Stenting of coeliac axis stenosis facilitates pancreatectomy.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
K V Menon
Publications and source records attributed to K V Menon.
Osteoclast-like giant cell tumour of the pancreas: an undifferentiated carcinoma of duct epithelial origin.
Explore the source record for details and available documents.
Adenocarcinoma↗
Redefining the R1 resection in pancreatic cancer.
BACKGROUND: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status. METHODS: A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non-standardized protocol was used (NSP series, n = 48). RESULTS: Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0.001), but not for the NSP series. There was a trend towards better median and actuarial 5-year survival after R0 resection in the SP pancreatic cancer subgroup. CONCLUSION: Standardized examination influences the reporting of RM status.
Adenocarcinoma↗
Successful outcome following resection of a pancreatic liposarcoma with solitary metastasis.
Liposarcomas are rare soft tissue tumors, commonly affecting the lower limbs and less commonly the retroperitoneum. Although other organs can be affected, the pancreas is one of the rarest, and metastasis at presentation has never been reported. We describe the case of a 76-year-old gentleman presenting with abdominal pain and an abdominal mass. Imaging confirmed a primary tumor in the body and tail of the pancreas, with a metastatic deposit in the mesentery adjacent to the second part of the duodenum. Biopsy confirmed a liposarcoma, and subsequently a complete surgical excision was achieved. He then received adjuvant radiotherapy and has remained disease free for the next 26 mo.
Aged↗
Re: heterotopic pancreatitis with obstruction of the major duodenal papilla.
Explore the source record for details and available documents.
Duodenal Diseases↗
Morphological study of rib regeneration following costectomy in adolescent idiopathic scoliosis.
This is a prospective observational study comparing cases with retrospective controls. The aim of the study is to compare rib regeneration with a scaffold placed intra-periosteally against no scaffold, after costectomy in adolescent idiopathic scoliosis. A prospective study was conducted at Amrita Institute of Medical Sciences on 16 consecutive patients (51 ribs) with adolescent idiopathic scoliosis who underwent costectomy and application of gel foam in the rib bed as a scaffold. These patients were compared with a retrospective group of 15 patients (33 ribs) who did not have the scaffold. All prospective and retrospective patients were followed up for a minimum period of 6 months and were analyzed radiographically for rib regeneration and morphology. A classification system was devised to include all possible morphologies of regenerate. The resulting data, when analyzed showed that majority of ribs re-grew to normal morphology in 3-6 months in the trial group. In comparison the regeneration in the retrospective controls was slower and poorer in quality. Ribs treated by placement of gel foam scaffold in the bed regenerate to a near normal radiological profile within 6 months of costectomy compared to a slower regeneration in those without gel foam scaffold.
Adolescent↗
In-contiguity and non-anatomical extension of right hepatic trisectionectomy for liver metastases.
BACKGROUND: In some patients undergoing right hepatic trisectionectomy for metastases, extension of the resection beyond the falciform ligament is necessary to achieve tumour clearance. The aim of the present study was to assess the early and long-term outcomes and hepatic function in patients who underwent extensive liver resection beyond right trisectionectomy. METHODS: Thirty-eight patients who had extension of a right trisectionectomy, either in contiguity (IC) or in a non-anatomical (NA) fashion, for liver metastases were included in the study. In-hospital mortality, hepatic function and other morbidity were recorded. Survival outcomes were analysed for the subgroup of patients with colorectal liver metastases. The clinical risk score described by the Memorial Sloan-Kettering Cancer Center was applied to all patients with colorectal liver metastases. RESULTS: Sixteen patients had IC resection, 15 NA resection, and seven had both IC and NA procedures. There was one in-hospital death. Hepatic dysfunction was seen in 25 patients and two developed liver failure. Disease-free actuarial 3-year survival was 42 per cent for patients with colorectal liver metastases. Survival was significantly better in patients with a clinical risk score of 3 or less. CONCLUSION: Extension of right trisectionectomy for liver metastases was associated with a low risk of death and hepatic failure.
