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Lad S, Bhandari S, Shah HR, Doctor N, Patankar R, Bhandari S. Per-oral cholangioscopy via a gastric access loop for the management of recurrent hepatolithiasis. Int J Gastrointest Interv 2022. [DOI: 10.18528/ijgii220006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sneha Lad
- Department of Digestive Diseases, Zen Multispeciality Hospital, Mumbai, India
| | - Suryaprakash Bhandari
- Gastrocare Centre of Excellence for Advanced Gastrointestinal Endoscopy and Endoscopic Surgery, Mumbai, India
| | - Hardik Rajesh Shah
- Gastrocare Centre of Excellence for Advanced Gastrointestinal Endoscopy and Endoscopic Surgery, Mumbai, India
| | - Nilesh Doctor
- Department of Digestive Diseases, Zen Multispeciality Hospital, Mumbai, India
| | - Roy Patankar
- Department of Digestive Diseases, Zen Multispeciality Hospital, Mumbai, India
| | - Smita Bhandari
- Gastrocare Centre of Excellence for Advanced Gastrointestinal Endoscopy and Endoscopic Surgery, Mumbai, India
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2
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Dhakre VW, Purushothaman G, Doctor N. Gallbladder Neuroendocrine Tumors: Is There a Need for a Specific Approach? Gastrointest Tumors 2022; 9:5-11. [PMID: 35528747 PMCID: PMC9021648 DOI: 10.1159/000520988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 10/06/2023] Open
Abstract
Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current guidelines and protocols are derived from the experience of managing lung small cell neuroendocrine carcinoma or gastrointestinal NETs. But, the overall outcome of gallbladder NETs (GB-NETs) seems worse than similarly staged lung NETs and adenocarcinoma of the gallbladder. This may be due to its rarity and lack of literature for a focused approach toward its treatment. Hence, the need for a specifically designed approach might help improve results of treatment for these rare tumors. We share our experience of 2 patients with GB-NETs and their 5-year outcome.
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Affiliation(s)
- Vijay Waman Dhakre
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Govind Purushothaman
- Department of Surgical Gastroenterology & HPB Surgery, Jaslok Hospital and Research Centre, Mumbai, India
| | - Nilesh Doctor
- Department of Surgical Gastroenterology & HPB Surgery, Jaslok Hospital and Research Centre, Mumbai, India
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3
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Akula B, Doctor N. A Prospective Review of Preoperative Nutritional Status and Its Influence on the Outcome of Abdominal Surgery. Cureus 2021; 13:e19948. [PMID: 34868791 PMCID: PMC8627379 DOI: 10.7759/cureus.19948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 11/24/2021] [Indexed: 11/06/2022] Open
Abstract
Aim To assess the incidence of malnutrition in a surgical gastroenterology unit and analyze its impact on postoperative complication rates. Method Data were prospectively accrued from patients admitted for emergency or elective surgery to the gastrointestinal surgery unit at Jaslok Hospital between May 2013 and May 2014. The nutritional status was preoperatively assessed by using anthropometric parameters like body mass index (BMI), midarm circumference (MAC), and tissue skinfold thickness (TSFT). In addition, a subjective global assessment scale (SGA), serum albumin, and absolute lymphocyte count (ALC) were used. Patients with BMI <18.5, MAC <24 cm in males and <22 cm in females, and TSFT <10 mm were considered malnourished. Patients with serum albumin between 3 and 3.5 g/dl were considered mild, 2.4-2.9 g/dl was moderate, and <2.4 g/dl were severely malnourished. Patients with ALC between 1200 and 2000/cm were labelled mild, between 800 and 1199/cm were moderate, and <800/cm were severely malnourished. As per SGA, well-nourished had less than 5% weight loss or if more than 5%, with recent gain and improved appetite, mild/moderately malnourished had 5% to 10% weight loss with no gain, mild subcutaneous fat loss, and those severely malnourished had more than 10% weight loss, severe subcutaneous fat loss, and muscle wasting. Postoperative complications were graded as per the Clavien-Dindo classification. Patients with grades 1 and 2 complications were labelled as minor and the rest as major. Result Men in the age group of 40-60 years comprised the majority of the study population. The most frequent reason for admission was cholelithiasis. The overall incidence of malnutrition was 22.16%. Out of the 96 patients who had complications, 45 had minor and 41 had significant complications. Amongst the well-nourished, the incidence of complications was 26.62% of which the majority were minor complications. Severely malnourished patients had a high complication rate (63.38%); 32% out of the 63.38% developed significant complications. The majority of the patients suffering from severe malnutrition belonged to the sub-group with chronic pancreatitis and carcinoma of the pancreas. According to the chi-square analysis of the data, ALC, serum albumin, and SGA correlate with the postoperative complication rate with a p-value <0.05 as significant. On the contrary, BMI, MAC, and TSFT did not correlate with postoperative complications. Conclusion Preoperative malnutrition is common among patients undergoing abdominal surgeries in the urban private health care sector. Although there have been studies that have analyzed the incidence of malnutrition in patients undergoing oncological surgeries, there is limited literature on malnutrition among patients subjected to gastrointestinal surgeries. We conclude that simple bedside nutritional assessment tools like serum albumin, absolute lymphocyte count, and SGA can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.
