Impact of the Timing of Percutaneous Catheter Drainage following Endoscopic Drainage on Outcomes in Acute Necrotizing Pancreatitis.

Background The role of dual-modality drainage of walled-off necrosis (WON) in patients with acute pancreatitis (AP) is established. However, there are no data on the association of clinical outcomes with the timing of percutaneous catheter drainage (PCD). We investigated the impact of the timing of PCD following endoscopic drainage of WON on clinical outcomes in AP. Materials and Methods This retrospective study comprised consecutive patients with necrotizing AP who underwent endoscopic cystogastrostomy (CG) of WON followed by PCD between September 2018 and March 2023. Based on endoscopic CG to PCD interval, patients were divided into groups (≤ and >3 days, ≤ and >1 week, ≤ and >10 days, and ≤ and >2 weeks). Baseline characteristics and indications of CG and PCD were recorded. Clinical outcomes were compared between the groups, including length of hospitalization, length of intensive care unit stay, need for surgical necrosectomy, and death during hospitalization. Results Thirty patients (mean age ± standard deviation, 35.5 ± 12.7 years) were evaluated. The mean CG to PCD interval was 11.2 ± 7.5 days. There were no significant differences in baseline characteristics and indications of CG and PCD between the groups. The mean pain to CG interval was not significantly different between the groups. Endoscopic necrosectomy was performed in a significantly greater proportion of patients undergoing CG after 10 days ( p = 0.003) and after 2 weeks ( p = 0.032). There were no significant differences in the complications and clinical outcomes between the groups. Conclusion The timing of PCD following endoscopic CG does not affect clinical outcomes.

Role of Ultrasound-Guided Fine-Needle Aspiration Cytology of Omentum in Diagnosis of Abdominal Tuberculosis.

AIM: To evaluate the efficacy of ultrasound-guided (USG) fine-needle aspiration cytology examination (FNAC) of the omentum in the diagnosis of abdominal tuberculosis (TB). METHODS: Retrospective review was conducted of data from patients who presented with clinically suspected peritoneal TB between June 2016 and April 2018. We included patients in whom imaging showed omental thickening with or without ascites. Additional features that were assessed on imaging included ascites, the presence of mesenteric or retroperitoneal adenopathy, ileocecal thickening, and involvement of solid abdominal organs. Ultrasound-guided FNAC of the omentum was performed using a 22-gauge needle. The cytologic assessment was done for granulomatous inflammation, bacilli on Zeihl-Neelson stain, and for other pathology if any. RESULTS: During the study period, 35 omental FNACs were done. Of these patients, malignancy was reported in eight (22.8%). Of the remaining 27 patients, positive results for TB were reported in 19 patients (70.4%). In these 19 patients with positive FNAC, the median age was 33 years (range 10-63 years), with eight males (42.1%). Ascites was present in 14 (73.7%), abdominal lymphadenopathy was present in 9 (47.4%), ileocecal thickening and involvement of solid abdominal organs were reported in 3 (15.8%) and 4 (21%) patients, respectively. Granulomatous inflammation was reported in 17 (89.5%) and acid-fast bacilli in 10 (57.6%) patients. The Genexpert analysis was done in two patients, with a positive result in one patient. CONCLUSION: Ultrasound-guided FNAC of the omentum is helpful to diagnose abdominal TB in patients having omental thickening with or without other abnormal findings.

Bronchial artery embolization in chronic pulmonary thromboembolism: A therapeutic dilemma.

Bronchial artery embolization is the treatment of choice for the management of life-threatening massive hemoptysis. Chronic pulmonary thromboembolism (PTE) is one of the rare causes of hemoptysis. Management of hemoptysis in chronic PTE is a point of debate. In this article, we have reported one case of hemoptysis in chronic PTE managed successfully with bronchial artery embolization.

Usefulness of ascitic fluid cholesterol as a marker for malignant ascites.

BACKGROUND: The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate the diagnostic efficacy of ascitic fluid cholesterol in comparison to the efficiency of ascitic/serum total protein, pH, glucose, total leukocyte count, and the serum/ascitic albumin gradient in differentiating "malignant" from non-malignant ascites. MATERIALS/METHODS: A total of 50 patients (25 with malignant ascites and 25 with non-malignant) were evaluated for total ascitic protein, ascites/serum (A/S) total protein ratio, serum ascites albumin gradient (SAAG), ascitic pH, serum & ascitic cholesterol with glucose. RESULTS: The mean ascitic cholesterol level was significantly higher in malignant ascites than in non-malignant ascites, with a cut off level of 70 mg/dl for ascitic fluid cholesterol; 22/25 (88%) patients with malignant ascites could be separated from the 25 patients with non-malignant ascites. The specificity (100%) and diagnostic efficiency (94%) of ascitic fluid cholesterol is better than the 84% specificity and 86% diagnostic efficiency of serum ascitic albumin gradient. CONCLUSIONS: Total Ascitic protein (70%), Ascitic serum protein ratio (74%), ascitic leukocyte count (54%), and malignant cytology (82%) yielded much lower diagnostic efficiency than ascitic fluid cholesterol (94%) or SAAG (86%) in the diagnosis of malignant ascites.