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Dhananjaya Sharma

Publications and source records attributed to Dhananjaya Sharma.

12 recordsLinked to original sources
PubMed2005

Dissection with a metal dissector: a useful adjunct to transhiatal oesophagectomy.

OBJECTIVE: Intraoperative cardiovascular instability is frequently observed during blunt finger dissection for transhiatal oesophagectomy. We conducted a prospective study using a metal ring dissector for blunt dissection of the oesophagus to overcome this problem. METHODS: Dissection with a metal ring dissector was used in 30 consecutive patients undergoing transhiatal oesophagectomy for carcinoma of the lower oesophagus (n=26) and oesophagogastric junction (n=4). RESULTS: Dissection of the oesophagus proximal to the growth was quick and straightforward in all instances. The procedure appeared less traumatic than the conventional manual technique and was not associated with any intraoperative cardiovascular instability or intramediastinal bleeding. None of the patients had tracheal injury or recurrent laryngeal nerve paralysis. There was one anastomotic leak and no deaths. CONCLUSION: Oesophageal blunt dissection with a metal ring dissector is safe, easy and quick. The correct plane of dissection minimizes the risk of intramediastinal bleeding and inadvertent trauma to neighbouring structures.

Adult↗
PubMed2005

Lymph node counts in indians in relation to lymphadenectomy for carcinoma of the oesophagus and stomach.

OBJECTIVE: Systemic lymphadenectomy for carcinoma of the oesophagus and stomach is increasingly accepted as effective surgical treatment. A review of available literature reveals a great variety in the number of lymph nodes removed during standard lymphadenectomy. The present study was conducted to find the normal number of lymph nodes in the Indian population in relation to lymphadenectomy for oesophageal and gastric carcinoma. METHODS: Lymph nodes situated at stations 1-16, relevant to lymphadenectomy for gastric cancer, were removed by lymph node dissection according to the recommendations of the Japanese Research Society for Gastric Cancer and those at the 22 stations, relevant to lymphadenectomy in oesophageal cancer, were removed according to the International Society for Diseases of the Esophagus recommendations in 10 cadavers without a history of any abdominal pathology or haematological lymphatic disease. Nodes were cleared by dissolving fatty tissue. All lymph nodes were histologically confirmed and the diameter of each lymph node was recorded. RESULTS: An average of 52.0 nodes (range, 37-78 nodes) was found at Stations 1-16, while an average of 183.6 nodes (range, 118-234 nodes) was found at the 22 stations. These numbers are higher than those in the literature. CONCLUSION: This anatomical study addresses the dual issues of determining the number of dissectable lymph nodes in a particular population as well as assessing the quality of nodal dissection by providing quantitative surgical guidelines.

Adult↗
PubMed2004

Tuberculous appendicitis in India.

Tuberculous appendicitis (TBA) is a rare condition. The present study has been conducted to study its prevalence and presentation. This retrospective study was performed in the Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India, in 870 consecutive appendectomies performed between January 1991 and December 2000. Of 870 consecutive appendicular specimens, 10 cases of primary (1.1%) and 16 of secondary TBA (1.8%) were encountered. Results of all pre-operative investigations were non-specific and the diagnosis was made only after histopathology. The prevalence of TBA in this study was 2.9%. Although it is a rare condition, its possibility should be kept in mind by clinicians as well as pathologists. All surgically removed appendix specimens should be histopathologically examined, whether or not the specimens are macroscopically normal. Given antitubercular treatment in addition to appendectomy, patients recover without complications.

Adolescent↗
PubMed2004

Quality of life after peptic perforation.