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Affiliation(s)
- Bharathi Akula
- Surgery, University Hospital of Leicester, Leicestershire, GBR
| | - Nilesh Doctor
- Gastrointestinal Surgery, Jaslok Hospital and Research Centre, Mumbai, IND
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4
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Malewadkar S, Shetty V, Vyas S, Doctor N. Undiagnosed Hepatic Tuberculosis Presenting With Intraabdominal Rupture and Hemoperitoneum, Requiring Urgent Hepatic Resection. J Clin Exp Hepatol 2021; 11:506-510. [PMID: 34276156 PMCID: PMC8267355 DOI: 10.1016/j.jceh.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis (TB) affecting the liver is unusual, and isolated liver TB presenting as a liver abscess more so, even in countries where the disease is endemic. As clinical symptoms and imaging are not typical, a high index of suspicion is necessary for diagnosis. We present here a lady who was admitted with fever and chills. Ultrasound imaging showed a liver abscess. She developed bleeding into the abscess cavity, necessitating an emergency right liver resection. Final histology confirmed mycobacterial granulomatous infection of the liver. Isolated hepatic abscess of tubercular origin is a rare cause of hemorrhage but should be considered as a differential diagnosis. Suspicious features on computerized tomography (CT) scan should prompt microbiological assessment of aspirate from the abscess, establishing the diagnosis, so appropriate treatment can be started, avoiding such complications.
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Affiliation(s)
- Shitesh Malewadkar
- Department of Hepato Biliary and Pancreatic Surgery, Jaslok Hospital and Medical Research Centre, Mumbai, India
| | - Vivek Shetty
- Department of Hepato Biliary and Pancreatic Surgery, Jaslok Hospital and Medical Research Centre, Mumbai, India
| | - Soumil Vyas
- Department of Hepato Biliary and Pancreatic Surgery, Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Nilesh Doctor
- Department of Hepato Biliary and Pancreatic Surgery, Jaslok Hospital and Medical Research Centre, Mumbai, India,Address for correspondence. Dr Nilesh Doctor, MS DNB FRCS, Department of Surgical Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India.
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5
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van Brunschot S, Hollemans RA, Bakker OJ, Besselink MG, Baron TH, Beger HG, Boermeester MA, Bollen TL, Bruno MJ, Carter R, French JJ, Coelho D, Dahl B, Dijkgraaf MG, Doctor N, Fagenholz PJ, Farkas G, Castillo CFD, Fockens P, Freeman ML, Gardner TB, Goor HV, Gooszen HG, Hannink G, Lochan R, McKay CJ, Neoptolemos JP, Oláh A, Parks RW, Peev MP, Raraty M, Rau B, Rösch T, Rovers M, Seifert H, Siriwardena AK, Horvath KD, van Santvoort HC. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. Gut 2018; 67:697-706. [PMID: 28774886 DOI: 10.1136/gutjnl-2016-313341] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. DESIGN We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). RESULTS Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). CONCLUSION In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.
