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Uncomplicated spontaneous rupture of pancreatic pseudocyst into stomach: A case report

World Journal of Gastrointestinal Endoscopy 2013年第9期5卷 461-464页

作者： Piyush O Somani Samit S Jain dharmesh k shah Amol A khot Pravin M Rathi Department of Gastroenterology Topiwala National Medical College Bai Yamunabai Laxman Nair Hospital

Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography(CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric *** fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.

关键词： Chronic pancreatitis Cystogastric fistula Fistula Pancreas Pancreatitis Pseudocyst

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Esophageal tuberculosis presenting with hematemesis

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World Journal of Gastrointestinal Endoscopy 2013年第11期5卷 581-583页

作者： Samit S Jain Piyush O Somani Rajeshkumar C Mahey dharmesh k shah Qais Q Contractor Pravin M Rathi Department of Gastroenterology Bai Yamunabai Laxman Nair HospitalTopiwala National Medical College Department of General Surgery Bai Yamunabai LaxmanNair HospitalTopiwala National Medical College

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy(EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy(Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.

关键词： Esophageal tuberculosis Esophagogastroduodenoscopy Hematemesis

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Quantitation of tadalafil in human plasma using a sensitive and rapid LC-MS/MS method for a bioequivalence study

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Journal of Pharmaceutical Analysis 2018年第4期8卷 271-276页

作者： Abhaysingh Bhadoriya Bhavesh Dasandi dharmesh Parmar Priyanka A. shah Pranav S. Shrivastav Bioanalytical Department Synchron Research Services Pvt. Ltd. Department of Chemistry School of Sciences Gujarat University

A highly sensitive liquid chromatography-tandem mass spectrometry（LC-MS/MS） method was developed for the determination of tadalafil（TAD） in human plasma. TAD and its deuterated internal standard（IS）, tadalafil-d3, were extracted from 200 mL plasma using Phenomenex Strata-X-C 33 m extraction cartridges. Chromatographic analysis was carried out on Synergi Hydro-RP C18（100 mm × 4.6 mm, 4 mm）column with a mobile phase consisting of methanol and 10 m M ammonium formate, p H 4.0（90：10, v/v）,delivered at a flow rate of 0.9 m L/min. Quantitation of the protonated analyte was done on a triple quadrupole mass spectrometer using multiple reaction monitoring via electrospray ionization. The precursor to product ions transitions monitored for TAD and TAD-d3 were m/z 390.3-268.2 and m/z393.1-271.2, respectively. The calibration curve was linear over the concentration range of 0.50–500 ng/m L with correlation coefficient, r2 Z 0.9994. Acceptable intra-batch and inter-batch precision（r3.7%） and accuracy（97.8% to 104.1%） were obtained at five concentration levels. The recovery of TAD from spiked plasma was highly precise and quantitative（98.95% to 100.61%）. Further, the effect of endogenous matrix components was minimal. TAD was found to be stable under different storage conditions in human plasma and also in whole blood samples. The validated method was successfully used to determine TAD plasma concentration in a bioequivalence study with 20 mg TAD tablets in 24 healthy volunteers. Method performance was evaluated by reanalyzing 115 study samples.

关键词： Tadalafil Tadalafil-d3 LC-MS/MS Sensitive Bioequivalence study Human plasma

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Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm

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World Journal of Pediatrics 2023年第6期19卷 586-594页

作者： Emilia Esterman Traci-Anne Goyen Pranav Jani Gemma Lowe Jane Baird Rajesh Maheshwari Daphne D’Cruz Melissa Luig dharmesh shah Department of Neonatology Westmead HospitalWestmeadAustralia Faculty of Medicine and Health The University of SydneySydneyAustralia

Background Systemic postnatal corticosteroid use in extremely preterm infants poses a risk of adverse neurodevelopmental *** study explores their use beyond seven days of age with early neurodevelopmental assessments during the fidgety period(9-20 weeks postterm age).Methods This retrospective single-center cohort study included inborn extremely preterm infants from 1 January 2014 to 31 December *** infants,those with congenital or genetic abnormalities,and those who received postnatal cor-ticosteroids for nonrespiratory reasons were *** cohort was dichotomized based on the status of corticosteroid *** neurodevelopmental outcomes were reported using Prechtl's General Movements *** Of the 282 infants,67(23.75%)received *** these,34(50.75%)received them for dependency on invasive ventilation(intermittent positive-pressure ventilation),and the remainder received them for dependency on non-invasive ventilation continuous positive airway pressure(CPAP)or bi-level positive airway pressure(BiPAP).Abnormal or absent fidgety movements were observed in 13% of infants(7/54)who received corticosteroids compared to 2% of infants(3/146)who did *** increased odds for an abnormal general movements assessment from corticosteroid use after adjusting for gestational age[adjusted odds ratio(aOR)=5.5,95% confidence interval(CI)=1.14-26.56]was *** motor optimality scores differed between the two groups[corticosteroid group:25.5(23-26)versus no-corticosteroid group:26(24-28);z=-2.02].A motor optimality score<20 was observed in 14.8% of infants(8/54)in the corticosteroid group compared to 2% of infants(3/146)in the noncorticosteroid *** difference was significant after adjustment for gestational age(aOR 5.96,95%CI 1.28-27.74).Conclusions Abnormal early neurodevelopment was observed in infants who received systemic postnatal *** relationship between these findings and other factors influen

关键词： Corticosteroids Early neurodevelopment General movement assessment Preterm infants

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