AIM OF STUDY: Quality of life (QOL) as outcome during treatment of acid peptic disease has been studied, but, peptic perforation, which is the commonest complication of acid peptic disease, has not been studied in the light of QOL outcome. The present-study addresses the important issue of QOL after peptic perforations. METHODS: This prospective study was carried on 51 adult consecutive survivors of peptic perforation managed in Gastrointestinal Surgery Unit, Department of Surgery, Government NSCB Medical College and Hospital, Jabalpur (MP) India. These underwent exploratory laparotomy with repair of perforation, and subsequently were discharged on anti-ulcer therapy (Pantoprazole 40 mg once a day) for 6 weeks. The instrument chosen to study their QOL was gastrointestinal quality of life index (GIQLI). Patients were assessed before they underwent surgery and 3 months and 6 months after operation. RESULTS: The overall GIQLI score (t = 20.1, p < 0.00 at 3 months; t = 8.2, p < 0.001 at 6 months) as well as its G I core (t = 14.5, p < 0.001 at 3 months; t = 7.3, p < 0.001 at 6 months), G I disease specific (t = 12.9, p < 0.001 at 3 months; t = 2.6, p < 0.02 at 6 months), psychological (t = 15.4, p < 0.001 at 3 months; t = 3.5, p < 0.001 at 6 months) and physical and social components (t = 10.9, p < 0.001 at 3 months; t = 4.2, p < 0.001 at 6 months) significantly increased over 3 and 6 months of follow-up, reflecting improvement in quality of life as perceived by the patients. Variations in the pattern of recovery, based on age and gender were not seen in the present study. CONCLUSION: Peptic perforation does not result in any long lasting impairment of QOL and the QOL improves to near normal in 6 months time after the perforation.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Correlation between serum-ascites albumin concentration gradient with gastrointestinal bleeding in patients of portal hypertension.

Non-availability of endoscopic screening to detect portal hypertensive patients at a high risk of index gastrointestinal (GI) haemorrhage led us to examine the relationship between serum-ascitic albumin concentration gradient (SAAG) measurements and the occurrence of GI haemorrhage in patients with portal hypertension and ascites. Fifty-six consecutive patients of portal hypertension with ascites attending the GI surgery outpatients clinic were divided into two groups on the basis of history: (a) those who had no history of GI bleeding; and (b) those who had an episode of GI bleeding within the past 21 days. Child-Pugh score was calculated for all patients. All the patients were assessed by ultrasonography and SAAG was estimated. Groups (a) and (b) were compared and sensitivity, specificity, positive and negative predictive value of using SAAG as a possible screening test for GI bleeding were calculated. SAAG values correlated significantly with bleeding and splenomegaly. For prediction of bleeding, SAAG had a sensitivity of 100% and specificity of 33.33%, positive predictive value of SAAG for GI bleeding was 71.4% and the negative predictive value was 100%. Estimation of SAAG is possible even in a small, modestly equipped laboratory, and could provide a new means for the identification of high-risk patients for GI bleeding and define patients more accurately for future clinical studies. The results of the present study are encouraging for clinicians working in developing countries and may help in optimizing prophylactic therapy and where available, improving the cost effectiveness of screening endoscopy.

Adolescent↗
PubMed2002

Surgical bypass is still relevant in the palliation of malignant obstructive jaundice.

Malignant tumours of the biliopancreatic system causing obstructive jaundice are not curable in most of the patients, and palliation plays a very important therapeutic role. The role of surgery in palliation of malignant obstructive jaundice has been questioned in the light of availability of endoscopic techniques. In developing countries, however, exploratory laparotomy and palliative surgery (when possible) is the only option available as sophisticated instruments and the expertise to use them is limited to a very few centres. This was a retrospective study of 83 consecutive cases with malignant obstructive jaundice admitted to the Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India from January 1996 to December 2000.

Adult↗
PubMed2002

Palliation by coeliac plexus block for upper abdominal visceral cancer pain.

Palliation of cancer related pain is one of the major concerns of patients suffering from cancer of the upper abdominal organs. The non-availability of imaging techniques to guide needle placement prompted us to use a blind technique of neurolytic coeliac plexus block. Thirty consecutive patients with intractable pain, due to documented inoperable upper abdominal visceral cancers, underwent neurolytic coeliac plexus block by blind percutaneous retrocrural unilateral neurolysis. The severity of pain was documented on a 0-10 visual analogue scale (VAS) performed pre-block and post-block at 1 day, 1 week, 1 month and 3 months. Pain relief was graded as excellent if the score was 0-2, good when VAS was 3-5, satisfactory whenVAS was 6-7 and unsatisfactory if VAS was 8-10. Excellent pain relief was obtained in 26/30 patients (86.6%). Relief from pain diminished with time and after 3 months, 16/30 patients (53.35) graded their pain relief as excellent. Transient but severe hypotension complicated 73% of blocks. Despite the proximity of vital structures, blind unilateral retrocrural neurolytic coeliac plexus blockade is a safe and effective means to relieve the terminal pain associated with upper abdominal visceral cancer. It deserves more widespread use in patients with upper abdominal cancer. Results of the present study are encouraging and relevant for clinicians working in developing countries.