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Affiliation(s)
- Sandra van Brunschot
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert A Hollemans
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Research and Development, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Olaf J Bakker
- Department of Surgery, University Medical Center Utrecht, Utrecht
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hans G Beger
- Department of Surgery, University of Ulm, Ulm, Germany
| | | | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ross Carter
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Jeremy J French
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Djalma Coelho
- Department of Surgery, Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Björn Dahl
- Department of Internal Medicine, Oldenburg Municipal Hospital, Oldenburg, Germany
| | - Marcel G Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Nilesh Doctor
- Department of Gastrointestinal Surgery, Jaslok Hospital and Research Center, Mumbai, India
| | - Peter J Fagenholz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gyula Farkas
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Paul Fockens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Martin L Freeman
- Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Timothy B Gardner
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Operating Rooms-Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rajiv Lochan
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin J McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - John P Neoptolemos
- Clinical Directorate of General Surgery, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Atilla Oláh
- Department of Surgery, Petz-Aladár Teaching Hospital, Györ, Hungary
| | - Rowan W Parks
- Department of Surgery, University of Edinburgh, Edinburgh, UK
| | - Miroslav P Peev
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Raraty
- Clinical Directorate of General Surgery, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Bettina Rau
- Department of Surgery, University of Rostock, Rostock, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maroeska Rovers
- Operating Rooms-Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Seifert
- Department of Internal Medicine, Oldenburg Municipal Hospital, Oldenburg, Germany
| | | | - Karen D Horvath
- Department of Surgery, University of Washington, Seattle, USA
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht, Utrecht.,Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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Vyas PK, Godbole C, Bindroo SK, Mathur RS, Akula B, Doctor N. Case-based discussion: an unusual manifestation of diaphragmatic hernia mimicking pneumothorax in an adult male. Int J Emerg Med 2016; 9:11. [PMID: 26924754 PMCID: PMC4770005 DOI: 10.1186/s12245-016-0108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/20/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
Diaphragmatic hernia is an important cause of emergency hospital admission associated with significant morbidity. It usually results from congenital defect or rupture in the diaphragm due to trauma. Prompt and appropriate diagnosis is necessary in patients with this condition, as surgical intervention by either abdominal or thoracic approach may be necessary. Here, we report a case of left-sided diaphragmatic hernia presenting with sudden onset of breathlessness, respiratory distress and left-sided chest pain radiating to the abdomen, mimicking pneumothorax, treated successfully with surgical intervention.
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Affiliation(s)
- Pradeep Kumar Vyas
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026.
| | - Chintamani Godbole
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
| | - Susheel Kumar Bindroo
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026
| | - Rajiv S Mathur
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026
| | - Bharathi Akula
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
| | - Nilesh Doctor
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
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7
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Gomes RM, Doctor N. Three level risk assessment for pancreatic fistula formation after distal pancreatectomy with a strategy for prevention. ACTA ACUST UNITED AC 2013; 33:207-13. [PMID: 23600052 DOI: 10.7869/tg.2012.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Distal pancreatectomy (DP) has a high post-operative morbidity predominantly due to pancreatic fistula though the mortality is very low. Data on distal pancreatectomy was reviewed to analyse the risk factors that contribute to this morbidity. METHODS Thirty three patients underwent distal pancreatectomy with sutured closure of the remnant, over a 5-year period between May 2006 and April 2011. Pancreatic fistula (PF) was defined according to the International Study Group on Pancreatic Fistula definition. Patient and surgical risk factors were subdivided as those reflecting a poorer pre-morbid status, those associated with increased complexity of surgery and those related to pancreas gland and were analyzed for incidence of pancreatic fistula. RESULTS Indications for DP included 16 (51.5%) pancreatic tumours, 13 (39.4%) chronic pancreatitis and 3 (9.1%) trauma. Spleen was preserved in 12 patients (36.4%). There was no mortality while the morbidity rate was 45.5% (n = 15). Incidence of pancreatic fistula was 30.3% (n = 10); eight were grade A (80%) and two were grade C (20%). Incidence of clinically significant pancreatic fistulae was 6.1%. PF was significantly more common if the pancreatic duct was not identified (p = 0.024) was significantly less with extensive peri-pancreatic adhesions (p = 0.036). CONCLUSIONS Identification and ligation of main pancreatic duct can help reduce the incidence of pancreatic fistulae. The identification of patients at high risk of developing a PF helps to implement prevention strategies.
