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Chavan R, Nabi Z, Lakhtakia S, Gupta R, Jahangeer B, Talukdar R, Singh AP, Karyampudi A, Yarlagadda R, Ramchandani M, Kalapala R, Jagtap N, Reddy M, Tandan M, Rao GV, Reddy ND. Impact of transmural plastic stent on recurrence of pancreatic fluid collection after metal stent removal in disconnected pancreatic duct: a randomized controlled trial. Endoscopy 2022; 54:861-868. [PMID: 35180798 DOI: 10.1055/a-1747-3283] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Disconnected pancreatic duct (DPD) after development of walled-off necrosis (WON) predisposes to recurrent (peri)pancreatic fluid collection (PFC). In this randomized controlled trial, we compared plastic stents with no plastic stent after removal of a large-caliber metal stent (LCMS) on incidence of recurrent PFCs in DPD. METHODS : Consecutive patients with WON who underwent endoscopic ultrasound (EUS)-guided drainage with LCMS between September 2017 and March 2020 were screened for eligibility. At LCMS removal (4 weeks after drainage), patients with DPD were randomized to plastic stent or no stent groups. The primary outcome was incidence of recurrent PFC at 3 months. Secondary outcomes were technical success of plastic stent deployment, adverse events, stent migration, and recurrence of PFC at 6 and 12 months. RESULTS 236 patients with WON underwent EUS-guided drainage using LCMS, and 104 (males 94, median age 34 years (interquartile range [IQR] 26-44.7) with DPD were randomized into stenting (n = 52) and no-stenting (n = 52) groups. Plastic stent deployment was successful in 88.5 %. Migration occurred in 19.2 % at median follow-up of 8 months (IQR 2.5-12). Recurrent PFCs occurred in six patients at 3 months (stent n = 3, no stent n = 3). There was no significant difference in PFC recurrence between the two groups at 3, 6, and 12 months. Reintervention was required in seven patients with recurrent PFCs, with no significant difference between the two groups. CONCLUSION In patients with WON and DPD, deployment of plastic stents after LCMS removal did not reduce recurrence of PFC.
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Affiliation(s)
- Radhika Chavan
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Basha Jahangeer
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupjyoti Talukdar
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Arun Karyampudi
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Mohan Ramchandani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manohar Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru Venkat Rao
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Abstract
Strategies to prevent infection and improve outcomes in patients with cirrhosis. HAV, hepatitis A virus; HBV, hepatitis B virus; COVID-19, novel coronavirus disease 2019; NSBB, nonselective β-blocker; PPI, proton pump inhibitors.Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications, and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection; the incremental preventive strategies for infections and sepsi; and the consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors' use, appropriate use of β-blockers, and vaccinations for viral diseases including novel coronavirus disease 2019. Secondary prevention includes early diagnosis and a timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable improved outcomes.
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Affiliation(s)
- Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Juan P Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Karan Kumar
- Department of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Nageshwar D Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Nagaraja R Padaki
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rajender K Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
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Kulkarni AV, Kumar K, Candia R, Arab JP, Tevethia HV, Premkumar M, Sharma M, Menon B, Rao GV, Reddy ND, Rao NP. Prophylactic Perioperative Terlipressin Therapy for Preventing Acute Kidney Injury in Living Donor Liver Transplant Recipients: A Systematic Review and Meta-Analysis. J Clin Exp Hepatol 2022; 12:417-427. [PMID: 35535072 PMCID: PMC9077193 DOI: 10.1016/j.jceh.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) is common in the perioperative transplant period and is associated with poor outcomes. Few studies reported a reduction in AKI incidence with terlipressin therapy by counteracting the hemodynamic alterations occurring during liver transplantation. However, the effect of terlipressin on posttransplant outcomes has not been systematically reviewed. Methods A comprehensive search of electronic databases was performed. Studies reporting the use of terlipressin in the perioperative period of living donor liver transplantation were included. We expressed the dichotomous outcomes as risk ratio (RR, 95% confidence interval [CI]) using the random effects model. The primary aim was to assess the posttransplant risk of AKI. The secondary aims were to assess the need for renal replacement therapy (RRT), vasopressors, effect on hemodynamics, blood loss during surgery, hospital and intensive care unit (ICU) stay, and in-hospital mortality. Results A total of nine studies reporting 711 patients (309 patients in the terlipressin group and 402 in the control group) were included for analysis. Terlipressin was administered for a mean duration of 53.44 ± 28.61 h postsurgery. The risk of AKI was lower with terlipressin (0.6 [95% CI, 0.44-0.8]; P = 0.001). However, on sensitivity analysis including only four randomized controlled trials (I2 = 0; P = 0.54), the risk of AKI was similar in both the groups (0.7 [0.43-1.09]; P = 0.11). The need for RRT was similar in both the groups (0.75 [0.35-1.56]; P = 0.44). Terlipressin therapy reduced the need for another vasopressor (0.34 [0.25-0.47]; P < 0.001) with a concomitant rise in mean arterial pressure and systemic vascular resistance by 3.2 mm Hg (1.64-4.7; P < 0.001) and 77.64 dyne cm-1.sec-5 (21.27-134; P = 0.007), respectively. Blood loss, duration of hospital/ICU stay, and mortality were similar in both groups. Conclusions Perioperative terlipressin therapy has no clinically relevant benefit.
