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Ernest EE, Bhattacharjee S, Baidya DK, Anand RK, Ray BR, Bansal VK, Subramaniam R, Maitra S. Effect of incremental PEEP titration on postoperative pulmonary complications in patients undergoing emergency laparotomy: a randomized controlled trial. J Clin Monit Comput 2024; 38:445-454. [PMID: 37968546 DOI: 10.1007/s10877-023-01091-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023]
Abstract
Postoperative pulmonary complications (PPC) has a significant negative impact and are associated with increased length of hospital stay and cost of care. Emergency surgery is a well-established risk factor for PPC. Previous studies reported that personalized positive end-expiratory pressure (PEEP) might reduce postoperative atelectasis and postoperative pulmonary complications. N = 168 adult patients undergoing major emergency laparotomy under general anesthesia were recruited in this study. A minimum driving pressure based incremental PEEP titration was compared to a fixed PEEP of 5 cmH2O. The primary outcome was PPC up to postoperative day 7. The mean (standard deviation) of the recruited patients was 41.7(16.1)y, and 48.8% (82 of 168 patients) were female. The risk of PPC at postoperative day 7 was similar in both the study groups [Relative risk (RR) (95% Confidence interval, CI) 0.81 (0.58, 1.13); p = 0.25]. In addition, the incidence of intraoperative hypotension [p = 0.75], oxygen-free days at day 28 [p = 0.27], duration of postoperative hospital stay [p = 0.50], length of postoperative intensive care unit stay [p = 0.28], and in-hospital mortality [p = 0.38] were similar in two groups. Incidence of PPC was not reduced with the use of an individualized PEEP strategy based on lowest driving pressure. However, the incidence of hypotension and bradycardia was also not increased with titrated PEEP.Trial Registration: www.ctri.nic.in ; CTRI/2020/12/029765.
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Affiliation(s)
- Emmanuel Easterson Ernest
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Rahul K Anand
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Bikash R Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India.
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Ravikumar RH, Maitra S, Prasanna M, Anand RK, Bansal VK, Baidya DK. Ultrasonographic assessment of brachial artery reactivity as a predictor of adverse outcome in patients undergoing emergency laparotomy for perforated peritonitis - Prospective observational study. Indian J Anaesth 2023; 67:905-912. [PMID: 38044920 PMCID: PMC10691603 DOI: 10.4103/ija.ija_625_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims This study aimed to assess if pre- and postoperative parameters of brachial artery reactivity (BAR), like flow-mediated dilation (FMD) and hyperaemic velocity (HV), could predict in-hospital mortality in perforation peritonitis patients undergoing emergency laparotomy. Methods In this prospective observational study, adult patients with perforation peritonitis undergoing emergency laparotomy were recruited. FMD and HV were measured preoperatively, postoperatively and at 24 and 48 h post-surgery. Adult patients undergoing elective laparotomy served as the control group. The primary outcome was in-hospital mortality. Baseline and BAR parameters were compared between survivors and non-survivors. Risk factors for mortality were identified by univariate analysis. Prognostic performances of BAR parameters were assessed by different models using logistic regression. All statistical analyses were performed on STATA version 13 for Mac OS. Results Seventy-six emergency laparotomy patients were recruited, and 26 died during the hospital stay. FMD and HV were comparable at all time points between survivors and non-survivors, except that HV was higher in survivors at 48 h post-surgery (median [interquartile range] 1.28 [1.16-1.49] vs. 1.16 [0.86-1.35], P = 0.010]. HV at 48 h predicted mortality (adjusted odds ratio [OR] [95% confidence interval] 21.05 [1.04-422.43], P = 0.046), and a model consisting of age, Acute Physiology and Chronic Health Evaluation (APACHE) score and HV at 48 h was the best predictor of mortality (area under the receiver operating characteristic (AUROC) curve 0.82). Conclusion HV, as measured by ultrasonography of the brachial artery at 48 h postoperatively, is a good predictor of mortality in patients undergoing emergency laparotomy for perforation peritonitis.
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Affiliation(s)
- Rajathadri Hosur Ravikumar
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mrudula Prasanna
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul K. Anand
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder K. Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K. Baidya
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Kute V, Asthana S, Gupta S, Agarwal SK, Swarnalatha G, Sahay M, Pal S, Sudhindran S, Sharma A, Seth S, Gokhale AGK, Hote MD, Chaudhury AR, Soin AS, Rela M, Malhotra R, Bansal VK, Rana DS, Ramesh V. NOTTO Guidelines for Vaccine Induced Thrombotic Thrombocytopenia in Organ Donation and Transplantation. Indian J Nephrol 2023; 33:157-161. [PMID: 37448895 PMCID: PMC10337218 DOI: 10.4103/ijn.ijn_539_21] [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] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/14/2022] [Indexed: 07/15/2023] Open
Abstract
From the context of organ donation, COVID-19 vaccine-induced thrombotic thrombocytopenia (VITT) is important as there is an ethical dilemma in utilizing versus discarding organs from potential donors succumbing to VITT. This consensus statement is an attempt by the National Organ and Tissue Transplant Organization (NOTTO) apex technical committees India to formulate the guidelines for deceased organ donation and transplantation in relation to VITT to help in appropriate decision making. VITT is a rare entity, but a meticulous approach should be taken by the Organ Procurement Organization's (OPO) team in screening such cases. All such cases must be strictly notified to the national authorities like NOTTO, as a resource for data collection and ensuring compliance withprotocols in the management of adverse events following immunization. Organs from any patient who developed thrombotic events up to 4 weeks after adenoviral vector-based vaccination should be linked to VITT and investigated appropriately. The viability of the organs must be thoroughly checked by the OPO, and the final decision in relation to organ use should be decided by the expert committee of the OPO team consisting of a virologist, a hematologist, and atreating team. Considering the organ shortage, in case of suspected/confirmed VITT, both clinicians and patients should consider the risk-benefit equationbased on available experience, and an appropriate written informed consent of potential recipients and family members should be obtained before transplantation of organs from suspected or proven VITT donors.
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Affiliation(s)
- Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sonal Asthana
- Department of Hepato Pancreato Biliary and Multi-Organ Transplant, Aster Medicity Hospital, Bangalore, Karnataka, India
| | - Subhash Gupta
- Department of Gastrointestinal Surgery and Liver Transplantation, Max Hospital, Delhi, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - G Swarnalatha
- Department of Nephrology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplantation, AIIMS, Delhi, India
| | - S. Sudhindran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Alla Gopala Krishna Gokhale
- Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Milind D. Hote
- Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi, India
| | - Arpita R. Chaudhury
- Department of Nephrology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Gurugram, Haryana, India
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajesh Malhotra
- Trauma Centre and Department of Orthopaedics, AIIMS, New Delhi, India
| | | | | | - Vasanthi Ramesh
- National Organ and Tissue Transplant Organisation, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Lopez-Lopez V, Navaratne L, Ferreras D, Gil PJ, Bansal VK, Mattila A, Parra-Membrives P, Marco TG, Ruiz-Manzanera JJ, Nassar AHM, Sánchez-Bueno F, Robles-Campos R, Martinez-Isla A. Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review. Langenbecks Arch Surg 2023; 408:45. [PMID: 36662260 DOI: 10.1007/s00423-023-02793-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. METHODS A retrospective multicenter study of all patients who underwent LBDE during pregnancy from five centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. RESULTS Five institutions reported performing LBDE during pregnancy in 8 patients. Median surgical time was 75 min (range: 60-140 min). The bile duct was cleared successfully in all patients, and the median hospital stay was 2 days (range: 1-3 days). The literature review identified a total of 7 patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal, or pregnancy-related complications in any of the total 15 patients included. The symptomatic common bile duct lithiasis with deranged liver function tests was the most frequent indication (n=7). CONCLUSION LBDE during pregnancy appears to be safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
| | - Lalin Navaratne
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pedro Jose Gil
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anne Mattila
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Pablo Parra-Membrives
- Hepatobiliary and Pancreatic Surgery Unit, Valme University Hospital, Sevilla, Spain
| | - Tania Gaspar Marco
- Department of Gynecology and Obstetrics, Vega Baja Hospital, Alicante, Spain
| | - Juan Jose Ruiz-Manzanera
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ahmad H M Nassar
- University Hospital Monklands, Lanarkshire, and University of Glasgow, Scotland, UK
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Alberto Martinez-Isla
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
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Prakash Prajapati O, Krishna A, Rai SK, S K, Kumar S, Misra MC, Bansal VK. A comparative analysis of trans-abdominal pre-peritoneal repair in uncomplicated vs complicated inguinal hernia repair. Asian J Endosc Surg 2023. [PMID: 36638824 DOI: 10.1111/ases.13163] [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: 06/23/2022] [Revised: 12/18/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Trans-abdominal pre-peritoneal (TAPP) repair is one of the standard techniques for laparoscopic repair of groin hernias. Literature has shown that both total extraperitoneal (TEP) and TAPP are equally effective with similar outcomes but TAPP has an advantage over TEP as there is more working space, and it provides access to the opposite side for repair of occult hernias. We reviewed our experience of TAPP repair in complicated groin hernias and compared the outcomes with uncomplicated groin hernia. METHODS Patients undergoing TAPP repair from January 2004 to December 2019 were analyzed, and divided into two groups-I uncomplicated and II complicated groin hernia. RESULTS TAPP repair was performed in 820 patients, of which 70.3% had uncomplicated and 29.7% patients had complicated hernias. Occult hernia was detected in 61 patients. The intra-operative complications (16.8% vs 1.3%) and conversions (2.4%) were higher in complicated hernias. Laparoscopic assisted repair was used in 16.8% patients with complicated hernias. The incidence of post-operative complications (62.1% vs 17.3%; P value <.01) were significantly higher in complicated groin hernia patients. The median follow-up was 15 months; only three patients in the uncomplicated hernia group developed recurrence, and chronic groin pain was higher in the complicated hernia repair patients (P > .05) at 6 months. CONCLUSION Although operative time, incidence of intra-operative and post-operative complications (albeit minor in nature), and conversions to open are higher after TAPP repair for complicated groin hernias, the short-term outcomes (hematoma, mesh infection) as well as long-term outcomes (chronic groin pain, port site hernia and recurrence) are not different when compared with uncomplicated hernias. TAPP repair can be used in both complicated and uncomplicated groin hernias with similar short-term and long-term outcomes, albeit with a slightly higher incidence of minor complications in complicated hernias. This can be taken into consideration while operating on patients with complicated hernias and taking informed consent.
