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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Ann Oncol 2023; 34:1094-1096. [PMID: 38072512 DOI: 10.1016/j.annonc.2023.10.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
| | - P Ali
- Editor-in-Chief, International Nursing Review
| | - V Barbour
- Editor-in-Chief, Medical Journal of Australia
| | | | | | | | | | | | - R Mash
- Editor-in-Chief, African Journal of Primary Health Care & Family Medicine
| | - P Sahni
- Editor-in-Chief, National Medical Journal of India
| | | | - P Yonga
- Editor-in-Chief, East African Medical Journal
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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. J Small Anim Pract 2023. [PMID: 37986558 DOI: 10.1111/jsap.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Affiliation(s)
| | - P Ali
- International Nursing Review, USA
| | | | | | | | | | | | | | - R Mash
- African Journal of Primary Health Care & Family Medicine, USA
| | - P Sahni
- National Medical Journal of India, USA
| | | | - P Yonga
- East African Medical Journal, USA
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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Anaesthesia 2023. [PMID: 37962064 DOI: 10.1111/anae.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Affiliation(s)
| | - P Ali
- International Nursing Review
| | | | | | | | | | | | | | - R Mash
- African Journal of Primary Health Care & Family Medicine
| | - P Sahni
- National Medical Journal of India
| | | | - P Yonga
- East African Medical Journal
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Atwoli L, Baqui AH, Benfield T, Bosurgi R, Godlee F, Hancocks S, Horton R, Laybourn-Langton L, Monteiro CA, Norman I, Patrick K, Praities N, Rikkert M, Rubin EJ, Sahni P, Smith R, Talley N, Turale S, Vázquez D. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health: Wealthy nations must do much more, much faster. BJOG 2021; 128:1715-1717. [PMID: 34520105 DOI: 10.1111/1471-0528.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atwoli L, H Baqui A, Benfield T, Bosurgi R, Godlee F, Hancocks S, Horton R, Laybourn-Langton L, Monteiro CA, Norman I, Patrick K, Praities N, Rikkert MGMO, Rubin EJ, Sahni P, Smith R, Talley NJ, Turale S, Vázquez D. Call for emergency action to limit global temperature increases, restore biodiversity and protect health. BMJ Mil Health 2021; 167:297-299. [PMID: 34483123 PMCID: PMC8485131 DOI: 10.1136/bmjmilitary-2021-001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - A H Baqui
- Journal of Health, Population and Nutrition, Baltimore, Maryland, USA
| | - T Benfield
- Danish Medical Journal, Copenhagen, Denmark
| | | | | | | | | | | | | | - I Norman
- International Journal of Nursing Studies, London, UK
| | | | | | | | | | - P Sahni
- National Medical Journal of India, New Delhi, India
| | - R Smith
- UK Health Alliance on Climate Change, London, UK
| | - N J Talley
- Medical Journal of Australia, Newcastle, New South Wales, Australia
| | - S Turale
- International Nursing Review, Geneva, Switzerland
| | - D Vázquez
- Pan American Journal of Public Health, Washington, DC, USA
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Sahni P, Kumar J. Effect of Nature Experience on Fronto-Parietal Correlates of Neurocognitive Processes Involved in Directed Attention: An ERP Study. Ann Neurosci 2020; 27:136-147. [PMID: 34556952 PMCID: PMC8455014 DOI: 10.1177/0972753121990143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several studies have demonstrated that brief interactions with natural environments can improve cognitive functioning. However, the neurocognitive processes that are affected by natural surroundings are not yet fully understood. It is argued that the "elements" in natural environment evoke "effortless" involuntary attention and may affect the neural mechanisms underlying inhibition control central to directed attention. METHODS The present study used electroencephalography (EEG) to investigate the effects of nature experience on neurocognitive processes involved in directed attention. During EEG recordings, participants (n = 53) were presented nature audio/video as stimuli to evoke nature experience, and flanker task was administered both before and after nature experience. An open eye rest condition was included randomly in either before or after nature experience cognitive task as a control condition. RESULTS The event-related potential analysis demonstrated a significant improvement in the response time after the nature experience. The analysis also demonstrated a significant difference for the inhibitory control process in fronto-parietal N2 (P < .01) and P3 (P < .05) for incongruent trials subsequent to nature experience. The spectral analysis also found an increase in alpha in all five brain regions (all Ps < .01) and fronto-central theta power (P < .01). CONCLUSION The findings suggest that improved inhibitory control processes could be one of the aspects of enhanced directed attention after nature experience. Increased alpha along with theta indicates a relaxed yet alert state of mind after nature experience.
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Affiliation(s)
- Pooja Sahni
- National Resource Centre for Value Education in Engineering Indian Institute of Technology Delhi, New Delhi, India
| | - Jyoti Kumar
- National Resource Centre for Value Education in Engineering Indian Institute of Technology Delhi, New Delhi, India
- Department of Design Indian Institute of Technology Delhi, New Delhi, India
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Abstract
It is commonly believed that patients in India do not need to be told about their operations as they are unable to understand the complexities and forget the salient facts soon afterwards. Obtaining informed consent is therefore considered to be an unnecessary ritual. We studied 100 consecutive patients undergoing elective major abdominal operations and asked them 5 days after their operations to recall certain details about the procedure which had been explained to them preoperatively. Seventy per cent of the patients recalled the relevant data. The ability was the same in males and females (67% and 69%) but the older, less educated and poorer patients performed worse than the others. Ninety-eight per cent of the patients appreciated being given the information as it reduced their anxiety about the operation. Indian patients are able to comprehend and should be informed about the details of their operation. Particular care should be taken during explanation to the old, poor and illiterate. In these informed consent should be a continuous process rather than a single event and the information should also be given to a younger and more educated relative.
