INTERNAL PANCREATIC FISTULAE WITH SEROUS EFFUSIONS IN CHRONIC PANCREATITIS

Background: Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum. Methods: To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy-en-Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease. Results: Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re-operation. There were two deaths: one with massive haematemesis and one with pre-existent multi-organ failure and sepsis. Conclusions: Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in this regard.     

Cultural adaptation,translation and validation of Cochin Hand Function Scale and evaluation of hand dysfunction in systemic sclerosis

Clinical Rheumatology - Hand dysfunction causes significant reduction in quality of life in systemic sclerosis. We assessed the validity and reliability of the culturally adapted Indian version of...     

Tachycardia-induced cardiomyopathy- a fully reversible phenomenon

Tachycardia induced cardiomyopathy (TIC) is a rare but potentially reversible cause of heart failure. The case of a patient with severe tachycardiomyopathy who had a favorable outcome following treatment of tachyarrythmia is presented here.     

Education effects on the international HIV dementia scale

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) within the Indian subcontinent continues to spread. Although the primary clade of HIV in India differs from that of most Western countries, recent evidence suggests that the Indian clade (Clade C) also impacts neurocognitive functioning. India also has extremely high illiteracy rates that may confound detection of neurocognitive impairment, since many assessments to detect such impairment are heavily influenced by formal schooling. Among those with HIV/AIDS who have had limited educational opportunities and who are in the early stage of infection, the confounding effects of education on tests for neurocognitive impairment may be particularly salient. We therefore tested influence of HIV serostatus and education on a commonly used tool to screen for cognitive impairment, the International HIV Dementia Scale (IHDS), among Indian men and women in the catchment area of the Post Graduate Institute of Medical Education and Research (PGIMER) located in Chandigarh, India. Adjusted analyses showed that from a sample of 295 HIV-positive and HIV-negative individuals, only education was significantly associated with performance on the IHDS. HIV-negative and HIV-positive individuals, who were in the early stages of infection, performed similarly. Further development of this test to account for the effects of education on cut-off scores used to indicate possible dementia are needed, particularly for use in resource-limited settings such as India where low levels of education are widespread.     

Auditory P300 Event‐Related Potentials and Neurocognitive Functions in Opioid Dependent Men and Their Brothers

Event‐related‐potentials (especially P300) and cognitive functioning as potential endophenotypes have not been studied in opioid dependence. We compared auditory P300 and cognitive functions in opioid‐dependent men, their brothers and normal controls in an exploratory study with a view to find shared genetic factors in the development of opioid dependence. Twenty abstinent opioid‐dependent males, their brothers and twenty matched controls were administered Wisconsin card sorting test (WCST), digit span test, trail making test‐B, and auditory event‐related potentials (P300) from an oddball task were recorded. The opioid dependent group performed the worst, the brothers group was intermediate, and the control group performed the best on tests of WCST, digit span and trail making test‐B. The opioid dependent group had the smallest amplitudes and longest latencies of P300, and was followed by the brothers group who had an intermediate position and the control group who had the largest amplitudes and the shortest latencies. P300 and executive neurocognitive functions can be considered endophenotypes for the genetic study of vulnerability to opioid dependence. These are reflective of executive dysfunction and disrupted behavioral inhibition and the intermediate position of brothers suggests a common genetic substrate as a component of the etiology.     

Is isolated Roux loop pancreaticojejunostomy superior to conventional reconstruction in pancreaticoduodenectomy?

Objectives:

Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancreaticoduodenectomy (PD). This study aimed to assess whether isolated Roux loop pancreaticojejunostomy (IPJ) is superior to conventional pancreaticojejunostomy (CPJ).

Methods:

Between September 2003 and July 2007, we performed 108 PDs. All patients underwent classical Kausch–Whipple PD with pancreaticojejunostomy (PJ). Patients were divided into two groups based on the type of PJ. Patients in group 1 underwent IPJ and those in group 2 underwent CPJ. A retrospective analysis of prospectively maintained data was performed to compare outcomes in the two groups.

Results:

There were 53 patients in group 1 and 55 in group 2. The two groups were comparable in both pre- and intraoperative parameters. The overall incidence of PF was 10.1% (five cases in group 1 vs. six in group 2). The course of clinically significant PF was similar in both groups in terms of fistula behaviour, management and the duration of spontaneous closure. Two patients in each group died. Overall complications, mortality and length of hospital stay were also similar; however, duration of surgery was significantly higher in group 1 vs. group 2 (442 min and 370 min, respectively; P= 0.005).

Conclusions:

Isolated Roux loop pancreaticojejunostomy is not superior to conventional PJ; instead, it increases the duration of surgery.     

Two hundred and forty-one consecutive liver resections: an experience from India

Background: Although liver resection has become an established procedure in western countries and South-east Asia it is still not performed frequently in most centres in India. In the last 10 years newly created specialized units have been performing more liver resections but no major series have been reported. Patients and methods: We analysed the results of 241 hepatic resections in the Gyan Burman Liver Unit, Sir Ganga Ram Hospital to compare our results with those published from established centres and to identify the factors relating to morbidity and mortality. To examine the effect of a greater experience with the procedure we compared the outcome of our operations from 1996–2000 (first period) and those from 2001–2005 (second period). Results: The overall mortality and morbidity rates were 6.6% and 44.8%, respectively, which are comparable with those of most recently published Western series. Life-threatening complications occurred in 12.4% patients. Multivariate analysis showed that the presence of comorbid conditions, intraoperative blood transfusions of >3 units, hepatocellular carcinoma with underlying cirrhosis and gall bladder carcinoma with jaundice were the independent risk factors for morbidity, whereas the presence of comorbid illness and underlying liver cirrhosis were the risk factors for mortality. During the second period there was an increase in the number of operations performed (66 vs 175; first vs second period), but the mortality rates remained essentially unchanged (6.1% vs 6.8%). Discussion: Hepatic resections can be performed safely in India with results comparable to those achieved in the West. Increasing experience did not reduce overall mortality. Perhaps more careful patient selection and better perioperative management of comorbid illnesses may reduce the morbidity and mortality further.