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Affiliation(s)
- Om Prakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeet K Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kruthika S
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- MS, FCLS, FACS, FRCS, Professor Emeritus, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Lopez-Lopez V, Gil-Vazquez PJ, Ferreras D, Nassar AHM, Bansal VK, Topal B, Zhu JG, Chuang SH, Jorba R, Bekheit M, Martinez-Cecilia D, Parra-Membrives P, Sgourakis G, Mattila A, Bove A, Quaresima S, Barreras González JE, Sharma A, Ruiz JJ, Sánchez-Bueno F, Robles-Campos R, Martinez-Isla A. Multi-institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures. J Hepatobiliary Pancreat Sci 2022; 29:1283-1291. [PMID: 35122406 DOI: 10.1002/jhbp.1123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single-stage management of choledocholithiasis. METHODS A retrospective multi-institutional study among 17 centers with proven experience in LBDE was performed. A cross-sectional survey consisting of a semi-structured pretested questionnaire was distributed covering the main aspects on the use of LBDE in the management of choledocholithiasis. RESULTS A total of 3950 LBDEs were analyzed. The most frequent indication was jaundice (58.8%). LBDEs were performed after failed ERCP in 15.2%. The most common approach used was the transcystic (63.11%). The overall series failure rate of LBDE was 4% and the median rate for each center was 6% (IQR, 4.5-12.5). Median operative time ranged between 60-120 min (70.6%). Overall morbidity rate was 14.6%, with a postoperative bile leak and complications ≥3a rate of 4.5% and 2.5%, respectively. The operative time decreased with experience (P = .03) and length of hospital stay was longer in the presence of a biliary leak (P = .04). Current training of LBDE was defined as poor or very poor by 82.4%. CONCLUSION Based on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pedro José Gil-Vazquez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ahmad H M Nassar
- University Hospital Monklands, Airdrie, UK
- University of Glasgow, Glasgow, UK
| | - Virinder K Bansal
- Departments of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Baki Topal
- Department of Visceral Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rosa Jorba
- Department of General and Digestive Surgery, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Mohamed Bekheit
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | | | - Pablo Parra-Membrives
- Hepatobiliary and Pancreatic Surgery Unit, Valme University Hospital, Sevilla, Spain
| | - Georgios Sgourakis
- Departament of General Surgery, Royal Blackburn Hospital NHS Trust, Burnley, UK
| | - Anne Mattila
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | | | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Speciality Hospital, Dehradun, India
| | - Juan Jose Ruiz
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
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Krishna A, Maqbool U, Bansal VK, Prakash O, Kumar S. Spontaneous renal allograft rupture of unknown etiology - A case report. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_69_18] [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: 12/31/2022] Open
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Anand A, Nambirajan A, Kumar V, Agarwal S, Sharma S, Mohta S, Gopi S, Kaushal K, Gunjan D, Singh N, Madhusudhan KS, Chauhan SS, Sharma MC, Bansal VK, Saraya A. Alterations in Autophagy and Mammalian Target of Rapamycin (mTOR) Pathways Mediate Sarcopenia in Patients with Cirrhosis. J Clin Exp Hepatol 2022; 12:510-518. [PMID: 35535114 PMCID: PMC9077178 DOI: 10.1016/j.jceh.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/13/2021] [Accepted: 05/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aims The pathophysiology of sarcopenia in cirrhosis is poorly understood. We aimed to evaluate the histological alterations in the muscle tissue of patients with cirrhosis and sarcopenia, and identify the regulators of muscle homeostasis. Methods Computed tomography images at third lumbar vertebral level were used to assess skeletal muscle index (SMI) in 180 patients. Sarcopenia was diagnosed based on the SMI cut-offs from a population of similar ethnicity. Muscle biopsy was obtained from the vastus lateralis in 10 sarcopenic patients with cirrhosis, and the external oblique in five controls (voluntary kidney donors during nephrectomy). Histological changes were assessed by hematoxylin and eosin staining and immunohistochemistry for phospho-FOXO3, phospho-AKT, phospho-mTOR, and apoptosis markers (annexin V and caspase 3). The messenger ribonucleic acid (mRNA) expressions for MSTN, FoxO3, markers of ubiquitin-proteasome pathway (FBXO32, TRIM63), and markers of autophagy (Beclin-1 and LC3) were also quantified. Results The prevalence of sarcopenia was 14.4%. Muscle histology in sarcopenics showed atrophic angulated fibers (P = 0.002) compared to controls. Immunohistochemistry showed a significant loss of expression of phospho-mTOR (P = 0.026) and an unaltered phospho-AKT (P = 0.089) in sarcopenic patients. There were no differences in the immunostaining for annexin-V, caspase-3, and phospho-FoxO3 between the two groups. The mRNA expressions of MSTN and Beclin-1 were higher in sarcopenics (P = 0.04 and P = 0.04, respectively). The two groups did not differ in the mRNA levels for TRIM63, FBXO32, and LC3. Conclusions Significant muscle atrophy, increase in autophagy, MSTN gene expression, and an impaired mTOR signaling were seen in patients with sarcopenia and cirrhosis.
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Key Words
- 4E-BP1, eukaryotic translation initiation factor 4E binding protein-1
- APASL, Asia Pacific Association for the study of the Liver
- BMI, body mass index
- CT, computed tomography
- EWGSOP, European Working Group on Sarcopenia in Older People
- Fox-O, forkhead O
- HCC, hepatocellular carcinoma
- HE, hepatic encephalopathy
- MSTN gene
- MuRF-1, muscle RING finger 1
- RNA, ribonucleic acid
- RT-PCR, real-time polymerase chain reaction
- SMI, skeletal muscle index
- autophagy
- cDNA, complementary deoxyribonucleic acid
- cirrhosis
- mRNA, messenger RNA
- mTOR, mammalian target of rapamycin
- qPCR, quantitative polymerase chain reaction
- sarcopenia
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Affiliation(s)
- Abhinav Anand
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sanchit Sharma
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Mohta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanth Gopi
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Kanav Kaushal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shyam S. Chauhan
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C. Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder K. Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence. Anoop Saraya, Professor and Head of Department Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Lingaraj C, Rai SK, Asuri K, Prajapati OP, Kumar S, Bhattacharjee H, Bansal VK. Effect of Short-term-focused Training on a Phantom Model in Improving Operative Room Performance Among Surgical Residents: A Randomized Trial. Surg Laparosc Endosc Percutan Tech 2021; 32:159-165. [PMID: 34690339 DOI: 10.1097/sle.0000000000001016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meta-analysis has shown the effectiveness of various training methods for the acquisition of laparoscopic skills in surgical training. However, there is very limited literature focusing on the translation of skill acquisition on training models into improved operating room (OR) performance. This study was conducted to evaluate the effectiveness of the Tuebingen trainer with integrated Porcine tissue in improving OR the performance of surgical trainees using standard assessment tools. MATERIALS AND METHODS The study was a single-blinded double-armed randomized control study conducted between July 2016 and March 2018. Eighteen, fourth, and fifth semesters of surgery residents were included in the study. The baseline performance was assessed in OR by performing laparoscopic cholecystectomy using validated scores, that is, Global Operative Assessment of Laparoscopic Skills (GOALS), Additional Five Criteria, Task-specific Checklist, Error Checklist, Visual Analogue Scale. The residents were then randomized into trainee and nontrainee groups. The training group received 5 days of short-term-focused training on the Tuebingen trainer, and the improvement was reassessed in OR. RESULTS The demographic profile of residents was similar. The baseline scores were comparable. The training group showed statistically significant improvement in GOALS (9.88±1.76 to 12±0.66, P=0.05 vs. 10.33±1.5 to 11.4±2.24, P=0.28), task-specific checklist (42.22±10.92 to 53.33±14.14, P=0.027 vs. 45.55±10.13 to 50±17.32, P=0.51), and error checklist. The operating time significantly reduced (36.0±4.03 vs. 50.44±11.39, P=0.0025) following training. CONCLUSIONS Our study concludes that the training on the Tuebingen trainer with integrated porcine organs results in a statistically significant improvement in the OR performance of surgical residents as compared with the nontrained residents, thereby indicating a transfer of skills from training to OR.