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Key Words
- AKI, acute kidney injury
- BMI, body mass index
- BUN, blood urea nitrogen
- C, control
- CI, confidence interval
- CNI, calcineurin inhibitors
- CTP, Child-Turcotte-Pugh score
- DDLT, deceased donor liver transplantation
- GRWR, graft-torecipient weight ratio
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HRS, hepatorenal syndrome
- ICU, intensive care unit
- LDLT, living donor liver transplantation
- MAP, mean arterial pressure
- MELD, model for end-stage liver disease
- NR, not reported
- PRBC, packed red blood cells
- RCT, randomized controlled trial
- RRT, renal replacement therapy
- SD, standard deviation
- SVR, systemic vascular resistance
- Tp, Terlipressin
- acute kidney injury
- hemodynamics
- mTORi, mammalian target of rapamycin inhibitors
- portal hypertension
- renal replacement therapy
- sCr, serum creatinine
- vasoconstrictors
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Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India,Address for correspondence. Dr. Anand V.Kulkarni, Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India.
| | - Karan Kumar
- Department of Hepatology, Pacific Institute of Medical Sciences, Udaipur, India
| | - Roberto Candia
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Juan P. Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Harsh V. Tevethia
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Balachandandran Menon
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru V. Rao
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nagaraja P. Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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Kulkarni AV, Vasireddy S, Sharma M, Reddy ND, Padaki NR. COVID-19 Masquerading as Autoimmune Hepatitis (AIH) Flare-The First Report. J Clin Exp Hepatol 2022; 12:241-243. [PMID: 34539127 PMCID: PMC8437694 DOI: 10.1016/j.jceh.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anand V. Kulkarni
- Address for correspondence. Anand V Kulkarni, Department of Hepatology & Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India.
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Nabi Z, Ramchandani M, Chavan R, Basha J, Reddy M, Darisetty S, Reddy ND. Double tunnel technique reduces technical failure during POEM in cases with severe submucosal fibrosis. Endosc Int Open 2021; 9:E1335-E1341. [PMID: 34466356 PMCID: PMC8367433 DOI: 10.1055/a-1499-6817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background and study aims Submucosal fibrosis (SMF) is one of the major reasons for technical failure during per-oral endoscopic myotomy (POEM). In this study, we aimed to evaluate the impact of double tunnel technique (DT-POEM) on the technical success of POEM in cases with severe SMF. Patients and methods Data from patients with achalasia in whom SMF was encountered during POEM from Jan 2013 to Jan 2020 at our center were retrospectively evaluated. The technical success and adverse events (AEs) were analyzed and compared between cases with SMF who underwent POEM via single tunnel versus DT-POEM technique. Results A total of 1,150 patients underwent POEM during the study period. There were 14 technical failures (1.2 %). SMF and severe SMF was found in 104 (9 %) and 21 (1.8 %) patients, respectively. The majority of patients (17, 80.9 %) with severe SMF had type I achalasia. Overall, technical failures occurred in 14 cases (1.2 %) and severe SMF resulted in the majority of the technical failures (10, 71.4 %). DT-POEM was utilized in 11 cases (52.4 %) with severe SMF. The median procedure time with DT-POEM was 150 minutes (85-210). There were no major AEs and DT-POEM was technically successful in all the patients. The technical success of POEM in cases with SMF improved after the adoption of the double tunnel technique (98.4 % vs 68.3 %, P = 0.0001). Conclusions Severe SMF is the most common reason for technical failure during POEM. DT-POEM improves the technical success rates of POEM in patients with severe SMF.
