Biomedical subjects
Publications and source records attributed to Ravul Jindal.
A 22-year-old woman with a diagnosis of Klippel-Trenaunay syndrome presented with pain in the left hypochondrium and vomiting. Investigations revealed a huge splenomegaly with multiple hypodense lesions and irregular, linearly enhanced areas. She underwent splenectomy and had good postoperative recovery. Histopathology showed hemangioma/lymphangioma of the spleen.
BACKGROUND: Pancreatic necrosectomy for necrotizing pancreatitis is a formidable operation. There are limited data from the Indian subcontinent regarding outcome and recent trends in management. METHODS: Patients undergoing pancreatic necrosectomy over a 12-year period were identified from a prospective database. Data regarding the hospital course, complications and outcome were extracted by case file review. Descriptive statistics were used to present the data. An attempt was made to identify trends in management and outcome over the study period. RESULTS: One hundred and eighteen patients underwent necrosectomy. The median age was 39.5 years (interquartile range, 32-46). Median Acute Physiology And Chronic Health Evaluation II score at admission was 8 (interquartile range, 6-10). Thirty-nine patients (33%) had organ failure at admission. Patients underwent surgery a median of 23 days (interquartile range, 14-34) after onset of illness. There was high incidence of loco-regional complications (68/118, 58%) and organ failure (88/118, 75%) in the postoperative period. The mortality rate was 38%. There was an increase in the median onset to surgery interval (17 vs 25.5 days; P = 0.001), increased use of percutaneous interventions (20 vs 36%; P = 0.05) and decreased mortality (47 vs 29%; P = 0.052) in the later half of the study period. CONCLUSION: Pancreatic necrosectomy continues to be associated with significant morbidity and mortality in India. A trend towards increased use of percutaneous interventions and delayed surgery is evident.
This is a retrospective study of the experience with extremity vascular trauma at a tertiary level referral centre in North India where the majority of the population lives in villages and the incidence of high-speed automobile accidents and civilian violence is low. The aim was to study the aetiology, pattern of injuries and the mortality and morbidity rates due to vascular trauma in our population. Data relating to 148 patients presenting with vascular trauma requiring surgical intervention other than amputation between January 1996 and December 2002 were collected retrospectively. There were 132 males and 16 females with a mean age of 39 years presenting to the casualty with a median delay of 9.3 h after injury. Blunt trauma accounted for 84% of the injuries with extremities involved in 88%. The brachial artery was the most common artery injured with the femoral next most common. Repair without graft interposition was done in 74% and autogenous vein grafts were used in 23% of cases. Comparison of our results with those that would have been obtained, had the recommendations of Mangled Extremity Severity Score (MESS) been followed, showed that this scoring system had low sensitivity and specificity for prediction of salvageability of limbs. Eight percent patients died due to associated visceral organ injuries. Complications occurred in 32% patients and amputation was required in 6% of patients after an initial surgical repair mainly due to inadequate functional recovery. Eighty-eight percent of the survivors with salvaged limbs were able to achieve full functional recovery. Judicious selection and appropriate intervention can result in satisfactory limb salvage with good functional outcomes even with delayed presentations.
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BACKGROUND AND AIM: Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. METHODS: Fifty-eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented. RESULTS: Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post-operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis. CONCLUSION: Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re-operation rates and mortality.
BACKGROUND: Vascular complications resulting from i.v. drug abuse constitute a range of clinical problems from simple to serious. In addition, patients who present with these complications frequently have viral infections, which are a hazard to health care workers. PATIENTS AND METHODS: The present study is a retrospective review of 46 male drug addicts with 52 vascular complications (45 arterial, seven venous). Pseudoaneurysm of the femoral artery was the most common complication (n = 35). Fourteen of these patients underwent ligation of the common, superficial and deep femoral arteries above and below the pseudoaneurysm. Twenty-one underwent bipolar ligation of the common femoral artery after complete excision of the pseudoaneurysm. The decision to revascularize was based on the presence or absence of postligation Doppler signal. Arterial reconstruction was performed in five patients. All eight brachial artery pseudoaneurysms were ligated and excised, and deep vein thrombosis was managed with anticoagulation. RESULTS: There was no mortality but three patients had to undergo late amputations of the lower limb after successful salvage following the initial surgery. The median postoperative ankle-brachial indices, after bipolar and triple ligations were 0.51 and 0.46, respectively. Positive blood cultures were present in 30% of patients and tissue cultures were positive in 72%, the most common organism isolated was methicillin-sensitive Staphylococcus aureus. Six patients were positive for viral markers. The median hospital stay was 43 days. CONCLUSION: Ligation and excision of pseudoaneurysms without revascularization is safe for drug addicts provided it is based on the presence of a postligation Doppler signal.
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Cystic adventitial disease is a rare disease affecting mainly young males. We describe two patients with this disease affecting the iliofemoral artery. These reports reemphasize the importance of keeping cystic adventitial disease as a differential diagnosis in young patients who present with leg ischemia.
BACKGROUND: Pulmonary complications remain a leading cause of morbidity after major abdominal operations. OBJECTIVE: To compare pulmonary function and the frequency of pulmonary complications after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). METHODS: Fifty-five patients with symptomatic gallstone disease undergoing elective cholecystectomy (LC 40, OC 15) under general anesthesia were evaluated using pulmonary function tests (forced vital capacity [FVC], forced expiratory volume at 1 second [FEV1], and forced expiratory flow at 25% to 75% [FEF25% -75%], chest X-ray and pulse oximetry before and after surgery. RESULTS: FVC, FEV1 and FEF25% -75% decreased by 21.5%, 21.2% and 30.3%, respectively, on postoperative day 1 following LC, and by 44.3%, 46.2% and 58.3%, respectively, after OC. Chest X-ray showed atelectasis in 15% of patients undergoing LC and 45% of those with OC. CONCLUSION: Impairment in pulmonary function after LC was less marked than after OC.