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Affiliation(s)
- Chaitra Lingaraj
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
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10
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Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 2019; 33:3069-3139. [PMID: 31250243 PMCID: PMC6722153 DOI: 10.1007/s00464-019-06907-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [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: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
Abstract In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
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Affiliation(s)
- R Bittner
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia. .,Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
| | - K Bain
- Department of Surgery, New York University, New York, USA
| | - V K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - F Berrevoet
- Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - J Bingener-Casey
- Division of Breast, Endocrine, Metabolic & Gastrointestinal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Chen
- Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Los Angeles, USA
| | - J Chen
- Department of Hernia and Abdominal Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Fengtai, China
| | - P Chowbey
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - U A Dietz
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - A de Beaux
- Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - G Ferzli
- Department of Surgery, New York University, New York, USA
| | - R Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, 1160, Vienna, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - M Iskander
- Department of Surgery, Mount Sinai Hospital, 1010 5th Avenue, New York, NY, 10028, USA
| | - Z Ji
- Department of Surgery, Southeast University School of Medicine, Main Add. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, China
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen NV, Denmark
| | - R Khullar
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - P Kirchhoff
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Germany
| | - J Kukleta
- Klinik im Park, Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - K LeBlanc
- Our Lady of the Lake Physician Group, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA
| | - J Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - D Lomanto
- Department of Surgery, YLL School of Medicine, National University Hospital, Level 2, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - F Mayer
- Paracelsus Medizinische Universität Salzburg (PMU), Universitätsklinik für Chirurgie, Salzburg, Austria
| | - V Meytes
- Department of Surgery, New York University, New York, USA
| | - M Misra
- Mahatma Gandhi University of Medical Sciences & Technology, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, 302 022, India
| | - S Morales-Conde
- Centro de Cirugía Mayor Ambulatoria Ave María, Avda. de la Palmera, 53, 41013, Seville, Spain
| | - H Niebuhr
- HANSECHIRURGIE, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Radvinsky
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - B Ramshaw
- Department of Surgery, University Surgeons Associates, 1930 Alcoa Highway, Bldg A, Ste 285, Knoxville, TN, 37920, USA
| | - D Ranev
- Lenox Hill Hospital-Northwell Health, New York, USA
| | - W Reinpold
- Abteilung für Chirurgie, Wilhelmsburger Krankenhaus, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Sharma
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - R Schrittwieser
- Abteilung für Chirurgie, LKH Hochsteiermark, Standort Bruck an der Mur Tragösser Str. 1, 8600, Bruck an der Mur, Austria
| | - B Stechemesser
- Hernienzentrum Köln, Zeppelinstraße 1, 50667, Cologne, Germany
| | - B Sutedja
- Gading Pluit Hospital, Jl. Boulevard Timur Raya Kelapa Gading, Jakarta, 14250, Indonesia
| | - J Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - J Warren
- Minimally Invasive Surgery, Greenville Health System, Department of Surgery, University of South Carolina School of Medicine, Greenville, USA
| | - D Weyhe
- Pius-Hospital Oldenburg, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Georgstraße 12, 26121, Oldenburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - G Woeste
- AGAPLESION ELISABETHENSTIFT gemeinnützige GmbH, Akademisches Lehrkrankenhaus, Landgraf-Georg-Strasse 100, 64287, Darmstadt, Germany
| | - Q Yao
- Department of Hernia and Abdominal Surgery, Huashan Hospital, Fudan University, Shanghai, China
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11
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Vassiliadis A, Zanoni A, Di Leo A, Zanella S, Lauro E, Moscatelli P, Ricci F, Huang H, Wada N, Furukawa T, Kitagawa Y, Hirukawa H, Takesue Y, Saito K, Sato H, Tada T, Choua O, Fu XJ, Yao QY, Yang S, Wang MG, Zhu YL, Cao JX, Shen YM, Togbe JO, Gbessi DG, Dossou FM, Iawani I, Cijan V, Gencic M, Scepanovic M, Bojovic P, Brankovic M, Agresta F, Verza LA, Prando D, Roveran MA, Azabdaftari A, Rubinato L, Vacca U, Lubrano T, Vidotto C, Falcone A, Grasso L, Ghiglione F, Morino M, Nácul M, Cavazzola L, Loureiro M, Bonin E, Ferreira P, Misra MC, Bansal VK, Subodh K, Krisha A, Bansal D, Ray S, Rajeshwari S, Wang P, Jia Z, Zhang FJ, Yan JJ, Zhu YH, Jiang K, Altinli E, Eroglu E, Sertel HI, Hizli F, Jacob B, Bresnaham E, Reiner M, Bates A. Inguinal Hernia: Lap vs Open. Hernia 2015; 19 Suppl 1:S57-62. [PMID: 26518862 DOI: 10.1007/bf03355327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Vassiliadis
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - A Zanoni
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - A Di Leo
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - S Zanella
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - E Lauro
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - P Moscatelli
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - F Ricci
- Ospedale S. Maria del Carmine, UO Chirurgia, Rovereto, Italy
| | - H Huang
- Union Hospital, Fujian Medical University, Fuzhou, China
| | - N Wada
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - T Furukawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - H Hirukawa
- Tachikawa General Hospital, Nagaoka, Japan
| | - Y Takesue
- Tachikawa General Hospital, Nagaoka, Japan
| | - K Saito
- Tachikawa General Hospital, Nagaoka, Japan
| | - H Sato
- Tachikawa General Hospital, Nagaoka, Japan
| | - T Tada
- Tachikawa General Hospital, Nagaoka, Japan
| | - O Choua
- N'Djaména School of Medecine, N'Djaména, Chad
| | | | - Q Y Yao
- Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - M G Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | - V Cijan
- Surgery department, Clinical Hospital Center Zvezdara, Belgrade, Serbia
| | | | | | | | | | - F Agresta
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - L A Verza
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - D Prando
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - M A Roveran
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - A Azabdaftari
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - L Rubinato
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - U Vacca
- Dept. of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - T Lubrano
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - C Vidotto
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - A Falcone
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - L Grasso
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - F Ghiglione
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - M Morino
- Azienda Ospedaliera Città della Salute e della Scienza, SCDU Chirurgia Generale I, Università degli Studi di Torino, Torino, Italy
| | - M Nácul
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L Cavazzola
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - E Bonin
- Universidade Positivo, Curitiba, Brazil
| | | | - M C Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - V K Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - P Wang
- Center of Hernia Surgery Department of Nanjing Medical, University associated HangZhou Hospital, Hangzhou, China
| | | | | | | | | | | | - E Altinli
- Dept. of General Surgery, TC Istanbul Bilim University, Istanbul, Turkey
| | - E Eroglu
- Dept. of General Surgery, TC Istanbul Bilim University, Istanbul, Turkey
| | - H I Sertel
- Florence Nightingale Kadikoy Hospital, Istanbul, Turkey
| | - F Hizli
- Florence Nightingale Kadikoy Hospital, Istanbul, Turkey
| | - B Jacob
- Mount Sinai Medical Center, New York, USA
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12
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LeBlanc K, Jensen K, Krarup PM, Jorgensen L, Mynster T, Zappa B, Begolli L, Quazi S, Bhargava A, Luque JB, Suarez Gráu JM, Menchero JG, Moreno JG, Juraro JG, Ferreras ID, Nardi M, Millo P, Usai A, Lorusso R, Grivon M, Persico F, Allieta R, Christoffersen M, Brandt E, Helgstrand F, Westen M, Rosenberg J, Kehlet H, Strandfeit P, Bisgaard T, Vanini P, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Katsumoto F, Ahlqvist S, Björk D, Jänes A, Weisby-Enbom L, Israelsson L, Cengiz Y, Ndungu B, Kiragu P, Odende K, Jovanovic S, Pejcic V, Filipovic N, Trenkic M, Pavlovic A, Jovanovc B, Tatic M, Jovanovic A, Misra MC, Bansal VK, Subodh H, Krishna A, Bansal D, Ray S, Rajeshwari S, Björklund I, Burman A, Riccio PA, Vetrone G, Linguerri R, Liotta S, Antor M, Scottá M, Khalil H, Ichihara K, Takuo H, Ogawa M, Hidaka S, Hara K, Taki T, Ohashi S, Yoshida K, Galimov O, Shkundin A, Khanov V, Sarik J, Basta M, Bauder A, Kovach S, Fischer J, Tang L, Fei X, Xu M. Incisional Hernia: Daily Cases. Hernia 2015; 19 Suppl 1:S85-92. [PMID: 26518867 DOI: 10.1007/bf03355332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K LeBlanc
- Our Lady of the Lake Physician Group, Baton Rouge, Louisiana, USA.,Department of Surgery, Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - L Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - T Mynster
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - B Zappa
- King George Hospital, London, UK
| | | | - S Quazi
- King George Hospital, London, UK
| | | | | | | | | | | | | | | | - M Nardi
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - P Millo
