Kallianpur AA, Gupta N, Vinod N
… +3 more, Rakesh G, Samra SS, Goyal S
Trop Gastroenterol
· 2014 · PMID 25276905
BACKGROUND: There is an increasing incidence of advanced unresectable gallbladder cancer even in patients who undergo re-exploration and these cases are marked by poor survival even after undergoing curative resection an...BACKGROUND: There is an increasing incidence of advanced unresectable gallbladder cancer even in patients who undergo re-exploration and these cases are marked by poor survival even after undergoing curative resection and adjuvant chemotherapy. Lack of suspicion during primary surgery, unavailability of frozen section facilities and delayed referrals are believed to contribute to this high incidence. AIM: Our aim was to evaluate the results of re-surgery in incidental gallbladder cancers detected after open or laparoscopic cholecystectomy and to assess the outcome in patients who underwent complete radical cholecystectomy and adjuvant therapy. METHOD: We retrospectively analyzed the data from a prospectively maintained computerized database of all patients with incidentally detected gallbladder cancers operated in the Department of Surgical Oncology, from June 2006 to January 2013. RESULTS: Forty-two patients with incidental gallbladder cancer were re-explored. The median time of re-exploration after initial surgery was 65 days. Eighteen (43%) patients were found inoperable due to locally advanced unresectable or metastatic disease. Among the 24 (57%) patients who underwent completion radical cholecystectomy, 11 developed recurrence over a median time of 11 months. CONCLUSION: Despite the dismal prognosis, more than half of the incidentally detected gallbladder carcinoma patients could receive curative treatment. Identification of patients with incidentally discovered gallbladder cancer and early referral to an oncology center may ensure these patients receive curative resection thereby increasing their chances for long-term disease free survival.
BACKGROUND AND AIM: Though, the morbidity following pancreatoduodenectomy remains high the mortality rate has reduced to < 5% in many high volume centres. The aim of this prospective study was to quantify the complicatio...BACKGROUND AND AIM: Though, the morbidity following pancreatoduodenectomy remains high the mortality rate has reduced to < 5% in many high volume centres. The aim of this prospective study was to quantify the complications following pylorus preserving pancreatoduodenectomy using international definitions and to prove that pylorus preservation and retrocolic duodenojejunostomy are not associated with increased incidence of delayed gastric emptying. METHODS: This was a prospective observational study at a single GI surgery referral unit, conducted from January 2010 to December 2012. Patients who underwent pylorus preserving pancreatoduodenectomy for various indications were included; barring those who underwent major surgical procedures along with pancreatoduodenectomy. RESULTS: 76 patients (M:F = 37:39) underwent pylorus preserving pancreatoduodenectomy during the study period; with median age 52 yrs (range: 29-83) and hospital stay 11 days (range: 8-50). Overall mortality and significant morbidity were 7.89% and 12.5%, respectively. Four patients each (5.26%) developed significant delayed gastric emptying (DGE) and pancreatic fistula. Presence of comorbidity (p = 0.019; odds ratio: 3.16) and periampullary tumours (p = 0.011; odds ratio: 7.91) were identified as risk factors for the development of complications. Pancreatic juice amylase levels in chronic pancreatitis were very low (p < 0.005). CONCLUSION: Pylorus preserving pancreatoduodenectomy can be performed with very low mortality and morbidity at high volume centres. DGE is not significantly increased with pylorus preservation and retrocolic duodenojejunostomy, and is often secondary to post-op complications. The International Study Group of Pancreatic Fistula (ISGPF) definition may miss pancreatic fistula in chronic pancreatitis.
BACKGROUND: Severe autoimmune hepatitis is an entity which has been rarely reported in the Indian literature. We describe here the clinicopathological profile and treatment of severe autoimmune hepatitis (SAH) which is t...BACKGROUND: Severe autoimmune hepatitis is an entity which has been rarely reported in the Indian literature. We describe here the clinicopathological profile and treatment of severe autoimmune hepatitis (SAH) which is to the best of our knowledge the first report from India addressing this illness. METHODS AND RESULTS: Between September 2010 and March 2013, 13 patients seeking treatment at our centre were diagnosed as SAH and treated with steroids. Jaundice along with coagulopathy was the presenting symptom in all these patients. Ascites was present in ten and encephalopathy in 6 patients. The median serum IgG was 2135 mg/dl (range: 1122-5490).Significant titers of autoantibodies were present in all patients except one. Transjugular liver biopsy in 9 patients showed characteristic features of SAH such as extensive bridging necrosis and moderate to dense portal inflammation. With corticosteroid therapy, 10 patients survived while three died. In those who survived, biochemical improvement was seen as early as seven days with excellent long-term remission. CONCLUSIONS: Clinical suspicion supported by liver biopsy and autoimmune serology led to the diagnosis of SAH in a cohort of patients with unexplained liver failure. Corticosteroids were beneficial in majority of patients affording excellent results and this could be predicted by early reduction in serum bilirubin within 7-15 days.
