Current state of art management for vascular complications after liver transplantation

Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threating consequences for the patient. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in the management of vascular complications after liver transplantation. Current trends show an increase in the utilization of endovascular interventions initially to address vascular complications after liver transplantation. Operative repair still has its major role, especially if endovascular procedures fail

randomized trial of epidural volume extension by sequential combined spinal epidural anesthesia using three different techniques

Sequential combined spinal epidural anesthesia [SCSEA] is gaining popularity in ASA grade III / IV, elderly, low cardiac output state and high risk patients. In view of contradicting results related to sensorimotor characteristics, we undertook this study with the null hypothesis that epidural volume extension [EVE] with local anesthetic or normal saline results in augmentation of initial intrathecal block. Prospective, randomized, double blind study. J N Medical College, Aligarh Muslim University, Aligarh, India. Seventy-five ASA I/II patients divided into three groups and operated upon from September 2007 to January 2009. Group I received 1.5 ml bupivacaine [0.5%] + 25 microg fentanyl in subarachnoid space and epidural catheter was inserted without any top ups. In group II and III with the same technique top ups were given after 10 minutes of the intrathecal block in the form of either 10 ml NS or 10 ml of 0.125% bupivacaine. Augmentation of initial intrathecal block. Significant increase in height of block was seen after EVE by different techniques of epidural top up [T4.64 +/- 0.86 and T3.92 +/- 0.99 in group II and III respectively, p-value < 0.05] as compared to group I [T7.12 +/- 0.83]. The average increase was 3.12 +/- 0.97 and 3.48 +/- 1.35 segments in group II and III respectively as compared to 0.48 +/- 0.51 segments in group I.. Height of low-dose intrathecal block can be enhanced by SCSE using EVE effect even with normal saline

Effect of dietary oil seeds on n-3 fatty acid enrichment, performance parameters and humoral immune response of broiler chickens

A 42-day study was conducted to evaluate the influence of full-fat flaxseed [FS] and canola seed [CS] on broiler performance, fatty acid [FA] profile of meat, serum lipid content and antibody response to sheep red blood cells antigen [SRBC]. A total of 324 one-day-old chicks were attributed to 6 experimental groups. C: control [soybean-corn]; CS1:7.5% CS; CS2:15% CS; CS-FS:10% FS + 10% CS; FS1:7.5% FS; FS2:15% FS. The diets containing FS and CS had a significant negative effect on performance parameters [P<0.01], however, feed consumption was not significantly [P>0.05] different among treatments. Inclusion of FS and CS significantly increased [P<0.01] the concentration of omega-3 FA and decreased the content of the arachidonic acid and n-6:n-3 polyunsaturated FA ratio. The serum lipid content and antibody titre against SRBC were not affected by dietary oil seeds [P>0.05]

alarming occurence of esophageal cancer in Balochistan

To evaluate the prevalence, geographical features and disease characteristics of Cancer of Esophagus in patients registered at Centre for Nuclear Medicine and Radiotherapy [CENAR]. From January 1991 to December 2001 832 cases of esophageal cancer were seen at CENAR Hospital Quetta. Only cases confirmed by Histopathology and for whom the esophagus was the primary site of tumor were included in the study. The mean age of the patients was 50 + 13year]. The geographical background and disease characteristics were elaborated, by calculating statistical ratios and percentages of various demographic variables, in different subgroups of patients. Cancer of esophagus is 3 rd commonest tumor [11.3% of total registered cases] and on average, the annual proportion of esophageal cancer constitutes a figure of 11 cases per hundred patients diagnosed at CENAR Hospital. It is third common tumor in male and 4 th common in female, with Male to female ratio of 1.37. It is about 1.33 times more common in Balochistan than in Afghanistan. Naswar and beetle nut chewing [31%], malnutrition [56%] and Alcohol [13%] were among the common risk factors present in this study population. About 90% of the cases were of Squamous cell variety and 85% of the patients were diagnosed when disease has progressed to stage 3/4 and upto 60% cases involve lower third of esophagus. Forty percent of the patients were in 4th decade of life at time of diagnosis. The areas that surround CENAR Hospital in Balochistan Province seem to be a high-risk belt for esophageal cancer. It is also common in Afghanistan and Peshawar. Naswar and beetle nut chewing along with malnutrition and alcohol might be important contributory risk factors

