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Biomedical subjects

G R Verma

Publications and source records attributed to G R Verma.

At least 19 recordsLinked to original sources
PubMed2006

Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy.

BACKGROUND: This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed. METHODS: For this study, 60 patients with chronic cholecystitis were divided into four groups of 15 each: group A (bupivacaine-soaked Surgicel kept in gallbladder bed), group B (bupivacaine infiltrated at trocar sites), group C (bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with visual analog scale (VAS) scoring. RESULTS: The findings showed that 78.33% of the patients had visceral pain, 70% experienced parietal, and 23.33% reported shoulder pain after laparoscopic cholecystectomy. The visceral pain was significantly less in the group A patients than in the control subjects (p < 0.05), and none of them experienced shoulder pain. The mean VAS score at 4, 8, and, 24 h in the group A patients also was less than in control group D: 26.37 +/- 16.24 versus 38.30 +/- 9.51, 23.23 +/- 14.28 versus 33.73 +/- 7.96, and 18.36 +/- 13.00 versus 28.60 +/- 9.42, respectively. Trocar-site infiltration alone was not effective in relieving the parietal pain. CONCLUSION: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.

Adult↗
PubMed2006

Liver abscess associated with hepatic artery pseudoaneurysm with arteriovenous fistula: imaging and interventional management.

Hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. Hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.

Aneurysm, False↗
PubMed2004

Contrast-free unilateral endoscopic palliation in malignant hilar biliary obstruction: new method.

BACKGROUND: Bilateral endoscopic drainage is difficult in malignant hilar biliary obstruction. Recently, unilateral drainage in malignant hilar biliary obstruction has been shown to be equally effective. However, contrast injection leads to cholangitis. There have been no reported studies on contrast-free metal stenting in malignant hilar biliary obstruction. The present study was undertaken to evaluate the results of contrast-free unilateral metal stenting in type II malignant hilar biliary obstruction. METHODS: We prospectively studied the results of unilateral metal stenting in type II malignant hilar biliary obstruction without contrast injection in 18 patients. RESULTS: A successful endoscopic drainage was achieved in 100% (18/18) of patients with hilar strictures. Cholangitis and 30-day mortality occurred in none. CONCLUSIONS: Unilateral endoscopic metal stenting without contrast in type II malignant hilar biliary obstruction is a safe and effective method of palliation.

Biliary Tract Neoplasms↗
PubMed2003

Utility of intrapleural streptokinase in management of chronic empyemas.

BACKGROUND: The nonsurgical medical approach with use of fibrinolytic agent is an alternative modality in management of chronic empyemas. With the introduction of purer forms of streptokinase, there has been renewed interest generated in the use of intrapleural thrombolytics with documented successful drainage of difficult to drain chronic empyemas. To evaluate the utility of streptokinase in the management of chronic difficult to drain empyemas in a single blind randomized case control study. MATERIAL AND METHODS: Twenty four cases of chronic/multiloculated empyema were included which had cases preferred having loculations or multiloculations and failure of drainage via thoracostomies for less than 100 ml during last 24 hours. Cases were randomized into two groups as 12 cases of streptokinases group and 12 cases of placebo group. Streptokinase given as 2.5 lac units in 100 ml of normal saline instilled intrapleurally for 6 consecutive days. In control group, 100 ml of normal saline without streptokinase was instilled intrapleurally through intercostal drain for 6 days. They were assessed by amount of drainage through intercostal drain for six days after instillation of streptokinase/placebo, duration of intercostal drainage in situ, and radiological improvement by standard x-ray chest. RESULTS: The study revealed increased drainage through intercostal drain in streptokinase group compared to control group. The mean duration of intercostal drainage in situ was shorter in streptokinase group compared to control group. Radiologically, streptokinase group revealed score 3 improvement in eight out of twelve cases and score 2 improvement in rest of the four cases. In control group, score 1 improvement was seen in two out of twelve cases and no improvement was seen in rest of the 10 cases. The observation difference is found to be highly significant statistically (p <0.001). No major adverse effects were noted in the streptokinase group. CONCLUSION: The study concludes the safety, efficacy, reduced hospital stay and decreased morbidity in patients treated with intrapleural streptokinase as compared to control group.

Adolescent↗
PubMed2001

Pericholecystic adhesions in single v multiple gallstones and their consequences for laparoscopic cholecystectomy.

BACKGROUND: Adhesions are amongst the common reasons for open conversion of laparoscopic cholecystectomy. It is not clear whether this problem is more common with single or multiple gallstones. PATIENTS AND METHODS: The clinical records of 110 patients with chronic cholelithiasis harboring multiple stones in the gallbladder (multiple stone group; MSG) and 45 patients with single stones in the gallbladder (SSG) undergoing laparoscopic cholecystectomy were analyzed for differences in the clinical presentation and outcome with special reference to the incidence of pericholecystic adhesions, size of the stones, and their implications for conversion and complications. RESULTS: Patients in the SSG had a significantly higher incidence of dense pericholecystic adhesions in the region of the porta hepatis (P = 0.003). Eleven patients in the SSG (24.4%) were converted to open cholecystectomy. Dense pericholecystic adhesions around the porta hepatis alone contributed to nine of these conversions (81.8%). The size of the stones was significantly greater (P < 0.001) in those patients of the SSG who required conversion to open cholecystectomy. Thirteen patients of the MSG (11.8%) required conversion to open cholecystectomy. Dense pericholecystic adhesions alone contributed to conversion in four cases (30.7%), and the size of the gallstones was not significantly different (P = 0.981) in patients with or without conversion to open cholecystectomy. There was no difference in the clinical presentation or complications in the two groups of patients. CONCLUSION: Dense adhesions in the porta hepatis are significantly more common in patients with single stones and are the most common reason for open conversion.

