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Adarsh Chaudhary

Publications and source records attributed to Adarsh Chaudhary.

15 recordsLinked to original sources
PubMed2006

Issues in management of pancreatic pseudocysts.

Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cause complications in 7-25% of patients with pancreatitis or pancreatic trauma. The first step in the management of PPs is to exclude a cystic tumor. A history of pancreatitis, no septation, solid components or mural calcification on CT scan and high amylase content at aspiration favor a diagnosis of PP. Endoscopic ultrasound (EUS)-guided FNAC is a valuable diagnostic aid. Intervention is indicated for PPs which are symptomatic, in a phase of growth, complicated (infected, hemorrhage, biliary or bowel obstruction) or in those occurring together with chronic pancreatitis and when malignancy cannot be unequivocally excluded. The current options include percutaneous catheter drainage, endoscopy and surgery. The choice depends on the mode of presentation, the cystic morphology and available technical expertise. Percutaneous catheter drainage is recommended as a temporizing measure in poor surgical candidates with immature, complicated or infected PPs. The limitations include secondary infection and pancreatic fistula in 10-20% of patients which increase complications following eventual definitive surgery. Endoscopic therapy for PPs including cystic-enteric drainage (and transpapillary drainage), is an option for PPs which bulge into the enteric lumen which have a wall thickness of less than 1 cm and the absence of major vascular structures on EUS in the proposed tract or those which communicate with the pancreatic duct above a stricture. Surgical internal drainage remains the gold standard and is the procedure of choice for cysts which are symptomatic or complicated or those having a mature wall,. Being more versatile, a cystojejunostomy is preferred for giant pseudocysts (>15 cm) which are predominantly inframesocolic or are in an unusual location. In PPs with coexisting chronic pancreatitis and a dilated pancreatic duct, duct drainage procedures (such as longitudinal pancreaticojejunostomy) should be preferred to a cyst drainage procedure.

Humans↗
PubMed2006

Flutamide in unresectable pancreatic adenocarcinoma: a randomized, double-blind, placebo-controlled trial.

PURPOSE: To evaluate the impact of flutamide on survival of patients with unresectable pancreatic cancer. METHODS: This single institution, randomized, double-blind, placebo controlled study compared flutamide in the dose of 250 mg three times daily (n = 23) versus placebo (n = 23) in patients with histologically proven, previously untreated unresectable pancreatic adenocarcinoma. The primary end point was overall survival; secondary endpoints included 6-month and 1-year survival rates, performance status and response rate. RESULTS: Both the groups were well matched with regards to demographic, disease related and treatment variables. This small sample sized study, failed to demonstrate a dramatic effect on survival with the use of flutamide. Median overall survival was 151 days with the use of flutamide as compared to 136 with placebo (p = 0.51). The 6-month survival rate was 39.13% in both arms of study and 1-year survival was 4.35% versus 13.04% for the flutamide group. There was no statistically significant difference in time to deterioration of performance status (flutamide 90 days versus placebo 68 days, p = 0.59) and all patients died as a result of tumor progression. CONCLUSIONS: Anti-androgen drug flutamide in the dose of 250 mg three times daily does not appear to prolong overall survival in unresectable pancreatic cancer.

Adenocarcinoma↗
PubMed2005

Frey's procedure using the harmonic scalpel.

Frey's procedure, which is performed for chronic pancreatitis, principally involves coring of the head of the pancreas and pancreaticojejunostomy. The coring of the inflamed and enlarged pancreatic head is the most difficult and time-consuming part of this operation and is often associated with considerable bleeding. We used the harmonic scalpel to perform Frey's procedure in six consecutive patients, which reduced intraoperative bleeding and made the operation technically easier.

Blood Loss, Surgical↗
PubMed2005

Analysis of abnormal recovery pattern of liver function tests after surgical repair of bile duct strictures.

BACKGROUND: Gradual normalization of conventional liver function tests occurs in a majority of patients with extrahepatic biliary obstruction following adequate biliary drainage. Abnormal recovery pattern of liver function has been reported in up to 70% of these patients and there is scarcity of relevant information about this. The purpose of the present paper was to identify variables predictive of abnormal recovery pattern of liver function tests after surgical repair of benign biliary stricture. METHODS: Patient data, disease-related characteristics and serial liver function tests were prospectively collected in 64 patients with post-cholecystectomy bile duct strictures undergoing hepaticojejunostomy. Hepatic histology (fibrosis, portal inflammation, ductular proliferation and cholestasis) was independently graded by two pathologists using a previously validated scale. A cut-off limit of longer than 2 weeks for normalization of liver function tests following definitive surgical repair was considered abnormal. The patients were accordingly dichotomized into groups. Univariate and multivariate analysis was performed. RESULTS: Fourteen patients (22%) each had abnormal recovery pattern of serum bilirubin and serum alanine aminotransferase (ALT) levels while 13 (20%) had abnormal recovery pattern of serum alkaline phosphatase (SAP) levels. Multivariate analysis revealed basal serum bilirubin level was an independent predictor of abnormal recovery pattern of serum bilirubin level while basal ALT level as well as degree of hepatic fibrosis were independent predictors of abnormal recovery of serum ALT level. Similarly, basal SAP level and degree of hepatic fibrosis were independent predictors of abnormal recovery of SAP level. CONCLUSIONS: Basal values of liver function tests and degree of hepatic fibrosis are the most important predictors of abnormal recovery pattern of liver function following adequate biliary decompression in patients with post-cholecystectomy bile duct stricture.