Comparison of survival periods and response in three modes of treatment for Cancer esophagus at CENAR Quetta

Esophageal cancer is a fatal disease, with mortality matching the incidence. Balochistan province and Afghanistan happen to fall in the "Esophageal Cancer Belt". This study was designed to compare survival periods and response in three different modes of treatment for cancer of esophagus at CENAR Quetta i.e Radiotherapy Plus Surgery, Radiotherapy plus Surgery plus single agent chemotherapy and Radiotherapy plus Surgery plus combined chemotherapy. During 1997, 59 patients with histopathological evidence of Ca esophagus were referred to CENAR from primary health care centers in Balochistan and Afghanistan. These 59 patients were divided into three groups. Group:I [n=22] treated by local irradiation plus surgery. Group:II [n=20] treated by local irradiation plus surgery plus Single agent chemotherapy i.e 5 florouracil. Group:III [n=17] treated by local irradiation plus surgery plus combination chemotherapy i.e Cis-Platinum and 5-florouracil. All patients were evaluated by endoscopic examination at 2 month intervals. This study of 59 patients [mean age 55'13 years and male to female ratio of 1:3], shows that 2 year survival is 29% and median survival period is 9 month for all the patients. For group I, median survival period = 5 month, 2 year survival =18% and complete response =17%. For group II, Median survival period = 9 months, 2 year survival =30% and complete response =20%. For group III, Median survival period = 11 months, 2 year survival = 41% and complete response = 22%. This study shows that overall survival is poor in cancer of esophagus and combined chemotherapy along with surgery and radiotherapy gives better results as compared to other two groups. Also single agent chemotherapy plus surgery plus radiotherapy give better results than radiotherapy plus surgery

study of 166 plus 80 patients: CA breast treatment complications in CENAR quetta and IRNUM peshawar during 4 years from 1991 to 1994

A retrospective study for treatment complications of 166 patients of Carcinoma Breast was carried out from 1st January 1991 to 31st December 1994 in the Centre for Nuclear Medicine and Radiotherapy [CENAR], Quetta. During this period 2742 new cases of cancer were registered. Cancer of Breast constituted 623 [22.72%] of all. It was noted that this cancer was fourth most common cancer registered in this centre and was the most common cancer in female. 166 patients come for follow up regularly for 5 years after completion of treatment. In these female to male ratio was, 9.37:1. During this period of follow up, the treatment complications were noted in these patients to highlight the subject and to recommend the factors helpful to avoid the complication and management of these complications. During this period, the same study of 80 patients was carried out in IRNUM Peshawar for the same purpose

Caecal amoeboma simulating malignant neoplasia, ileocaecal tuberculosis and Crohn's disease

We report two cases of amoeboma of caecum. The patients were initially diagnosed with acute appendicitis but a large cecal mass was found on surgery, giving the gross impression of tumor, Ileocaecal tuberculosis or Crohn's disease necessitating right hemicolectomy. On histopathological examination, the mass was found to be 'Amoeboma'. Mode of presentation, clinical examination and operative findings are presented along with the review of literature. A 39 years old woman presented to the surgical outpatient department with complaints of right lower abdominal pain and fever for 2 days. Pain was localized to right iliac fossa. It was continuous and severe in intensity with no aggravating or relieving factors. The patient had intermittent fever upto 101 F. On clinical examination, the right iliac fossa was markedly tender. Total leukocyte count was 12.6 x 109 /L. A clinical diagnosis of acute appendicitis was made. Peroperatively, a focal inflammed caecal mass was found, grossly appearing like Crohn's disease. Rest of the abdomen was normal. Limited right hemicolectomy was done. Distal 6 inches of ileum along with proximal ascending colon was resected and an end to end anastomosis made. The postoperative recovery remained uneventful. Histopathological examination of the resected specimen turned out to be caecal amoeboma