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Affiliation(s)
- Rachel M Gomes
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India.
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8
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Gupta RA, Udwadia FE, Agrawal P, Doctor N. Pancreatic glucagonoma with pancreatic calcification. Pancreatology 2012; 13:327-9. [PMID: 23719610 DOI: 10.1016/j.pan.2012.11.308] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glucagonoma is an uncommon type of pancreatic neuroendocrine tumor [NET] which is characterized by diabetes mellitus, necrolytic migratory erythema, depression and deep vein thrombosis. The typical rash is often misdiagnosed and the diagnosis is delayed by 7-8 years. Pancreatic NETs and other pancreatic tumors are known to show calcifications within the tumor but calcification of the remaining normal pancreas is very uncommon. It occurs when there is ductal obstruction leading to acute or chronic pancreatitis. CASE REPORT We present a case of glucagonoma with coexistent pancreatic calcification. CONCLUSION Glucagonoma should be suspected in a diabetic patient with migratory rash. Pancreatic tumor should be suspected in patient with idiopathic focal pancreatitis.
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Affiliation(s)
- Rahul Amreesh Gupta
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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Gandhi V, Doctor N, Marar S, Nagral A, Nagral S. Major hemobilia--experience from a specialist unit in a developing country. Trop Gastroenterol 2011; 32:214-218. [PMID: 22332338] [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: 05/31/2023]
Abstract
BACKGROUND AND AIM Hemobilia is a rare but potentially life threatening problem, which can be difficult to diagnose and treat. In the last few decades there has been a change in the etiologic spectrum and management of this problem in the West. The aim of this study was to analyze the etiology, clinical features, management and outcome of major hemobilia in a tertiary referral centre from western India. METHODS A retrospective analysis was undertaken on 22 patients (16 males, 6 females; mean age 39 years, range 13 to 74) who presented with major hemobilia over a 5-year period. RESULTS The etiology was iatrogenic in 13 patients (percutaneous transhepatic biliary drainage 8, post laparoscopic cholecystectomy 3, endoscopic retrograde cholangiopancreatography 1, and liver biopsy 1), liver trauma in 6 and liver tumors in 3 patients. Twenty patients presented with gastrointestinal bleeding (melena 20 patients, hemetemesis with melena 8 patients), 5 with jaundice and 8 had fever. Abdominal angiography was performed in 20 patients. Angiography revealed pseudoaneurysm of the right hepatic artery or its branches in 14 patients, left hepatic artery in 2, an arterio-biliary fistula in 1, tumor blush in 1 and the source could not be located in 2 patients. Seventeen of the 22 patients were treated with radiological intervention, 3 required surgery (liver resection for tumors 2, laparotomy for venous collateral bleeding of portal cavernoma 1) and two were managed conservatively. Radiological intervention involved embolisation with coils and/or glue in 16, and chemoembolisation in 1 patient. Sixteen of 17 patients responded to embolisation. Overall there were two deaths. CONCLUSION The spectrum of hemobilia seen in India is now similar to that in the developed world with iatrogenic causes being the commonest. Interventional radiology can treat a majority of patients reducing the need and morbidity associated with surgery.
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Affiliation(s)
- Vidhyachandra Gandhi
- Department of Gastrointestinal Surgery, Jaslok Hospital and Research Centre, Mumbai - 400026, India
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10
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Doctor N, Philip S, Gandhi V, Hussain M, Barreto SG. Analysis of the delayed approach to the management of infected pancreatic necrosis. World J Gastroenterol 2011; 17:366-71. [PMID: 21253397 PMCID: PMC3022298 DOI: 10.3748/wjg.v17.i3.366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/02/2010] [Accepted: 09/09/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP).
METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed.
RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.
CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
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Gandhi V, Philip S, Maydeo A, Doctor N. Ruptured subcapsular giant haematoma of the spleen--a rare complication of acute pancreatitis. Trop Gastroenterol 2010; 31:123-124. [PMID: 20862992] [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: 05/29/2023]
Affiliation(s)
- Vidhyachandra Gandhi
- Department of Surgical Gastroenterology, Jaslok Hospital & Research Centre, Mumbai.
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13
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Doctor N, Gandhi V, Shah S, Hussain M, Marar S, Philip S. Stent angioplasty of narrowed portocaval shunt in Budd Chiari syndrome: a case report. Cases J 2009; 2:1. [PMID: 19117529 PMCID: PMC2648948 DOI: 10.1186/1757-1626-2-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/01/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results. CASE PRESENTATION A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt. CONCLUSION At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.
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Affiliation(s)
- Nilesh Doctor
- Department of Gastrointestinal Surgery, Jaslok Hospital & Research Centre, Mumbai, India
| | - Vidhyachandra Gandhi
- Department of Gastrointestinal Surgery, Jaslok Hospital & Research Centre, Mumbai, India
| | - Sharad Shah
- Department of Gastroenterology, Jaslok Hospital & Research Centre, Mumbai, India
| | - Maharra Hussain
- Department of Gastrointestinal Surgery, Jaslok Hospital & Research Centre, Mumbai, India
| | - Shaji Marar
- Department of Interventional Radiology, Jaslok Hospital & Research Centre, Mumbai, India
| | - Sujith Philip
- Department of Gastrointestinal Surgery, Jaslok Hospital & Research Centre, Mumbai, India
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Nagral A, Nabi F, Humar A, Nagral S, Doctor N, Khubchandani SR, Amdekar YK. Reversal of severe hepato-pulmonary syndrome in congenital hepatic fibrosis after living-related liver transplantation. Indian J Gastroenterol 2007; 26:88-9. [PMID: 17558074] [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
We report a 5-year-old girl with congenital hepatic fibrosis who presented with clubbing and cyanosis. Partial pressure of oxygen was 40 mmHg with oxy-gen saturation of 70% on room air, which improved to 128 mmHg and 92% on inhalation of 100% oxygen. Macroaggregated albumin scan showed 58% shunting to the brain, suggestive of severe hepatopulmonary syndrome. Echocardiogram and pulmonary angiogram ruled out pulmonary hypertension. Four weeks after living-related liver transplantation, she had normal blood gases and reduction in shunting to 7% on macroaggregated albumin scan.
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Affiliation(s)
- Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India.
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Bhandari M, Shah S, Nagral S, Doctor N. Treatment of symptomatic polycystic liver disease with resection-fenestration. Indian J Gastroenterol 2002; 21:163-4. [PMID: 12385552] [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
Polycystic liver disease with severe symptoms is difficult to treat. We report a 35-year-old man with advanced disease, who had a successful outcome after resection and fenestration.
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Affiliation(s)
- M Bhandari
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Center, Mumbai
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16
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Doctor N. Non-hepatic surgery in patients with chronic liver disease. Indian J Gastroenterol 2001; 20 Suppl 1:C108-10. [PMID: 11293173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- N Doctor
- Jaslok Hospital and Medical Research Center, Mumbai
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Rai R, Dick R, Doctor N, Dafnios N, Morris R, Davidson BR. Predicting early mortality following percutaneous stent insertion for malignant biliary obstruction: a multivariate risk factor analysis. Eur J Gastroenterol Hepatol 2000; 12:1095-100. [PMID: 11057454 DOI: 10.1097/00042737-200012100-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Percutaneous stent placement is an accepted method of palliation in malignant biliary obstruction. Factors predicting early mortality after this procedure have not been identified. METHODS We performed a retrospective study of 141 patients with malignant biliary obstruction who underwent percutaneous stent placement for biliary decompression to identify the risk factors associated with early mortality (< or = 30 days). RESULTS Of 14 clinicopathological and laboratory variables analysed blood urea, albumin, haemoglobin and alkaline phosphatase were found to be significant on univariate analysis. The age and gender of the patient along with cancer type, level of obstruction, presence of pyrexia and bilirubin level had no influence on early mortality. Stepwise logistic regression identified the haemoglobin level and blood urea to be independently significant in predicting early mortality. Overall 30-day mortality was 20.5% (29/141). Patients with blood urea over 4.3 mmol/l and a haemoglobin less than 10.9 g/dl had a mortality rate of 52% (12/23) compared with 14% (17/118) in the remainder. Using these two variables a regression equation has been derived which allows calculation of the probability of survival at 30 days after the percutaneous procedure. CONCLUSIONS Laboratory variables in patients with malignant obstructive jaundice can be used to predict mortality following percutaneous stent insertion.