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Affiliation(s)
- Zaheer Nabi
- Asian institute of Gastroenterology, Hyderabad, India
| | | | | | | | - Manohar Reddy
- Asian institute of Gastroenterology, Hyderabad, India
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Kulkarni AV, Parthasarathy K, Kumar P, Sharma M, Reddy R, Chaitanya Akkaraju Venkata K, Gupta R, Gupta A, Swaroop S, Giri Vishwanathan P, Senapathy G, Menon PB, Reddy ND, Padaki NR. Early liver transplantation after COVID-19 infection: The first report. Am J Transplant 2021; 21:2279-2284. [PMID: 33508881 PMCID: PMC8013377 DOI: 10.1111/ajt.16509] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/25/2023]
Abstract
COVID-19 (coronavirus disease 2019) has impacted solid organ transplantation (SOT) in many ways. Transplant centers have initiated SOT despite the COVID-19 pandemic. Although it is suggested to wait for 4 weeks after COVID-19 infection, there are no data to support or refute the timing of liver transplant after COVID-19 infection. Here we describe the course and outcomes of COVID-19-infected candidates and healthy living liver donors who underwent transplantation. A total of 38 candidates and 33 potential living donors were evaluated from May 20, 2020 until October 30, 2020. Ten candidates and five donors were reverse transcriptase-polymerase chain reaction (RT-PCR) positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pretransplant. Four candidates succumbed preoperatively. Given the worsening of liver disease, four candidates underwent liver transplant after 2 weeks due to the worsening of liver disease and the other two candidates after 4 weeks. Only one recipient died due to sepsis posttransplant. Three donors underwent successful liver donation surgery after 4 weeks of COVID-19 infection without any postoperative complications, and the other two were delisted (as the candidates expired). This report is the first to demonstrate the feasibility of elective liver transplant early after COVID-19 infection.
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Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India,Correspondence Anand V. Kulkarni, Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
| | - Kumarswamy Parthasarathy
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pramod Kumar
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Raghuram Reddy
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rajesh Gupta
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Anand Gupta
- Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shakti Swaroop
- Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Gayathri Senapathy
- Department of Radiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Palat B. Menon
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D. Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nagaraja R. Padaki
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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Siddiqui A, Naveed M, Basha J, Lakhtakia S, Nieto J, Shah J, Binmoeller K, Murphy M, Talukdar R, Ramchandani MK, Nabi Z, Gupta R, Kowalski TE, Loren DE, Sharaiha RZ, Kahaleh M, Eyck PT, Noor A, Mumtaz T, Kalalala R, Reddy ND, Adler DG. International, multicenter retrospective trial comparing the efficacy and safety of bi-flanged versus lumen-apposing metal stents for endoscopic drainage of walled-off pancreatic necrosis. Ann Gastroenterol 2021; 34:273-281. [PMID: 33654370 PMCID: PMC7903561 DOI: 10.20524/aog.2021.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background To compare fully covered bi-flanged metal stents (BFMS) and lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainage/debridement of pancreatic walled-off necrosis (WON). Methods Patients with WON managed by EUS-guided therapy were divided into those who underwent: 1) drainage using BFMS; and 2) drainage using LAMS and scheduled direct endoscopic necrosectomy (DEN). Clinical success (resolution of the WON), technical success (successful stent placement), and adverse events (AEs) were evaluated. Results 387 patients underwent WON endoscopic drainage, 205 using BFMS and 182 using LAMS. The clinical success in the BFMS or LAMS groups were similar (197 [96.1%] vs. 174 [95.6%]; P=0.81). Median number of procedures required for WON resolution was significantly lower in BFMS compared to LAMS (2 vs. 3, P<0.001). Technical success for stent placement was similar in BFMS and LAMS groups (203 [99%] vs. 180 [99%], P=0.90). Procedure-related AEs were similar in the BFMS and LAMS groups (19 [9.3%] vs. 20 [10.9%], P=0.61). Stent dysfunction with occluding debris was higher in the BFMS group compared to LAMS group (21 [10.2 %] vs. 11 [5.9%], P=0.04). The migration rate was higher in the BFMS group than in the LAMS group (15 [7.3%] vs. 3 [1.6%]; P<0.001). DEN was required in 23 [11.2%] patients in the BFMS group after lack of WON resolution by conservative means. Conclusion BFMS with a “step-up approach” and LAMS with scheduled DEN are both safe and effective for EUS-guided drainage/debridement of WON.
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Affiliation(s)
- Ali Siddiqui
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Mariam Naveed
- University of Iowa, Iowa City, IA, USA (Mariam Naveed, Patrick Ten Eyck)
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, FL, USA (Jose Nieto)
| | - Janak Shah
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA (Janak Shah, Kenneth Binmoeller)
| | - Kenneth Binmoeller
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA (Janak Shah, Kenneth Binmoeller)
| | - Megan Murphy
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Rupjyoti Talukdar
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Mohan K Ramchandani
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Thomas E Kowalski
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - David E Loren
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Reem Z Sharaiha
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - Michel Kahaleh
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - Patrick Ten Eyck
- University of Iowa, Iowa City, IA, USA (Mariam Naveed, Patrick Ten Eyck)
| | - Arish Noor
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Tayebah Mumtaz
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Rakesh Kalalala
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Nageshwar D Reddy
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Douglas G Adler
- University of Utah, Salt Lake City, UT, USA (Douglas G. Adler)
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Kumar SK, Singh JR, Kumar M, Nagbhushan K, Reddy ND, Rao G. Direct Percutaneous Puncture and Embolization of Visceral Pseudoaneurysm: Safety and Clinical Efficacy. Journal of Clinical Interventional Radiology ISVIR 2020. [DOI: 10.1055/s-0040-1721529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Purpose The aim of the study is to assess the safety and clinical effectiveness of direct percutaneous embolization of visceral artery pseudoaneurysms.