Adolescent↗
PubMed2004

Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures.

HYPOTHESIS: Simplified evaluation based on clinical and biochemical variables might predict the degree of hepatic fibrosis in patients with postcholecystectomy bile duct strictures. DESIGN: Prospective cohort study. SETTING: Tertiary care referral and teaching hospital. PATIENTS: Sixty-four patients with postcholecystectomy bile duct strictures undergoing definitive repair. Prospectively collected information included demographics, disease-related characteristics, and serial liver function tests. Hepatic histologic features (fibrosis, cholestasis, portal inflammation, and ductular proliferation) were independently graded by 2 pathologists masked to clinical data using a previously validated scale. Patients were dichotomized into groups based on degree of hepatic fibrosis. Univariate and multivariate analyses were performed. MAIN OUTCOME MEASURE: Identification of variables that predict the presence of advanced hepatic fibrosis (grade 2-3). RESULTS: Thirty-five patients (55%) had early hepatic fibrosis (grade 0-1), and the remaining 29 (45%) had advanced fibrosis (grade 2-3). Univariate analysis demonstrated that duration of biliary obstruction, presence of portal hypertension, basal alanine aminotransferase (ALT) levels, and time to normalization of serum total bilirubin, ALT, and alkaline phosphatase levels after surgical drainage were statistically significantly associated with the presence of advanced hepatic fibrosis. However, multivariate analysis revealed that only duration of biliary obstruction (odds ratio [OR], 1.6048; P =.009), basal ALT levels (OR, 0.9634; P =.02), and time to normalization of ALT levels after surgical drainage (OR, 1.6680; P =.006) were significant predictors of advanced hepatic fibrosis. CONCLUSION: Duration of biliary obstruction, basal ALT level, and time to normalization of ALT level after surgical repair are independent predictors of advanced hepatic fibrosis (grade 2-3) in patients with postcholecystectomy bile duct strictures.

Adolescent↗
PubMed2004

Complications after Frey's procedure for chronic pancreatitis.

BACKGROUND: Frey's operation is indicated on patients with chronic pancreatitis who have "head dominant" disease and involves resection of the head of pancreas and lateral pancreaticojejunostomy (LRLPJ). There is little information about the postoperative complications after this procedure and the factors likely to be responsible for them. This paper addresses this aspect of LRLPJ. METHODS: A retrospective review was made of records of 41 patients undergoing LRLPJ for chronic pancreatitis between January 1990 to June 2003. RESULTS: Sixteen (39%) patients had 19 complications in the early postoperative period; septic complications were the commonest. One patient died. Regression analysis showed preoperative endoscopic pancreatic stenting to be the factor responsible for majority of these complications (P = 0.0041). Patients with a history of pancreatic stenting had a prolonged hospital stay (P = 0.022). CONCLUSIONS: Postoperative complications after LRLPJ are usually septic in nature and are likely to occur more often in patients in whom endoscopic pancreatic stenting has been performed before surgical intervention.

Abdominal Pain↗
PubMed2003

Carcinoma of pelvic pouch following restorative proctocolectomy: report of a case and review of the literature.

One of the possible long-term complications following an ileoanal pouch procedure is the development of malignancy in the mucosa of the rectal stump. Only 10 such cases have been reported so far. We report the case of a 23-year-old male who had ulcerative colitis with high-grade dysplasia and underwent an ileoanal pouch procedure. He was found to have a malignancy in the rectal stump 5 years after surgery. The malignancy presented with symptoms of refractory pouchitis. Pouch excision was performed. The risk of developing malignancy in the rectal mucosa after an ileoanal pouch procedure mandates regular follow-up in these patients, with a high index of suspicion especially in patients with delayed onset pouchitis.

Adenocarcinoma↗
PubMed2002

Reoperative surgery for postcholecystectomy bile duct injuries.

BACKGROUND: Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery. METHODS: Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury. RESULTS: Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome. CONCLUSION: Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.

