Jain V.,Asian Medical Institute
World Journal of Endocrine Surgery | Year: 2017
Thyroidectomy is a commonly performing surgery worldwide with known complications of recurrent laryngeal nerve injury (RLN) and vocal cord paralysis. To avoid RLN palsy, various methods of RLN identification have been defined, one of which is called as defining Beahrs’ triangle. © 2017, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
Ahmed A.,Asian Medical Institute |
Arora D.,Asian Medical Institute
Indian Journal of Palliative Care | Year: 2017
Introduction: The pain from upper gastrointestinal malignancy leads to considerable morbidity. The celiac plexus and splanchnic nerve neurolysis are good therapeutic options. Although splanchnic nerve neurolysis less frequently performed, but it has an edge over celiac plexus as it can be performed in patients with altered celiac plexus anatomy by enlarged lymph nodes. Methods: The fluoroscopy-guided splanchnic nerve neurolysis was done in about 21 patients with intractable upper abdominal pain with pain intensity of ≥7 in numerical rating scale (NRS) from upper gastrointestinal cancers with distorted celiac plexus anatomy from enlarged celiac lymph nodes as seen by computed tomography scan after positive diagnostic splanchnic nerve neurolysis. The demographic features, pain intensity, daily opioid dose, functional status and quality of life was measured at baseline and 1 week, 1 and 3 months after the procedure. Results: There was a significant improvement in pain intensity, opioid requirement, functional status, and physical components quality of life after the neurolysis (P < 0.05) and this improvement had continued till 3 months. There were also more than 50% reduction in pain intensity and significant decrease in opioid requirement in all the patients after neurolysis. Conclusion: The fluoroscopy-guided splanchnic nerve neurolysis results significant pain relief, decrease in opioid intake, improvement in functional status, and quality of life for up to 3 months in upper abdominal pain from gastrointestinal cancers in patients with distorted celiac lymph node anatomy not amenable to celiac plexus neurolysis. © 2017 Indian Journal of Palliative Care | Published by Wolters Kluwer - Medknow.
Ramchandani M.,Asian Medical Institute |
Pal P.,Asian Medical Institute |
Reddy D.N.,Asian Medical Institute
Digestive Endoscopy | Year: 2017
Acute cholangitis is infectious disease of the biliary system and potentially can cause significant morbidity and mortality. With advances in intensive care, antibiotic therapy advances and endoscopic and other modalities of biliary drainage, mortality rates have significantly come down of late. Although most cases respond to antibiotics alone, definitive therapy is required later in most of the patients. Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction. Biliary decompression increases antibiotic penetration in bile. Therefore, patients with high-risk factors and organ dysfunction require early and urgent biliary drainage, respectively, as they are unlikely to respond with antibiotics alone. Biliary decompression is best achieved by endoscopic retrograde cholangiopancreatography (ERCP) compared to percutaneous and surgical decompression. ERCP can be technically difficult and sometimes unsuccessful especially in patients with altered anatomy and upper gastrointestinal obstruction. Earlier percutaneous transhepatic biliary drainage (PTBD) and surgery were the only viable options in those patients. PTBD requires a dilated biliary system, is more invasive and cannot achieve ductal clearance in cholangitis as a result of choledocholithiasis, whereas surgery is associated with high morbidity and mortality. Advances in therapeutic endoscopy such as balloon enteroscopy-guided biliary drainage or endoscopic ultrasound guided-biliary drainage have added new dimensions to endoscopic management of acute cholangitis as a result of choledocholithiasis obviating the need for more invasive procedures. © 2017 The Authors. Digestive Endoscopy © 2017 Japan Gastroenterological Endoscopy Society
Kandi V.,Asian Medical Institute
Annals of Tropical Medicine and Public Health | Year: 2017
Among many infectious diseases prevalent in the world, a few are emerging and emerging infectious diseases, which include the influenza virus. There are some other infections, which are spread throughout the world causing pandemics like the human immunodeficiency virus (HIV). Human parasitic infectious diseases assume greater significance in public health perspective, as they contribute to majority of the morbidity especially in the developing and economically weak nations usually affecting the pediatric age and the young adults, as well as immunocompromised individuals. Human strongyloidiasis is one such parasitic disease, which is least studied and under reported undermining its clinical significance. This manuscript attempts to reinvent the pathogenic potential of Strongyloides stercoralis infection, laboratory identification of human strongyloidiasis and future perspectives. © 2017 Annals of Tropical Medicine and Public Health | Published by Wolters Kluwer - Medknow.