Materials and Methods Retrospective analysis of patients who had undergone direct percutaneous embolization of visceral artery pseudoaneurysms between January 2012 and May 2017 was performed. The study included 26 patients with a mean age of 36 years (range 10–71 years). The indications for direct percutaneous embolization included the inability to catheterize endovascularly (n = 24) or prior embolization (n = 2) of the feeding artery. Patient demographics, details of the procedure, complications, and outcomes were evaluated. Patients were followed for a mean of 15 months to assess for recurrence of the pseudoaneurysms on ultrasound.
Results Splenic artery (n = 13), gastroduodenal artery (n = 4), right hepatic artery (n = 3), pancreaticoduodenal arteries (n = 3), left gastric artery (n = 2), and left hepatic artery (n = 1) were the embolized arteries. Etiology for pseudoaneurysm were pancreatitis (n = 20), trauma (n = 2), postoperative (n = 2), and few were incidentally detected (n = 2). N-butyl cyanoacrylate (NBCA) with lipiodol was used in 23 (88.4%) patients, coil in one (3.8%), and both coil and NBCA in two patients (7.7%). Embolization of the pseudoaneurysm was successful in all cases. No procedure-related complication was observed. Follow-up showed no recurrence of the pseudoaneurysm. Self-limiting splenic infarct was seen in six patients. Self-limiting abdominal pain was seen in all the patients with embolization with NBCA. One patient developed liver infarct and subsequent liver abscess requiring percutaneous drainage.
Conclusion Direct percutaneous embolization is safe and effective in the treatment of visceral artery pseudoaneurysms and should be considered as an alternative in patients with a failed endovascular approach.
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Affiliation(s)
- Sunil K. Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Jagadeesh R. Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Mahesh Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - K.N. Nagbhushan
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Nageshwar D. Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - G.V. Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Kumar S, Singh JR, Kumar MT, Nagbhushan K, Reddy ND, Rao G. Endovascular Management of Pancreatitis-Related Hemorrhage: Single-Center Experience. Journal of Clinical Interventional Radiology ISVIR 2020. [DOI: 10.1055/s-0040-1705290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Purpose The main purpose of this article is to assess the outcomes of endovascular management of pancreatitis-related hemorrhage.
Materials and Methods Retrospective analysis of patients referred for endovascular management of pancreatitis-related bleeding from January 2010 to December 2017 was performed. Patients’ demographics, clinical presentation, etiology, laboratory findings, angiography findings, details of the endovascular procedure, technical outcome, clinical outcome, and complications were assessed.
Results One hundred and five patients with a mean age of 37 years were included in this study. Splenic artery (41.7%) was the most commonly involved vessel. Middle colic, left colic, superior mesenteric, jejunal, left inferior phrenic, and left renal subcapsular arteries were the less commonly involved vessels. Embolization was performed using coils in 72 (68.5%) patients, n-butyl cyanoacrylate (n-BCA) in 21 (20%) patients, both coil and n-BCA in 8 (7.6%) patients, and 4 (3.8%) patients underwent stent graft placement. Technical success was achieved in 98% (n = 103) and clinical success in 93.2% (n = 96) of patients. Rebleeding was seen in 6.8% (n = 7) of patients. Six patients with rebleeding were managed by reintervention. Four patients had rebleeding from the same vessel, and two patients had rebleeding from a different vessel. One patient died due to massive rebleeding. Minor complications were seen in 14.2% (n = 15), major complications were seen in 3.8% (n = 4), and mortality rate was 0.9% (n = 1).
Conclusion Endovascular treatment is effective in the management of pancreatitis-related bleeding and is associated with low rebleeding rate and low mortality rate.