John A, Al Kaabi S, Dweik N
… +14 more, Yakoub R, John A, Al Mohannadi M, Sharma M, Wani H, Butt MT, Derbala MF, Rasul K, Al Qahtani D, Taher M, Al Sada H, Suleiman J, Ghanem I, Abdulla F
BACKGROUND AND AIM: Colorectal cancer (CRC) is one of the leading causes of cancer related mortality globally. Though Asia has traditionally been considered a relatively low incidence area for colorectal cancer, the inci...BACKGROUND AND AIM: Colorectal cancer (CRC) is one of the leading causes of cancer related mortality globally. Though Asia has traditionally been considered a relatively low incidence area for colorectal cancer, the incidence is reportedly increasing. The Asia Pacific Working Group for Colorectal Cancer has recommended screening of individuals at average risk starting from 50 years of age. Based on these recommendations we conducted a pilot study to assess the need and feasibility of a colorectal cancer screening program in the state of Qatar. METHODS AND RESULTS: We screened 1385 individuals by fecal immunochemical testing for occult blood, at the primary health center level and positive cases were referred for colonoscopy. Among those who tested positive for fecal occult blood, we picked up five patients with cancers and seven with neoplastic polyps. CONCLUSION: Our results compare with the yield of screening programs in western countries thus suggesting an emerging role for colorectal cancer screening in Asian countries.
BACKGROUND: Serum cholinesterase (ChE) is an enzyme synthesised by hepatocytes and its serum levels reflect the synthetic function of liver. METHODS: In patients with cirrhosis, liver function tests, PT INR and serum ChE...BACKGROUND: Serum cholinesterase (ChE) is an enzyme synthesised by hepatocytes and its serum levels reflect the synthetic function of liver. METHODS: In patients with cirrhosis, liver function tests, PT INR and serum ChE levels were done within a week of enrolment. We studied 178 cirrhosis patients and 154 healthy controls prospectively. Receiver operator characteristics (ROC) curve analysis was employed to compute an optimal cut-off level to distinguish these groups. Correlation between ChE activity and serum bilirubin, albumin, PT INR and MELD score (Model for End-Stage Liver Disease) was analysed. RESULTS: Median serum ChE in cirrhotics was 1590 IU/L (110-8143) compared to controls 7886 IU/L (2022- 21673), p < 0.001. Serum ChE levels below 3506 had a 98.7% sensitivity and 80.3% specificity in predicting cirrhosis. Median serum ChE was higher (p < 0.001) in CC (n = 51) 4246 IU/L (680-8143) compared to DC (n = 127) 1324 IU/L (110-4550). ChE level less than 2385 IU/L had 80.1% sensitivity and 88.2% specificity in predicting DC. Follow-up levels in 25 patients showed good correlation with clinical course. The correlation coefficient between ChE and albumin was -0.67, 0.53 with PT INR and 0.59 with MELD score, (p < 0.001). CONCLUSIONS: Serum ChE is an excellent biomarker of cirrhosis with good sensitivity and specificity. It shows good correlation with serum albumin, PT INR and MELD score. Since it distinguishes DC from CC well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease. Long-term follow-up studies are warranted to define its exact role in clinical practice.
The role of radiologists in the management of portal hypertension (PHT) had been confined to its diagnosis and treatment planning. However, with the advancements in the field of interventional radiology various minimally...The role of radiologists in the management of portal hypertension (PHT) had been confined to its diagnosis and treatment planning. However, with the advancements in the field of interventional radiology various minimally invasive techniques have been evolved for the management of portal hypertension and its complications such as recanalisation techniques, shunt creation and variceal bleeding control. Thus, with these technical advances, there is shift in the role of radiologist from diagnosis to management of portal hypertension. In this review, we discuss the nuances of various radiological interventions available for the treatment of portal hypertension.