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Acute renal dysfunction in liver diseases

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World Journal of Gastroenterology 2007年第42期13卷 5552-5559页

作者： Alex P Betrosian Banwari agarwal Emmanuel E Douzinas Third Department of Critical Care Athens University Evgenidion Hospital Papadiamantopoulou 20 Athens 11528 Greece Intensive Therapy Unit Royal Free Hospital London United Kingdom

Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver *** presence of renal impairment in both groups is a poor prognostic *** failure is often multifactorial and can present as pre-renal or intrinsic renal *** or post renal dysfunction only rarely complicates liver *** syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal *** of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular *** expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal *** vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in *** renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.

关键词： Hepatorenal syndrome Transjugular intrahepatic portosystemic shunt Continuous renalreplacement therapy Molecular absorbent recirculatingsystem Acute liver failure Systemic vascular resistance Renal blood flow

Endoscopic management of acute cholangitis in elderly patients

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World Journal of Gastroenterology 2006年第40期12卷 6551-6555页

作者： Naresh agarwal Barjesh Chander Sharma Shiv K Sarin Department of Gastroenterology GB Pant Hospital New Delhi India

AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute ***: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patien

关键词： Acute cholangitis Endoscopic biliary drainage Endoscopic retrograde cholangio-pancreatography Common bile duct stones Carcinoma gall bladder

Role of liver transplantation in human immunodeficiency virus positive patients

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World Journal of Gastroenterology 2015年第43期21卷 12311-12321页

作者： Deepak Joshi Kosh agarwal Institute of Liver Studies King’s College Hospital NHS Foundation Trust

End-stage liver disease(ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus(HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus(HCV) infection,drug-induced hepatotoxicity related to combined antiretro-viral therapy,alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore,anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However,HIV-HCV coinfection transplant outcomes remain suboptimal due to recurrence. In this article,we review the key challenges faced by this patient cohort in the pre- and posttransplant period.

关键词： Hepatitis B virus Hepatitis C virus Human immunode

Dengue encephalitis - a case report

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Asian Pacific Journal of Tropical Medicine 2009年第2期2卷 74-75页

作者： P.C.Bhattacharyya Jagdish Prasad agarwal Department of Medicine & Paediatric Down Town HospitalGuwahatiAssamIndia

Encephalitis is an uncommon manifestation of dengue *** we present a 4 years old female child from Northeast Region of India who suffered from dengue *** our knowledge,this is probably the first diagnosed case of deng... 详细信息

关键词： Encephalitis Dengue fever

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

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World Journal of Orthopedics 2016年第7期7卷 426-433页

作者： Raju Vaishya Vipul Vijay Vikas P Birla Amit K agarwal Department of Orthopaedics Joint Replacement and ArthroscopyIndraprastha Apollo Hospital

AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty(TKA) using computer tomography(CT) based patient specific blocks(PSB) to conventional instruments(CI).METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle(MFT angle) was measured on long leg x-rays using picture archiving and communication system(PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical ***: The PSB group(group 1) included 17 females and seven males while in CI group(group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23°(SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73°(SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment(P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB(7 Knee) compared to those operated with CI(17 Knee).CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation.

关键词： Knee Replacement Arthroplasty Patient specific jigs Conventional jigs

Triple tube drainage for “difficult” gastroduodenal perforations:A prospective study

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World Journal of Gastrointestinal Surgery 2017年第1期9卷 19-24页

作者： Nitin agarwal Nishant Kumar Malviya Nikhil Gupta Iqbal Singh Sanjay Gupta Department of Surgery and Renal Transplant Postgraduate Institute of Medical Education and Research (PG-IMER) and Dr. Ram Manohar Lohia Hospital Depart-ment of Surgery University College of Medical Sciences and Guru Tegh Bahadur Hospital Department of Surgery Post Graduate Institute of Medical Education and Research (PGIMER) and Dr RML Hospital