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Affiliation(s)
- Sunil Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Jagadeesh R. Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Mahesh T. Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - K.N. Nagbhushan
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Nageshwar D. Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - G.V. Rao
- Department of Surgical Gastroenterology, Asian Institute of gastroenterology, Hyderabad, Telangana, India
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10
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Kulkarni AV, Kumar P, Singh S, Sharma M, Talukdar R, Murthy VH, Singh V, Reddy ND, Rao NP. Prevention of paracentesis‐induced circulatory dysfunction—A systematic review and network meta‐analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ygh2.395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology Asian Institute of Gastroenterology Hyderabad India
| | - Pramod Kumar
- Department of Hepatology Asian Institute of Gastroenterology Hyderabad India
| | - Siddharth Singh
- Department of Gastroenterology, and Division of Biomedical Informatics University of California San Diego La Jolla CA USA
| | - Mithun Sharma
- Department of Hepatology Asian Institute of Gastroenterology Hyderabad India
| | - Rupjyoti Talukdar
- Department of Gastroenterology Asian Institute of Gastroenterology Hyderabad India
| | | | | | - Nageshwar D Reddy
- Department of Gastroenterology Asian Institute of Gastroenterology Hyderabad India
| | - Nagaraja Padaki Rao
- Department of Hepatology Asian Institute of Gastroenterology Hyderabad India
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11
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Affiliation(s)
- Nageshwar D Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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12
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Windsor JA, Reddy ND. Endoscopic vs. Surgical Interventions for Painful Chronic Pancreatitis: What is Needed for Future Clinical Trials. Clin Transl Gastroenterol 2017; 8:e213. [PMID: 28079861 PMCID: PMC5288602 DOI: 10.1038/ctg.2016.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/29/2016] [Indexed: 12/29/2022] Open
Abstract
The treatment of painful chronic pancreatitis remains controversial. The available evidence from two randomized controlled trials favor surgical intervention, whereas an endotherapy-first approach is widely practiced. Chronic pancreatitis is complex disease with different genetic and environmental factors, different pain mechanisms and different treatment modalities including medical, endoscopic, and surgical. The widely practiced step-up approach remains unproven. In designing future clinical trials there are some important pre-requisites including a more comprehensive pain assessment tool, the optimization of conservative medical treatment and interventional techniques. Consideration should be given to the need of a control arm and the optimal timing of intervention. Pending better designed studies, the practical way forward is to identify subgroups of patients who clearly warrant endotherapy or surgery first, and to design the future clinical trials for the remainder.
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Affiliation(s)
- John A Windsor
- Department of Surgery, Auckland Clinical School, University of Auckland, Auckland, New Zealand
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13
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Affiliation(s)
- Sundeep Lakhtakia
- Gastroenterology and Therapeutic Endoscopy Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Gastroenterology and Therapeutic Endoscopy Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Domenico Galasso
- Digestive Endoscopic Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mohan Ramchandani
- Gastroenterology and Therapeutic Endoscopy Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Palle Manohar Reddy
- Gastroenterology and Therapeutic Endoscopy Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru V Rao
- Surgery Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D Reddy
- Gastroenterology and Therapeutic Endoscopy Department, Asian Institute of Gastroenterology, Hyderabad, India
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14
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Kim TH, Kim JH, Seo DW, Lee DK, Reddy ND, Rerknimitr R, Ratanachu-Ek T, Khor CJL, Itoi T, Yasuda I, Isayama H, Lau JYW, Wang HP, Chan HH, Hu B, Kozarek RA, Baron TH. International consensus guidelines for endoscopic papillary large-balloon dilation. Gastrointest Endosc 2016; 83:37-47. [PMID: 26232360 DOI: 10.1016/j.gie.2015.06.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/11/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Tae Hyeon Kim
- Department of Gastroenterology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jin Hong Kim
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nageshwar D Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, National University Health System, Tan Tock Seng Hospital, Singapore
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - James Y W Lau
- Department of Surgery, Endoscopic Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hsiu-Po Wang
- Endoscopic Division, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Hoi-Hung Chan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bing Hu
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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15
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Jayashree BS, Nigam S, Pai A, Patel HK, Reddy ND, Kumar N, Rao CM. Targets in anticancer research--A review. Indian J Exp Biol 2015; 53:489-507. [PMID: 26349312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer is a complex disease characterized by a loss in the normal cell regulatory mechanisms that govern cell survival, proliferation, and differentiation. Current chemotherapeutics, as anticancer agents, are developing resistance to single drug and also to treatment therapies involving multiple drugs. Cross resistance associated with the specificity and selectivity of existing drugs has restricted the application of chemotherapy. Alternatively, these limitations have given better insight in understanding the underlying molecular mechanisms responsible for the development of various stages in cancer. In the light of this, continuous efforts are being made in order to identify and validate newer anticancer targets. This review presents some of the important targets that have been already reported, such as aromatase, farnesyl transferase, histone deacetylase, tyrosine kinase and cyclin-dependent kinase. A few molecules designed against these targets have successfully reached clinical trials. However, only limited marketed drugs are available from these classes. Besides, the review also highlights some of the other important targets and strategies that have also drawn considerable attention in the area of anticancer drug development such as, cancer stem cells and monoclonal antibodies. Further, the integration of the tools in molecular biology with the results from preclinical and clinical trials would strengthen the effectiveness of treatment regimens in cancer patients. There lies a much scope for designing promising lead compounds and treatment therapies against these established targets.