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Affiliation(s)
- A K Sanwal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
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Padhan RK, Nongthombam SK, Venuthurimilli A, Dhingra R, Sahni P, Garg PK. Assessment of safety and efficacy of an indigenous self-expandable fully covered esophageal metal stent for palliation of esophageal cancer. Indian J Cancer 2018; 53:534-537. [PMID: 28485345 DOI: 10.4103/0019-509x.204760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with unresectable esophageal cancer require palliation for dysphagia. Placement of a self-expandable metal stent (SEMS) is the procedure of choice for palliation of dysphagia. OBJECTIVE To evaluate the safety and efficacy of an indigenous fully-covered SEMS in patients with esophageal cancer. METHODS Eligible patients with unresectable esophageal cancer requiring palliation for dysphagia were included in the study. An indigenous fully covered SEMS of appropriate length was placed under endoscopic and fluoroscopic guidance. Outcome measures assessed were adverse events and improvement in dysphagia. RESULTS Twenty one patients (mean age 57.71±13.14 years; 17 males) were included. After stenting, dysphagia score decreased from 3.2+0.4 to 0.35+0.74 at 4 weeks. Adverse events included retrosternal pain, respiratory distress and aspiration pneumonia in 12, 2 and 1 patients respectively. Five patients required repeat stenting due to stent migration in 4 (following radiotherapy in 3) and tumour ingrowth in 1. There was primary stent malfunction in one patient. The median survival of patients was 140 (76-199) days, which was higher in those who received radiotherapy. CONCLUSION The stent was reasonably safe and effective to relieve dysphagia due to unresectable esophageal cancer.
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Affiliation(s)
- R K Padhan
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - S K Nongthombam
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - A Venuthurimilli
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - R Dhingra
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
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- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - P Sahni
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi, India
| | - P K Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
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Sahni P, Trivedi N, Omer A. Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia. Endocrinol Diabetes Metab Case Rep 2016; 2016:EDM160064. [PMID: 27855237 PMCID: PMC5093380 DOI: 10.1530/edm-16-0064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 11/08/2022] Open
Abstract
A 65-year-old obese Caucasian woman presented with symptomatic postprandial hypoglycemic episodes, resolution of symptoms with carbohydrate intake and significantly elevated anti-insulin antibody levels. She did not have any evidence for the use of oral antidiabetic medications, insulin, herbal substances, performing strenuous exercise or history of bariatric surgery. Fingerstick blood glucose readings revealed blood sugar of 35 mg/dL and 48 mg/dL, when she had these symptoms. Her medical history was significant for morbid obesity, hypothyroidism and gastro esophageal reflux disease. Her home medications included levothyroxine, propranolol and omeprazole. A blood sample obtained during the symptoms revealed the following: fingerstick blood sugar 38 mg/dL, venous blood glucose 60 mg/dL (normal (n): 70-99 mg/dL), serum insulin 202 IU/mL (n: <21), proinsulin 31.3 pmol/L (n: <28.9), C-peptide 8 ng/mL (n: 0.9-7), beta-hydroxybutyrate 0.12 mmol/L (n: 0.02-0.27) anti-insulin antibody >45.4 U/mL (n: <0.4). The result obtained while screening for serum sulfonylurea and meglitinides was negative. The repeated episodes of postprandial hypoglycemia associated with significantly elevated anti-insulin antibodies led to a diagnosis of insulin antibody syndrome (IAS). Significant improvement of hypoglycemic symptoms and lower anti-insulin antibody levels (33 U/mL) was noted on nutritional management during the following 6 months. Based on a report of pantoprazole-related IAS cases, her omeprazole was switched to a H2 receptor blocker. She reported only two episodes of hypoglycemia, and anti-insulin antibody levels were significantly lower at 10 U/mL after the following 12-month follow-up. LEARNING POINTS Initial assessment of the Whipple criteria is critical to establish the clinical diagnosis of hypoglycemia accurately.Blood sugar monitoring with fingerstick blood glucose method can provide important information during hypoglycemia workup.Autoimmune hypoglycemia is a rare cause of hypoglycemia, which can be diagnosed on high index of clinical suspicion and systematic evaluation.
