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Long.term outcome of g.stric access loop in hepaticojejunostomy

Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 152-155页

作者： Eswaran Selvakumar Shanmug.sundaram Rajendran tirupporur g. balachandar Devy g.under Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajag.pal Surendran Department of Surg.cal g.stroenterolog. Center for G.I.Bleed & Division of Hepatobiliary Pancreatic Diseases Government Stanley Medical College Hospital The Tamilnadu Dr. M.G.R. Medical University Chennai-600001 Tamilnadu India

BACKg.OUND:?The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been desig.ed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investig.ted the effectiveness and safety of g.stric access loop. METHODS:A retrospective analysis was conducted on 13 patients who had underg.ne hepaticojejunostomy with g.stric access loop between June 1999 and September 2003. Eleven patients were followed up for a mean period of 51 months (rang. 20-81 months). Two patients were lost to follow up. RESULTS:?On follow-up, 8 patients had patent jejuno- g.strostomy (end to side anastomosis between Roux loop of jejunum and stomach) and hepaticojejunostomy. Three patients developed stricture of jejunog.strostomy at 41 months, 63 months and 81 months of follow-up. Among.these 3 patients, one also had hepaticojejunostomy stricture. In the patient with hepaticojejunostomy stricture, dilatation of jejunog.strostomy stricture was attempted but failed. None of the patients had any evidence of bile g.stritis/cholang.tis. There was no procedure related morbidity/mortality. CONCLUSIONS:Further studies involving.larg. numbers of patients are required before wide application of g.stric access loop in hepaticojejunostomy thoug. it is a safer option than percutaneous transhepatic manipulations or revision surg.ry.

关键词： access loop hepaticojejunostomy anastomotic stricture biliary stricture

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Neuroendocrine carcinoma of the ampulla of Vater:a clinicopatholog.c evaluation

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 422-425页

作者： Eswaran Selvakumar Shanmug.sundaram Rajendran tirupporur g.vindaswamy balachandar Devy g.under Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajag.pal Surendran Department of Surg.cal g.stroenterolog. Center for G.I.Bleeding & Division of Hepatobiliary Pancreatic Diseases Government Stanley Medical College Hospitalthe Tamilnadu Dr. M.G.R.Medical UniversityChennai 600001TamilnaduIndia

BACKg.OUND:Only 105 cases of neuroendocrine tumor(NET)of the ampulla of Vater have been described, mostly as sing.e case *** incidence of NET is *** chang.s in incidence may result from chang.s in *** study was to determine the relative incidence and clinicopatholog.cal characteristics of hig.- g.ade neuroendocrine carcinoma(small cell carcinoma and larg. cell carcinoma)of the ampulla of Vater at a sing.e institution. METHODS:Sections from paraffin blocks of tumors of the ampulla of Vater taken from 45 patients who underwent Whipple’s procedure and 6 patients who underwent palliative bypass between September 2003 and January 2007 were subjected to immunohistochemical *** clinical and patholog.cal data from 5 patients diag.osed with NET of the ampulla of Vater were analyzed. RESULTS:The patients were 3 men and 2 women,rang.ng.in ag. from 39 to 47 years(mean 44 years).Operative procedures included Whipple’s procedure in 4 patients and palliative bypass in 1 *** examination revealed larg.-cell neuroendocrine carcinoma in 2 patients,small cell carcinoma in 2,and carcinoid in *** patients with hig.-g.ade neuroendocrine carcinoma who had underg.ne Whipple’s procedure died at postoperatively 7,11,and 13 *** patient who had underg.ne palliative triple bypass died 3 months after ***:The relative incidence of hig.-g.ade neuroendocrine carcinomas of the ampulla of Vater is hig.er than that g.nerally *** tumors behave ag.ressively and have a dismal prog.osis despite ag.ressive treatment.

关键词： neuroendocrine tumor carcinoid tumor ampulla of Vater Whipple's procedure

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Outcome of severe acute pancreatitis: Is there a role for conservative manag.ment of infected pancreatic necrosis?

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 599-604页

作者： Amarapathy Sivasankar Devy g.under Kannan Palaniappan Ravichandran Sathyanesan Jeswanth tirupporur g.vindasamy balachandar Rajag.pal Surendran Department of Surg.cal g.stroenterolog. Government Stanley Medical College Hospital the Tamilnadu Dr. M.G.R. Medical University Chennai India

BACKg.OUND: Infected pancreatic necrosis is associated with hig. morbidity and mortality and is mandatory for surg.cal or radiolog.cal intervention. A selected g.oup of patients with CT evidence of infected pancreatic necrosis and a comparatively lower APACHE score may be clinically stable throug.out the course of their illness. METHODS: Case records of 52 patients with severe acute pancreatitis admitted from October 2000 to September 2005 were retrospectively analysed to assess the feasibility of conservative manag.ment of infected pancreatic necrosis. CT evidence of retroperitoneal air pockets, deteriorated clinical condition, sepsis and positive blood culture were used to diag.ose infected pancreatic necrosis. RESULTS: In the 52 male patients reviewed, 24 patients had infected pancreatic necrosis. Eig.teen patients who had prog.essively deteriorated clinical conditions required surg.cal intervention; five patients of whom (27.8%) died. Six patients with transient end org.n dysfunction and stable clinical conditions were treated with prolong.d administration of antibiotics and ICU support. All these patients recovered and discharg.d from the hospital, and no symptoms or readmission happened during.follow-up of 6-44 months. CONCLUSIONS: Selected patients with infected pancreatic necrosis who are clinically stable with transient end org.n dysfunction can be treated conservatively with a favourable outcome. Necrosectomy associated with hig. morbidityand mortality in these patients can be avoided. The need for intervention should be individualized and based on clinical conditions of the patients.

关键词： acute necrotizing.pancreatitis APACHE Ⅱ multiple org.n dysfunction syndrome mortality antibiotics

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Larg. cell neuroendocrine carcinoma of the ampulla of Vater

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Hepatobiliary & Pancreatic Diseases International 2006年第3期5卷 465-467页

作者： Eswaran Selvakumar Velayutham Vimalraj Shanmug.sundaram Rajendran tirupporur g.balachandar Devy g.Kannan Satyanesan Jeswanth Palaniappan Ravichandran Arunachalam Sundaram Rajag.pal Surendran Departments of Patholog. and Surg.cal g.stroenterolog. Center for g.I.Bleeding.& Division of Hepatobiliary Pancreatic Diseases Government Stanley Medical College Hospitalthe Tamilnadu Dr.M.G.R.Medical UniversityChennaiTamilnaduIndia

BACKg.OUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of larg. cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructive jaundice was admitted to our hospital. On examination the patient was found to have a periampullary g.owth and subsequently underwent the Whipple's procedure. RESULTS: Histopatholog.cal examination and immunohistochemistry revealed features of LCNEC of the ampulla of Vater. The patient developed multiple liver metastases 6 months after Whipple's procedure. CONCLUSION: LCNEC of the ampulla of Vater is rare and hig.ly ag.ressive, with a dismal prog.osis.

关键词： larg. cell neuroendocrine carcinoma ampulla of Vater Whipple's procedure periampullary g.owth

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维普期刊数据库

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