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Affiliation(s)
- R Rai
- University Department of Surgery, Royal Free and University College Medical School, London, UK
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Davidson BR, Burnett S, Javed MS, Seifalian A, Moore D, Doctor N. Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy. Br J Surg 2000; 87:790-5. [PMID: 10848861 DOI: 10.1046/j.1365-2168.2000.01427.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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: 02/07/2023]
Abstract
BACKGROUND Ensuring adequate haemostasis is a major difficulty in the field of liver surgery. This study aimed to evaluate a novel fibrin sealant (Vivostat), designed for autologous preparation, in a porcine model of partial hepatectomy. METHODS Thirty-six Large White Landrace pigs underwent partial left hepatectomy by finger fracture under portal vascular inflow occlusion. Animals were randomized to treatment of the resected surface with either fibrin sealant (Vivostat, n = 12) or regenerated oxidized cellulose gauze (Surgicel, n = 12), or were left untreated (controls, n = 12). Blood loss from the resection margin was measured at 2-min intervals for 10 min, and the time to haemostasis was recorded. Following complete haemostasis the animals recovered for 7 days. RESULTS Median (range) blood loss in the control group was 94.3 (17.3-467.0) g, and was significantly reduced with Vivostat (13.8 (5.5-150.9) g) and Surgicel (22.8 (5.8-67.3) g). Median (range) time to haemostasis in controls (31 (12-52) min) was also significantly reduced by Vivostat (8 (0-32) min) and Surgicel (10 (0-19) min) (both P < 0.001 versus controls, Kruskal-Wallis test). CONCLUSION The novel fibrin sealant, Vivostat, is as effective as Surgicel cellulose gauze in achieving haemostasis after porcine partial hepatic lobectomy.
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Affiliation(s)
- B R Davidson
- University Department of Surgery and Comparative Biology Unit, Royal Free and University College School of Medicine, London, UK
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Davidson BR, Rai R, Nandy A, Doctor N, Burroughs A, Rolles K. Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies. Liver Transpl 2000; 6:201-6. [PMID: 10719021 DOI: 10.1002/lt.500060215] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Advances in radiological and endoscopic techniques have allowed many biliary complications after orthotopic liver transplantation (OLT) to be managed without surgery. The influence of nonsurgical management on the outcome of patients requiring surgical revision has not been addressed. We reviewed our 10-year experience (October 1988 to January 1998) of Roux-en-Y choledochojejunostomy (CDJ) to treat biliary complications after OLT. Forty-six patients underwent CDJ for biliary complications (32 men, 14 women; age, 22 to 65 years; median, 60 years). Biliary reconstruction at the time of OLT was duct to duct in 41 patients, primary CDJ in 3 patients, and gall bladder conduit in 2 patients. T-tubes were used only in patients with gallbladder conduit. The indication for CDJ was biliary leak (23 patients), stricture (20 patients), biliary stones (2 patients), and biliary sludge (1 patient). Two patients (4.3%) had associated hepatic artery thrombosis. The bile leaks were diagnosed at a median of 29 days post-OLT (range, 2 to 65 days) and strictures at a median of 2 years (range, 33 days to 6.5 years) post-OLT. Before surgery, 25 patients (54%) underwent an attempt at radiological or endoscopic therapeutic intervention that failed. Median follow-up was 5 years (range, 9 months to 10 years). Early complications occurred in 12 patients (26%); the most common was chest infection (4 patients). There were 3 perioperative deaths (6%); 1 death was directly related to surgery. Late complications, mainly anastomotic strictures, occurred in 10 patients (22%), half of which were successfully treated by biliary balloon dilatation. The complication rate post-CDJ was less in those who underwent a failed nonsurgical approach than those proceeding straight to surgery (9 of 25 patients; 36% v 13 of 21 patients; 62%; P =.21, not significant). The procedure-related mortality for surgical revision of biliary complications after OLT is low, but early and late complications are common. A failed attempt at nonsurgical management does not increase the complications of reconstructive surgery. Strictures after CDJ should be considered for biliary balloon dilatation.
