Biomedical subjects

Rajan Saxena

Publications and source records attributed to Rajan Saxena.

5 recordsLinked to original sources

PubMed2003

Longterm survival after extended resections in patients with gallbladder cancer.

BACKGROUND: Surgery is the treatment of choice for gallbladder cancer, but the extent of resection and its benefits remain unclear. STUDY DESIGN: Survival analysis of 42 patients who underwent extended resections for gallbladder cancer was performed. Resections were labeled R0 (curative) or R1 (noncurative) based on histopathologic evaluation. Survival curves were constructed using the Kaplan-Meier method, and survival data were analyzed by univariate and multivariate analyses to identify factors associated with longterm (>2 years) survival. RESULTS: R0 status was achieved in 18 patients (43%): 100%, 100%, 45%, and 0% in stages I, II, III, and IV, respectively. Patients with R0 resections had a significantly better survival than those with R1 resections (median 25.8 months versus 17.0 months; p = 0.03). R0 status was achieved in only 3 of 20 patients (15%) with node positive (N1) disease compared with 14 of 17 patients (82%) with node negative (N0) disease. Patients with N0 disease had a significantly better survival than those with N1 disease (median not reached versus 17 months; p = 0.01). None of the patients with N1 disease survived 5 years; 5-year survival for N0 patients was 58%. Adjuvant therapy did not have a significant effect on survival. CONCLUSIONS: In patients with gallbladder cancer, R0 status could be achieved in only 43% of patients undergoing extended resections. R0 status and N0 disease were associated with better longterm survival.

Adult↗

PubMed2003

Hilar benign biliary strictures: need for subclassification.

BACKGROUND: A uniformly accepted classification allows an accurate comparison of results and formulation of a standardized treatment plan. Suggested herein is a subclassification of Bismuth type III post-cholecystectomy benign biliary strictures (BBS). METHODS: Fifty-seven patients (41%) with Bismuth type III and eight patients (6%) with type IV BBS out of a total of 139 patients with BBS were analysed retrospectively. Strictures were subclassified as type IIIA where the confluence was healthy and type III B where the roof of the confluence was healthy and right and left ductal continuity was maintained, although the floor of the confluence was scarred. RESULTS: Of 57 patients with type III BBS, 44 were subclassified as type IIIA and 13 as type IIIB. Statistically significant differences were observed in the mean operative blood loss (317 vs 635 mL, P = 0.004; 317 vs 606 mL, P = 0.006), blood transfused (0.8 vs 2.2 units, P = 0.0007; 0.8 vs 2.0 units, P = 0.0008), and duration of surgery (3.8 vs 5.1 h, P = 0.002; 3.8 vs 5.6 h; P = 0.0004) between type IIIA and IIIB, and between type IIIA and IV strictures, respectively. There were no differences in the operative parameters between type IIIB and IV strictures. There was no difference in the overall morbidity (18% vs 15% vs 25%) and septic complications among the three groups. At a mean follow up of 36.4 months, 87%, 91% and 100% of patients had excellent/good outcome in type IIIA, IIIB and IV, respectively. CONCLUSIONS: Type III biliary strictures need to be subclassified, based on whether the floor of the confluence is healthy or scarred because it influences the degree of operative difficulty and morbidity. Type IIIB BBS behave like and should be classified with type IV strictures for uniformity of result evaluation.

Adult↗

PubMed2002

Perioperative management of a patient presenting with a spontaneously ruptured esophagus.

