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ABSTRACT Objective: This study aimed to evaluate the prevalence of some epidemiologically important comorbidities in patients with Chagas megaoesophagus in relation to the population without megaoesophagus, and whether this condition would be a protective or a risk factor for the conditions analysed. Methods: This observational descriptive study collected data from the medical records of patients with a previous diagnosis of megaoesophagus (timing: from 2005 to 2020). The patients were divided by age into a general (all ages) and an older group (aged 60 years or more). Associations were searched for four main areas/systems/involvements: cardiovascular, respiratory, endocrine and neurological. Results: The general group included 546 patients and the older group included 248 patients. As for the prevalence of comorbidities in the general group, the three most prevalent diseases were hypertension, with 44.3% (CI95%: 40.21-48.51%); dyslipidaemia, with 17.8% (CI95%: 14.79-21.19%); and heart failure, with 15.2% (CI95%: 12.43-18.45%). Similar to that in the general group, the most prevalent comorbidities in the group of older patients were hypertension, dyslipidaemia, and heart failure. Conclusion: Systemic arterial hypertension, dyslipidaemia, and heart failure were the most prevalent comorbidities in this population. The lower prevalence of diabetes mellitus and Alzheimer's disease suggests the association of enteric nervous system denervation and requires further investigation.
RESUMO Objetivo: Este estudo teve como objetivo avaliar a prevalência de algumas comorbidades epidemiologicamente importantes em pacientes com megaesôfago chagásico em relação à população sem o megaesôfago e se essa condição seria um fator protetor ou de risco para as condições analisadas. Métodos: Este estudo descritivo observacional coletou dados de prontuários de pacientes com diagnóstico prévio de megaesôfago (período: de 2005 a 2020). Os pacientes foram divididos por idade em um grupo geral (todas as idades) e um grupo idoso (60 anos ou mais). Foram pesquisadas associações para quatro áreas/sistemas/envolvimentos principais: cardiovascular, respiratório, endócrino e neurológico. Resultados: O grupo geral incluiu 546 pacientes e o grupo idosos incluiu 248 pacientes. Quanto à prevalência de comorbidades no grupo geral, as três doenças mais prevalentes foram hipertensão, com 44,3% (IC95%: 40,21-48,51%); dislipidemia, com 17,8% (IC95%: 14,79-21,19%); e insuficiência cardíaca, com 15,2% (IC95%: 12,43-18,45%). Assim como no grupo geral, as comorbidades mais prevalentes no grupo de idosos foram hipertensão, dislipidemia e insuficiência cardíaca. Conclusão: Hipertensão arterial sistêmica, dislipidemia e insuficiência cardíaca foram as comorbidades mais prevalentes nessa população. A menor prevalência de diabetes mellitus e doença de Alzheimer sugere uma associação de denervação do sistema nervoso entérico e requer mais investigação.
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Chronic back pain is a common and frequent clinical presentation in any population. Presence of disc disease, facet syndrome, and vertebral body disease are usually addressed by the radiologists. Facet joints are proven to be the culprit in 15 – 45 % of patients with low back pain. We wanted to compare effectiveness of fluoroscopy and computed tomography guided lumbar facet injections for pain relief in patients with facet arthropathies and mild canal stenoses. METHODSThis is a retrospective cross-sectional study performed in the Department of Radiology at our Hospital in Dhahran. This record-based study was performed in our department from Jan. 2015 - 2020. All patients (N = 112) who underwent fluoroscopy and computed tomography (CT) guided facet injections (either alone or with epidural injections) for relief of chronic back pains (due to facet arthropathies and mild canal stenoses) were included, and grouped as (i) facet injections under fluoroscopy (F), and (ii) facet injections under CT guidance (C). Patients with acute disc prolapse, trauma to spine, lumbar surgeries, moderate to severe lumbar stenoses, spondylolisthesis, known systemic arthritides, those not suitable for the procedures, and those lost to follow-up were excluded. Repeat procedure within one year for recurrent complaints was used as a measure of effectiveness of the procedure. Proportional Z-test was used, and a p-value less than 0.05 was considered to be significant. RESULTSOut of a total of 112 patients, 64 were females (57 %) and 48 were males (43 %). The mean age was 56.4. Twenty out of 78 patients with facet injections under fluoroscopy and 3 out of 34 patients with facet injections under CT underwent repeat procedures (P = 0.042). CONCLUSIONSCT guided facet injections combined with epidural injections may be more effective in relief of lower back pain in patients with facet arthropathies and mild canal stenoses
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Background: Aim of the study was to evaluate prospectively the outcomes of laparoscopic floppy Nissen fundoplication in cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD) and hiatus hernia without pre-operative 24 hours oesophageal pH and manometry study. Methods: Thirty-four patients with typical symptoms of GERD, from March 2009 to November 2019, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by operating surgeon with typical symptoms (heartburn, regurgitation, and dysphagia) of GERD and hiatal hernia. Laparoscopic Nissen’s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery.Result: Laparoscopic Nissen’s fundoplication is an effective long-term treatment for GERD and may be performed in patients with typical symptoms of GERD and hiatus hernia and endoscopic findings suggestive of reflux esophagitis and patient who wants to get rid of life long proton-pump inhibitors (PPI) and antacids medication.Conclusions: Preoperative oesophageal manometry and 24-hour pH monitoring are not mandatory for laparoscopic fundoplication if the patient selection is appropriate but may be required in selected patients with atypical symptoms.