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Affiliation(s)
- B R Davidson
- Hepatobiliary and Liver Transplantation Unit, Royal Free Hospital and Royal Free and University College Medical School, London, UK
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Doctor N, Dick R, Rai R, Dafnios N, Salamat A, Whiteway H, Dooley J, Davidson BR. Results of percutaneous plastic stents for malignant distal biliary obstruction following failed endoscopic stent insertion and comparison with current literature on expandable metallic stents. Eur J Gastroenterol Hepatol 1999; 11:775-80. [PMID: 10445799 DOI: 10.1097/00042737-199907000-00016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Endoscopic stenting is an effective method of relieving biliary obstruction in patients with unresectable malignancy. If this fails, optimal management is controversial. Percutaneous insertion of plastic or mesh metal stents has been advocated. AIM To review the outcome of percutaneous plastic stents and compare this with contemporary data from the literature on mesh metal stenting. PATIENTS AND METHODS Over a period of six years, 400 patients had attempted endoscopic stenting for distal malignant biliary obstruction which failed in 54 (13.5%). These 54 patients were treated with percutaneously placed plastic stents. RESULTS Percutaneous stenting was technically successful in 48 patients (89%). Early complications occurred in 13 patients (24%), the commonest being acute cholangitis in seven (12%). There was no procedure-related mortality but a 30-day mortality of 11 % (n = 6). Ten patients (18%) required re-admission after 30 days for stent block (mean period 4 months). Forty-seven patients (87%) were followed up until death. The median survival for the patients undergoing palliative stenting was 3 months (5 days to 17 months). CONCLUSIONS These results suggest that percutaneous plastic stents can be used safely and effectively in patients who have failed endoscopic stenting.
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Affiliation(s)
- N Doctor
- Department of Surgery, Royal Free Hospital and Medical School, London, UK
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Abstract
BACKGROUND Bile leaks and bile duct strictures are major complications of cholecystectomy which increased in incidence after the introduction of laparoscopic surgery. The management and outcome of these complications following the introduction of laparoscopic cholecystectomy was reviewed. METHODS Eighteen patients of median age 45 (range 22-70) years were treated between January 1992 and December 1995. Six patients had a common hepatic duct (CHD) stricture, four following a failed previous repair. Nine patients had bile leaks from bile duct transection (four), cystic stump (four) or segment V duct (one). Two patients had partial bile duct damage with primary sutured repair at time of cholecystectomy. One patient had recurrent haemobilia from a hepatic artery pseudoaneurysm. RESULTS Cystic stump or segment V leaks were treated successfully by endoscopic stenting (median follow-up 42 months). Roux loop biliary reconstruction was carried out in nine patients: two CHD strictures, three of the four failed primary CHD repairs and four bile duct transections. All had normal liver function test results at median follow-up of 30 months. The two patients with partial duct injuries repaired at initial surgery required no further intervention. The right hepatic artery aneurysm was successfully embolized. There have been no deaths or major complications of endoscopic, radiological or surgical intervention. CONCLUSION Endoscopic stenting successfully treats cystic stump and segment V duct leaks. Duct strictures, including failed initial repairs and transections, have a good outcome with Roux-en-Y loop reconstruction.
