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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 123-128页

作者： Prashant Bhangui Institute of Liver Transplantation and Regenerative Medicine Medanta–The MedicitySector 38GurgaonDelhi NCR 122001India

Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for *** recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in *** review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic *** therapies have helped make curative resection or LT a reality in selected *** review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy *** patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.

关键词： Hepatocellular carcinoma Portal vein tumour thrombosis Downstaging therapies Living donor liver transplantation and resection Outcomes

Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications

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Hepatobiliary Surgery and Nutrition 2018年第3期7卷 167-174页

作者： Sanjay Goja Sanjay Kumar Yadav Amardeep Yadav Tarun Piplani Amit Rastogi Prashant Bhangui Sanjiv Saigal Arvinder Singh Soin Institute of Liver Transplant and Regenerative Medicine MedantaThe MedicityGurgaonDelhi(NCR)India Department of Radiology and Nuclear Medicine MedantaThe MedicityGurgaonDelhi(NCR)India

Background: An accurate preoperative volumetric assessment of donor liver is essential for successful living donor liver transplant by ensuring adequate remnant and graft recipient weight ratio (GRWR). Methods: The study cohort consisted of 744 right lobe (RL), 65 left lobe (LL) and 33 left lateral sector (LLS) grafts from July 2010 to January 2014. A semi-automated interactive commercial software called AW Volume share 6 was used for volumetry. Bland Altman plot was used for assessing the agreement between estimated graft weight (EGW) and actual graft weight (AGW). Results: There was no statistically significant difference between EGW and AGW for RL graft weight (722±134 vs. 717±126 gm;P=0.06). Although Bland Altman graph showed that 95% limits of agreement was more in LL (?164 to +110) than RL (?156 to +147) and LLS grafts (?137 to +239), CT scan significantly overestimated LL graft weight (EGW =460±118 gm vs. AGW =433±102 gm;P=0.003) and underestimated LLS graft weight (EGW =203±48 gm vs. AGW =254±49 gm;P<0.001). Conclusions: CT volumetry overestimate LL graft and underestimate LLS graft weight. This should be factored in when selecting LL graft by taking higher GRWR.

关键词： Liver transplantation graft weight CT volumetry living donor

Post liver transplant recurrence in patients with hepatocellular carcinoma:not necessarily the end of the road!

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Hepatoma Research 2020年第10期6卷 60-74页

作者： Prashant Bhangui Sanjay Yadav AS Soin medanta Institute of Liver Transplantation and Regenerative Medicine Medanta-The MedicityGurgaonDelhi NCR 122001India

Aim:We analysed outcomes using multimodality therapy in patients with hepatocellular carcinoma(HCC)recurrence post living donor liver transplantation(LDLT).Methods:Of 2363 LDLT’s performed between 2005 to mid 2018,435(18.4%)were for HCC within our expanded selection criteria(absence of extrahepatic disease and vascular invasion,irrespective of tumor size and number).Survival after recurrence,and prognostic factors for these patients were ***:Of 435 LDLT patients,51%had HCC beyond Milan and 43%beyond UCSF criteria at the time of ***-LT AFP>100 ng/mL and tumour FDG-18 PET avidity predicted overall survival(OS),whereas pre-LT AFP>100 ng/mL,UCSF criteria,and FDG-18 PET avidity predicted recurrence-free *** patients(23%)developed HCC recurrence at a median time of 16 months(range 2-108 months)post ***(53%),liver(37%),and bone(21%)were the most common sites of ***-five patients received tyrosine kinase inhibitors(TKI)after recurrence and 62 received mTOR inhibitors(protocol-based after LDLT,or post recurrence).Surgical resection of metastases was performed in 14 patients,15 received stereotactic body radiotherapy,and 18 underwent ablation(radiofrequency,microwave ablation,transarterial chemoembolisation,or percutaneous ethanol injection).One-and 3-yr OS after recurrence were 57%,and 24%respectively,with a maximum post recurrence survival of 7.5 *** recurrence within one year after LDLT(P=0.004,HR=2.38,95%CI:1.325-4.276),AFP>200 ng/mL at the time of recurrence(P=0.02,HR=2.075,95%CI:1.121-3.841),and recurrence at multiple sites(P=0.047,HR=1.831,95%CI:1.009-3.321)were poor prognostics factors for post recurrence *** management of recurrence using combined medical,surgical,ablative treatments and radiotherapy significantly improved survival compared to the use of TKI’s or mTORi’s alone,or in ***:In patients accepted for LDLT beyond the conventional size-number criteria,even after HC