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Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.
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Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.
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The aim of present study was to evaluate the linkage disequilibrium (LD) of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphism of TP53 and their haplotypes association with oesophageal cancer risk in patients from Punjab, northwest India. A total of 466 samples, including 233 oesophageal cancer patients and 233 healthy individuals were analysed. Data analysis revealed the gender specific association. In female group, arginine–proline (RP) genotype (P = 0.08) and P allele (P = 0.07) of p.R72P polymorphism was marginally associated with increased risk of oesophageal cancer. A1A2 genotype (P = 0.06) and A2 allele (P = 0.07) of PIN3 Ins16bp polymorphism was marginally associated with decreased risk of oesophageal cancer in male group. A1A2–GA genotype combination (P = 0.04) of PIN3 and r.13494g[a polymorphisms was significantly associated with decreased risk of oesophageal cancer in male group. In female group, PP–GA genotype combination (P = 0.02) of p.R72P and r.13494g[a polymorphisms and RP–A1A1–GG genotype combination (P = 0.04) of p.R72P, PIN3 and r.13494g[a polymorphisms was significantly associated with increased risk of oesophageal cancer. We observed moderate LD between two intronic polymorphisms PIN3 Ins16bp and r.13494g[a (D0 = 0.90; r 2 = 0.68). Haplotype analysis revealed that none of the haplotype combination was associated with oesophageal cancer risk when both the genders were considered. Stratification on the basis of gender showed that P-A2-P-A-A haplotype of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphisms was marginally associated with reduced oesophageal cancer risk in male group (P = 0.08). Replication of these findings in independent cohorts may be insightful for the role of TP53 in oesophageal cancer pathogenesis.
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The relationship between the long noncoding RNA (lncRNA) expression and oesophageal cancer prognosis has been widely studied, but less consensus has been reached. We conducted this study to evaluate the relationship between the expression of lncRNAs and the prognosis and clinical pathology of oesophageal cancer. We conducted a systematic search of PubMed, EMBASE and Cochrane Library until 25 January 2019. Studies that evaluated the associations of a specific lncRNA with survival and/or clinicopathology of oesophageal cancer were included. Pooled hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs) were calculated using fixed or random-effect models. Sensitivity analysis was used to verify the stability of results. Publication bias was detected using Begg tests and adjusted utilizing the trim-and-fill method if a bias existed. A total of 51 studies comprising 6510 patients and regarding 41 lncRNAs were included in the present systematic review and meta-analysis. The results showed that dysregulation of lncRNAs was associated with overall survival, disease-free survival, and progression-free survival. The expression of lncRNAs was related to some certain clinicopathological parameters of oesophageal cancer, including tumour size, T classification, lymph node metastasis, tumour node metastasis (TNM) stage and differentiation. Among these findings, lncRNA AK001796, CASC9, HOTAIR, MALAT1 and UCA1 were identified and were expected to be ideal biomarkers for the prognosis and clinicopathology of oesophageal cancer. Although significant publication bias was observed in some studies, the results were not changed after adjustment using the trim-and-fill method. Abnormal lncRNA-expression profiles could serve as a promising indicator for prognostic evaluation of patients with oesophageal cancer. The combination of these lncRNAs will contribute to clinical decision-making in the future.
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Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.
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Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.
