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Endoscopic management of postcholecystectomy biliary leakage

Hepatobiliary & Pancreatic Diseases International 2010年第4期9卷 409-413页

作者： virendra singh Gurpreet singh Ganga R Verma Rajesh Gupta Departments of Hepatology Postgraduate Institute of Medical Education and Research Departments of Surgery Postgraduate Institute of Medical Education and Research

BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known. METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated. RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients Four developed mild pancreatitis which improved with conservative treatment.CONCLUSIONS: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.

关键词： biliary fistulae endoscopic retrograde cholangiopancreatography sphincterotomy biliary stent nasobiliary drain biliary strictures

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Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 88-92页

作者： virendra singh Gurpreet singh Vikas Gupta Rajesh Gupta Rakesh Kapoor Departments of Hepatology Postgraduate Institute of Medical Education and Research Departments of Surgery Postgraduate Institute of Medical Education and Research Departments of Radiotherapy Postgraduate Institute of Medical Education and Research

BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are costly.There have been no reports on the use of air cholangiography.METHODS:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.RESULTS:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were studied.Air cholangiography detected type Ⅱ obstruction in all patients,similar to MRCP.The patients underwent unilateral stenting.Successful endoscopic drainage was achieved in all patients.The mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications.Air cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal stenting.CONCLUSION:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.

关键词： air cholangiogram hilar obstruction malignant plastic stent metal stent unilateral

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Seasonal variations and health risk assessment of trace elements in the Badigad River,lesser Himalayas,Nepal

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Acta Geochimica 2023年第4期42卷 689-703页

作者： Ramesh Raj Pant Kiran Bishwakarma Kshitiz Kandel Sudip Poudel Jharana Nepal Bhanu Bhakta Neupane virendra Bahadur singh Central Department of Environmental Science Institute of Science and TechnologyTribhuvan UniversityKathmanduNepal University of Chinese Academy of Sciences Beijing 100049China Institute of Tibetan Plateau Research Chinese Academy of SciencesBeijing 100101China Central Department of Chemistry Institute of Science and TechnologyTribhuvan UniversityKathmanduNepal Department of Environmental Studies Ram Lal Anand CollegeUniversity of DelhiNew Delhi 110021India

The consumption of contaminated river water can have severe effects on human health.This study aims to investigate the trace elements(TEs)content and their health risk assessment in the Badigad River Basin in the lesser Himalayas of Nepal.In total,44 water samples were collected from 22 different sites during the pre-monsoon and monsoon seasons,and 25 TEs were analyzed.Correlation matrix and principal component analysis(PCA)were used to analyze the potential relationship between the measured TEs and their source tracking.Furthermore,the water quality index(WQI),metal index(MI),and cancer index(CI)were evaluated.The TEs content in all samples were found to be within the WHO recommended guideline for drinking and domestic purposes.The dominancy order of the TEs was observed as Sr>Ba>Li>Rb>Zn>Cr>Sc>Mn>Ti>Cu>As>Ni>Co>U>V>Pb>Cs>Ga>Y>Tl>Th>Zr>Bi>Cd>Nb.The PCA analysis suggested that TEs could have natural,anthropogenic,and mixed origins.The WQI indicated that the river water is safe from a human health perspective.The MI suggested that Badigad River can be considered safer for drinking purposes,and the cancer index(CI)showed that all the reported TEs are at low-risk levels.The findings of this study could be useful for government agencies in developing more sustainable water management policies in the region.However,it is suggested that further investigations should be conducted in terms of other hydrogeochemical variables,including major ions,at spatiotemporal levels for the sustainability of the river basin.

关键词： Trace elements Water quality Health risk assessment Multivariate analysis Badigad River

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Endoscopic management of hilar biliary strictures

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World Journal of Gastrointestinal Endoscopy 2015年第8期7卷 806-813页

作者： Rajiv Ranjan singh virendra singh Departments of Hepatology Post Graduate Institute of Medical Education and Research

Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined.

关键词： Biliary strictures Malignant Benign Endoscopy Endoscopic retrograde cholangiopancreatography

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印度不断扩大饲草作物生产

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国外畜牧学（草原与牧草） 1997年第1期 38-39页

作者： virendra singh 徐长林

为了满足家畜集约化生产对饲草的需要,印度最大限度地扩大饲草种植面积,这是由于其他可以直接被人类利用的作物不可能再增加而产生的压力,而且这些作物的产量将来很可能有下降趋势。为了集约化种植达到最大效益和最满意的系统,应该达... 详细信息

