4 U/ml) of controls. Serum p53 rises in patients with carcinoma of the bladder and correlates with the grade of the disease .It can therefore be used as a tumor marker for bladder cancer. © Springer-Verlag 2004.
Staging of Bladder Carcinoma: MRI - Pathologic Correlation
(2003) Mufti Mahmood; U.S. Dwivedi; Vipul Tandon; Harbans Singh; O.P. Sharma; P.B. Singh
Objective: To evaluate the accuracy of MR imaging in the staging of bladder carcinoma and to correlate the results with pathological stage. Material and methods: Through June 2001 to January 2003, 20 patients of newly diagnosed bladder carcinoma with a mean age of 45 ± 9.94 years who were candidates for radical cystectomy were included in the study. Patients with distant metastases or those with past history of malignancy elsewhere were excluded. The clinical stage for each patient was determined from the results of the conventional techniques. To avoid artifacts and edema of the bladder wall, cystoscopy and cold cup biopsy/transurethral resection was performed at best 2-3 weeks before magnetic resonance imaging (MRI). MRI was performed with a 0.2 tesla permanent magnet system (Sigma 0.2T System GEM SO CO1). Within 3 weeks after MRI all patients underwent radical cystectomy. MRI images were prospectively interpreted by two radiologists and reviewed for consensus by one urologist without knowledge of the final pathological findings obtained after surgery. All patients were treated by retrograde radical cystectomy with either ileal conduit or ureterosigmoidostomy or ileal neobladder. Histopathological evaluation included the determination of the type, grade and stage of the tumor. The tumor was staged as per the tumor-node-metastasis (TNM) system (1997). The pathologic findings were finally correlated with the MRI findings. Results: Extension through the deep muscle of the bladder wall was present in 18 of the 20 patients and was diagnosed with a sensitivity of 94.4% and specificity of 100%. Extension to perivesical fat was present in 11 of 20 patients and was diagnosed with a sensitivity of 82% and a specificity of 100%. Invasion of the adjacent organs was present in 3 of 20 patients and was diagnosed with a sensitivity of 33.3% and a specificity of 100%. On the basis of MR findings, the tumor was correctly staged, according to the TNM staging (1997), in 15 of 20 (75%) patients. Tumor extension was overestimated in 2 of 20 (10%) patients and underestimated in 3 of 20 (15%). Conclusion: In summary, MRI is an accurate non-invasive modality for assessing whether the tumor is confined to or extends beyond the bladder wall. It is superior to clinical staging of T2b, T3b and T4 lesions. It is possible to distinguish T 2a from T2b lesions involving the full thickness of bladder wall and this may have therapeutic implications.
The correlation of tissue p53 protein overexpression and p53 antigen in serum of patients with bladder cancer
(2002) M. Gopi Kishore; Arif Hamid; U.S. Dwivedi; Vipul Tandon; Mufti Mahmood; Harbans Singh; P.B. Singh
Objective: The purpose of this study was to evaluate the association between the p53 protein status in the sera and tumors of bladder cancer patients. Patients and methods: We studied clinical data, i.e. age, sex, type, grade, stage, surgery and prognosis of 38 patients with carcinoma of bladder. The sera of these patients were analyzed for serum p53 protein by enzyme-linked immunosorbent assay (ELISA) and tissue p53 by immunohistochemical technique. Results: Serum p53 antigen and tissue p53 were detected in the sera of 26 of the 38 (68.4%) and 18 of the 38 patients (47.4%), respectively. The mean serum p53 level in positive tissue p53 patients was 55.2 U/ml, which was significantly higher when compared with mean serum p53 level in negative tissue p53 patients (t = 4.93, p < 0.001). In patients with positive tissue p53 (n = 18), serum p53 was positive in 17 (94.4%) patients and negative in 1 (5.5%) patient only, which was statistically insignificant. In negative tissue p53 patients (52.6%) (n = 20), serum p53 was negative in 11 (55%) patients and positive in 9 (45%) patients. Statistically significant correlation was observed between tissue p53 and serum p53 with type (F = 9.21, p < 0.001), grade (F = 8.44, p < 0.001) and stage (F = 11.88, p < 0.001) of the tumor. Statistically significant correlation was observed between recurrence of the tumor and tissue p53 and serum p53 status (p < 0.01). Survival was estimated by the Kaplan-Meier method and log-rank test, which showed that the overall survival was better in tissue p53 and serum p53 negative patients. Conclusion: This study shows a strong relationship between p53 protein overexpression and the occurrence of p53 in the sera of bladder cancer patients. The expression of p53 in sera seems to be an event in cases of bladder cancer with an unfavorable tumor-specific outcome. Because of the small number of cases and the short follow-up time, further quantitative studies will hopefully demonstrate whether this might be of prognostic importance. Further studies to elucidate the mechanism of p53 migration into the sera will be necessary for a better understanding of the immune status in bladder cancer patients.