Adult↗
PubMed1999

Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy.

BACKGROUND: Injury induces systemic inflammatory response. The degree of response is proportionate to the trauma. METHODS: Patients with ultrasound-proven gall stones posted for operation were randomized into two groups. Laparoscopic cholecystectomy was performed in one group while the other group underwent conventional cholecystectomy. Peripheral venous blood samples for inflammatory mediators, namely tumour necrosis factor, C-reactive protein, oxygen release from monocytes and polymorphonuclear leucocytes were drawn 1 day before surgery and repeated on the first and third days after surgery. Partial pressure of arterial oxygen was also measured in both groups. Only patients who met selection criteria and had uncomplicated postoperative courses were included in the study. There was a total of 40 patients for the final analysis, 20 in each group. RESULTS: There was no significant difference (P > 0.1) in age, sex or body mass index in both groups of patients. The level of all of the inflammatory mediators was elevated on the first postoperative day; however, the elevation was significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy (P < 0.01). Although the values came down on the third postoperative day, they remained above the respective controls. Postoperative hypoxaemia was significantly more in patients of conventional than laparoscopic cholecystectomy (P < 0.001). CONCLUSIONS: Trauma-induced inflammatory response is significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy. It appears to be related to degree of trauma.

Adult↗
PubMed1998

Laparoscopic treatment of hepatic hydatid cyst.

A case of hydatid cyst treated by laparoscopic surgery is described. The principles of conventional surgery in hydatid disease were achieved. The role of laparoscopic surgery is reemphasized.

Adult↗
PubMed1997

Pancreatoduodenectomy in abdominal trauma: a viable alternative.

Pancreatoduodenectomy was performed in five patients with severe pancreatoduodenal trauma following vehicular accidents. Three of them presented within five hours of injury and two patients, four and ten days later. Surgery was performed within 6-12 hours of hospitalization. All patients underwent pancreatoduodenectomy; in one the pancreatic stump was closed completely owing to its friability. Three patients survived; two succumbed to ongoing preoperative septicemia due to late presentation. The results of pancreato-duodenectomy are good when patients are operated on early, before the development of sepsis.

Abdominal Injuries↗
PubMed1997

Churg Strauss syndrome-clinicopathological aspects--report of a case.

An elderly person presented with exertional dyspnoea, cough, rhinorrhea and multiple swelling in submandibular region. This case was found to have marked eosinophilia with upper, as well lower respiratory tract involvements. Erroneous treatment patient received in past for pulmonary tuberculosis without any beneficial result. Open lung biopsy was undertaken, revealed evidence of vascultitis and perivascular inflammatory changes. The case findings and histopathological discussions are reviewed briefly.

Biopsy↗
PubMed1997

Nipple involvement in peripheral breast carcinoma: a prospective study.

Twenty six females patients of carcinoma of the breast were studied prospectively to find out the incidence of microscopic involvement of the Nipple Areolar Complex (NAC). The tumours were situated at minimum of 2.5 cms away from areola and the nipple was grossly normal. Majority of the patients (69.3%) had T.N.M. stage II disease. Tumours were situated within 4 cms of areola in 88.5% of the cases. Axillary lymph node metastasis was present in 38.4% of the cases. Irrespective of the size & stage of the tumour and tumour areola distance, the incidence of the microscopic involvement of NAC was 0%.

Adult↗
PubMed1992

Reconstruction of a major abdominal and chest wall defect using latissimus dorsi and extended deep inferior epigastric artery flap.

Large defects of the chest and abdominal cavity are a challenging reconstructive problem. We present reconstruction of a major chest and abdominal wall defect in a patient who had recurrent chondrosarcoma. The defect extended from just below the nipple almost to the umbilicus, and measured 28 x 30 cm. An "extended" latissimus dorsi muscle flap and extended deep inferior epigastric artery flap were used for reconstruction of the defect. A 1-year follow-up of the patient is presented.

Abdominal Neoplasms↗
PubMed1984

Pancreatic abscess: a review of seventeen cases.

Seventeen patients out of a total of 190 cases of acute pancreatitis, over a period of 12 years, developed the rare but serious complication of pancreatic abscess. Presence of toxaemia, fever, tachycardia and a tender epigastric mass suggested the possibility of abscess formation. Significant hyperamylasaemia was present in 2 patients only. Barium enema examination showed colonic changes due to direct involvement in 3 patients. Pre-operative management included complete rest to the gastrointestinal tract, correction of fluid and electrolyte imbalance, monitoring of vital signs and other parameters and antibiotic cover with penicillin in combination with broad spectrum antibiotic. In recent years Metronidazole was added in 7 patients, and this resulted in significant improvement of results. Surgical drainage was performed in all cases. The postoperative course was stormy and a significant number of patients developed both local as well as systemic complications with multiorgan failure. Residual/recurrent abscess was seen in one case only. Ten patients died in the immediate postoperative period. The survival rate was 41 per cent.

Abscess↗