Adult↗
Early changes in pulmonary function following thoracotomy for scoliosis correction: the effect of size of incision.
It is generally believed that minimal access surgery may produce less change in pulmonary function than conventional open thoracotomy for scoliosis correction. Though there is considerable literature regarding changes in pulmonary function tests (PFT) after thoracotomy, there is scant data available regarding the effect of the magnitude of thoracic wall disruption on pulmonary function, particularly in the early postoperative weeks. This study aims to evaluate the effect of the size of incision on pulmonary function after anterior release and fusion in patients with moderate thoracic curves due to adolescent idiopathic scoliosis. The study group was made up of 19 patients with thoracic curves due to adolescent idiopathic scoliosis. The subjects had had thoracotomy for anterior release, followed by posterior instrumentation and fusion at a second sitting. The ten patients who had had conventional, large thoracotomy were placed in group A and the nine minimal access cases in group B. PFTs consisting of volume (FVC) and flow (FEV1) were obtained before the anterior release, 2 weeks later (before the posterior instrumented fusion), and 3 months after the posterior fusion. The degree of deformity in the sagittal and the coronal plane preoperatively and postoperatively were measured and documented. The mean preoperative pulmonary function was significantly less than the predicted values for both patient groups. There was a decline in the postoperative pulmonary function (both percentage predicted value and absolute value) in both groups at 2 weeks and at 3 months. The deterioration of pulmonary function was less in the small-thoracotomy group, but this difference between the groups was statistically significant only for the 2-week values. Our study shows that there is significant pulmonary function restriction even in patients with moderate thoracic curves. There was a lesser decline in pulmonary function in the minimal-access group, as compared with the standard thoracotomy group, but this difference was only in the early postoperative period and became insignificant by 3 months.
Adolescent↗
Multiport staging laparoscopy in esophageal and cardiac carcinoma.
Between February 1993 and September 2000, 320 patients with esophageal cancer were referred to our oesophagogastric unit. One hundred and thirty-three consecutive patients with histologically proven carcinoma of the esophagus were assessed with a view to resection using multiport staging laparoscopy. Multiport staging laparoscopy was performed as a short stay/day case procedure in 133 patients with esophageal and oesophagogastric junctional carcinoma. Multiple ports were used to inspect the liver, omentum, peritoneal surfaces, coeliac/left gastric lymph nodes and obtain biopsies and cytology. Satisfactory assessment was possible in 127 cases (95%). Laparoscopy detected incurable disease in 31 patients (24%), some of whom had more than one contraindication to surgery, including hepatic metastases (n = 10), peritoneal metastases (n = 12) and malignant small volume ascites (n = 5). Lymph node metastases were confirmed histologically by biopsy at laparoscopy in 26 patients (fixed nodes, n = 14; mobile nodes, n = 12). Sensitivity for the detection of liver and peritoneal metastases was 100%, and lymph node metastases were 83%. Specificity for detection of hepatic metastases was 99%, 100% for peritoneal metastases and 82% for lymph node metastases. Ninety-nine patients proceeded to definitive surgery and only two were unresectable. Multiport laparoscopic assessment of metastases in patients with esophageal carcinoma avoids unnecessary surgery and allows for more efficient use of theatre and intensive care time.
Adult↗
Spinal fixation device: a 6-year postimplantation study.
Long-term tissue response to a metal device is described here. The components of a spinal fixation device were removed 6 years after implantation, following the need for revision surgery after a fall. Scanning electron microscopy (SEM) revealed changes in surface topography of the metal. Examination of the adjacent tissue showed a chronic inflammatory response with occasional metal debris. Immunohistochemistry identified the predominant macrophages and abundant neovascularization. The presence of macrophages in tissues adjacent to the implants, in an otherwise asymptomatic person, is noteworthy.
Bone Plates↗
Use of epidural analgesia for pain management after major spinal surgery.