PURPOSE: To report a case of spontaneous rupture of the esophagus and its anesthetic management. CLINICAL FEATURES: A 52-yr-old male presented with a seven day history of chest pain, respiratory distress, and swelling in the neck following forceful vomiting. Examination revealed hypotension, decreased air entry in the right lower lung field with crepitations, epigastric tenderness with abdominal distension and guarding of both right and left hypochondria. A contrast esophagogram showed extravasation of contrast material from the lower third of the esophagus into the mediastinum without pleural cavity involvement. Reinforced primary closure of a 5-cm transmural tear in the right anterolateral wall of the esophagus 5 cm above the gastro-esophageal junction was performed along with right-sided chest drainage. The anesthetic drugs and technique in this case were selected to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. Invasive monitoring was used to assess early hemodynamic changes and to administer fluid therapy and vasoactive drugs. Due to prolonged surgery, lung congestion, large fluid shifts, a long surgical incision and abnormal arterial blood gases, the patient was ventilated mechanically in the intensive care unit. Subsequently he developed an esophageal leak, septic shock, and multiple organ failure and died. CONCLUSION: In a patient with a spontaneous rupture of esophagus, the anesthetic considerations include avoidance of further aggravation of the esophageal tear, and resuscitation from a morbid inflammatory condition.

Anesthesia↗

PubMed2002

Early gallbladder cancer.

BACKGROUND: The majority of patients with gallbladder cancer (GBC) have advanced disease at the time of diagnosis and are unresectable. Longterm survival is usually seen in a subset of patients with early GBC (EGBC)-cancer confined to the mucosa (pT1a) and muscularis (pT1b). Management guidelines of EGBC are not yet defined and are controversial. The purpose of this article is to evaluate the diagnostic aspects and effects of resectional procedures on survival outcome in patients with EGBC. STUDY DESIGN: EGBC was defined as cancer confined to the mucosa (pT1a) or muscularis (pT1b) according to the TNM classification. Clinicopathological details and survival data of 14 patients who had EGBC were analyzed. There were 9 women and 5 men, with a mean age of 60 years. RESULTS: A definite preoperative diagnosis was possible in only three patients and three patients were diagnosed at operation; the majority of patients were diagnosed incidentally after cholecystectomy for associated gallstones. Two patients underwent extended cholecystectomy and 12 patients underwent simple cholecystectomy. Two patients had pT1a and 12 had pT1b lesions. Mean (SD) survival was 71.5 (12.2) months and median survival was 42 months. There were five treatment failures with locoregional recurrence and death; all with pT1b tumors were treated by simple cholecystectomy. Cumulative 1-, 3-, and 5-year survival was 92%, 68%, and 68% respectively [corrected]. CONCLUSIONS: Simple cholecystectomy is an adequate treatment only for mucosal GBC. Patients with pT1b tumors require extended cholecystectomy. Incidental GBC extending up to the muscularis merits early reoperation for completion of extended cholecystectomy, which offers the only chance of cure.

Adult↗

PubMed2002

Pancreatic abscess: 10 years experience.

BACKGROUND: Secondary infections of pancreatic and peripancreatic necrosis account for most of the deaths following acute pancreatitis. These infections occur in the form of 'infected pancreatic necrosis' and 'pancreatic abscess'. The latter is a rare complication of acute pancreatitis in comparison with the former. METHODS: Twenty-one patients with pancreatic abscess were managed over a 10-year period at a tertiary care centre in Northern India. The present report details the clinical profile, investigations performed and management strategy (surgery and intervention radiology) of these patients. The role of surgery and percutaneous catheter drainage (PCD) in the management of pancreatic abscess is discussed, with emphasis on the successful outcome seen in a properly selected group of patients managed by PCD. RESULTS: Of the 21 patients, 12 were managed by percutaneous intervention, nine were managed surgically (of these, two had a prior PCD) and two patients were managed conservatively. The overall mortality was 9.5% (2/21). Thus, percutaneous management was suitable for 57% patients, was successful in 83.3%, with a mortality of 8.3%. Surgical therapy alone was offered to 33% of patients, was successful in 85.7%, with a mortality of 14.2%. Complications were seen in four of the nine patients managed by percutaneous drainage alone and eight of the nine patients managed surgically. CONCLUSIONS: Pancreatic abscess is a potentially lethal complication in patients recovering from acute pancreatitis. Early diagnosis and prompt intervention with careful selection of patients based on computed tomography imaging for surgical or percutaneous radio-logical management, is met with a successful outcome in a majority of patients. The roles of surgery and PCD are complementary.

Abscess↗