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Affiliation(s)
- Pooja Sahni
- Division on Endocrinology and Metabolic Medicine and Department of Internal Medicine , St Vincent Hospital, Worcester, Massachusetts , USA
| | - Nitin Trivedi
- Division on Endocrinology and Metabolic Medicine and Department of Internal Medicine , St Vincent Hospital, Worcester, Massachusetts , USA
| | - Abdulkadir Omer
- Division on Endocrinology and Metabolic Medicine and Department of Internal Medicine , St Vincent Hospital, Worcester, Massachusetts , USA
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Sahni P, Trivedi A, Omer A, Trivedi N. Adrenal incidentalomas: are they being worked up appropriately? J Community Hosp Intern Med Perspect 2016; 6:32913. [PMID: 27802863 PMCID: PMC5089157 DOI: 10.3402/jchimp.v6.32913] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Adrenal incidentalomas are defined as masses picked up on imaging studies that were done for apparently different reasons. With frequent use of imaging modalities, incidental adrenal masses are commonly encountered in clinical practice. Guidelines are currently available for the diagnosis and management of adrenal incidentalomas, but the appropriateness of initial work-up and subsequent follow-up of incidental adrenal masses in the community hospital setting is unknown. OBJECTIVE We studied the appropriateness of initial work-up and follow-up of incidental adrenal masses discovered on abdominal computerized tomography (CT). METHODS In our retrospective study, we reviewed sequential CT scans of the abdomen performed in the month of January 2010 at a community hospital. Once patients with one or more adrenal masses were identified, outpatient charts for initial biochemical testing and follow-up imaging were obtained either through directly accessing the electronic medical records or through contacting primary care physician's offices. Patient charts were reviewed to assess the data for the next 2 years following the discovery of an adrenal abnormality. RESULTS Twenty adrenal masses were incidentally discovered on 723 abdominal CTs performed within the month of January 2010 resulting in an overall incidence of 2.76%. Of the patients with incidentally discovered adrenal masses, appropriate biochemical and follow-up imaging were only performed in patients referred to an endocrinologist (2 of 20 patients). Thirty percent of patients with incidental masses received a repeat CT scan for non-adrenal reasons, and no change in the mass size was noted. CONCLUSION Despite published guidelines, the initial work-up and follow-up of patients with an incidentally discovered adrenal mass is unsatisfactory. There is a desperate need for education of providers regarding appropriate work-up of incidental adrenal masses.
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Affiliation(s)
- Pooja Sahni
- Division of Hematology and Oncology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Apoorva Trivedi
- Apoorva Trivedi is a Third Year Medical Student, University of Vermont Medical School, Burlington, VT, USA
| | - Abdulkadir Omer
- Division of Endocrinology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Nitin Trivedi
- Division of Endocrinology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA;
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Singh K, Raina M, Sahni P. The Concept and Measure of Sukha–Dukha: An Indian Perspective on Well-Being. Journal of Spirituality in Mental Health 2016. [DOI: 10.1080/19349637.2016.1231604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kamlesh Singh
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, Delhi, India
| | - Mahima Raina
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, Delhi, India
| | - Pooja Sahni
- National Resource Centre for Value Education in Engineering, Indian Institute of Technology Delhi, Delhi, India
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Aggarwal R, Gogtay NJ, Kumar R, Sahni P. The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink. J Postgrad Med 2016; 62:69-72. [PMID: 26821564 PMCID: PMC4944353 DOI: 10.4103/0022-3859.175001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - P Sahni
- Editor, The National Medical Journal of India,
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Ramakrishnaiah VPN, Dash NR, Pal S, Sahni P, Kanti CT. Quality of life after oesophagectomy in patients with carcinoma of oesophagus: A prospective study. Indian J Cancer 2014; 51:346-351. [DOI: 10.4103/0019-509x.146750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Shalini Chawla
- Department of Pharmacology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
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Roy V, Sahni P, Gupta P, Sethi GR, Khanna A. Blood levels of pyrazinamide in children at doses administered under the Revised National Tuberculosis Control Program. Indian Pediatr 2011; 49:721-5. [PMID: 22317983 DOI: 10.1007/s13312-012-0164-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/31/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the blood levels, pharma-cokinetics and pharmacodynamic indices of pyrazinamide (PZA) in children suffering from tuberculosis, at doses administered under the weight band system of Revised National Tuberculosis Control Program of India (RNTCP) of India. DESIGN Prospective, open-label, non-randomized single-dose study. SETTING 20 children in the age group 5-12 years attending out-patient tuberculosis clinic of a tertiary hospital. OUTCOME MEASURES Blood levels of pyrazinamide after single dose administration, as per the weight band system of RNTCP. RESULTS Group I (n=7) included children who received pyrazinamide within the recommended 30-35 mg/kg dose (mean 31.9 ± 0.8 mg/kg) and Group II (n=13) included those who received a dose lower than 30 -35 mg/kg (mean 28.1 ± 0.3 mg/kg). The Cmax (95% CI of difference 2.2, 13.2; P=0.008) and AUC (95% CI of difference 28.6, 208.1; P=0.01) were significantly lower in Group II. The duration of time for which the concentration was maintained above 25 ug ml-1 was 4-8 h in Group I and 3-5.5 h in Group II (95% CI of difference 0.1, 2.0; P=0.03). The half life, elimination rate constant, clearance and volume of distribution were comparable in the two groups. The ratios of Cmax and AUC to MIC (25 ug ml-1) in children were lower than that recommended for PZA in adults. CONCLUSIONS Lower blood concentrations are being attained in children receiving PZA doses under the existing weight band system of RNTCP of India. The weight bands may need to be revised and dose recommendations be based on pharmacokinetic and efficacy data in children.
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Affiliation(s)
- V Roy
- Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, Bahadurshah Zafar Marg, New Delhi 110 002, India.
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Prati PS, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. J Postgrad Med 2009; 54:78-9. [PMID: 18480516 DOI: 10.4103/0022-3859.40766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Indian J Cancer 2008; 45:39-40. [PMID: 18626145 DOI: 10.4103/0019-509x.41767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kandpal H, Sharma R, Srivastava DN, Sahni P, Vashisht S. Diffuse cavernous haemangioma of colon: magnetic resonance imaging features. Report of two cases. ACTA ACUST UNITED AC 2007; 51 Spec No.:B147-51. [PMID: 17875140 DOI: 10.1111/j.1440-1673.2007.01837.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Large bowel haemangiomas are rare but can cause significant morbidity. The clinical features are non-specific, and misdiagnosis is very common. Non-invasive imaging is very useful in the diagnosis and management of this condition. Magnetic resonance imaging surpasses all other imaging modalities, as it is most specific and depicts the extent of the lesion accurately. Two cases of cavernous haemangioma of the rectum are presented highlighting the MRI features.