OBJECTIVE: This is a retrospective study of the role of postoperative epidural analgesia in major spinal surgical procedures. With the number and complexity of the procedures performed on the spine ever-increasing, this method of analgesia is becoming more important. METHODS: Results of 74 consecutive cases of major spinal surgeries between January 2000 and January 2001 at the Spine Division, Amritha Institute of Medical Sciences and Research Centre, Kochi, India, were studied. 32 cases were posterior procedures and the other 42 were anterior procedures of the thoracic and lumbar regions. The use of various combinations of local anaesthetic and opioid to control postoperative pain after spinal surgery were analysed. RESULTS: 36 (49%) of 74 patients did not require any parenteral supplements. Of the remaining 38 patients who required supplementary parenteral analgesia in the first 48 hours, 25 (34%) received a single dose and 13 (18%) required more than one dose. The number of patients requiring parenteral analgesia immediately after operation were 11; between 2 and 6 hours were 12; and between 6 and 24 hours were 11. Of the 74 patients, 67 had a sound sleep after epidural administration. There were 2 cases of respiratory depression and 2 of transient hypotension. CONCLUSION: Most epidural analgesic regimens significantly reduced postoperative pain, and the requirement for supplementary parenteral analgesics was minimal. Adverse effects were rare, yet we recommend that patients treated with this protocol be managed in high-dependency units.
Analgesia, Epidural↗
Laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease.
Laparoscopic antireflux surgery has been performed in neurologically impaired and scoliotic children. We aimed to assess the effectiveness of laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease that failed to respond to medical therapy. Data were prospectively collected (symptoms, medical therapy, endoscopies' findings) on 12 children (nine boys, three girls) aged 9-15 years with gastroesophageal reflux disease. Pre- and postoperative ambulatory 24-h pH and DeMeester and Johnson scores were also recorded. Effectiveness of surgery was assessed by comparison of pre- and postoperative total acid exposure time, Visick grade, need for antireflux medication and symptom scores. In total, 11 children underwent a laparoscopic Nissen fundoplication and one underwent a Toupet procedure. Median length of stay was 2 (2-3) nights. The median preoperative pH acid exposure time (AET) was 4.7 (0.8-16.4) percent compared with postoperative AET of 0.4 (0-3) percent. Early postoperative dysphagia occurred in four out of 12 patients, requiring a total of six dilatations. Postoperative Visick scores were: grade I=7 and grade II=5. Laparoscopic fundoplication can be safely performed and is effective in children with GERD who have failed to respond to medical therapy.
Adolescent↗
Can a district general hospital serving a population of 480,000 offer subspecialty training? --A prospective audit.
BACKGROUND: Subspecialty training has been mostly restricted to teaching hospitals. We aimed to assess whether higher surgical trainees can be offered subspecialty training in a district general hospital serving a large population. METHODS: The surgical unit consisted of four subspecialty firms (upper gastrointestinal, vascular, colorectal and breast/endocrine). Each firm consisted of two consultants, one higher surgical trainee and one basic surgical trainee. The breast/endocrine firm had, in addition, a staff grade surgeon. Trainees collected data prospectively on their subspecialty experience and this was then compared with the subspecialty workload in the respective firms. RESULTS: Subspecialty related workload was 48% on the vascular, 57% on the colorectal and 53% breast/endocrine firms. Subspecialty workload on the upper gastrointestinal firm (27%) was skewed by one non-specialist consultant Trainees on the respective firms were involved in 74% vascular, 82% upper gastrointestinal, 79% colorectal and 54% breast/endocrine index subspecialty operations. Supervision with regards to index operations was 63%, 70%, 81% and 100% on the colorectal, breast/endocrine, upper gastrointestinal and vascular firms, respectively. CONCLUSIONS: 50% of the workload on the vascular, breast/endocrine and colorectal firms is subspecialty-related with the potential for training. With shortened training and some specialities having disproportionately more trainees, higher surgical training committees need to identify more subspecialty units that offer such training.
Cardiology↗
Bone disease in primary biliary cirrhosis: independent indicators and rate of progression.