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16
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Lakhtakia S, Pericherla BR, Bhardwaj KV, Ramchandani MJ, Gupta R, Reddy ND. Common bile duct compression caused by cyanoacrylate glue injection into bleeding duodenal varices: a rare adverse event (with videos). Gastrointest Endosc 2014; 79:1005-6: discussion 1007. [PMID: 24556048 DOI: 10.1016/j.gie.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 01/03/2014] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India
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17
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Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, Khor CJL, Ponnudurai R, Moon JH, Seo DW, Pantongrag-Brown L, Sangchan A, Pisespongsa P, Akaraviputh T, Reddy ND, Maydeo A, Itoi T, Pausawasdi N, Punamiya S, Attasaranya S, Devereaux B, Ramchandani M, Goh KL. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28:593-607. [PMID: 23350673 DOI: 10.1111/jgh.12128] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/13/2022]
Abstract
Hilar cholangiocarcinoma (HCCA) is one of the most common types of hepatobiliary cancers reported in the world including Asia-Pacific region. Early HCCA may be completely asymptomatic. When significant hilar obstruction develops, the patient presents with jaundice, pale stools, dark urine, pruritus, abdominal pain, and sometimes fever. Because no single test can establish the definite diagnosis then, a combination of many investigations such as tumor markers, tissue acquisition, computed tomography scan, magnetic resonance imaging/magnetic resonance cholangiopancreatography, endoscopic ultrasonography/intraductal ultrasonography, and advanced cholangioscopy is required. Surgery is the only curative treatment. Unfortunately, the majority of HCCA has a poor prognosis due to their advanced stage on presentation. Although there is no survival advantage, inoperable HCCA managed by palliative drainage may benefit from symptomatic improvement. Currently, there are three techniques of biliary drainage which include endoscopic, percutaneous, and surgical approaches. For nonsurgical approaches, stent is the most preferred device and there are two types of stents i.e. plastic and metal. Type of stent and number of stent for HCCA biliary drainage are subjected to debate because the decision is made under many grounds i.e. volume of liver drainage, life expectancy, expertise of the facility, etc. Recently, radio-frequency ablation and photodynamic therapy are promising techniques that may extend drainage patency. Through a review in the literature and regional data, the Asia-Pacific Working Group for hepatobiliary cancers has developed statements to assist clinicians in diagnosing and managing of HCCA. After voting anonymously using modified Delphi method, all final statements were determined for the level of evidence quality and strength of recommendation.
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Affiliation(s)
- Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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18
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Marwaha V, Ghosh I, Bajaj N, Reddy ND, Singh B, Narayanan CS, Mathur AD. P28 A clinical study to evaluate the efficacy of viscosupplementation in patients with osteoarthritis of knee. Indian Journal of Rheumatology 2011. [DOI: 10.1016/s0973-3698(11)60138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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19
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Ghosh I, Marwaha V, Bajaj N, Singh H, Bahl R, Reddy ND, Narayanan CS, Mathur AD. P66 Rheumatological manifestations of HIV infection in a tertiary centre. Indian Journal of Rheumatology 2011. [DOI: 10.1016/s0973-3698(11)60176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Nagar N, Dubale N, Jagadeesh R, Nag P, Reddy ND, Rao G. Unusual locations of pseudo aneurysms as a sequel of chronic pancreatitis. J Interv Gastroenterol 2011; 1:28-32. [PMID: 21686110 DOI: 10.4161/jig.1.1.14597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 07/23/2010] [Accepted: 07/25/2010] [Indexed: 11/19/2022]
Abstract
In patients with chronic pancreatitis, an actively bleeding pseudo aneurysm can be life threatening. Common sites of pseudoaneurysms are splenic, gastro-duodenal, superior & inferior pancreaticoduodenal arterial branches. Angioembolisation is an effective alternative to a complex and morbid operative management. Here we report 4 cases of unusual sites of pseudoaneurysms as a complication of pancreatitis, involving superior mesenteric and inferior phrenic arteries. Successful angioembolisation using glue and coil was achieved in 3 patients where as one underwent surgery. Technical success was 100% with the combination approach, though one patient died from multiorgan failure. This short case series reiterates the importance of vascular complications in pancreatitis at rare sites and also timely combined radiological and surgical approach for ensuring favorable outcome.