Adult↗
PubMed2002

Pancreatic tuberculosis: still a histopathological diagnosis.

BACKGROUND: Pancreatic tuberculosis is usually unsuspected as it can present in various forms. Though an uncommon disease, once diagnosed it is potentially curable. PATIENTS AND METHODS: Retrospective review of the records of 9 patients with histologically proven tuberculosis of the pancreas. RESULTS: In none of the 9 patients was a preoperative diagnosis of tuberculosis possible. The diagnoses considered included: pancreatic cancer (n = 5); acute pseudocyst (n = 1); pancreatic abscess (n = 1); chronic pancreatitis with pancreatic head mass (n = 1), and carcinoma of the colon causing massive lower gastrointestinal bleeding (n = 1). All the patients underwent surgery. The diagnosis of tuberculosis was confirmed by histopathological examination of biopsy specimens obtained at the time of laparotomy. One patient died, the remaining patients received antitubercular therapy and are doing well at a median follow-up period of 26 months. CONCLUSION: In view of the nonspecific and variable clinical presentation and atypical radiological signs, a clinical diagnosis of pancreatic tuberculosis is usually not possible. Therefore there should be a high index of suspicion for this disease in young patients residing in endemic areas. Our experience highlights the importance of performing biopsy in apparently inoperable pancreatic mass lesions.

Adolescent↗
PubMed2001

Biliary Complications of Pancreatic Necrosis.

Pancreatic necrosis has the potential to cause avariety of locoregional complications (1). This isbecause of the propensity of the necrotic tissue tospread far beyond the confines of the pancreas. Theproximity of the biliary tract to the pancreas makesit particularly vulnerable to damage by the inflammatory process, and though likely, there are only isolated case reports of involvement of the biliarytract through the necrotic process (2-5). This papershares our experience in managing six patients withbiliary complications of pancreatic necrosis.

Journal Article↗
PubMedDate not supplied

Surgical management of obstructive gastroduodenal tuberculosis.

BACKGROUND: Gastroduodenal tuberculosis is a rare but potentially curable condition. The aim of the present study was to evaluate the clinical presentation, pre-operative status, management and outcome in patients with histologically proven diagnosis of gastroduodenal obstruction due to tuberculosis. METHODS: We retrospectively reviewed the records of 17 patients managed surgically for gastroduodenal obstruction due to tuberculosis. RESULTS: The site of obstruction was the pyloroduodenal canal in 53% of patients, second part of the duodenum in 24%, third part of the duodenum in 12% and duodenjojejunal flexure in 12%. The obstruction was caused by fibrotic stricture formation in 59% of patients and extrinsic compression by a lymph nodal mass in 41%. Endoscopic biopsy was diagnostic in only 29% of the patients in whom it was performed. Overall, a pre-operative diagnosis of gastroduodenal tuberculosis was suspected in only 35% of patients. All the patients underwent surgical drainage procedures and the diagnosis was confirmed by histopathological examination of biopsies taken at the time of laparotomy. CONCLUSIONS: In view of its rarity and non-specific findings on clinical, radiological and endoscopic evaluation, tuberculosis as a cause of gastroduodenal obstruction is seldom diagnosed pre-operatively. Hence, a high index of suspicion is required in young patients residing in endemic areas. Surgical intervention helps not only in relieving obstruction but also in confirming the diagnosis.

Adolescent↗
PubMedDate not supplied

Median pancreatectomy: a report of three cases.

Conventional pancreatic resections may be unnecessary for tumors of the pancreas that are benign or of low malignant potential and can place the patient at increased risk of developing postoperative exocrine and endocrine complications. Median pancreatectomy is an option that has been investigated in the management of such tumors located in the body of the pancreas. We present our experience with three women who underwent this procedure successfully for neuroendocrine tumors (2) and cystadenoma (1).

Adult↗
PubMedDate not supplied

Treatment of post-cholecystectomy bile duct strictures--push or sidestep?

Management of post-cholecystectomy bile duct strictures can be complex. Traditional treatment has been surgical reconstruction. In recent years endoscopic stenting has been successful in a selected subgroup of patients with iatrogenic bile duct strictures. Adequate information about long-term results of endoscopic stenting as definite treatment for such strictures is still awaited. Surgery is a reliable and time-tested method and results of numerous studies show its long-term success in relieving biliary obstruction with minimal morbidity.

Bile Ducts↗
PubMedDate not supplied

Squamous cell carcinoma of stomach.

Squamous cell carcinomas in the gastrointestinal tract are known to occur in oro-pharynx, esophagus and anal canal. Gastric squamous cell carcinoma is a rare epithelial tumour. Surgical treatment is the same as that for an adenocarcinoma, though prognosis is probably worse.

Carcinoma, Squamous Cell↗