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Affiliation(s)
- H Kandpal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Kandpal H, Sharma R, Das CJ, Sahni P, Das AK, Neyaz Z. Solid pseudopapillary tumor of the pancreas with portal vein compression presenting as portal hypertension. ACTA ACUST UNITED AC 2007; 51 Suppl:B287-91. [PMID: 17991087 DOI: 10.1111/j.1440-1673.2007.01839.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Solid pseudopapillary tumour (SPT) of the pancreas is a rare neoplasm, which occurs predominantly in young females and is usually amenable to cure by surgical resection. Imaging plays an important role in its diagnosis. We present the sonographic, CT and MRI features of SPT in a young female whose chief complaint was recurrent haematemesis secondary to portal venous compression.
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Affiliation(s)
- H Kandpal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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20
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Srivastava DN, Sharma S, Pal S, Thulkar S, Seith A, Bandhu S, Pande GK, Sahni P. Transcatheter arterial embolization in the management of hemobilia. ACTA ACUST UNITED AC 2007; 31:439-48. [PMID: 16447087 DOI: 10.1007/s00261-005-0392-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This retrospective analysis evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) in the treatment of significant hemobilia. The imaging findings, embolization technique, complications, and efficacy are described. METHODS Thirty-two consecutive patients (21 male, 11 female, age range 8-61 years) who were referred to the radiology department for severe or recurrent hemobilia were treated by TAE. Causes of hemobilia were liver trauma (n = 19; iatrogenic in six and road traffic accident in 13), vasculitis (n = 6), vascular malformations (n = 2), and hepatobiliary tumors (n = 5). Iatrogenic liver trauma was secondary to cholecystectomy in those six patients. Four of five hepatobiliary tumors were inoperable malignant tumors and one was a giant cavernous hemangioma. Arterial embolization was done after placing appropriate catheters as close as possible to the bleeding site. Embolizing materials used were Gelfoam, polyvinyl alcohol particles or steel coils, alone or in combination. Postembolization angiography was performed in all cases to confirm adequacy of embolization. Follow-up color Doppler ultrasound and contrast-enhanced computed tomography was done in all patients. RESULTS Ultrasonic, computed tomographic, and angiographic appearances of significant hemobilia were assessed. Angiogram showed the cause of bleeding in all cases. Three patients with liver trauma due to accidents required repeat embolization. Eight patients required surgery due to failed embolization (continuous or repeat bleeding in four patients, involvement of the large extrahepatic portion of hepatic artery in two, and coexisting solid organ injuries in two). Severity of hemobilia did not correlate with grade of liver injury. All 13 patients with blunt hepatic trauma showed the cause of hemobilia in the right lobe. No patient with traumatic hemobilia showed an identifiable cause in the left lobe. There were no clinically significant side effects or complications associated with TAE except one gallbladder infarction, which was noted at surgery, and cholecystectomy was performed with excision of the hepatic artery aneurysm. CONCLUSION TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.
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Affiliation(s)
- Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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21
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Abstract
BACKGROUND Gallstone disease as well as gallbladder cancer are more common in women and female sex hormones may be involved in their etiology. AIM AND METHODS To determine whether female sex hormones have a role in the pathogenesis, of gallbladder carcinoma and in its prognosis, we estimated, by enzyme immunoassay, the estrogen and progesterone receptors (ER and PgR) in the gallbladders of 21 patients with gallbladder cancer, 19 patients with cholelithiasis, and 6 patients who underwent incidental removal of essentially normal gallbladder as a component of wider resection. RESULTS ER were present in the gallbladder mucosa in all the three groups in proportions which were not significantly different (9/21 in carcinoma, 4/19 in gallstones, and 1/6 normal), whereas the expression of PgR was greater in carcinomas (13/18), less in cholelithiasis (4/12), and absent in normal gallbladders. PgR expression was higher in tumors of lower stage (7/7) and lower in advanced disease stage IV tumors (6/11). PgR expression was associated with better disease stage (p=0.05) and significantly longer overall survival (median survival of 301 d vs 54 d) as well as better survival within the same stage (269 d vs 54 d for stage IV disease, p=0.011). Cox's regression analysis showed that PgR was an independent risk factor (R=0.2283, p=0.0035). CONCLUSIONS Our findings suggest that the female sex hormones may have a role in the pathogenesis of gallbladder cancer and that PgR expression has a prognostic significance. We believe that when this relationship is reaffirmed by larger studies, gallbladder cancer may be treated with appropriate sex hormonal manipulation.
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Affiliation(s)
- V Baskaran
- Department of Gastrointestinal Surgery & Liver Transplantation, The All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Abstract
Thoracic duct injury is an uncommon complication of esophagectomy. Experience in managing these cases is limited to large centers performing esophagectomies in good numbers. We analyzed the prospectively maintained esophageal diseases database of patients presenting to a surgical unit between 1982 and 2002. Among 552 esophagectomies during this period we had encountered 14 cases of chylothorax (2.54%). We analyzed the type and site of lesion and the impact of neoadjuvant therapy on the incidence of thoracic duct injury. Among 459 patients of transhiatal esophagectomy, 11 developed postoperative chylothorax (2.40%). In 93 transthoracic resections, there were three cases of chylothorax (3.23%; (P = 0.9185)). The incidence following preoperative radiotherapy was 2.17%. None of the 31 patients, who had undergone esophagectomy for benign diseases had developed chylothorax. In the carcinoma group the incidence in middle third lesions was 5.85% and in lower third lesions was 0.80% (P = 0.0018). Seven patients were managed conservatively. Two of these patients, for whom surgery had been planned, died before they could be taken up for surgery. In the remaining seven patients transthoracic ligation of the thoracic duct was performed. Two patients in this group died. The average hospital stay was 20 days in the conservative group and 12 days in the surgery group. Among the factors studied, patients with middle third lesions were at increased risk of developing postoperative chylothorax, when compared to upper or lower third lesions.