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21
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Kunwar A, Bansal P, Kumar SJ, Bag PP, Paul P, Reddy ND, Kumbhare LB, Jain VK, Chaubey RC, Unnikrishnan MK, Priyadarsini KI. In vivo radioprotection studies of 3,3'-diselenodipropionic acid, a selenocystine derivative. Free Radic Biol Med 2010; 48:399-410. [PMID: 19931386 DOI: 10.1016/j.freeradbiomed.2009.11.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 11/05/2009] [Accepted: 11/12/2009] [Indexed: 11/22/2022]
Abstract
3,3'-Diselenodipropionic acid (DSePA), a diselenide and a derivative of selenocystine, was evaluated for in vivo radioprotective effects in Swiss albino mice, at an intraperitoneal dose of 2 mg/kg body wt, for 5 days before whole-body exposure to gamma-radiation. The radioprotective efficacy was evaluated by assessing protection of the hepatic tissue, the spleen, and the gastrointestinal (GI) tract and survival against sub- and supralethal doses of gamma-radiation. DSePA inhibited radiation-induced hepatic lipid peroxidation, protein carbonylation, loss of hepatic function, and damage to the hepatic architecture. DSePA also attenuated the depletion of endogenous antioxidants such as glutathione, glutathione peroxidase, superoxide dismutase, and catalase in the livers of irradiated mice. DSePA also restored the radiation-induced reduction in villus height, crypt cell numbers, and spleen cellularity, indicating protective effects on the GI tract and the hematopoietic system. The results from single-cell gel electrophoresis of the peripheral blood leukocytes showed that DSePA can attenuate radiation-induced DNA damage. The mRNA expression analysis of genes revealed that DSePA augmented GADD45alpha and inhibited p21 in both spleen and liver tissues. DSePA also inhibited radiation-induced apoptosis in the spleen and reversed radiation-induced alterations in the expression of the proapoptotic BAX and the antiapoptotic Bcl-2 genes. In line with these observations, DSePA improved the 30-day survival of irradiated mice by 35.3%. In conclusion, these findings clearly confirm that DSePA exhibits protective effects against whole-body gamma-radiation and the probable mechanisms of action involve the maintenance of antioxidant enzymes, prophylactic action through the attenuation of the DNA damage, and inhibition of apoptosis.
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Affiliation(s)
- Amit Kunwar
- Radiation & Photochemistry Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
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22
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Bhavani RSS, Lakhtakia S, Sekaran A, Tandan M, Reddy ND. Amyloidosis presenting as postcricoid esophageal stricture. Gastrointest Endosc 2010; 71:180-1; discussion 181. [PMID: 19836745 DOI: 10.1016/j.gie.2009.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 08/12/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Raju S S Bhavani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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23
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Banerjee R, Bhargav P, Reddy P, Gupta R, Lakhtakia S, Tandan M, Rao VG, Reddy ND. Safety and efficacy of the M2A patency capsule for diagnosis of critical intestinal patency: results of a prospective clinical trial. J Gastroenterol Hepatol 2007; 22:2060-3. [PMID: 17614957 DOI: 10.1111/j.1440-1746.2007.05039.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The presence of a critical intestinal stricture is a contraindication for conventional capsule endoscopy for the risk of impaction. Prior assessment of intestinal patency can substantially minimize this risk. The aim of the present study was to assess the safety and efficacy of the M2A patency capsule (PC) for verification of intestinal strictures. METHODS The M2A PC consists of a biodegradable body surrounding a small radiofrequency identification (RFID) tag. This capsule was administered to patients with known or suspected intestinal strictures. Patency was verified if the capsule was excreted intact. The capsule disintegrated into small fragments and only the RFID tag was excreted if retained at the stricture beyond a stipulated time. The patency scanner was used to detect the RFID tag externally. The M2A video capsule (VC) was administered to patients who excreted the intact capsule. RESULTS Twenty-six patients with known or suspected intestinal strictures were administered the M2A PC. This included 16 (61%) patients with tuberculosis, eight (31%) with Crohn's disease, and one each of postoperative and malignant strictures. Eight capsules were excreted intact within 72 h and two at 109 and 110 h. Fifteen capsules disintegrated in the G(I) tract and one capsule was removed during surgery. No PC-related complications were noted. Six of the eight patients who tested positive for patency were tested with the regular M2A VC with normal excretion. CONCLUSION The M2A PC is a reliable indicator of functional patency in suspected or even known cases of intestinal stricture. It could be used prior to conventional capsule endoscopy to predict and minimize the risk of impaction.