BACKGROUND/AIMS: To identify indicators of osteoporosis and to determine the rate of bone loss in patients with primary biliary cirrhosis (PBC). METHODS: Bone mineral density of the lumbar spine and hip was measured at annual intervals over 7 years of follow-up in 176 patients with PBC. RESULTS: Osteoporosis (t-score below -2.5) was found in 20% of patients and occurred 32.1 times more frequently in patients with PBC than expected. Patients with histologic stage 3 or 4 disease had a 5.4-fold increased risk of osteoporosis compared to patients with stage 1 or 2. Age, body mass index, advanced stage (3 or 4), and history of fractures were the only independent indicators of osteoporosis. After 3 years of follow up, the rate of bone loss in patients with stage 1 or 2 increased and equaled that seen in patients with stage 3 or 4. Serum bilirubin level was the only variable independently associated with the rate of bone loss over time. CONCLUSIONS: Severity of the liver disease contributes significantly to the severity of bone disease in PBC. PBC patients who are older, thinner and have more advanced liver disease may have the most benefit from bone density measurements and treatment for their osteoporosis.
Adult↗
Regional and systemic hemodynamic disturbances in cirrhosis.
In cirrhosis of the liver there is an imbalance between factors mediating vasodilatation such as nitric oxide and factors mediating vasoconstriction such as endothelins. These imbalances result in portal hypertension, hepatorenal syndrome, portopulmonary hypertension, hepatopulmonary syndrome, as well as alterations in cerebral blood flow.
Animals↗
Late hepatic allograft dysfunction.
1. Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients. 2. Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity. 3. In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management. 4. Recurrence of disease is the most common cause of late hepatic allograft dysfunction. 5. Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation. 6. Major advances have been made in preventing recurrence of hepatitis B by the use of hepatitis B immune globulin in combination with lamivudine therapy. 7. Autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis have a recurrence rate of approximately 20% to 30%. 8. In patients developing recurrence of autoimmune hepatitis, steroid withdrawal is the most common cause. 9. Recurrent hepatocellular cancer can be markedly reduced if strict guidelines are adhered to in selecting patients. 10. Drug hepatotoxicity must always be considered in the differential diagnosis of late hepatic allograft dysfunction.
Biliary Tract Diseases↗
Pathogenesis, diagnosis, and treatment of alcoholic liver disease.
Alcohol-related liver disease is a major cause of morbidity and mortality in the United States. Alcoholic liver disease encompasses a clinicohistological spectrum, including fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is a benign and reversible condition, but progression to alcoholic hepatitis and cirrhosis is life-threatening. Alcoholic hepatitis is diagnosed predominantly on clinical history, physical examination, and laboratory testing, although liver biopsy is often necessary to secure the diagnosis. The major focus of management is abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Corticosteroid therapy is controversial but should be considered in patients with a discriminant function greater than 32 and/or presence of spontaneous hepatic encephalopathy in the absence of infection, gastrointestinal bleeding, and renal failure. The only curative therapy for advanced alcoholic cirrhosis is liver transplantation. Several recent advances in understanding the pathogenesis of alcoholic liver disease may lead to novel future treatment approaches, including inhibition of tumor necrosis factor a, antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.
Diagnosis, Differential↗
What do we need to know about non-A-to-E viral hepatitis?
The list of potential hepatotrophic viruses continues to grow, with the recent discovery of the GB virus-C, the TT virus, and the SEN virus. Prevalence rates of the GB virus-C have ranged from 1.2% to 13% among healthy blood donors from all over the world. Higher prevalence rates have been reported among intravenous drug users. Similarly, the TT virus has a global distribution. However, in spite of numerous reports of the presence of both of these viruses in various kinds of liver diseases, definite evidence linking it to a specific disease or illness is lacking. The SEN virus is thought to be a novel viral agent that may be linked to cryptogenic chronic hepatitis, but data are awaited.
Hepatitis Viruses↗