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Extrahepatic metastasis of hepatocellular carcinoma to the paravertebral muscle:A case report

World Journal of Hepatology 2017年第22期9卷 973-978页

作者： Kazuhiro Takahashi krishna g Putchakayala Mohamed Safwan Dean Y Kim Transplant and Hepatobiliary Surgery Henry Ford HospitalDetroitMI 48202United States

Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.

关键词： Hepatocellular carcinoma Skeletal muscle Paravertebral muscle Extrahepatic metastasis Stereotactic hypo-fractionated image guided radiation therapy Hepatitis B virus

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Appraisal of needle-based confocal laser endomicroscopy inthe diagnosis of pancreatic cysts

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World Journal of gastroenterology 2016年第4期22卷 1701-1710页

作者： Somashekar g krishna Jeffery H Lee Department of gastroenterology Hepatologyand NutritionThe Ohio State University Medical CenterColumbusOH 43210United States Department of gastroenterology Hepatologyand NutritionThe University of Texas MD Anderson Cancer CenterHoustonTX 77030United States

Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Eventhough most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Current evaluation of suspicious cystic lesions includes a combination of radiologic imaging, endoscopic ultrasound(EUS) and cyst fluid analyses. Despite these attempts, precise diagnostic stratification among nonmucinous, mucinous, and malignant cystic lesions is often not possible until surgical resection. EUS-guided needle based confocal laser endomicroscopy(n CLE) for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. Though limited imaging data from 3 large clinical trials(INSPECT, DETECT and CONTACT) are currently the reference standard for n CLE imaging, nonetheless these have not been validated in large studies. The aim of this review article is to review the evolving role of EUS-guided n CLE in management of pancreatic cystic lesions in terms of its significance, adverse events, limitations, and implications.

关键词： Pancreatic cyst Needle-based confocal laserendomicroscopy Endoscopic ultrasound Intraductalpapillary mucinous neoplasm Mucinous cystadenoma Serous cystadenoma Pancreatic cancer

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High-grade pancreatic intraepithelial lesions： prevalence and implications in pancreatic neoplasia

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Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 202-208页

作者： Jean R Park Feng Li Veeral M Oza Brett C Sklaw Kevin M Cronley Michael Wellner Benjamin Swanson Somashekar g krishna Division of Hospital Medicine The Ohio State University Wexner Medical Center Columbus Ohio USA Division of gastroenterology Hepatology and Nutrition The Ohio State University Wexner Medical Center Columbus Ohio USA Department of Pathology The Ohio State University Wexner Medical Center Columbus Ohio USA

BACKgROUND： High-grade pancreatic intraepithelial neoplasia（Pan IN-3）, a precursor of pancreatic ductal adenocarcinoma（PDAC）, is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of Pan IN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms（IPMNs）.METHODS： A retrospective review of a tertiary care center pathology database（1/2000-6/2014） was performed. Demographics, imaging, pathology, disease-recurrence, and survival data were ***： A total of 458 patients who underwent primary pancreatic resection were included. “Pan IN-3” lesions were found in 74（16.2%） patients who either had PDAC（n=67） or main duct（MD）-IPMN（n=7）. Among IPMN-MDs, Pan IN-3 lesions were exclusively found in those with pathological evidence of chronic pancreatitis. For PDACs, the median overall survival（OS） for pancreata with Pan IN-3 lesions was significantly better than those without（OS 1.12 years, interquartile range [IQR] 0.72, 2.05 years vs OS 0.86 years, IQR 0.64,1.60 years respectively; P=0.04）. Multivariate Cox regression analysis demonstrated that the presence of Pan IN-3 lesions was associated with a reduced risk of death（HR=0.43; 95% CI： 0.23-0.82; P=0.01）.CONCLUSIONS： Following primary resection of pancreatic adenocarcinoma, the lower survival observed in patients without Pan IN-3 lesions might suggest a state of complete or accelerated transformation. Further investigations are necessary to validate these findings that might impact disease prognosis and management.