为了满足家畜集约化生产对饲草的需要,印度最大限度地扩大饲草种植面积,这是由于其他可以直接被人类利用的作物不可能再增加而产生的压力,而且这些作物的产量将来很可能有下降趋势。为了集约化种植达到最大效益和最满意的系统,应该达到如下目的: (1)最大潜力,以所要实现的单位面积和单位时间内新鲜牧草和干物质来表示;

关键词：牧草饲料作物栽培

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埃及三叶草——一种很有潜力的饲料作物

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世界热带农业信息 1993年第6期 52-54页

作者： virendra singh 莫治雄

埃及三叶草(Trifolium alexandrinum L.),又名埃及车轴草,阿拉伯名为bersym或berzun。这是一种很有价值的豆科饲料作物,优于其它三叶草(如T.nigrescens、绛车轴草、T.resupinatum和T.vesiuculosum)。在印度,其茎叶产量和干物质产量分别... 详细信息

埃及三叶草(Trifolium alexandrinum L.),又名埃及车轴草,阿拉伯名为bersym或berzun。这是一种很有价值的豆科饲料作物,优于其它三叶草(如T.nigrescens、绛车轴草、T.resupinatum和T.vesiuculosum)。在印度,其茎叶产量和干物质产量分别比苜蓿高21.0吨/公顷和4.05吨/公顷。它是亚热带地区生产力和营养价值最高的冬季饲料作物之一。

关键词：埃及三叶干物质产量绛车轴草 Trifolium 营养价值种子产量混种紫狼尾草亚热带地区最佳播种期

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Suspended sediment dynamics in the meltwater of Chhota Shigri glacier, Chandra basin, Lahaul-Spiti valley, India

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Journal of Mountain Science 2018年第1期15卷 68-81页

作者： virendra Bahadur singh AL.RAMANATHAN School of Environmental Sciences Jawaharlal Nehru University

Present study shows suspended sediment dynamics in the meltwater of Chhota Shigri glacier,Himachal Pradesh,India for different melt seasons during the period 2011-2014.Maximum suspended sediment concentration in the meltwater was found during the month of July 2011,2012 and 2014 constituting to 55.2%,48.3% and 46.9%,respectively.Whereas in 2013,maximum suspended sediment concentration was observed in August accounting for46.1% of the total.On the other hand,maximum suspended sediment load was monitored in the month of July 2011,2012 and 2014 constituting 59.5%,63% and 55.7% of the total,respectively.Whereas in2013,maximum suspended sediment load was observed in the month of August accounting for 49.8% of the total suspended sediment load.Annual distribution of suspended sediment concentration(SSC)and suspended sediment load(SSL)in the Chhota Shigri glacier shows higher value of SSC and SSL during the study period 2012 and 2013,which may be due to the presence of high glacial runoff and negative mass balance of the studied area during these time periods.Marked diurnal variation has been observed in the SSC of meltwater.Strong correlation was observed between SSC and SSL with discharge.On the other hand,SSC and SSL also showed strong exponential correlation with air temperature of the studied area.Sediment yield from the catchment of Chhota Shigri glacier is high during the peak melt season(July and August)and low during the late melt season(September and October).The average value of erosion rate for Chhota Shigri glacier basin during the study period 2011-2014 was calculated to be 1.1mm/yr,which is lower than the average erosion rate of other Himalayan glaciers such as Rakiot,Chorabari and Gangotri glaciers,which may be caused by its geological setting containing high erosion resistant rocks such as granite,granite gneiss and porphyritic granite.

关键词：沉积动力学冰河印度山谷

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沙棘——一种具有潜力的饲料植物

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国际沙棘研究与开发 2008年第3期6卷 44-47页

作者： virendra singh Bhupinder singh M.P.Narang 刘莹何京亮喜马偕尔邦农业大学 176062 帕兰波(Palampur)地方研究所 176061 北京林业大学水土保持学院水土保持重点实验室北京100038

沙棘是一种落叶、多刺,具有固氮能力的灌木或小乔木,高2～4m,在喜玛拉雅山脉干旱区有大量的生长(singh,1994;1995,singh et al.,1995;singh and Dogra,1996;singh,1998).沙棘果实中含有丰富的维生素和生物活性物质,可用于生产多种食品... 详细信息

沙棘是一种落叶、多刺,具有固氮能力的灌木或小乔木,高2～4m,在喜玛拉雅山脉干旱区有大量的生长(singh,1994;1995,singh et al.,1995;singh and Dogra,1996;singh,1998).沙棘果实中含有丰富的维生素和生物活性物质,可用于生产多种食品、化妆品以及药物.沙棘发达的水平根根幅可达10m,能够固定陡坡上的土壤颗粒.鉴于其具有极高的经济和生态价值,沙棘已经引起了全球科学家、环保人士以及世界各地决策者们的广泛关注.在印度Lahaul Spiti地区,其他的植物在8月份就已经干枯,而沙棘树叶可保持鲜绿至早冬(9～11月),供农民放牧.