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Affiliation(s)
- D V L N Rao
- Department of GI Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi-110029, India
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Abstract
Diaphragmatic hernia may be congenital or traumatic in origin. Traumatic hernia may menifest immediately or several months/years after the incident. Congenital hernia usually manifests in the early years of life. Diaphragmatic hernia may be complicated by gastric volvulus. Acute gastric volvulus is surgical emergency where as chronic gastric volvulus presents with nonspecific abdominal symptoms. Diagnosis of gastric volvulus is difficult and is based on imaging studies. We describe four cases of diaphragmatic hernia complicated by gastric volvulus, diagnosed on imaging and managed surgically.
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Affiliation(s)
- Gamanagatti Shivanand
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Srivastava DN, Thulkar S, Sharma S, Pandey GK, Sahni P, Julka PK, Acharya SK. Therapeutic radiological interventional procedures in hepatocellular carcinoma. Indian J Gastroenterol 2002; 21:96-8. [PMID: 12118934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used.
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Affiliation(s)
- Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
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Rao YG, Saxena R, Sahni P, Pande GK, Chattopadhyay TK. Functional outcome and patient satisfaction after ileal pouch anal anastomosis for ulcerative colitis in a developing country. Trop Gastroenterol 2002; 23:66-9. [PMID: 12632971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
AIM To study the long-term outcome and patient satisfaction of patients with an ileal pouch-anal anastomosis (IPAA) for ulcerative colitis in India. PATIENTS AND METHODS We studied 35 patients who had undergone IPAA for ulcerative colitis between 1985 and 1998 and had intestinal continuity restored for more than 6 months. These patients were asked to answer a detailed questionnaire on their bowel function, urogenital function, etc. A complete haemogram, serum iron studies, liver function tests and D-Xylose absorption test were done. In addition hepatobiliary ultrasound, stool microscopy, pouchoscopy and pouch biopsies were also performed. Patient satisfaction after the procedure was also evaluated. RESULTS Thirty-five patients (17 men and 18 women) underwent a complete evaluation. The duration after restoration of continuity ranged from 6 months to 164 months (mean 78.6 months). The mean stool frequency was 7.2 stools per 24 hours. Five patients had urgency of stool, 9 had occasional soiling and 1 had major incontinence. Four patients had minimal restriction of social activities and 1 discontinued his employment. All patients were sexually satisfied except one man who had impotence and one woman who had dyspareunia. Fifteen patients had abnormal serum iron studies (Haemoglobin < 9 g/dl in 11). Eleven patients had D-Xylose absorption below normal values. Two patients were found to have gallstones. All pouch biopsies showed chronic inflammation and 1 patient had histological evidence of pouchitis. Eighty-five percent of patients reported that they were very satisfied with the procedure. CONCLUSION Good functional recovery and acceptance of the procedure over the long term suggests that it is a valid procedure to be recommended for patients with ulcerative colitis in India.
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Affiliation(s)
- Y Govardhana Rao
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
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26
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Armour SJ, Bastone P, Birnbaum M, Garrett C, Greenough PG, Manni C, Ninomiya N, Renderos J, Rottman S, Sahni P, Shih CL, Siegel D, Younggren B. Education issues in disaster medicine: summary and action plan. Prehosp Disaster Med 2001; 16:46-9. [PMID: 11367941 DOI: 10.1017/s1049023x00025577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education. METHODS Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration, (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis. DISCUSSION Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences. CONCLUSIONS The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.
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Affiliation(s)
- S J Armour
- Disaster Preparedness Resources Centre, University of British Columbia, Vancouver, British Columbia, Canada
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Srivastava DN, Gandhi D, Seith A, Pande GK, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging 2001; 26:510-4. [PMID: 11503090 DOI: 10.1007/s00261-001-0007-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2000] [Indexed: 12/24/2022]
Abstract
BACKGROUND This prospective study evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) for the treatment of symptomatic cavernous hemangiomas of the liver. The technique, its complications, and effectiveness also were analyzed. METHODS Eight patients (five male, three female; mean age +/- SD = 47.75 +/- 8.59 years) with symptomatic cavernous hemangiomas of the liver were treated by TAE with polyvinyl alcohol particles or gelfoam and steel coils (single session) followed by supportive treatment. Tumor characterization (including the extent and number of lesions) was done on triple-phase helical computed tomography or gadolinium-enhanced dynamic magnetic resonance imaging. RESULTS The lesions were located in the right lobe in five patients, left lobe in one, and both lobes in two. The largest diameter of the lesions was 6-18 cm (9.28 +/- 5.13 cm). The treatment response was assessed on follow-up ultrasound and color Doppler and/or contrast-enhanced helical computed tomography. There were no treatment-related deaths and morbidity was minimal. Embolization was the only method of treatment in seven patients; however, one patient had surgery after TAE because the symptoms were only partly relieved. Indications for embolization were abdominal pain (eight patients), rapid tumor enlargement (four of eight), and recurrent jaundice (one of eight). Symptomatic improvement was documented in all patients after embolization. Symptoms did not worsen in any patient. The mean size of the tumor did not show any statistically significant change on follow-up radiologic examinations. However, in one patient, the tumor significantly regressed in size after embolization. CONCLUSION TAE of hepatic cavernous hemangioma is a useful procedure in the therapy of symptomatic hemangiomas.