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Chronic liver disease develops when the functional capacity of the liver is deranged, and it is not able to maintain normal physiological conditions. This study was carried to find out the association of portal vein size with gastro-oesophageal varices in diagnosed cases of cirrhosis of liver, so that this parameters can be used in predicting propensity to oesophageal varices non-invasively, and thus help in starting prophylactic therapy earlier to prevent bleeding and other complications of varices.METHODS100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were included for the study. Ultrasonography was done in all cases to find out the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was performed to see the presence of oesophageal varices of different grades. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient. p Value of <0.05 was considered for significant.RESULTSAmong 100 patients studied, 90% patients were found to have oesophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 oesophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of splenic diameter with grades of oesophageal varices, it was found that patients with splenic diameter >13 cm had higher grades of oesophageal varices i.e. 32 patients were grade 2 and 18 patients were grade 3, with p<0.001 and was found highly significant.CONCLUSIONSIn this study, we found that with increasing spleen size there are chances of formation of higher grades of oesophageal varices and both are also having positive association.
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Gastrointestinal tract obstructions are the most common surgical emergencies in neonatal period. The aetiology of these disorders is diverse and mostly the consequences prenatal developmental malformations. The management and survival are still a challenge, especially in developing countries like India.METHODSA prospective observational study was conducted in a tertiary care paediatric institute from October 2016 to September 2019. Newborns in the age group of one to 28 days, who were operated in the hospital for gastrointestinal tract obstruction were analysed. Institutional Ethics Committee approval was taken. Data with regard to demographic patterns, clinical profile, management approach and outcome, were collected and analysed.RESULTSOut of 531 newborns operated for gastrointestinal obstruction, 80% cases presented within first week of life. Male neonates were more commonly affected than females (M: F=2.2:1) and 58% cases were having low birth weight. Anorectal malformation was the commonest cause of obstruction (40.7% cases) followed by intestinal atresia (18% cases). Hirschsprung’s disease, malrotation, meconium ileus and hypertrophic pyloric stenosis were among the important aetiologies. The overall mortality in this study was 13% and septicaemia was the leading cause.CONCLUSIONSAetiology of gastrointestinal obstruction in newborn is diverse ranging from oesophageal atresia to anorectal malformations. Low birth weight and other co-morbidities are associated in many cases. The overall outcome is in improving trend due to gradual understanding about the pathology and advancement of neonatal care. Early diagnosis, surgical intervention and availability of well-equipped neonatal intensive care unit facility are essential for better survival.
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Ingestion of corrosive substances and chronic sequelae associated with it is the major public health problem in the developing countries. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury in life-long morbidity. Colonic conduit for bypassing diseased oesophagus with distal anastomosis with stomach is well documented and practiced procedure. Authors have encountered a case of 21-year-old lady with corrosive injuries to oesophagus and stomach, later developed non dilatable oesophageal stricture with completely cicatrised and adherent stomach. Due to unavailability of stomach, authors have used colon as a conduit and colo-jejunal anastomosis bypassing the oesophagus, stomach and duodenum. Colo-jejunal anastomosis for chronic corrosive oesophageal stricture is not commonly practiced procedure which makes this case a rare one.
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Hoarseness of voice is a very common symptom and needs thorough clinical examination and investigation to determine the underlying cause in every patient. The spectrum of the symptom ranges from minor infections to life threating malignancies. Acute onset causes may be due to secondary viral infections, voice abuse, smoking, trauma to the larynx during thyroid surgeries. Chronic onset may be due to vocal polyp, vocal cord nodules, laryngeal papillomatosis, laryngeal neoplasms, tumours of the vocal cord, functional dysphonia, smoking, gastro-oesophageal reflux, malignancy of thyroid, oesophagus, lungs and neurological involvement by systemic disease like diabetes and TB. We wanted to evaluate the common causes of hoarseness of voice.METHODSThis was a longitudinal study conducted among 100 patients with benign laryngeal lesions attending the Department of ENT-HNS of Rajarajeswari Medical College and Hospital, from 1st December 2015 to 31st November 2016. A detailed history including information on patient’s demographics, clinical presentation, history of trauma, along with history of associated medical and surgical condition was obtained. A thorough systemic examination and laryngeal examination was done.RESULTSMale:Female ratio was noted to be 1.7:1. Labourers constituted the single largest group of patients comprising of about 36% of cases. Three fourth of patients were from the rural area. Duration of hoarseness ranged from 1 day (acute onset) to 5 yrs. (mean - 3 months). Septic foci in oral cavity and oropharynx were noted in 42% cases. Apart from change in voice other common symptoms were cough, fever and vocal fatigue. Signs of chronic laryngitis were noted in majority of the cases (22%).CONCLUSIONSThe spectrum of etiological factors for hoarseness varies from minor functional voice disorders to major pathological conditions such as malignancy. Septic foci are important predisposing factor for chronic laryngitis.