关键词：饲料植物沙棘喜玛拉雅山脉固氮能力小乔木干旱区落叶灌木

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几种沙棘果实与种子中脂肪酸成分分析

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国际沙棘研究与开发 2004年第3期2卷 1-8页

作者： virendra singh Rajesh Kr.Gupta Shishir Tandon R.C.Sawhney CSK喜马偕尔邦农业大学农业研究与推广中心防护生理应用研究所

对来自拉浩地区 (半干旱地区 )与斯皮特 (干旱地区 )的 8年生沙棘种子与果肉粗提物中脂肪酸组成进行了研究。所选的中亚沙棘产自拉浩与斯皮特 ,同时研究的还有来自拉浩地区的柳叶沙棘与HI 1型沙棘 (外来品种 ) ,该外来品种种植在喜马偕... 详细信息

对来自拉浩地区 (半干旱地区 )与斯皮特 (干旱地区 )的 8年生沙棘种子与果肉粗提物中脂肪酸组成进行了研究。所选的中亚沙棘产自拉浩与斯皮特 ,同时研究的还有来自拉浩地区的柳叶沙棘与HI 1型沙棘 (外来品种 ) ,该外来品种种植在喜马偕尔邦农业大学高山农业研究与推广中心。该研究中心位于拉浩斯皮特地区的拉浩谷地的库坎姆西瑞 (海拔 2 730m) ,处于印度温和干燥的喜马拉雅山地区。在所有种类的果肉油脂中 ,不饱和脂肪酸含量的比例 (5 2 8%～ 6 0 7% )高于饱和脂肪酸 (10 6 %～ 2 9 9% )。同样 ,除了柳叶沙棘以外 ,种子油脂中不饱和脂肪酸含量 (5 1 7%～ 86 5 % )要高于饱和脂肪酸含量(12 5 %～ 2 7 2 % )。在果肉油脂中 ,主要的饱和脂肪酸是棕榈油酸 (37 1%～ 4 6 4 % )、亚油酸 (6 4 %～15 0 % )、油酸 (4 0 %～ 6 9% )和软脂酸 (9 1%～ 2 8 1% )。柳叶沙棘果肉油脂中含有丰富的亚油酸(15 0 % )和α 亚麻酸 (1 3% )。棕榈油酸是最主要的不饱和脂肪酸 (37 1%～ 4 6 4 % ) ,在拉浩种群中含量最高 (4 6 4 % )。软脂酸是主要的饱和脂肪酸 ,除了斯皮特种群 (9 1% ) ,其他类型中的含量基本相同(2 6 4 %～ 2 8 1% )。在种子油脂中 ,斯皮特种群中含量最丰富的是亚油酸 (39 8% )和α

关键词：中亚沙棘柳叶沙棘 HI-1(外来沙棘) 果肉和种子脂肪酸组成

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沙棘饮料的化学成分和最优口感的研究

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国际沙棘研究与开发 2008年第1期6卷 40-44页

作者：杨唐英温秀凤 Shipra Saklani H. R. Sharma virendra singh 北京林业大学水土保持学院北京100083 水利部沙棘开发管理中心北京100038 College of Home Science Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya PalampurIndia 176 062 CSKHPKV山地农业推广中心 BajauraKullu 175 125India

沙棘(Hippophae rhamnoids L.),属于胡颓子属,在印度喜马偕尔邦地区称作"Chharma and Surch",沙棘能够在这种非常恶劣的气候条件下自然生长。本文介绍了制作沙棘饮料的一系列程序和如何储存饮料120d而不使其变质的方法。沙棘果实采自印... 详细信息

沙棘(Hippophae rhamnoids L.),属于胡颓子属,在印度喜马偕尔邦地区称作"Chharma and Surch",沙棘能够在这种非常恶劣的气候条件下自然生长。本文介绍了制作沙棘饮料的一系列程序和如何储存饮料120d而不使其变质的方法。沙棘果实采自印度喜马偕尔邦河谷。用碎浆机提取沙棘汁,制作沙棘饮料要准备好合适比例的沙棘汁和制作饮料所需的糖。随着果浆比例的升高,维生素C的含量明显增加(P≤0.05),随着贮藏时间的延长,维生素C的含量明显降低。而随着糖和果浆的增加以及储存期的延长,还原性糖呈上升趋势。当饮料中果浆和糖的比例分别为10%和13%、12.5%和13%、15%和15%时,饮料最为宜口,给于较高的评价。在喜马偕尔邦,人们一直认为沙棘具有商业价值,但是其价值在此前一直没有得到足够的重视。

关键词：沙棘化学成分感官 RTS饮料

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