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Affiliation(s)
- D N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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28
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Pande GK, Sahni P. The new kid on the block. Trop Gastroenterol 2000; 21:1-2. [PMID: 10835950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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29
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Das Sinha S, Sahni P, Nundy S. Does exchanging comments of Indian and non-Indian reviewers improve the quality of manuscript reviews? Natl Med J India 1999; 12:210-3. [PMID: 10613000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The quality of peer reviewing in developing countries is thought to be poor. To examine whether this was so, we compared the performance of Indian and non-Indian reviewers who were sent original and review articles submitted to The National Medical Journal of India. We also tested whether informing reviewers that their comments would be exchanged improved the quality of their reviews. METHODS In a prospective, randomized, blinded study, we sent 100 manuscripts to pairs of peer reviewers (Indian and non-Indian) of which 78 pairs of completed replies were available for analysis. Thirty-eight pairs of reviews were exchanged and 40 were not. The quality of the reviews was assessed by two editors who were unaware of the reviewers' nationality and whether they had been told that their reviews would be exchanged. The quality of the reviews was scored out of 100 (based on a predesigned evaluation proforma). We also measured the time taken to return a manuscript. RESULTS Overall, non-Indian reviewers scored higher than Indians (mean scores non-Indians first, 56.7 v. 48.6, p < 0.001), especially those in the non-exchanged group (58.4 v. 47.3, p < 0.001) but not the exchanged group (54.8 v. 50.0, p < 0.06). Being informed that reviews would be exchanged did not affect the quality of reviews by non-Indians (54.8 exchanged v. 58.4 non-exchanged) or of reviews by Indians (50.0 exchanged v. 47.3 non-exchanged). The editors' assessment of the reviewers matched well (r = 0.59, p < 0.001). Non-Indians took the same amount of time as Indians to return their reviews, although the postage time was at least eight days longer. CONCLUSIONS We found that non-Indian peer reviewers were better than Indians and informing them that their views would be exchanged did not seem to affect the quality of their reviews. We suggest that Indian editors should also use non-Indian reviewers and start training programmes to improve the quality of peer reviews in India.
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Affiliation(s)
- S Das Sinha
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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30
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Srivastava DN, Yadav S, Sahni P, Pande G. Emergency percutaneous occlusion of surgical portosystemic shunt using steel coils and balloon catheter. AJR Am J Roentgenol 1999; 172:1453-4. [PMID: 10227544 DOI: 10.2214/ajr.172.5.10227544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The evaluation of percutaneous contrast injection into splenic parenchyma as an alternative technique for computed tomographic (CT) portography in the preoperative assessment of primary hepatobiliary tumors. METHODS Thirty-two patients underwent a nonenhanced CT scan of the liver, after which a 19-gauge, 10-cm-long needle was introduced into the splenic parenchyma under CT guidance. One hundred forty milliliters of contrast medium (200 mgI/mL; 28 g/I) were injected through this needle: first, a 20-mL bolus (in 5 s) and then 2 mL/s for 60 s. At the end of the bolus injection (5 s), 8-mm-thick contiguous axial scans of the liver were obtained. RESULTS The success rate of the procedure was 93.7% (30/32; two technical failures). The average time required for the entire study was 13 min and 50 s (range = 7 min 53 s to 25 min 17 s). Hepatic parenchymal enhancement was good in 24/30 (80%), moderate in 3/30 (10%), and unsatisfactory in caudal sections of the liver in 3/30 (10%). Artifactual perfusion defects were seen in 4/30 (13%) due to inadvertant injection of small quantities of air. Intrasplenic subcapsular contrast accumulation occurred in 56.2% (18/32; minimal 15, moderate 3), extrasplenic contrast leakage in 12. 5% (4/32), and left shoulder pain in 18.7% (6/32). No major complications were observed. CONCLUSIONS Direct intrasplenic contrast injection for CT portography is a simple, effective, and safe technique with a high success rate and requires significantly less time and lower doses of contrast medium; it also eliminates angiography, indwelling arterial catheters, and patient transfers from angiography to the CT area.
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Affiliation(s)
- R Jain
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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32
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Kumar D, Dhar A, Jain R, Karak AK, Dwivedi DN, Sahni P, Sharma MP. Benign cystic peritoneal mesothelioma in a man. Indian J Gastroenterol 1998; 17:156-7. [PMID: 9795511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Benign cystic mesothelioma of the peritoneum is uncommon and usually occurs in women. We report this condition in a man, who was treated successfully by surgical excision of the tumor.