关键词： Living donor liver transplantation hepatocellular carcinoma recurrence multimodality treatment outcomes prognostic factors

Alveolar echinococcosis with portal vein thrombosis:An unusual cause for liver transplantation

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Asian Pacific Journal of Tropical Medicine 2015年第8期8卷 671-672页

作者： Bhawna Jha Lipika Lipi Smeeta Gajendra Rashi Sharma Ritesh Sachdev Department of Pathology and Laboratory Medicine Medanta-The MedicitySector -38GurgaonHaryana 122 001India

Alveolar echinococcosis(AE),caused by larval stage of Echinococcus multilocularis,is a very aggressive and potentially fatal infestation which affects primarily the liver and can metastasize to any part of the body through hematogenous *** displays a prolonged latency period before clinical presentation,behaving like a slow-growing liver cancer with subsequent invasion of liver tissues

关键词： echinococcosis Echinococcus subsequent potentially presentation latency invasion fatal prolonged affects

A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

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World Journal of Cardiovascular Diseases 2024年第5期14卷 343-350页

作者： Kunal Tewari Vibhu Raghuvanshi Deepak Mishra Nitin Pahuja Maj Jyotsna Om Bahadur Thapa Department of Anaesthesiology and Critical Care Armed Forces Medical College Pune India Chauhan medicity and Trauma Centre Pathankot India Department of Anaesthesiology and Critical Care Command Hospital (Southern Command) Pune India

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotensi

关键词： Pulse Pressure Variation (PPV) Propofol Fluid Responsiveness

Newer methods of cardiac output monitoring

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World Journal of Cardiology 2014年第9期6卷 1022-1029页

作者： Yatin Mehta Dheeraj Arora Institute of Critical Care and Anesthesiology Medanta The Medicity

Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.

关键词： Cardiac output Pulse contour analysis Pulse power analysis Bioimpedance Doppler Echocardiography

Acute motor axonal neuropathy following anti-rabies human diploid cell vaccine:A rare case and review

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Asian Pacific Journal of Tropical Medicine 2022年第9期15卷 425-426页

作者： Tanushree Chawla Jyoti Sehgal Surekha Dabla Vinay Goyal Department of Neurology Institute of Neurosciences Medantathe Medicity GurugramHaryanaIndia Department of Neurology Pt BD Sharma Post Graduate Institute of Medical SciencesRohtakHaryanaIndia

Rationale:Guillain Barre syndrome(GBS)is an acute neurological illness leading to quadriparesis with respiratory *** can be triggered by infections,vaccinations,surgery,trauma,transplantation and ***-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine,can be very rarely associated with *** concerns:A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for ***:Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell ***:Intravenous high dose ***:Patient recovered completely within 1 ***:Although anti-rabies cell culture vaccines are highly immunogenic and safe,they are rarely associated with *** should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.

关键词： Immunization Rabies Guillain Barre syndrome Human diploid cell vaccine Acute motor axonal neuropathy

Transition from open to robotic assisted liver resection:A retrospective comparative *** experience of laparoscopic liver resections needed?