关键词： pancreatic intraepithelial neoplasia intraductal papillary mucinous neoplasms pancreatic neoplasia pancreatic ductal adenocarcinoma

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Recent advances in the diagnostic evaluation of pancreatic cystic lesions

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World Journal of gastroenterology 2022年第6期28卷 624-634页

作者： Devarshi R Ardeshna Troy Cao Brandon Rodgers Chidiebere Onongaya Dan Jones Wei Chen Eugene J Koay Somashekar g krishna Department of Internal Medicine Ohio State University Wexner Medical CenterColumbusOH 43210United States College of Medicine Ohio State UniversityColumbusOH 43210United States James Molecular Laboratory Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Pathology Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of gI Radiation Oncology The University of Texas MD AndersonHoustonTX77030United States Division of gastroenterology Department of Internal MedicineOhio State University Wexner Medical CenterColumbusOH 43210United States

Pancreatic cystic lesions(PCLs)are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general *** has become crucial to identify these PCLs and subsequently risk stratify them to guide *** the high morbidity associated with pancreatic surgery,only those PCLs at high risk for malignancy should undergo such ***,current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying ***,research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for *** sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive *** cyst fluid glucose has reemerged as a potential biomarker,cyst fluid molecular markers have improved accuracy for identifying specific types of *** ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying *** most of these recent diagnostics are only practiced at selective tertiary care centers,they hold a promise that management of PCLs will only get better in the future.

关键词： Pancreatic cystic lesion Intraductal papillary mucinous neoplasms Mucinous cystic neoplasm Microforceps biopsy Radiomics Confocal laser endomicroscopy

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In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study

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World Journal of gastroenterology 2017年第18期23卷 3338-3348页

作者： Somashekar g krishna Rohan M Modi Amrit K Kamboj Benjamin J Swanson Phil A Hart Mary E Dillhoff Andrei Manilchuk Carl R Schmidt Darwin L Conwell Division of gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Department of Internal Medicine The Ohio State University Wexner Medical Center College of Medicine The Ohio State University Wexner Medical Center Department of Pathology The Ohio State University Wexner Medical Center Division of Surgical Oncology The Ohio State University Wexner Medical Center Deparment of general Surgery The Ohio State University Wexner Medical Center

To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs).METHODSIn a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging *** total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a “fern pattern” of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical *** vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

关键词： Confocal laser endomicroscopy Serous cystadenoma Pancreatic neuroendocrine tumor Intraductal papillary mucinous neoplasm Pancreatic cystic neoplasm

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Business analysis & valuation

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1000年

作者： Palepu krishna g.

来源：畅想之星图书光盘版（南... 评论

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Hospital outcomes and early readmission for the most common gastrointestinal and liver diseases in the United States:Implications for healthcare delivery

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World Journal of gastrointestinal Surgery 2021年第2期13卷 141-152页

作者： Somashekar g krishna Brandon K Chu Alecia M Blaszczak gokulakrishnan Balasubramanian Hisham Hussan Peter P Stanich Khalid Mumtaz Alice Hinton Darwin L Conwell Division of gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKgROUND gastrointestinal(gI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource *** ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial ***-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common gI *** To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common gI and liver diseases in the United *** A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common gI *** 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases,Ninth Revision,Clinical Modification *** outcomes were mortality(index admission,calendar-year),hospitalization costs,and thirty-day readmission and secondary outcomes were predictors of thirty-day *** For the year 2013,the thirteen most common gI diseases contributed to 2.4 million index hospitalizations accounting for about$25 *** thirty-day readmission rates were highest for chronic liver disease(25.4%),Clostridium difficile(***)infection(23.6%),functional/motility disorders(18.5%),inflammatory bowel disease(16.3%),and gI bleeding(15.5%).The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease(6.1%and 12.6%),*** infection(2.3%and 6.1%),and gI bleeding(2.2%and 5.0%),***-day readmission correlated with any subsequent admission mortality(r=0.798,P=0.001).Medicare/Medicaid insurances,≥3 Elixhauser comorbidities,and length of stay>3 d were significantly associated with thirty-day readmission for all the thirteen gI *** Preventable and non-chronic gI disease contributed to a significant economic and health