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Affiliation(s)
- Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
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24
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Dua KS, Reddy ND, Rao VG, Banerjee R, Medda B, Lang I. Impact of reducing duodenobiliary reflux on biliary stent patency: an in vitro evaluation and a prospective randomized clinical trial that used a biliary stent with an antireflux valve. Gastrointest Endosc 2007; 65:819-28. [PMID: 17383650 DOI: 10.1016/j.gie.2006.09.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Accepted: 09/05/2006] [Indexed: 12/27/2022]
Abstract
BACKGROUND The mechanisms leading to occlusion of plastic biliary stents (PBS) are not known. OBJECTIVE To evaluate the impact of reducing duodenobiliary reflux on stent patency rate. DESIGN A newly designed antireflux PBS (AR-PBS) was tested in vitro by using ox bile. A prospective randomized trial in human beings was conducted. SETTING Tertiary medical center. PATIENTS Patients with malignant bile-duct strictures were studied. INTERVENTIONS A PBS or an AR-PBS stent was placed by using standard techniques, and the patients were followed at regular intervals. Patients presenting with stent occlusion underwent re-stent placement with either a PBS or a metal stent. MAIN OUTCOME MEASUREMENTS In vitro: resistance to retrograde flow and comparison of the basal and peak antegrade flow pressures between the 2 stents. In vivo: stent patency rates, complications, and the efficacy of the stents in improving the liver test. RESULTS The AR-PBS stent could withstand a retrograde pressure gradient of >320 mm Hg compared with <1 mm Hg for the PBS. Secondary to the siphon effect of the valve, the antegrade flow resistance offered by the AR-PBS was on the negative side for all flow rates compared with PBS (P < .001). The median patency of the AR-PBS in human studies was 145 days (range, 52-252 days) compared with 101 days (range, 41-210 days) for the PBS (P = .002). Both stents were equally effective in improving the liver test, and complication rates were similar in the 2 groups. LIMITATIONS The occluded stents were not examined microscopically. CONCLUSIONS The antireflux biliary stent remains patent for a longer time and hence duodenobiliary reflux may be contributing to stent occlusion.
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Affiliation(s)
- Kulwinder S Dua
- Pancreatico-biliary Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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25
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Sriram PVJ, Rao GV, Reddy ND. Successful closure of spontaneous esophageal perforation (Boerhaave's syndrome) by endoscopic clipping. Indian J Gastroenterol 2006; 25:39-41. [PMID: 16567897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic clips have been used mainly for control of gastrointestinal (GI) bleeding and occasionally for closure of GI perforations. However, closure of spontaneous esophageal perforation (Boerhaave's syndrome) by clipping has not been reported. We described successful non-surgical closure of spontaneous esophageal perforation by endoscopic clipping in a patient with bilateral pyopneumothorax and septicemia.
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Affiliation(s)
- Parupudi V J Sriram
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad.
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26
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Reddy ND, Fanwick PE, Walton RA. An intramolecular disproportionation reaction leading to the formation of the quadruply bonded complex Cl(4)ReReCl(2)(dppf) (dppf = 1,1'-bis(diphenylphosphino)ferrocene). An example of the missing 1,3-Re(2)Cl(6)(PR(3))(2) isomer. Inorg Chem 2001; 40:1732-3. [PMID: 11312726 DOI: 10.1021/ic0011819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N D Reddy
- Department of Chemistry, Purdue University, 1393 Brown Building, West Lafayette, Indiana 47907-1393, USA
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27
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Muralidharan K, Reddy ND, Elias AJ. Syntheses of novel exo and endo isomers of ansa-substituted fluorophosphazenes and their facile transformations into spiro isomers in the presence of fluoride ions. Inorg Chem 2000; 39:3988-94. [PMID: 11198851 DOI: 10.1021/ic0001863] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reactions of the dilithiated diols RCH2P(S)(CH2OLi)2 [R = Fc (1), Ph (2) (Fc = ferrocenyl)] with N3P3F6 in equimolar ratios at -80 degrees C result exclusively in the formation of two structural isomers of ansa-substituted compounds, endo-RCH2P(S)(CH2O)2[P(F)N]2(F2PN) [R = Fc (3a), Ph (4a)] and exo-RCH2P(S)(CH2O)2[P(F)N]2(F2PN) [R = Fc (3b), Ph (4b)], which are separated by column chromatography. Increasing the reaction temperature to -40 degrees C results in more of the exo isomers 3b and 4b at the expense of the endo isomers. The formation of the ansa-substituted compounds is found to depend on the dilithiation of the diols, as a reaction of the silylated phosphine sulfide FcCH2P(S)(CH2OSiMe3)2 (5) with N3P3F6 in the presence of CsF does not yield either 3a or 3b but instead gives the spiro isomer [FcCH2P(S)(CH2O)2 PN](F2PN)2 (6) as the disubstitution product of N3P3F6. The ansa isomers 3a and 3b are transformed into the spiro compound 6 in the presence of catalytic amounts of CsF at room temperature in THF, while 4a and 4b are transformed into the spiro compound [PhCH2P(S)(CH2O)2PN](F2PN)2 (7) under similar conditions. The novel conversions of ansa-substituted phosphazenes into spirocyclic phosphazenes were monitored by time-dependent 31P NMR spectroscopy. The effect of temperature on a transformation was studied by carrying out reactions at various temperatures in the range from -60 to +33 degrees C for 3b. In addition, compounds 3a, 3b, 4a, and 6 were structurally characterized. In the case of the ansa compounds, the nitrogen atom flanked by the bridging phosphorus sites was found to deviate significantly from the plane defined by the five remaining atoms of the phosphazene ring.
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Affiliation(s)
- K Muralidharan
- Department of Chemistry, Indian Institute of Technology, Kanpur 208 016, India
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