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Background: Oesophageal carcinoma is one of the leading causes of cancer related deaths worldwide and is also associated with high morbidity. Hence early diagnosis and treatment are the only effective way to improve survival and quality of life in oesophageal carcinoma patients. Early-stage oesophageal carcinoma are often asymptomatic and may also present with common upper gastrointestinal symptoms hence diagnosis of early oesophageal carcinoma is only based on detection of suspicious lesions through endoscopy and histopathological evaluation of biopsies from these suspicious lesions. The study is designed to see whether using alarming upper gastrointestinal symptoms, risk of oesophageal carcinoma in patients can be predicted.Methods: Present study comprises of 200 patients presenting with upper gastrointestinal symptoms at JSS Hospital, Chamarajanagar (both out patients and referred patients) during the period of October 2018 to December 2019, who underwent upper gastrointestinal endoscopy.Results: Out of 200 patients, 135 patients were males and 65 patients were females. According to the study, dysphagia was found to be a significant predictive factor and in contrary to the global statistics this study showed females aged more than 60 years were significantly at higher risk of developing oesophageal carcinoma.Conclusions: We recommend to do an early endoscopy for any patient presenting with upper gastrointestinal symptoms and to take multiple biopsies from any suspicious lesion especially for male gender older than 50 years and female gender older than 60 years presenting with dysphagia.
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ABSTRACT: A 9-year-old male Shih Tzu dog presented with a mass on the ventral region of the neck and developed ptyalism. Radiographs revealed a radiodense nodule located in the mid-third of the oesophagus compressing the trachea. Preoperative cytology showed large neoplastic cells with abundant vacuolated cytoplasm arranged in clusters. The nodule was removed by oesophagectomy and submitted for histopathology. Microscopically, the oesophageal mass was multilobulated and unencapsulated. It had a mixed cellular growth pattern with areas showing squamous and glandular differentiation. The squamous component of the tumor was formed by solid strands of neoplastic epithelial cells; many neoplastic cells had undergone central keratinization and sometimes formed keratin pearls. The deeper adenocarcinomatous portion of the tumor consisted of tubules filled with slightly basophilic mucinous material. Histological and immunohistochemical examination confirmed the diagnosis of primary adenosquamous carcinoma (ASC) of the esophagus. This is the first report of primary ASC of the cervical oesophagus in a dog.
RESUMO: Um cão Shih Tzu de nove anos de idade apresentou uma massa na região ventral do pescoço e desenvolveu ptialismo. As radiografias revelaram um nódulo radiodenso localizado no terço médio do esôfago que comprimia a traqueia. A citologia pré-operatória mostrou células neoplásicas grandes com citoplasma vacuolizado abundante, dispostas em aglomerados. O nódulo foi removido por esofagectomia e submetido à histopatologia. Microscopicamente, a massa esofágica era multilobulada e não encapsulada. Apresentava um padrão de crescimento celular misto, com áreas mostrando diferenciação escamosa e áreas de diferenciação glandular. O componente escamoso do tumor era formado por filamentos sólidos de células epiteliais neoplásicas; muitas células neoplásicas demonstravam queratinização central e, por vezes, formavam pérolas de queratina. A porção adenocarcinomatosa mais profunda do tumor consistia em túbulos preenchidos com material mucinoso levemente basofílico. O exame histológico e imunohistoquímico confirmaram o diagnóstico de carcinoma adenoescamoso primário do esôfago. No conhecimento dos autores, este é o primeiro relato de carcinoma adenoescamoso primário do esôfago cervical em um cão.
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@#A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesophagogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.
