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Biomedical subjects

S R Shah

Publications and source records attributed to S R Shah.

43 records · Page 3Linked to original sources
PubMedDate not supplied

Surgical management of the Budd-Chiari syndrome: early experience.

BACKGROUND: Early decompression is needed in the Budd-Chiari syndrome (BCS) to prevent liver dysfunction and death. AIMS: To study the technical difficulties during surgery and the results of surgery for BCS. METHODS: Retrospective review of nine patients operated on between 1994 and January 1998 for BCS--1 for uncontrolled fundal variceal bleed and 8 for chronic BCS. Isolated hepatic vein block was found in 5, inferior vena cava (IVC) block in 1 and a combination in 3 patients. Preoperative liver biopsies did not reveal cirrhosis in any patient. Portacaval shunt (3), portorenal shunt (2), mesocaval shunt (1), mesoatrial shunt (2) and devascularisation (1) were the operations performed. RESULTS: In 3 patients, side-to-side portacaval shunt was not possible because of caudate lobe hypertrophy (1), aberrant right hepatic artery (1) and presence of IVC stent (1); they required portorenal (2) or interposition mesocaval (1) shunts. Both mesoatrial shunts were unsuccessful. Devascularisation was effective in controlling the acute bleed. There was no intraoperative death. Postoperatively there were 3 deaths. Of the 6 survivors, 5 are asymptomatic over a mean follow up of 19.7 months. CONCLUSIONS: Side-to-side portacaval shunt is effective in the management of BCS; results with the mesoatrial shunt are disappointing.

Adult↗
PubMedDate not supplied

Extensive portal and splenic vein thrombosis: differences in hemodynamics and management.

BACKGROUND/AIMS: To assess the incidence of extensive portal and splenic vein thrombosis in patients with extrahepatic portal vein obstruction and determine the differences in presentation, portal hemodynamics and management as compared to patients with portal vein thrombosis alone. METHODOLOGY: 118 patients of extrahepatic portal vein obstruction presenting with variceal hemorrhage, having received no definitive treatment prior to presentation were divided into two groups--with portal and splenic vein thrombosis and with portal vein thrombosis, based on ultrasonography and splenoportography. Collateralization patterns on splenoportography were studied. Results of endoscopic variceal sclerotherapy were compared. RESULTS: Portal and splenic vein thrombosis was seen in 39 patients. Collateralization in case of portal and splenic vein thrombosis, in contrast to portal vein thrombosis, was predominantly left sided (74% vs. 9%, p < 0.0001). Fundal gastric varices were seen more often in patients with portal and splenic vein thrombosis (28% vs. 11%, p = 0.02), developing even after variceal obliteration, though obliteration was achieved in fewer sessions. Surgery for control of variceal bleed was performed more in the portal and splenic vein thrombosis group (33% vs. 15%, p = 0.02), especially for gastric varices (28% vs. 9%, p = 0.006). CONCLUSIONS: Portal and splenic vein thrombosis is present in 33% of patients with extrahepatic portal vein obstruction. Hemodynamic patterns differ, accounting for the preponderance of gastric varices on presentation in patients with portal and splenic vein thrombosis and an increased need for surgery.

Adolescent↗
PubMedDate not supplied

Meshlaparostomy--a comparison between polypropylene mesh and indigenous nylon net.

Polypropylene mesh, the routinely used material for mesh laparostomies is expensive. A economical and easily available substitute-nylon net was compared with polypropylene mesh with regard to efficacy and wound complications in a retrospective study. 51 patients, 25 in the polypropylene mesh group and 26 in the nylon net group were studied. The groups were matched with respect to age, sex, indication for surgery and mortality. The mean hospital stay (65 vs 54 days), fate of the wound, incidence of mesh extrusion (26% vs 20%), bowel perforation (1 vs none) and incisional hernia formation (21% vs 20%) in those with polypropylene mesh and nylon net respectively was similar. In conclusion, nylon net is an effective and inexpensive indigenous substitute for polypropylene mesh for mesh laparostomies.

Abdominal Muscles↗