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - A Usai
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Lorusso
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Grivon
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - F Persico
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Allieta
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Christoffersen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - E Brandt
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - F Helgstrand
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - M Westen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - J Rosenberg
- Gastro Unit, Surgical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Strandfeit
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - T Bisgaard
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - F Katsumoto
- Katsumoto Day Surgery Clinic, Kitakyusyu, Japan
| | - S Ahlqvist
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - D Björk
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L Weisby-Enbom
- Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden
| | - L Israelsson
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - Y Cengiz
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - B Ndungu
- The University of Nairobi, Nairobi, Kenya
| | - P Kiragu
- Maralal County Hospital, Maralal, Kenya
| | - K Odende
- Kenyatta National Hospital, Nairobi, Kenya
| | - S Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - V Pejcic
- Center for minimally invasive surgery, Nis, Serbia
| | - N Filipovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M Trenkic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Pavlovic
- Center for minimally invasive surgery, Nis, Serbia
| | - B Jovanovc
- Center for minimally invasive surgery, Nis, Serbia
| | - M Tatic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M C Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - V K Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - H Subodh
- All India Institute of Medical Sciences, New Delhi, India
| | - A Krishna
- All India Institute of Medical Sciences, New Delhi, India
| | - D Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - S Ray
- All India Institute of Medical Sciences, New Delhi, India
| | - S Rajeshwari
- All India Institute of Medical Sciences, New Delhi, India
| | | | - A Burman
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | | | | | | | | | - M Antor
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | | | | | - H Takuo
- Katsusika Medical Center, Tokyo, Japan
| | - M Ogawa
- Katsusika Medical Center, Tokyo, Japan
| | - S Hidaka
- Katsusika Medical Center, Tokyo, Japan
| | - K Hara
- Katsusika Medical Center, Tokyo, Japan
| | - T Taki
- Katsusika Medical Center, Tokyo, Japan
| | - S Ohashi
- Katsusika Medical Center, Tokyo, Japan
| | - K Yoshida
- Katsusika Medical Center, Tokyo, Japan
| | - O Galimov
- Bashkir State Medical University, Ufa, Russia
| | - A Shkundin
- Bashkir State Medical University, Ufa, Russia
| | - V Khanov
- Bashkir State Medical University, Ufa, Russia
| | - J Sarik
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - M Basta
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - A Bauder
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - S Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - L Tang
- Shaoxing people' hospital, Shaoxing, China
| | - X Fei
- Shaoxing people' hospital, Shaoxing, China
| | - M Xu
- Shaoxing people' hospital, Shaoxing, China
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13
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Khandelwal P, Sinha A, Hari P, Bansal VK, Dinda AK, Bagga A. Outcomes of renal transplant in patients with anti-complement factor H antibody-associated hemolytic uremic syndrome. Pediatr Transplant 2014; 18:E134-9. [PMID: 24814615 DOI: 10.1111/petr.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
Abstract
Atypical HUS associated with anti-CFH autoantibodies is an uncommon illness associated with high risk of progression to end-stage renal disease. Disease relapses after transplantation, observed in one-third cases, often lead to graft loss. We report four patients with anti-CFH antibody-associated HUS who underwent renal transplantation 16-62 months from initial presentation. Two patients each received organs from deceased and living-related donors. Anti-CFH antibody titers were monitored during the illness and following transplantation. All patients received two doses of IV rituximab before or after transplantation; three patient each received 1-2 g/kg of IV immunoglobulin or underwent 2-5 sessions of plasma exchanges. The use of therapeutic plasma exchange, IV immunoglobulin, and rituximab in two cases enabled two-third reduction in anti-CFH antibody titers before transplantation. At 5- to 26-month follow-up, all patients showed satisfactory graft function without recurrence of HUS. This is the first report of patients with anti-CFH antibody-associated HUS who underwent living-related renal transplantation. Clearance of anti-CFH antibody by therapeutic plasma exchange and adjuvant immunosuppression aimed at decreasing antibody levels may enable successful transplantation and recurrence-free survival.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Bansal VK, Raveendran R, Misra MC, Bhattacharjee H, Rajan K, Krishna A, Kumar P, Kumar S. A prospective randomized controlled blinded study to evaluate the effect of short-term focused training program in laparoscopy on operating room performance of surgery residents (CTRI /2012/11/003113). J Surg Educ 2014; 71:52-60. [PMID: 24411424 DOI: 10.1016/j.jsurg.2013.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/12/2013] [Accepted: 06/17/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Laparoscopic surgery requires certain specific skills. There have been several attempts to minimize the learning curve with training outside the operation room. Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Several randomized controlled trials and systematic reviews have demonstrated that the technical skills learned on these simulators transfer to the operating room. Currently, however, the integration of these simulated models into formal residency training curricula is lacking. In our institute, we have adopted the Tuebingen Trainer devised by Professor GF Buess from Germany. The purpose of this study was to evaluate the training of surgical residents on an ex vivo phantom model for basic laparoscopic skill acquisition and its transferability to the OR performance. MATERIALS AND METHODS Seventeen general surgery residents were randomized into 2 groups: Laparoscopic Training Group (n = 9, Group A) and Standard Training Group (n = 8, Group B). Group A underwent training in the Minimally Invasive Surgery Training Centre on the porcine phantom model and did 10 laparoscopic cholecystectomies, whereas Group B did not undergo training in the Minimally Invasive Surgery Training Centre. All the participants performed a laparoscopic cholecystectomy in the operation theater in the presence of a consultant who was blinded to the training status of the participants. The performance of the residents in both groups in the operation theater was assessed using GOALS criteria, surgical performance assessment parameters, task-specific checklists, and visual analog scale for gallbladder perforation difficulty and overall competence. RESULTS The Laparoscopic Training Group had better performance than the Standard Training Group regarding operation time, GOALS criteria, and Task-specific checklists. Although the surgical performance assessments, i.e. cystic duct and artery identification scores, gallbladder perforation scores, and liver injury scores, were better in the Laparoscopic Training Groups, they were not statistically significant. The overall difficulty of the surgery was comparable in both the groups. The Laparoscopic Training Group exhibited significant overall competence on visual analog scale scores. CONCLUSION Our study has clearly shown that training on the Tuebingen Trainer with integrated porcine organs results in a statistically significant improvement in the operating room performance of surgical residents as compared with the nontrained residents, thereby indicating a transfer of skills from training to the operating room.
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Affiliation(s)
- Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Raveendran
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanga Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Rajan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Mallick S, Dinda AK, Rajan K, Bansal VK, Sharma MC, Singh L. Malignant melanoma of soft parts with osteoclast-rich giant cells: A rare tumor of the jejunum. Australas Med J 2014. [DOI: 10.21767/amj.2014.1970] [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: 11/25/2022]
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Mayerhofer R, Good AG, Bansal VK, Thiagarajah MR, Stringam GR. Molecular mapping of resistance to Leptosphaeria maculans in Australian cultivars of Brassica napus. Genome 2012; 40:294-301. [PMID: 18464830 DOI: 10.1139/g97-041] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Doubled haploid (DH) lines together with a cotyledon bioassay were employed for the molecular analysis of resistance to the blackleg fungus Leptosphaeria maculans in the Australian Brassica napus cultivars Shiralee and Maluka. We used bulked segregant analysis to identify 13 RAPD and two RFLP markers linked to the resistance phenotype and mapped these markers in the segregating DH population. Our data suggest the presence of a single major locus controlling resistance in the cultivar Shiralee, confirming our previous results obtained from Mendelian genetic analyses. In addition, preliminary mapping data for the cultivar Maluka also support a single locus model for resistance and indicate that the resistance genes from 'Shiralee' and 'Maluka' are either linked or possibly identical. The molecular markers identified in this study should be a useful tool for breeding blackleg resistant varieties using marker-assisted selection, and are the essential first step towards the map-based cloning of this resistance gene.