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Plummer Vinson syndrome or Paterson-Brown-Kelly syndrome is a rare disorder is characterized by a triad of iron deficiency anemia, post-cricoid dysphagia and upper oesophageal web. This is a condition that is hypothesized to occur in people with long-term iron-deficiency anemia. It is more prevalent in females than in male patients. This disorder is characterized by iron deficiency anemia, post-cricoid dysphagia and oesophageal webs, symptoms typically progress over a period of six months and often include other systemic effects such as angular cheilitis, glossitis, and spooning of the fingernails. Here we report a case of 38 years female admitted in general medicine female with complaints of breathlessness and tightness of chest relieving after vomiting and had history of anemia, dysphagia insidious in onset and dysphagia associated with solid food over a year on examination patient was found to be gross pallor, angular cheilitis, spoon-shaped nails of fingers and toes. The lab findings were hemoglobin of 7.8 g/dl, serum ferritin levels 7.23 ng/ml, vitamin B12 175.2 pg/ml and upper oesophageal endoscopy revealed oesophageal web in the post-cricoid region. Treatment of Plummer Vinson syndrome includes iron supplementation followed by endotracheal dilation if necessary.
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Objective: In this study our main objective is to evaluate therelationship between Oesophageal varices, Portal veindiameter and splenic length (antero-posterior).Methodology: This Cross-sectional comparative studyconducted at the Department of Hepatology, BangabandhuSheikh Mujib Medical University (BSMMU) from Jan 2010 toDec 2011 where 50 Patients with cirrhosis of liver attending thedepartment of Hepatology, BSMMU were included as apopulation in this study.All the data was checked and edited after collection. It wasexpressed as Mean and SD. Data has been analyzed byANOVA. p value of less than 0.05 was considered statisticallysignificant. Statistical analysis was done by using SPSS-15(Statistical package for social sciences) win version 15software programme.Results: During the study, the mean age was43.12±15.68years. The highest frequency of cirrhosis patientswas found in 41-50 years age groups (Frequency 12). Leadingcause was HBV (68%) followed by HCV (12%), NBNC (12%),Wilson’s disease (6%) and both HVB& HCV (2%). Also,grade-3 mean portal Vein diameter was found 12.67±2.47 mmwhereas; mean splenic length (antero-post.) was 13.82±2.12cm.Conclusion: Splenic antero-posterior measurement is not areliable predictor for sizes of oesophageal varices. Furtherstudy is needed for better outcome.
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Wounds and their management are fundamental to the practice of surgery, as any kind of surgical intervention will result in a wound. Post operative wound complication is common, but sometimes a difficult event is experienced by a surgeon. A similar situation is a faecal fistula. Aims and objectives: 1.To Identify various causes of fecal fistula and there management in surgical patients. Methods: The present study was conducted in the Department of Surgery, GMC, Jammu w-e-f 1-11-2014 to 31-10-2015. Patients admitted in various surgical units of the department were incorporated in study design. Presenting features and detailed history of the disease was recorded as per enclosed proforma. Inclusion Criteria: All patients developing faecal fistula following open/laparoscopic abdominal surgery both elective and emergency cases including Gynaecological /vascular/ thoracoabdominal/ urological surgeries. Exclusion Criteria: Pharyngeal, oesophageal, anorectal and urinary fistulas were excluded from the study. Results: Among twenty five patients of small bowel fistula in our series, thirteen patients had spontaneous closure within 30.7 days with the range of 14 days (a case of post LSCS faecal fistula) to 70 days (a case operated for intestinal obstruction). Conclusion: In the end it is concluded that faecal fistula is a post operative complication with significant morbidity and mortality in relation to patient on one side and a lot of dedicated effort in limiting the morbidity(malnutrition,electrolyte imbalance,sepsis) to be performed by a doctor on the other side with utmost care of the patient with faecal fistula.
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@#Alpha-fetoprotein (AFP)-producing carcinoma which microscopically mimics hepatocellular carcinoma (HCC) is a rare entity known as hepatoid adenocarcinoma (HC). They usually arise in the stomach, while oesophageal origin is only occasionally encountered. This tumour is highly aggressive and is associated with a poor prognosis. They frequently metastasise to the liver, thus giving rise to diagnostic difficulty, especially in cases where simultaneous oesophageal and liver mass are present. We reported a case of oesophageal hepatoid carcinoma with multiple liver metastasis, that was associated with an increased serum AFP. The distinction between HCC and HC is important because HC is more aggressive and has a poorer prognosis with limited therapeutic options. An extensive diagnostic work-up which include a thorough clinical history, radiological investigations (computed tomography or magnetic resonance imaging) as well as tissue biopsy supported by a panel of immunohistochemical markers are necessary to aid in the diagnosis of HC.