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Laparoscopic, Endoscopic and Robotic Surgery 2019年第4期2卷 94-98页

作者： Sanjay Goja Sanjay Kumar Yadav Rohan Jagat Chaudhary Manoj Kumar Singh Arvinder Singh Soin Institute of Liver Transplantation and Regenerative Medicine Medanta-The MedicityGurugram122001India Liver Transplant Narayan Health City BengaluruIndia

Objective:The authors present outcomes of robotic liver resections in comparison with open technique questioning the need to have experience of laparoscopy for such procedures before transition to robotic *** and methods:Retrospective review of liver resections done robotically from February 2015 to June 2017 compared to matched control cohort of open cases from January 2012 to December ***:Twenty-one patients in the study groupwere comparedwithmatched control of 42 open cases(1:2 ratio).The types of procedure were similar in both the *** were 4 left lateral hepatectomy,3 left hepatectomy,and 1 left hepatectomy with hepatico-jejunostomy,3 right hepatectomy,3 right posterior sectorectomy,4 bisegmentectomy and 4 *** were 9 patients with primary liver cancer,2 each with livermetastasis and carcinoma gall bladder and 8 patients had benign liver *** blood losswas 370±311ml in the robotic group compared to 451±330ml in control group(p=0.06).Minor complications developed in 19.0%of robotic cases compared to 40.5%in open surgery,while major complications occurred in 4.7%of robotic cases compared to 7.1%of open *** hospital staywas 5.3±0.8 days for the robotic group and 7.7±4.2 days for open group(p=0.02).Local tumor recurrence occurred in 1 out of 13 resections done for malignancy in the robotic group and 7 out of 26 in the open ***:This study highlights the utility of surgical robots for segmental and complex liver resections with equivalent outcomes and decreased length of hospital stay compared to open surgery without having experience of same with the laparoscopy.

关键词： Robotic Liver resection Open surgery

Sudden sensorineural hearing loss-A contemporary review of management issues

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Journal of Otology 2020年第2期15卷 67-73页

作者： Anup Singh David Victor Kumar Irugu Department of Otorhinolaryngology and Head and Neck Surgery Medanta-the MedicityGurugramHaryanaIndia Department of Otorhinolaryngology and Head and Neck Surgery All India Institute of Medical SciencesNew DelhiIndia

Sudden sensorineural hearing loss(SSNHL)is an enigmatic entity,with obscure pathophysiology and debatable efficacy of the treatment agents *** underlying cause is identified in only 10-15%of *** management of the remaining patients,classified as‘idiopathic’,is empirical,and is conventionally with systemic steroids,vasodilator therapy,rheological agents,and antioxidants,to list a few amongst the host of the agents employed for the *** availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment *** the present review,we discuss the various controversial issues and newer developments in the management of idiopathic *** current review aims to present a narrative outlook of the updated evidence base available from PUBMED,augmented with relevant designated publications.

关键词： Hearing loss Sudden Sensorineural Instillation Drug Dexamethasone Prognosis

Treating morbid obesity in cirrhosis: A quest of holy grail

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World Journal of Hepatology 2015年第28期7卷 2819-2828页

作者： Naveen Kumar Narendra Singh Choudhary Department of Transplant Hepatology Medanta Liver Institute Medanta the Medicity

The problem of obesity is increasing worldwide in epidemic proportions; the situation is similarly becoming more common in patients with cirrhosis which negatively affect the prognosis of disease and also makes liver transplantation difficult especially in the living donor liver transplantation setting where low graft to recipientweight ratio negatively affects survival. Treatment of obesity is difficult in cirrhosis due to difficulty in implementation of lifestyle measures, limited data on safety of anti-obesity drugs and high risk of surgery. Currently approved anti-obesity drugs have limited data in patients with cirrhosis. Bariatric surgery remains an option in selected compensated cirrhotic patients. Endoscopic interventions for obesity are emerging and are quite promising in patients with cirrhosis as these are minimally invasive. In present review, we briefly discuss various modalities of weight reduction in obese patients and their applicability in patients with cirrhosis.

关键词： Obesity Intragastric balloon Antiobesitydrugs Bariatric surgery Cirrhosis