Abdominal Neoplasms↗
PubMedDate not supplied

Esophago-gastric dissociation complicating devascularization procedure for portal hypertension.

Devascularization surgery for portal hypertension, indicated in selected patients, is considered safe. A 15-year-old boy with cirrhosis underwent elective modified Sugiura's devascularization procedure for secondary prophylaxis of variceal bleeding. He developed esophago-gastric dissociation, which was successfully managed with emergency feeding jejunostomy and restoration of gut continuity three months later.

Adolescent↗
PubMedDate not supplied

Correlation of trauma scoring systems with abdominal septic complications in abdominal trauma.

INTRODUCTION: Anatomical trauma scoring systems can predict the occurrence of postoperative abdominal septic complications (ASC) after major abdominal trauma; however, this has not been validated in any Indian study. We attempted such an evaluation in patients attending a teaching hospital in central India. METHOD: A retrospective analysis of data from 169 patients who had undergone emergency laparotomy for penetrating or blunt abdominal injury between August 1996 and July 2001 was done. Every patient was scored using three trauma severity indices and the occurrence of ASC was identified. RESULTS: Patients who developed ASC had higher trauma severity scores than those who did not. Thirty-eight patients had isolated small bowel injury; trauma scores underestimated the occurrence of ASC in these patients. CONCLUSIONS: Trauma severity indices may serve as useful tools to predict the occurrence of postoperative ASC in patients with abdominal trauma, except in those with isolated small bowel injury. There is thus a need to modify the weight of small bowel injury in these scoring systems.

Abdominal Injuries↗
PubMedDate not supplied

A simplified prognostic scoring system for peptic ulcer perforation in developing countries.

BACKGROUND: Several complex prognostic scoring systems are available for abdominal sepsis. We constructed and assessed a simplified scoring system for peptic perforation, which can be easily used in developing countries. METHODS: One hundred and forty consecutive patients with perforated pre-pyloric or duodenal ulcer undergoing Graham's patch omentopexy closure were studied prospectively. Each factor was given a score based on its severity in accordance with the APACHE-II scoring system to construct the simplified prognostic (Jabalpur) scoring system, and multiple regression analysis was used to identify risk factors. This system was prospectively validated in the next 50 consecutive patients and compared to existing systems. RESULTS: The factors associated with mortality were age, presence of co-morbid illness, perforation-to-operation interval, preoperative shock, heart rate, and serum creatinine. The mean score in survivors (4.9) was less than that in those who died (12.5; p<0.0001). This scoring system compared favorably with other scoring systems. CONCLUSIONS: The Jabalpur scoring system is effective for prognostication in cases of peptic perforation. It is simple and user-friendly as it uses only six routinely documented clinical risk factors.

APACHE↗
PubMedDate not supplied

Repair of duodenal fistula with rectus abdominis musculo-peritoneal (RAMP) flap.

INTRODUCTION: Large duodenal defects/fistulae are difficult to repair, due to complex duodenal anatomy. Musculo-epithelial flaps are conventionally used for reconstruction of large soft tissue defects. We report the clinical use of rectus abdominis musculo-peritoneal (RAMP) flap for repair of duodenal fistulae. METHODS: Eight patients with duodenal fistulae underwent repair using right RAMP flap, based on the position of the superior epigastric artery. Feeding jejunostomy was done routinely to start early enteral feeding. RESULTS: Duodenal fistulae healed within 3-5 days in all the cases except one, in whom bile continued to leak for 30 days. One patient died within 12 hours of second surgery. Superficial wound infection was a common (n=3) cause of morbidity. CONCLUSION: RAMP flap for closure of duodenal defect is a simple, technically easy and dependable procedure, which can be performed quickly in critically ill patients. It can be used for repair of large duodenal defects with friable edges when omentum is not available or when other conventional methods are impractical.

Duodenal Diseases↗