AIMTo prospectively study the outcome of difficult gastroduodenal perforations (GDPs) treated by triple tube drainage (TTD) in order to standardize the *** presenting to a single surgical unit of a tertiary hospital with difficult GDPs (large, unfavourable local and systemic factors) were treated with TTD (gastrostomy, duodenostomy and feeding jejunostomy). Postoperative parameters were observed like time to return of bowel sounds, time to start enteral feeds, time to start oral feeds, daily output of all drains, time to clamping/removal of all drains, time for skin to heal, complications, hospital stay, and, mortality. Descriptive statistics were *** December 2013 and April 2015, 20 patients undergoing TTD for GDP were included, with mean age of 44.6 ± 19.8 years and male:female ratio of 17:3. Mean pre-operative APACHE II scores were 10.85 ± 3.55; most GDPs were prepyloric (9/20; 45%) or proximal duodenal (8/20; 40%) and mean size was 1.83 ± 0.59 cm (largest 2.5 cm). Median times of resumption of enteral feeding, removal of gastrostomy, removal of duodenostomy, removal of feeding jejunostomy and oral feeding were 4 d (4-5 IQR), 13 (12-16.5 IQR), 16 (16.25-22.25 IQR), 18 (16.5-24 IQR) and 12 d (10.75-18.5 IQR) respectively. Median hospital stay was 22 d (19-26 IQR) while mortality was 4/20 (20%).CONCLUSIONTTD for difficult GDP is feasible, easy in the emergency, and patients recover in two-three weeks. It obviates the need for technically demanding and riskier procedures.

关键词： Peptic ulcer Perforation peritonitis APACHE Triple tube drainage Duodenostomy

Endoscopic management of postoperative bile leaks

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Hepatobiliary & Pancreatic Diseases International 2006年第2期5卷 273-277页

作者： Naresh agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin Department of Gastroenterology GB Pant hospital New DelhiIndia

BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD

关键词： biliary fistulae endoscopic retrograde cholangiopancreatography sphincterotomy biliary stent nasobiliary drain common bile duct stones

Pancreatic ductal adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia:report of a case

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 553-556页

作者： Rajkumar Krishnasamy Shaleen agarwal Shivendra Singh Sunil Puri Puja Sakhuja Anil K agarwal Department of Gastrointestinal Surgery Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002India Department of Radiology Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002 Department of Pathology Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002

BACKGROUND:The presence of pancreatic ductal intraepithelial neoplasia in patients with chronic pancreatitis is a risk factor for development of pancreatic adenocarcinoma. METHOD:A case of pancreatic ductal adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia was diagnosed in the setting of chronic pancreatitis. RESULTS:Distal pancreatectomy combined with splenec- tomy was performed with a diagnosis of pancreatic body *** examination suggested adenocarcinoma associated with pancreatic ductal intraepithelial *** tumor was detected in the remaining head of the pancreas,for which a total pancreatectomy was done. CONCLUSIONS:When a patient with pancreatic ductal intraepithelial neoplasia associated with adenocarcinoma of the pancreas in the setting of chronic pancreatitis is at an increased risk of recurrence in the remaining pancreatic parenchyma,total pancreatectomy may be feasible.

关键词： pancreatectomy pancreatic ductal carcinoma chronic pancreatitis

Tuberculosis in kidney transplant candidates and recipients

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World Journal of Transplantation 2024年第3期14卷 59-69页

作者： Pallavi Prasad Sourabh Sharma Subashri Mohanasundaram Anupam agarwal Himanshu Verma Department of Nephrology Vardhman Mahavir Medical College and Safdarjung HospitalNew Delhi 110029DelhiIndia Department of Nephrology Prashanth HospitalChennai 600042Tamil NāduIndia

Tuberculosis(TB)is the leading cause of infectious mortality and morbidity in the world,second only to coronavirus disease *** with chronic kidney disease and kidney transplant recipients are at a higher risk of developing TB than the general *** TB is difficult to diagnose in this population due to close *** transplant candidates should be screened for latent TB infection and given TB *** who develop active TB pre-or post-trans-plantation should receive multidrug combination therapy of antitubercular therapy for the recommended duration with optimal dose modification as per glomerular filtration rate.

关键词： Tuberculosis Latent Antitubercular therapy Kidney transplantation Donor Interferon-gamma release assays Tuberculin Rifampicin Isoniazid