Roy P.,Fortis Escorts Hospital and Research Center |
Roy P.,Asian Medical Institute |
De A.,Fortis Escorts Hospital and Research Center |
De A.,Asian Medical Institute
Langenbeck's Archives of Surgery | Year: 2010
Objective: The aim of this pilot study is to assess the safety, feasibility, and short-term outcomes of single-incision laparoscopic trans-abdominal preperitoneal (TAPP) mesh hernioplasty using conventional laparoscopic instruments. Methods: During a 3-month study period, data from all consecutive patients referred for inguinal hernia repair to the general and minimally invasive surgery unit of our institution who agreed to undergo single-incision TAPP mesh hernioplasty were included in the prospective study. Outcome measures included completion rate of the attempted procedure, operative time, length of hospital stay, postoperative pain, and assessment of complications. Follow-up was done for 3 months. Result: Fifteen patients completed our protocol. Two patients had bilateral inguinal hernias while all other patients had unilateral hernia. Two patients had sliding hernia on the left side which had sigmoid colon as content. None of the patients required any additional port. There were no intraoperative complications. Conclusions: The concept of laparoscopic single-incision surgery is an attractive and understandable innovation as laparoscopic surgery has become more commonplace. Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond the actual outcome with respect to postoperative pain and long-term complications, needs to be evaluated and compared to standard laparoscopic TAPP mesh hernioplasty. © Springer-Verlag 2010.
Neal E.,Asian Medical Institute
Medical Acupuncture | Year: 2015
The practice of physician acupuncture faces unique challenges in its development and inclusion as a recognized medical specialty. Information contained in early Chinese medical texts offers solutions to some of the divides that separate Chinese Medicine from contemporary biomedicine. Recent advances in classical text research - made possible by the establishment of Chinese language databases - provide new hypotheses of disease pathogenesis and new strategies for treating various acute and chronic illnesses. The Vascular Model of Disease Pathogenesis summarizes some theories of early Chinese medicine into language recognizable by modern science. This theory bridges some of the current disparities between ancient and modern practices and offers a new model of human health, illness, and clinical therapeutics. © Mary Ann Liebert, Inc. 2015.
Banerjee R.,Asian Medical Institute |
Reddy D.N.,Asian Medical Institute
Indian Journal of Gastroenterology | Year: 2011
Gastroesophageal reflux disease (GERD) and GERD-related symptoms are common, and affect 25% to 30% of the general population. Upper gastrointestinal endoscopy of the esophagus has been the most widely used modality for the diagnosis and grading of reflux disease. Endoscopic imaging today has evolved beyond the confines of routine white light endoscopy (WLE) to advanced optical imaging with a precise and real time endoscopic diagnosis. These technological advances have helped circumvent the limitation of WLE in reflux disease by a) improved detection of subtle irregularities, b) characterization of anomalies, and c) possible optical biopsies providing real-time diagnosis. This review attempts to define the current status of these newer technologies vis-a-vis the diagnosis and management of gastroesophageal reflux disease. © 2011 Indian Society of Gastroenterology.
Tandan M.,Asian Medical Institute |
Nageshwar Reddy D.,Asian Medical Institute
World Journal of Gastroenterology | Year: 2013
Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. Pancreatic ductal strictures are managed by single large bore stents. Multiple stents are placed for refractory strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention. © 2013 Baishideng. All rights reserved.
Agarwal J.,Asian Medical Institute
Indian Journal of Pediatrics | Year: 2013
The lack of information about management of chronic constipation in children amidst general physicians has necessitated this review. A literature search in PubMed was conducted with regard to epidemiology, clinical features, investigation and management of chronic constipation in children. English language studies published over the last 20 y were considered and relevant information was extracted. Constipation is a common problem among children; the commonest cause is functional (95 %). An elaborate history and thorough physical examination are only essential things required to make a diagnosis of functional constipation. Management consists of disimpaction, followed by maintenance therapy with oral laxative, dietary modification and toilet training. A regular follow-up with slow tapering of laxative is the must for effective treatment. Early withdrawal of laxative is the commonest cause of recurrence. © Dr. K C Chaudhuri Foundation 2013.
Talukdar R.,Asian Medical Institute |
Talukdar R.,Asian Healthcare Foundation |
Reddy D.N.,Asian Medical Institute
World Journal of Gastroenterology | Year: 2013
Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute. © 2013 Baishideng. All rights reserved.