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Affiliation(s)
- D Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi
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Sharma MC, Gill SS, Kashyap S, Kataria R, Gupta DK, Sahni P, Acharya SK. Gastrointestinal mucormycosis--an uncommon isolated mucormycosis. Indian J Gastroenterol 1998; 17:131-3. [PMID: 9795498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Isolated mucormycosis of the gastrointestinal tract is uncommon, with only two case reports from India. OBJECTIVES To study the clinicopathologic features of gastrointestinal mucormycosis in Indian patients. METHODS Eight cases of isolated gastrointestinal mucormycosis, seen over six years (1992-97) are reviewed. RESULTS Five of the patients were premature babies or infants, one was a 12-year-old boy, and two were middle aged. Symptomatology included vomiting, bloody diarrhea, upper gastrointestinal bleeding, abdominal lump and abdominal distention. All the neonates presented with intestinal perforation. The duration of symptoms was ten days or less in six cases. Mucormycosis was not suspected clinically in any patient. In six cases the diagnosis was established antemortem from resection or biopsy material. Only two patients received antifungal therapy and only one patient responded. CONCLUSIONS Isolated gastrointestinal mucormycosis is not uncommon in India. Early diagnosis may be helpful in reducing the high mortality.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi.
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Abstract
Although arteritis of the gastrointestinal tract is well known, an isolated phlebitis without associated arteritis of the colon and cecum is rare. We describe a distinct form of giant cell phlebitis in a 16-year-old girl causing ischemic stricture of the large intestine. She presented with subacute intestinal obstruction and was suspected of suffering from tuberculosis. However, histopathologic examination showed giant cell phlebitis, the arterioles and arteries being spared. Although this is an extremely rare form of nonprogressive vasculitis, it should be considered in the differential diagnosis of strictures in the large intestine, especially in the young.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi.
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35
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Abstract
There are few reports on operations in patients with nonalcoholic pancreatitis. Between 1985 and 1995 we operated on 58 such patients, 38 of whom were male and 20 female with a mean age of 35 years (range 5-72 years). The indications for operation were pain (n = 49), biliary obstruction (n = 12), duodenal obstruction (n = 10), portal hypertension (n = 11), cysts (n = 14), and pancreatic ascites (n = 3). Thirty-four patients with a dilated pancreatic duct underwent pancreaticojejunostomy; cysts were drained internally in eight, and biliary and duodenal obstruction was bypassed. Ten patients also underwent surgery for portal hypertension. Four (7%) patients died during the postoperative period. Of the remaining 54 patients, 48 (89%) were followed up for a median period of 63 months (range 6 months to 10 years). Six died: four of pancreatic cancer, one of cerebrovascular accident, and one of malnutrition. Of the 34 surviving patients operated for pain, 30 (88%) felt better, of whom 24 (71%) had complete relief of pain; 14 (41%) recorded a weight gain. Pancreatic decompression results in immediate and lasting pain relief in most patients with nonalcoholic chronic pancreatitis.
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Affiliation(s)
- A K Sharma
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
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36
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Abstract
We studied 25 consecutive patients with noncirrhotic portal hypertension to determine whether portal hypertensive gastropathy occurred and whether it was related to hypoacidity, hypergastrinemia, or portal venous congestion. Preoperative tests included gastrointestinal endoscopy, gastric mucosal biopsies, gastric acid estimation, and serum gastrin measurements. All patients had a central splenorenal shunt performed during which a full-thickness gastric biopsy was performed. The tests were repeated 3 to 16 months postoperatively. Eight of the 25 patients showed endoscopic evidence of portal hypertensive gastropathy. The shunt procedure reversed the gastropathy in 6 of 7 patients followed up. Mucosal biopsies revealed vascular ectasia in 24 of 25 patients; in 8 of the most severely affected there was partial or complete regression after surgery. The basal and peak acid outputs in the patients were normal for our laboratory at 2.9 +/- 0.25 meq/hour and 16.37 +/- 0.96 meq/hour, respectively. They remained unchanged after surgery. Fasting serum gastrin levels were also normal both before and after surgery. Our findings indicate that venous congestion is the cause of portal hypertensive gastropathy in patients with noncirrhotic portal hypertension and that it can be reversed by a decompressive procedure.
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Affiliation(s)
- A S Soin
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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37
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Reddy KS, Karak PK, Sharma S, Rao RC, Vijayaraghavan M, Sahni P. Epithelial hepatoblastoma in a middle aged woman. Trop Gastroenterol 1997; 18:163-4. [PMID: 9612098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K S Reddy
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Minocha A, Mitra DK, Sahni P, Karak A. Massive gastrointestinal bleeding associated with hookworm infestation in a child: case report. Pediatr Surg Int 1996; 11:402-3. [PMID: 24057730 DOI: 10.1007/bf00497827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/1995] [Indexed: 10/26/2022]
Abstract
We report a rare case of massive haematochezia due to hookworm infestation that required two laparotomies before the cause of bleeding could be diagnosed. The need to consider this parasite as a possible cause of gut bleeding in endemic countries is stressed, as early recognition may avoid unnecessary investigations and surgical interventions.