关键词： gastrointestinal disease Thirty-day readmission Nationwide readmission database Outcomes Mortality Cost

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苋科植物雁来红叶提取物对大鼠的胃细胞保护及抗分泌作用(英文)

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中西医结合学报 2011年第9期9卷 1031-1038页

作者： Venkatapura C. Devaraj Burdipad g. krishna Department of Pharmacology Bioneeds Laboratory Animals and Preclinical Services Department of Pharmacognosy R.R College of Pharmacy

目的:验证苋科植物雁来红(Amaranthustricolor Linn.)叶的提取物对不同胃溃疡模型大鼠的抗溃疡作用。方法:通过5种不同的大鼠胃溃疡模型(乙酸、幽门结扎、乙醇、消炎痛及缺血再灌注模型)证实雁来红叶对大鼠胃分泌功能的影响及胃细胞的... 详细信息

目的:验证苋科植物雁来红(Amaranthustricolor Linn.)叶的提取物对不同胃溃疡模型大鼠的抗溃疡作用。方法:通过5种不同的大鼠胃溃疡模型(乙酸、幽门结扎、乙醇、消炎痛及缺血再灌注模型)证实雁来红叶对大鼠胃分泌功能的影响及胃细胞的保护作用。不同的雁来红叶的提取物(乙醇、石油醚、三氯甲烷及乙酸乙酯)以200mg/kg的剂量给予大鼠服用以检测其功效。结果:急性口服毒性实验显示各种提取物的安全口服剂量可达2000mg/kg,故选取该剂量的十分之一即200mg/kg作为实验用剂量。乙醇提取物及乙酸乙酯提取物对乙酸所致大鼠慢性胃溃疡有治愈作用;对幽门结扎大鼠有抑制其胃分泌功能的作用;对乙醇及消炎痛所致胃溃疡大鼠有胃细胞保护作用。而石油醚及三氯甲烷提取物没有明显的抗大鼠胃溃疡的作用。结论:本研究证明雁来红叶的提取物对实验性大鼠胃溃疡有很好的治疗作用,这一作用与文献所报道的该植物在民间医学中的应用相符。

关键词：苋属植物提取物胃溃疡细胞保护抗溃疡病药大鼠

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Rare double fracture-dislocation of the thumb： a case report and review of the literature

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Chinese Journal of Traumatology 2013年第4期16卷 240-242页

作者： Davinder Singh Loveneesh g krishna Sunil Dhaka Surender Kumar Sumit Arora Central Institute of Orthopaedics Vardhman MahavirMedical College & Safdarjung Hospital New Delhi 110029India

Simultaneous fracture/dislocation of the thumb carpometacarpal （CMC）joint and dislocation of the metacarpophalangeal （MCP） joint is considered as a rare injury pattern. We report an unusual case of dorsal disloca- tion of MCP joint of the thumb associated with extraarticular fracture of the base of the first metacarpal in a 28-year-old man. The dislocation of MCP joint had been missed during initial presentation at a peripheral centre. The patient made an uneventful recovery following open reduction and fixa- tion with 1.25 mm Kirschner wire of the MCP joint along with repair of the ulnar collateral ligament. This injury pat- tern has not been previously reported to the best of our knowledge in the English-language based medical literature.

关键词： Carpometacarpaljoints Metacarpopha- langeal joint Thumb

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Confocal endomicroscopy and cyst fluid molecular analysis: Comprehensive evaluation of pancreatic cysts

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World Journal of gastrointestinal Endoscopy 2018年第1期10卷 1-9页

作者： Feng Li Ahmad Malli Zobeida Cruz-Monserrate Darwin L Conwell Somashekar g krishna Division of gastroenterology Hepatology and Nutrition Ohio State University Wexner Medical Center

Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.

关键词： Pancreas Pancreatic cyst Pancreatic adenocarcinoma Confocal endomicroscopy Next generation sequencing Molecular marker

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