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Bhattacharjee HK, Misra MC, Kumar S, Bansal VK. Duodenal perforation following blunt abdominal trauma. J Emerg Trauma Shock 2012; 4:514-7. [PMID: 22090749 PMCID: PMC3214512 DOI: 10.4103/0974-2700.86650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 03/23/2011] [Indexed: 12/31/2022] Open
Abstract
Duodenal perforation following blunt abdominal trauma is an extremely rare and often overlooked injury leading to increased mortality and morbidity. We report two cases of isolated duodenal injury following blunt abdominal trauma and highlight the challenges associated with their management. In both these patients, the diagnosis of the duodenal injuries was delayed, leading to prolonged hospital stay. The first patient had two perforations, one on the anterior and the other on the posterior wall of the duodenum, of which the posterior perforation was missed at initial laparotomy. In the other patient, the duodenal injury was missed during the initial assessment in the emergency department. He returned to the emergency department 24 hours after discharge with abdominal pain and vomiting. During trauma related laparotomy, complete kocherization (mobilization) of the duodenum must be mandatory, even in the presence of obvious injury on its anterior wall. We emphasize on keeping the management protocol simple by a “triple tube decompression”, i.e. duodenorrhaphy (simple closure), tube gastrostomy, reverse tube duodenostomy and a feeding jejunostomy.
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Affiliation(s)
- Hemanga K Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Jindal V, Misra MC, Bansal VK, Choudhury N, Garg SK, Khan RN, Krishna A, Panwar R, Rewari V. Technical challenges in laparoscopic cholecystectomy in situs inversus. J Laparoendosc Adv Surg Tech A 2010; 20:241-3. [PMID: 20156123 DOI: 10.1089/lap.2009.0359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laparoscopic cholecystectomy in patients with situs inversus can be a technically challenging procedure. Although laparoscopic cholecystectomy has been described in patients with situs inversus, no standard technique has been described. We are presenting our experience of laparoscopic cholecystectomy in two patients with situs inversus and discuss the problems encountered during surgery and likely remedies.
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Affiliation(s)
- Vikas Jindal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Khan RN, Jindal V, Kapoor S, Panwar R, Bansal VK, Kumar S, Misra MC. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse (Br J Surg 2010; 97: 167-176). Br J Surg 2010; 97:961; author reply 961-2. [PMID: 20474014 DOI: 10.1002/bjs.7144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Jindal V, Khan RN, Panwar R, Bansal VK, Misra MC. Nationwide study of early outcomes after incisional hernia repair (Br J Surg 2009; 96: 1452-1457). Br J Surg 2010; 97:617-8; author reply 618. [PMID: 20205221 DOI: 10.1002/bjs.7054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bansal VK, Misra MC, Garg P, Prabhu M. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc 2010; 24:1986-9. [PMID: 20135172 DOI: 10.1007/s00464-010-0891-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 01/01/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND The optimal management of patients with concomitant common bile duct stones and gallstones is still evolving. With the introduction of laparoscopic common bile duct exploration, many centers prefer single-stage laparoscopic cholecystectomy and common bile duct exploration over preoperative endoscopic bile duct clearance followed by laparoscopic cholecystectomy. The present study was done to compare these two management options. PATIENTS AND METHODS 30 patients with symptomatic gallstones and common bile duct stones were randomized to either treatment option. Preoperative endoscopic ultrasound (EUS) and/or magnetic resonance pancreaticography (MRCP) was done in all patients to confirm the diagnosis. In group I, laparoscopic cholecystectomy and common bile duct exploration was done at the same sitting; in group II, endoscopic stone clearance was followed by laparoscopic cholecystectomy 4-6 weeks later. Success was defined as successful treatment by the intended modality. RESULTS 15 patients were randomized to each group and the two groups had comparable demographic and clinical profile. In group I there was a success rate of 93.5% in comparison with 86.7% in group II (p = 0.32, Fisher's exact test). The complications were similar in the two groups. CONCLUSIONS The results showed equivalent success rate in terms of morbidity and hospital stay. Laparoscopic approach seems to be favorable because of the smaller number of procedures and hospital visits.
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Affiliation(s)
- Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No 5045, 5th Floor, Teaching Block, New Delhi, India.
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Jain S, Guleria S, Dinda AK, Mahajan S, Bhowmik D, Gupta S, Agarwal SK, Tiwari SC, Gupta A, Bansal VK, Panigarhi A, Mehra NK. To assess the impact of protocol biopsies in tacrolimus versus cyclosporine in a live related renal transplant program. Indian Journal of Transplantation 2009. [DOI: 10.1016/s2212-0017(11)60102-0] [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: 11/25/2022] Open
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Reddy VS, Guleria S, Gupta A, Bansal VK, Mahajan S, Bhowmik D, Sagar R, Tiwari SC. A prospective study of quality of life of live related kidney donors. Indian Journal of Transplantation 2009. [DOI: 10.1016/s2212-0017(11)60112-3] [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: 11/26/2022] Open
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Misra MC, Kumar S, Bansal VK. Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study. Surg Endosc 2008; 22:1947-58. [PMID: 18437480 DOI: 10.1007/s00464-008-9897-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 01/27/2008] [Accepted: 02/25/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND Creation of extraperitoneal space during TEP repair requires an expensive commercially available balloon. PATIENTS AND METHODS Fifty-six patients suffering from uncomplicated primary unilateral or bilateral groin hernia were randomized into two groups; group 1--indigenous balloon dissection and group 2--direct telescopic dissection. RESULTS There were 55 males and 1 female, with an average age of 49 years; 50% of the inguinal hernias were bilateral. Creation of extraperitoneal space was considered as satisfactory in majority of patients (94.6%) with satisfactory anatomical delineation. Peritoneal breach was noticed during dissection in 36 (64.3%) patients. There was one (3.8%) conversion of TEP to TAPP in group 2. Distance between pubic symphysis to umbilicus was an important factor, which affected the easiness of dissection. In patients with this distance <or=14 cm lateral placement of ports was considered for easy use of graspers. The incidence of scrotal edema was significantly higher in group 2 as compared with group 1 (p < 0.01). Patients with indirect inguinal hernias in group 2 presented with a greater number of scrotal edema. Pain score on VAS at 6 h after surgery was significantly higher in group 2 (p < 0.021). Patients with age <65 years, bilateral hernias, and indirect hernias had a correlation with higher pain score at 6 h. Of the patients, 17.9% developed seroma in group 1 versus 64.3% in group 2 (p < 0.001). CONCLUSION Anatomical delineation of inguinal area and dissection in the extraperitoneal space in TEP repair was equally satisfactory with both low-cost indigenous balloon (group 1) and telescopic dissection (group 2). Balloon dissection was associated with significantly reduced postoperative pain at 6 h, scrotal edema, and seroma formation. However at 3 months follow-up balloon dissection did not offer significant advantage over direct telescopic dissection in the overall long-term outcome of TEP repairs. If balloon dissection is considered useful for the beginner, low-cost indigenous balloon may be used to avoid higher cost of commercially available balloon dissector with added early advantages.
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Affiliation(s)
- Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, India.
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Misra MC, Bansal VK, Kulkarni MP, Pawar DK. Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 2008; 20:1839-45. [PMID: 17063290 DOI: 10.1007/s00464-006-0118-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 04/11/2006] [Indexed: 12/19/2022]
Abstract
BACKGROUND Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of consensus, needs prospective randomized controlled trials. METHODS Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive either open retro-rectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group). RESULTS Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (approximately 50%) in both groups. There was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55). CONCLUSIONS Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome.
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Affiliation(s)
- M C Misra
- Department of Surgical Disciplines and Anaesthesiology, All India Institute of Medical Sciences, 5th Floor Room No. 5031, Teaching Block, New Delhi 110029, India
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Misra MC, Bansal VK, Kumar S, Prashant B, Bhattacharjee HK. Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center. Hernia 2007; 12:65-71. [PMID: 17828462 DOI: 10.1007/s10029-007-0281-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 08/17/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND The laparoscopic repair of groin hernia is increasingly being used. However, the relative merits and demerits of laparoscopic repair are debatable. The present study was undertaken to evaluate the total extra-peritoneal (TEP) repair of groin hernia. METHODS This prospective study was undertaken at a single surgical unit between January 2004 and June 2006. Consecutive patients with elective groin hernias were offered laparoscopic TEP repair. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Polypropylene mesh was used in all of the patients and mesh fixation was performed with tackers. RESULTS A total of 185 patients with age range 18-92 years were included; 180 were males. TEP repair was attempted in 298 groin hernias in 185 patients with a success rate of 89.5%. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Thirty-one (31, 10.5%) TEP repairs were converted to transabdominal pre-peritoneal or open repair. Two patients developed recurrence during follow-up. CONCLUSION TEP is an excellent technique for laparoscopic groin hernia repair, with acceptable rates of complication.
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Affiliation(s)
- M C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Guleria S, Aggarwal S, Bansal VK, Varma MC, Kashyap L, Tandon N, Mahajan S, Bhowmik D, Agarwal SK, Mehra NK, Misra MC. The first successful simultaneous pancreas-kidney transplant in India. Natl Med J India 2005; 18:18-9. [PMID: 15835486] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Insulin-dependent diabetes mellitus is associated with renal failure, diabetic retinopathy, neuropathy and vasculopathy. We report the first successful simultaneous pancreas-kidney transplant in India in a young diabetic with renal failure. The dual transplant has cured his diabetes and renal failure and has had a beneficial effect on his neuropathy, retinopathy and quality of life. Obstacles to dual transplant in India include a lack of suitable recipients and a cadaver donor programme that is still in its infancy.