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Affiliation(s)
- A Minocha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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39
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Arora M, Banerjee JK, Sahni P, Pande GK, Nundy S. Which are the best undergraduate medical colleges in India? Natl Med J India 1996; 9:135-40. [PMID: 8664827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Arora
- All India Institute of Medical Sciences, New Delhi, India
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40
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Sharma AK, Sahni P. Pancreatic ascites. Trop Gastroenterol 1995; 16:1-3. [PMID: 8854947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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41
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Sharma MC, Verma K, Sahni P. Gastric mucormycosis. INDIAN J PATHOL MICR 1994; 37 Suppl:S8-9. [PMID: 8613186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- M C Sharma
- Department of Pathology and Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi
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Abstract
OBJECTIVE The results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated. SUMMARY BACKGROUND DATA Extrahepatic portal venous obstruction, a common cause of portal hypertension in children in India, is being treated increasingly by endoscopic sclerotherapy instead of by proximal splenorenal shunt. It is believed that surgery (or the operation) carries high mortality and rebleeding rates and is followed by portosystemic encephalopathy and postsplenectomy sepsis. However, a proximal splenorenal shunt is a definitive procedure that may be more suitable for children, particularly those who have limited access to medical facilities and safe blood transfusion. METHODS Between 1976 and 1992, the authors performed 160 splenorenal shunts in children. Twenty were emergency procedures for uncontrollable bleeding and 140 were elective procedures--102 for recurrent bleeding and 38 for hypersplenism. RESULTS The overall operative mortality rate was 1.9%--10% (3/160-2/20) after emergency operations and 0.7% (1/140) after elective operations. Rebleeding occurred in 17 patients (11%), and pneumococcal meningitis developed in 1 patient who recovered later. Encephalopathy did not develop in any patient. Four patients died in the follow-up period--two of rebleeding, one of chronic renal failure and a subphrenic abscess, and one of unknown causes. The 15-year survival rate by life table analysis was 95%. CONCLUSIONS A proximal splenorenal shunt, a one-time procedure with a low mortality rate and good long-term results, is an effective treatment for children in India with extrahepatic portal venous obstruction.
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Affiliation(s)
- A S Prasad
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi
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Chandra J, Narayan S, Shome DK, Sahni P, Mandal RN, Logani KB, Sharma D. Congenital biphenotypic leukemia. Indian Pediatr 1993; 30:1028-30. [PMID: 8125576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi
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Abstract
Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.
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Affiliation(s)
- M K Mohapatra
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi
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Chandra J, Narayan S, Kumar P, Ravi RN, Sahni P, Logani KB, Sharma D. Myelofibrosis. Indian Pediatr 1992; 29:911-4. [PMID: 1428146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi
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Abstract
Although Indian doctors produce half the articles published from the third world, little has been written about Indian medical journals. We examined 75 of the 113 serious English-language journals published in India. Of the 22 included in the Cumulated Index Medicus only 8 were judged by Indian and foreign referees to be of international standard. A survey of Indian authors indicated that foreign journals were chosen for the best papers because of their wider circulation, better refereeing practices, and punctuality. More than 98% of medical articles from India probably go unnoticed by the international medical community.
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Affiliation(s)
- P Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi
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47
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Dev V, Kaul U, Sahni P, Sharma S. Balloon angioplasty for complete obstruction of inferior vena cava: needle puncture followed by balloon dilatation. Cathet Cardiovasc Diagn 1992; 25:320-2. [PMID: 1533348 DOI: 10.1002/ccd.1810250414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report herein 2 cases with complete obstruction of the suprahepatic portion of the inferior vena cava successfully treated by balloon angioplasty after crossing the obstructing segment with the stiff end of the guidewire in 1 case and the Brockenbrough's trans-septal needle in the other. The gradients across the obstruction fell from 13 and 20 mm Hg to 3 and 4 mm Hg, respectively. Angioplasty resulted in dramatic clinical hemodynamic and angiographic improvement.
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Affiliation(s)
- V Dev
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi
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48
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Affiliation(s)
- T H Rao
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi
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49
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Anand AC, Sahni P, Vashisht S, Tandon RK. Congenital biliary cysts in Indian adults. Am J Gastroenterol 1991; 86:850-3. [PMID: 2058627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Only one report of congenital biliary cysts has been described so far from India, and that was in children. We present our experience with 22 adult Indian patients with this condition. The main presenting symptoms were abdominal pain, icterus, and fever, and the classical triad of jaundice, pain, and abdominal mass was seen in only one patient. The mean age of presentation was 25.5 +/- 10.1 yr, and females predominated (82%). Type Ia cysts (fusiform choledochal cyst) were the commonest. Intrahepatic cysts were seen in four patients; three of these were associated with extrahepatic biliary ductal cysts (type IVa). Internal drainage procedures performed elsewhere in six patients were followed by recurrent cholangitis, necessitating excision of the cyst. Hence, the preferred operation for congenital biliary cysts is cyst excision and hepaticojejunostomy.
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Affiliation(s)
- A C Anand
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi
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50
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Reddy KS, Sahni P, Pande GK, Nundy S. Research in Indian medical institutes. Natl Med J India 1991; 4:90-92. [PMID: 29751463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND METHODS The research output of medical institutions in India is thought to vary considerably, although no studies have been done since 1965. We consulted the Corporate Index of the Science Citation Index to count the number of publications included from each of the 128 medical institutions in India between 1981 and 1988. We also compared these results to the number of publications from leading international institutions in 1988. RESULTS Only 6 (4.7%) institutions had over 50 articles per year included, 33 (26%) had 5 to 50 articles included, 43 (38%) had 1 to 5 articles and 41 (32%) had less than one article included. Seven medical colleges had none. Only the All India Institute of Medical Sciences, New Delhi and the Post-graduate Institute of Medical Education and Research, Chandigarh could be compared with the world leaders. CONCLUSIONS The quality of research from Indian medical colleges is low. To improve it we suggest teaching institutions should forbid their faculty to undertake private practice. research grants should be disbursed more evenly and research achievement should be considered an important criterion for selection and promotion.
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Affiliation(s)
- K Sudhakar Reddy
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi 110029, India
| | - P Sahni
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi 110029, India
| | - G K Pande
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi 110029, India
| | - S Nundy
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi 110029, India
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