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Affiliation(s)
- N Doctor
- Department of Surgery, Royal Free Hospital and Medical School, London, UK
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Doctor N, Dafnios N, Jones A, Davidson BR. Primary squamous carcinoma of liver: presentation as liver abscess. Indian J Gastroenterol 1998; 17:28-9. [PMID: 9465512] [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
Primary keratinizing squamous carcinoma of the liver has been reported as arising in a hepatic cyst, in association with prolonged cholestasis or chronic biliary sepsis. We describe the occurrence of such a tumor without predisposing factors, with presentation similar to that of hepatic abscess.
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Affiliation(s)
- N Doctor
- University Department of Surgery, Royal Free Hospital and School of Medicine, London, England
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Nagral S, Doctor N, Davidson BR. Liver resection. Indian J Gastroenterol 1997; 16:144-8. [PMID: 9357187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- S Nagral
- Department of Surgery, K E M Hospital, Mumbai.
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Doctor N, Dafnios N, Dick R, Davidson BR. Peritoneal seeding of pancreatic head carcinoma following percutaneous transhepatic drainage and stenting. Br J Surg 1997; 84:197. [PMID: 9052432] [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: 02/03/2023]
Affiliation(s)
- N Doctor
- University Department of Surgery, Royal Free Hospital School of Medicine, London, UK
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Doctor N, Dafnios N, Dick R, Davidson BR. Peritoneal seeding of pancreatic head carcinoma following percutaneous transhepatic drainage and stenting. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02548.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Doctor N, Dafnios N, Dick R, Davidson BR. Peritoneal seeding of pancreatic head carcinoma following percutaneous transhepatic drainage and stenting. Br J Surg 1997. [DOI: 10.1002/bjs.1800840215] [Citation(s) in RCA: 3] [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: 11/11/2022]
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Doctor N, Dooley JS, Davidson BR. Assessment of pancreatic duct damage following trauma: is endoscopic retrograde cholangiopancreatography the gold standard? Postgrad Med J 1995; 71:116-7. [PMID: 7724424 PMCID: PMC2397958 DOI: 10.1136/pgmj.71.832.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 01/26/2023]
Abstract
A 12-year-old girl was admitted as an emergency with blunt pancreatic trauma. Computed tomography (CT) showed an intact pancreas. She failed conservative treatment. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated division of the pancreatic duct at the neck of pancreas. At laparotomy, however, there was complete necrosis of the pancreatic head. She recovered well following enteric drainage of the body of pancreas. CT and ERCP are considered the optimal imaging for pancreatic trauma but the findings may be misleading.
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Affiliation(s)
- N Doctor
- Hepatobiliary and Liver Transplant Unit, Royal Free Hospital and School of Medicine, London, UK
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Navani S, Shah P, Pandya S, Doctor N. Abdominal cocoon--the cauliflower sign on barium small bowel series. Indian J Gastroenterol 1995; 14:19. [PMID: 7860113] [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
We report a case of abdominal cocoon encasing the small bowel diagnosed pre-peratively on radiology. Barium small bowel series showed the ileal loops clumped together as within a sac, giving a cauliflower-like appearance on sequential films. At surgery, the membrane enclosing the loops was thin and flimsy.
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Affiliation(s)
- S Navani
- Department of Radiology, K E M Hospital, Bombay
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Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med 1992; 38:112-4, 111. [PMID: 1303408] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To study the effect of hyperbaric oxygen therapy in chronic diabetic foot lesions, a prospective controlled study was undertaken. Thirty diabetics with chronic foot lesions were randomised to study group (conventional management and 4 sessions of hyperbaric oxygen therapy) and control group (conventional management). The patients were assessed for average hospital stay, control of infection and wound healing. The control of infection spread was quicker. Positive cultures decreased from initial 19 to 3 in study group as against from 16 to 12 in the control group. (p < 0.05). This difference was most pronounced for Escherichia coli. Also, the need for major amputation was significantly less in the study group (n = 2) as against the control group (n = 7) (p < 0.05). The average hospital stay was not affected. We conclude that hyperbaric oxygen therapy can be safely used and is beneficial as an adjuvant therapy in chronic diabetic foot lesions.
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Affiliation(s)
- N Doctor
- Dept of Surgery, Seth GS Medical College, Parel, Bombay, Maharashtra
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