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Affiliation(s)
- S Guleria
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Beto JA, Bansal VK, Hart J, McCarthy M, Roberts D. Hemodialysis prognostic nutrition index as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis. Council on Renal Nutrition National Research Question Collaborative Study Group. J Ren Nutr 1999; 9:2-8. [PMID: 9861095 DOI: 10.1016/s1051-2276(99)90015-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Prospectively examine the use of a hemodialysis prognostic nutrition index (HD-PNI) as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis. DESIGN Prospective randomized collaborative study group. SETTING There were 211 chronic hemodialysis centers; 202 from 43 United States, 9 from Canada. PATIENTS There were 1527 hemodialysis patients undergoing treatment a minimum of 3 months and at least 18 years of age. Sample mirrored United States Renal Data System data for age, sex, race, and etiology of renal failure. INTERVENTIONS None; routinely collected demographic, biochemical, and clinical data for 8-month baseline and 3-month predictive phases. METHODS HD-PNI calculated from baseline data as linear mathematical equation using level of serum albumin, level of serum creatinine, and number of days and times hospitalized; HD-PNI risk defined as >/=0.8. Adequacy of dialysis calculated as urea reduction ratio (URR) from baseline data; adequacy risk defined as URR of </=65%. MAIN OUTCOME MEASURES Number of times and days hospitalized, mortality. RESULTS For this research, 1167 patients completed the study (76%) with 360 (24%) dropped due to death, incomplete data, transfer, or change in modality. Patients completing study with HD-PNI risk (n = 208, 18%) compared with patients who had no HD-PNI risk (n = 959, 82%) were hospitalized more often (57.2% v 28.5%, P <. 01), hospitalized with infection more often (14.6% v 4.6%, P <.01), and had greater mortality (7.7% v 2.5%, P <.01). Stratification of HD-PNI risk by URR of >/=65% did not significantly improve prediction. CONCLUSIONS Use of HD-PNI is an effective screening tool to identify hemodialysis patients at risk for morbidity and mortality. No correlation was found between URR and HD-PNI.
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Affiliation(s)
- J A Beto
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA
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Abstract
The reliability and validity of any clinical laboratory test is directly affected by the integrity of the blood specimen obtained for analysis. Renal failure patients undergo a high number of laboratory tests, primarily to monitor the quality of care. Subsequent tests to confirm laboratory abnormalities are costly and place the patient at unnecessary risk for additional blood loss. Three of the four Health Care Financing Administration core clinical outcome indicators have nutritional implications and use laboratory values as part of review criteria: adequacy of dialysis, albumin, and anemia. National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI) Clinical Practice Guidelines have recommended standardized predialysis and postdialysis blood draw procedures to increase accuracy for adequacy of dialysis. The National Committee on Clinical Laboratory Standards publishes peer-reviewed guidelines for venipuncture. Together, the adoption of these standards would minimize preanalytical variation and improve the data used to monitor the quality of care in renal patients.
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Affiliation(s)
- J A Beto
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA.
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Affiliation(s)
- J A Beto
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA.
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Beto JA, Bansal VK, Ing TS, Daugirdas JT. Variation in blood sample collection for determination of hemodialysis adequacy. Council on Renal Nutrition National Research Question Collaborative Study Group. Am J Kidney Dis 1998; 31:135-41. [PMID: 9428465 DOI: 10.1053/ajkd.1998.v31.pm9428465] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inadequate dialysis has been associated with high morbidity and mortality in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis. The accurate estimation of dialysis adequacy, measured either as a calculated urea kinetics (Kt/V) or a simple urea reduction ratio (URR) is dependent on the proper collection of blood samples for predialysis and postdialysis blood urea nitrogen (BUN) determination. Because no established protocol exists for blood sampling, we surveyed the study cohort of dialysis centers participating in the National Kidney Foundation Council on Renal Nutrition National Research Question Collaborative Study to determine the comparability of BUN data that were collected to calculate URR to determine adequacy of dialysis. Surveys were completed by 100% of the 202 units participating: 195 in the United States (from 43 states) and seven from Canada, treating approximately 15,000 hemodialysis patients in total. The distribution of the sample by the type of facility mirrored that of 1996 United States Renal Data System (USRDS) Annual Report facilities data. Results showed a 5.0% error in predialysis blood draw and an 8.4% to 41.6% error in the postdialysis counterpart. There was a large variability in the observed postdialysis methods in general. Dilution of predialysis sample with either heparin or saline will falsely underestimate Kt/V and URR. The presence of access-derived, recirculated blood in the postdialysis sample will falsely overestimate Kt/V and URR. Excessive delay in drawing postdialysis sample will reduce Kt/V and URR because of urea rebound. Adoption by all dialysis providers of a uniform blood sample draw procedure will result in a consistency necessary to allow reliable and valid comparison of adequacy of dialysis parameters within and between ESRD patients, units, and clinical trials.
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Affiliation(s)
- J A Beto
- Collaborative Study Data Coordinating Center, Loyola University Medical Center, Division of Renal Disease and Hypertension, Maywood, IL 60153, USA.
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Beto JA, Bansal VK, Gohlke NP, Hano JE. Using the hemodialysis prognostic nutrition index and urea reduction ratio to predict morbidity and mortality: a pilot study of the 1995 council on renal nutrition national research question. J Ren Nutr 1998; 8:21-4. [PMID: 9724826 DOI: 10.1016/s1051-2276(98)90033-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To validate the use of the hemodialysis prognostic nutrition index (HPNI) in an alternate hemodialysis population and to determine if use of urea reduction ratio would improve use in outcome prediction for morbidity and mortality. DESIGN Prospective random cohort. SETTING Hospital based non-for-profit outpatient dialysis unit. PATIENTS Forty chronic hemodialysis patients, 50% men, 50% black, 16% diabetic, 67.2 mean months on hemodialysis, mean age 54.5 years. INTERVENTIONS None; observational; tracking of routinely collected demographic, biochemical, and clinical data. MAIN OUTCOME MEASURES Number of times and days hospitalized, mortality RESULTS Plotting of HPNI against urea reduction ratio produced risk quadrants for hospitalization that were more predictive than HPNI alone. CONCLUSION Application continues as a multicenter collaborative Council on Renal Nutrition National Research Question.
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Affiliation(s)
- J A Beto
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL, USA
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Abstract
The best therapeutic choice in lupus nephritis remains shrouded in a body of controversial literature. The purpose of this review was to assess and compare by meta-analysis the efficacy of therapeutic agents used in the treatment of lupus nephritis using outcomes of end-stage renal disease (ESRD) and total mortality. An exhaustive search was performed using MEDLINE (1970 to 1995) and manual search of bibliographic notations and nonindexed sources. Twenty prospective controlled trials with treatment allocation by random assignment or consecutive enrollment were identified using diagnostic evidence of systemic lupus erythematosus based on American Rheumatism Association (ARA) criteria and clinical/biopsy evidence of lupus nephritis. One trial was excluded, resulting in 19 trials (n = 440) using treatment groups of oral prednisone alone, azathioprine with and without concomitant prednisone, oral cyclophosphamide with prednisone, azathioprine and oral cyclophosphamide with prednisone, and intravenous cyclophosphamide with prednisone. Crude risk data was pooled. An adjusted pooled risk was calculated using the random effects model of DerSimonian and Laird. Two measures of clinical effectiveness were used to compare treatments: absolute risk differences and number needed to treat. Analysis was completed between treatment groups as follows: oral prednisone compared with all immunosuppressive agents with prednisone and all treatment groups compared with one another. When compared with oral prednisone alone, immunosuppressive agents used in conjunction with oral prednisone were found to be statistically more effective for both total mortality and ESRD (absolute risk differences, 13.2% and 12.9%, respectively). When treatment groups were compared, intravenous cyclophosphamide in conjunction with oral prednisone was found to be statistically more effective than oral prednisone alone for both total mortality and ESRD (absolute risk differences, 19.9% and 16.2%, respectively). The simultaneous use of azathioprine and oral cyclophosphamide concomitant with oral prednisone was found to be 16.9% more effective than oral prednisone alone in reducing incidence of ESRD. No difference was seen in total mortality and data represented only two studies (n = 30). No immunosuppressive agent was found to be statistically more effective than another for either total mortality or ESRD. Future prospective studies are needed to control for numerous variables and renal function changes to provide more definitive answers.
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Affiliation(s)
- V K Bansal
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA
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Beto JA, Listecki RE, Meyer DA, Budhy RJ, Bansal VK. Use of pharmacy computer prescription database to access hypertensive patients for mailed survey research. Ann Pharmacother 1996; 30:351-5. [PMID: 8729887 DOI: 10.1177/106002809603000405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate the use of a pharmacy computer prescription database (PCPD) to identify and sample hypertensive patients outside of their treatment setting for mailed, self-administered survey research comparing the presence and lack of participation incentives and mailed follow-up reminders. SETTING Two independent, privately owned, free-standing community pharmacies. PARTICIPANTS A total of 735 individuals identified from a PCPD search who had been prescribed at least 1 of 130 PCPD medications potentially used in hypertensive therapy. METHODS PCPD was searched by the pharmacist/owner per protocol; participants were sent an individually addressed cover letter on pharmacy letterhead signed by the pharmacist that requested voluntary anonymous completion of an enclosed self-administered, quality-of-life opinion survey; the first search used no incentive or follow-up; the second search used an incentive and mailed a follow-up reminder. Research protocol followed published ethics guidelines. RESULTS There was a mean 84% return with incentive and follow-up strategies compared with a mean 25% return without strategies (p < 0.01) for all drug groups between searches; no statistical difference in response was shown between the same drug groups (alpha 1-blockers, calcium-channel blockers, and centrally acting alpha 2-agonists) within searches. CONCLUSIONS Acceptable response rates (74-93% return) can be obtained with traditional follow-up mailed incentives, prescription issuance within 6 months, incentives to both hypertensive and nonhypertensive responders, and sampling strategies within potential drug groups. Methodology can be adapted to other populations by alternative drug sampling strategies.
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Affiliation(s)
- J A Beto
- Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL, USA
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Chi Y, Mota de Freitas D, Sikora M, Bansal VK. Correlations of Na+-Li+ exchange activity with Na+ and Li+ binding and phospholipid composition in erythrocyte membranes of white hypertensive and normotensive individuals: a nuclear magnetic resonance investigation. Hypertension 1996; 27:456-64. [PMID: 8698453 DOI: 10.1161/01.hyp.27.3.456] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Enhanced Na+-Li+ exchange activity has been reported in red blood cells (RBCs) of white patients with essential hypertension compared with RBCs of normotensive individuals. To understand the factors responsible for this finding, we applied novel and conventional spectroscopic and kinetic methods to blood samples from 10 hypertensive and 10 normotensive individuals. We measured the kinetic parameters (V std, V max, and K m) for RBC Na+-Li+ exchange by atomic absorption spectrophotometry and used 23Na and 7Li nuclear magnetic resonance relaxation methods to measure Na+ and Li+ binding to RBC membranes as well as 31P nuclear magnetic resonance spectroscopy to measure membrane phospholipid compositions. We found significant differences between the two groups for the affinity of Na+ for the RBC membrane (0.202 +/- 0.054 mmol/L-1 for hypertensive patients versus 0.296 +/- 0.071 mmol/L-1 for normotensive subjects, P<.005). The kinetic parameters of RBC Na+-Li+ exchange (V std, V max, and K m) were 0.32 +/- 0.09 and 0.66 +/- 0.17 mmol Li+/L cell.h and 160 +/- 62 mmol/L, respectively, for hypertensive patients versus 0.21 +/- 0.06 and 0.32 +/- 0.14 mmol Li+/L cell.h and 86 +/- 69 mmol/L for normotensive subjects (P<.05). The fractions of phosphatidylserine and phosphatidylethanolamine were 0.153 +/- 0.009 and 0.294 +/- 0.016 for hypertensive patients versus 0.138 +/- 0.013 and 0.325 +/- 0.018 for normotensive subjects (P<.05). The Na+ binding constants were negatively correlated with the Km values for both the hypertensive (r=-.61, P=.01) and normotensive (r=-.43, P=.04) groups. Changes in lipid-protein interactions in the RBC membranes of hypertensive patients appear to be responsible for weaker Na+ binding to the membrane and for the faster rates of RBC Na+-Li+ exchange.
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Affiliation(s)
- Y Chi
- Department of Chemistry, Loyola University of Chicago, Illinois 60626, USA
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Costanzo MR, Beto JA, Potempa LD, Bansal VK, Heroux AL, Kao WG, Pifarre R, Johnson MR. Longitudinal effects of cyclosporine administration at 0 to 60 months after heart transplantation. Transplant Proc 1994; 26:2704-9. [PMID: 7940847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M R Costanzo
- Department of Medicine, Loyola University Chicago, Maywood, Illinois
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38
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Abstract
OBJECTIVE To examine methodologic issues of access and confidentiality regarding the use of pharmacy computer prescription databases (PCPDs) for participant selection to receive mailed, self-administered, hypertensive quality-of-life survey outside a primary-care setting. DESIGN Two separate PCPD searches by pharmacist owners for patients prescribed at least one of 130 potential antihypertensive medications. The first PCPD used a nonrandom sample of all patients (n = 635); the second PCPD used a random sample (n = 100) of three specific antihypertensive drug groups. Research protocol was approved by the investigators' institutional review board. SETTING Two independent, privately owned PCPDs. PATIENTS OR OTHER PARTICIPANTS Individuals prescribed at least 1 of 130 PCPD medications potentially used in antihypertensive treatment. INTERVENTIONS Individually addressed cover letter on pharmacy letterhead signed by a pharmacist requesting voluntary completion of the enclosed, self-administered, opinion survey on quality of life. MAIN OUTCOME MEASURE Anonymous survey return to off-site post office box in envelope provided. RESULTS Favorable or no opposition to PCPD methodology from pharmacist or participants. Ethical opposition was encountered when incorporating PCPD sampling technique into grant proposal. CONCLUSIONS The American Pharmaceutical Association Code of Ethics is used as a basis to provide recommendations to examine and justify PCPD investigative use. Increasing availability of PCPD technology encourages more efficient and easier methods of research strategy. PCPD use, however, demands identical stringent guidelines used in traditional research and raises potential issues regarding pharmacist-patient confidentiality as well as the right of PCPD use by others.
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Abstract
A metaanalysis was performed to determine the effects on quality of life (QL) in hypertension as reported in published clinical trials of antihypertensive drug therapy. All studies included compared active treatment to baseline (placebo or no treatment) with the patients as their own control and used blinded, randomized trials. Change was measured by self and/or interviewer-assisted evaluation, standardized psychomotor/cognitive tests, or sleep laboratory observations. After an exhaustive literature search (1970 to 1990), nine published trials of 27 population groups (n = 1620) using 14 drugs from six pharmacological groups met selection criteria and were analyzed for five QL constructs: sexual function, sleep, psychomotor, general well-being, and mood. Small positive effect size (d) improvement with treatment was seen for sleep (d = 0.106), psychomotor (d = 0.283), general well-being (d = 0.139), and mood (d = 0.167) while no effect could be determined for sexual function (d = -0.030) based on 95% confidence intervals. Either a comparably small improvement with treatment or no effect was seen among various pharmacological drug groups; no negative effect with treatment was identified. A larger positive effect could be postulated if the drug choice was individualized to the patient rather than randomized as in clinical trial methodology. Although none of the drug groups had a clearly superior effect, a more frequent positive effect with angiotensin converting enzyme inhibitors and beta-blockers was seen for all constructs. Narrower demographics and smaller sample sizes may have biased similar positive effects in calcium-channel blockers and diuretics.
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Affiliation(s)
- J A Beto
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153
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40
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Stiff PJ, McKenzie RS, Potempa LD, Albain K, Koch D, Braud E, Bansal VK, Weidner MK, Lanzotti VJ, Chun HG. A phase I trial of high-dose diaziquone and autologous bone marrow transplantation: an Illinois Cancer Council study. J Clin Oncol 1991; 9:1487-94. [PMID: 2072148 DOI: 10.1200/jco.1991.9.8.1487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diaziquone (AZQ), a synthetic quinone with demonstrated activity against acute nonlymphocytic leukemia (ANLL), primary CNS tumors, and non-Hodgkin's lymphoma (NHL), is virtually devoid of nonhematopoietic toxicity at conventional doses. As a prelude to its inclusion into bone marrow transplant (BMT) preparative regimens, a phase I study of high-dose AZQ with autologous BMT (ABMT) was performed. Patients with refractory solid tumors and lymphomas were treated with a single 24-hour infusion of AZQ at 50 to 355 mg/m2 in dose escalations of 20%. Fifty-six patients received 69 courses. Those receiving greater than 60 mg/m2 had nadir granulocyte and platelet counts less than 500/microL and 20,000/microL, respectively. Nausea, vomiting, stomatitis, and diarrhea were mild, transient, and not dose-related. Transient minimal elevations of liver function tests were seen in five patients and were also not dose-related. The maximally tolerated dose (MTD) of high-dose AZQ was found to be 245 mg/m2, with nephrotoxicity being dose-limiting. Significant azotemia was seen in four of 12 patients treated at 295 and 355 mg/m2, including fatal anuric renal failure in three of these patients. Reversible proteinuria also occurred in 24 of 26 courses above 150 mg/m2, including nephrotic range proteinuria in eight courses, all at doses of 205 to 355 mg/m2. The proteinuria was also associated with multiple proximal tubular defects including generalized aminoaciduria and proximal renal tubular acidosis. There were six early deaths including two of early renal failure (295 and 355 mg/m2), two of sepsis (205 and 245 mg/m2), one of a pulmonary embolus (85 mg/m2), and one of progressive disease (60 mg/m2). Of 50 patients who were assessable for response, there were seven responses including two of 10 with primary CNS tumors, one of 12 with malignant melanoma, one of five with non-small-cell lung carcinoma, two of two with breast carcinoma, and one of one with ovarian carcinoma. Because of its activity in ANLL and NHL and its unique toxicity spectrum, high-dose AZQ may improve the efficacy of current BMT preparative regimens without significantly increasing their nonhematopoietic toxicity.
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Affiliation(s)
- P J Stiff
- Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL
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Popli S, Leehey DJ, Daugirdas JT, Bansal VK, Ho DS, Hano JE, Ing TS. Asymptomatic, nonketotic, severe hyperglycemia with hyponatremia. Arch Intern Med 1990; 150:1962-4. [PMID: 2393329] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe five patients with asymptomatic, nonketotic, severe hyperglycemia (serum glucose concentrations between 45.8 and 92 mmol/L) in the face of renal insufficiency are described. As opposed to most of the previously described patients with hyperglycemic, nonketotic, hyperosmolar coma, our patients were hyponatremic. The lack of symptoms in our patients may be related to the absence of cerebral cellular dehydration. Aggressive treatment of hyperglycemia in such patients is unnecessary. Attention to the serum sodium level as well as to the serum glucose concentration will allow recognition of this clinical entity.
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Affiliation(s)
- S Popli
- Department of Medicine, Veterans Administration Hospital, Hines, Ill. 60141
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Ramasamy R, Mota de Freitas D, Bansal VK, Dorus E, Labotka RJ. Nuclear magnetic resonance studies of lithium transport in erythrocyte suspensions of hypertensives. Clin Chim Acta 1990; 188:169-76. [PMID: 2379313 DOI: 10.1016/0009-8981(90)90161-k] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We have applied a nuclear magnetic resonance (NMR) method, based on the 7Li nucleus, to discriminate between intracellular and extracellular lithium ions (Li+) in red blood cell (RBC) suspensions. The NMR method was compared with atomic absorption, a technique that requires physical separation of intra- and extracellular Li+ prior to chemical analysis. The rates and rate constants of RBC Na(+)-Li+ countertransport measured by the 7Li NMR method correlated significantly with the measurements made by atomic absorption for both the hypertensive (r = 0.964) and control (r = 0.961) groups. The rates of RBC Na(+)-Li+ countertransport measured by NMR were significantly higher for hypertensive patients than for normotensive controls. The fact that the NMR method does not require cell membrane lysis, and its potential to reveal structural and mechanistic information on Li+ binding and transport in cellular systems, makes it promising for understanding the basis of Li+ transport variations in RBCs, and possibly other tissues, from hypertensive patients.
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Affiliation(s)
- R Ramasamy
- Department of Chemistry, Loyola University of Chicago, IL 60626
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Kozeny GA, Quinn JP, Bansal VK, Vertuno LL, Hano E. Pneumocystis carinii pneumonia: a lethal complication of "pulse" methylprednisolone therapy. Int J Artif Organs 1987; 10:304-6. [PMID: 2960621] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A previously healthy, HIV-negative, 67-year-old man developed rapidly progressive glomerulonephritis. Following "pulse" methylprednisolone therapy he developed Pneumocystis carinii pneumonia. This complication should be recognized as a potential hazard of "pulse" steroid therapy.
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Affiliation(s)
- G A Kozeny
- Section of Nephrology, Loyola University Medical Center, Maywood, Illinois
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Kozeny GA, Barr W, Bansal VK, Vertuno LL, Fresco R, Robinson J, Hano JE. Occurrence of renal tubular dysfunction in lupus nephritis. Arch Intern Med 1987; 147:891-5. [PMID: 3034179] [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: 01/03/2023]
Abstract
We prospectively evaluated 30 patients who presented with active systemic lupus erythematosus (SLE) for the presence of tubular abnormalities. All patients fulfilled the American Rheumatology Association criteria for SLE. When appropriate, a renal biopsy was performed. Of the 30 patients studied, 12 had no abnormal tubular study results, whereas 18 patients had some form of defect in the handling of potassium, sodium, or hydrogen ions. Eight patients had distal renal tubular acidosis (dRTA) due to an isolated proton secretory defect. Five had dRTA of the gradient or acid back-leak type. Two had an unresponsive voltage-dependent form of dRTA; one had a responsive voltage-dependent form of dRTA. One individual had hyporeninemic hypoaldosteronism and one had dRTA plus hypoaldosteronism. Clinically, patients with the abnormal tubular study results more often presented with nephritis or nephrotic sediment, peripheral edema, or anemia. Renal biopsies failed to demonstrate any difference in glomerular histologic findings and calculated activity, chronicity, or interstitial indexes. We conclude that SLE may be associated with a variety of tubular defects.
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Kozeny GA, Ragona BP, Bansal VK, Hurley RM, Dixon DW, Vertuno LL, Hano JE. Myocardial infarction with normal results of coronary angiography following diltiazem withdrawal. Am J Med 1986; 80:1184-6. [PMID: 3728513 DOI: 10.1016/0002-9343(86)90682-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abrupt withdrawal of calcium channel blocking agents has been associated with symptoms of ischemic heart disease, but acute myocardial infarction has not been noted. Herein is described a severely uremic patient who had an acute myocardial infarction shortly after discontinuance of diltiazem, although results of subsequent coronary arteriography were normal. It is postulated that myocardial damage occurred because of increased intracellular calcium flux, augmented myocardial contractility, and/or drug withdrawal-related coronary spasm.
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Bansal VK, Kozeny GA, Fresco R, Vertuno LL, Hano JE. De novo membranous nephropathy following renal transplantation between conjoint twins. Transplantation 1986; 41:404-6. [PMID: 3513400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kozeny GA, Hurley RM, Vertuno LL, Bansal VK, Zeller WP, Hano JE. Hypertension, mineralocorticoid-resistant hyperkalemia, and hyperchloremic acidosis in an infant with obstructive uropathy. Am J Nephrol 1986; 6:476-81. [PMID: 3565506 DOI: 10.1159/000167258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An 8-week-old infant with hypertension, hyperkalemia, and hyperchloremic acidosis, presumably due to chloride shunt type of distal renal tubular acidosis, is described. The patient's renin-aldosterone axis was intact. The infant was also found to have an obstructed solitary kidney. Despite correction of the obstruction and improvement in the glomerular filtration rate accompanied by normal development, hyperkalemia and renal tubular acidosis persisted. The defect was still demonstrable 9 months following relief of the obstruction. We conclude that neonatal obstructive uropathy can result in renal tubular acidosis of the chloride shunt type. The reversibility of this defect is, as yet, unknown.
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Kozeny GA, Hurley RM, Fresco R, Vertuno LL, Bansal VK, Hano JE. Systemic lupus erythematosus presenting with hyporeninemic hypoaldosteronism in a 10-year-old girl. Am J Nephrol 1986; 6:321-4. [PMID: 3535507 DOI: 10.1159/000167183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hyperkalemia has been noted to occur spontaneously in patients with long-standing systemic lupus erythematosus who did not have advanced renal insufficiency. The patients previously described all had relatively normal renin-aldosterone systems, and the hyperkalemia was thus presumed to be secondary to a primary defect in renal tubular potassium secretion. We describe at 10-year-old girl with lupus nephritis, without significant renal insufficiency, who had hyperkalemia from hyporeninemic hypoaldosteronism postulated to be due to vasculitis involving the afferent/efferent arterioles and juxtaglomerular apparatus.
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49
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Kozeny GA, Bansal VK, Vertuno LL, Hurley RM, Hano JE. Complications of subclavian vein dialysis. Int J Artif Organs 1985; 8:239-42. [PMID: 4086114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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50
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Nand S, Bansal VK, Kozeny G, Vertuno L, Remlinger KA, Jordan JV. Red cell fragmentation syndrome with the use of subclavian hemodialysis catheters. Arch Intern Med 1985; 145:1421-3. [PMID: 4026473] [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: 01/08/2023]
Abstract
The red cell fragmentation syndrome can occur due to abnormalities of the heart or the blood vessels or vascular malformations. We describe three patients who developed symptomatic hemolytic anemia due to red cell fragmentation with the use of single-lumen subclavian hemodialysis catheters. Retrospective analysis of 75 other patients who had undergone dialysis through this catheter disclosed five additional cases. Red cell fragmentation appears to be associated with partial catheter occlusion by thrombus or development of a clot at the catheter tip or both. The fragmentation resolved in all cases on withdrawal of the catheter. All patients with this catheter should be closely monitored for the red cell fragmentation syndrome, and the catheter should be withdrawn if it develops. White cell fragmentation was also seen in one patient.
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