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Agrawal S.,Indraprastha Apollo Hospitals | Daruwala C.,Temple University | Khurana J.,Temple University
Annals of Surgery | Year: 2012

Objective: A review of the literature to identify current modalities for the diagnosis of autoimmune pancreatitis (AIP) with the objective of establishing a strategy to distinguish it from pancreaticobiliary cancers. Background: Pancreatic and biliary manifestations of AIP mimic pancreaticobiliary cancers. Misdiagnosis of AIP can result in major surgery for a steroid-responsive disease. Methods: A review of the literature was performed to identify recent advances in the diagnosis of AIP and evaluate outcomes with various diagnostic strategies to minimize operative intervention for an autoimmune disease. Results: Diagnostic criteria for AIP are based on histology, imaging, serology, extrapancreatic organ involvement, and response to steroid therapy. The most commonly involved extrapancreatic sites are bile duct, kidney, and retroperitoneum. The Mayo Clinic diagnostic strategy utilizes core biopsy of the pancreas and the Japanese strategy depends on a characteristic pancreatogram. The rate of operative intervention was similar with both strategies and none of the patients with cancer received steroid therapy. Immunoglobulin G subtype 4 (IgG4)-associated cholangitis mimics cholangiocarcinoma and presence of more than 10 IgG4-positive plasma cells/high power field on endoscopic biopsy of the bile duct was diagnostic for AIP in 88% patients. Biliary complications and early relapse are common after surgical resection and immunomodulatory drugs can maintain long-term remission. Conclusion: Criteria based on histology, imaging, endoscopy, serology, extrapancreatic organ involvement, and response to steroid therapy improve the diagnostic yield for AIP. Application of diagnostic and therapeutic protocols by a multidisciplinary team will optimize outcomes with a decline in the rate of operative intervention for AIP, a steroid-responsive disease with propensity for relapse. © 2012 by Lippincott Williams & Wilkins.


Agrawal S.,Indraprastha Apollo Hospitals | Daruwala C.,Temple University
HPB | Year: 2011

Objective: A review of the peri-operative risk associated with hepatic resection in patients with metabolic syndrome (MetS) and identification of measures for the improvement of cardiometabolic disturbances and liver-related mortality. Background: MetS and its hepatic manifestation non-alcoholic fatty liver disease (NAFLD) are associated with an increased operative mortality in spite of a significant improvement in peri-operative outcome after hepatic resection. Methods: A review of the English literature on MetS, liver resection and steatosis was performed from 1980 to 2011 using the MEDLINE and PubMed databases. Results: MetS is a predictor of NAFLD and patients with multiple metabolic risk factors may harbour non-alcoholic steatohepatitis (NASH) predictive of operative and cardiovascular mortality. Pre-operative diagnosis of unsuspected NASH with the selective use of a liver biopsy can modify the operative strategy by limiting the extent of hepatic resection, avoiding or altering the pre-operative chemotherapy regimen and the utilization of portal vein embolization. Thiazolidinediones are therapeutic for MetS and NASH and Vitamin E for active NASH; however, their utility in improving the peri-operative outcome after hepatic resection is unknown. A short-term regimen for weight loss improves post-operative patient and liver-related outcomes in patients with >30% steatosis. Cardiovascular disease associated with MetS or NAFLD should be managed aggressively. Peri-operative measures to minimize thrombotic events and acute renal injury secondary to the pro-inflammatory, prothrombotic state of MetS may further improve the outcome. Conclusion: Potential candidates for hepatic resection should be screened for MetS as the pre-operative identification of NASH, short-term treatment of significant steatosis, cardiovascular risk assessment and optimization of each component of MetS may improve the peri-operative outcome in this high-risk subset of patients. © 2011 International Hepato-Pancreato-Biliary Association.


Agrawal S.,Indraprastha Apollo Hospitals | Khurana J.,Temple University | Sahu M.,Temple University
Journal of Gastrointestinal Surgery | Year: 2012

Introduction: Simple cysts of the liver are usually discovered incidentally on abdominal imaging, and asymptomatic simple cysts do not require treatment regardless of size. Discussion: We report a case of a symptomatic simple cyst of the liver complicated by intracystic hemorrhage for which a partial hepatectomy was performed. Treatment of simple hepatic cysts is indicated in the presence of associated symptoms or complications, and inability to exclude a cystic neoplasm requires operative intervention. © 2012 The Society for Surgery of the Alimentary Tract.


Handa R.,Indraprastha Apollo Hospitals
Indian Journal of Rheumatology | Year: 2014

Rheumatology is a neglected subject in postgraduate medical curriculum in India. This article provides the author's perspective on possible reasons and potential solutions. Copyright © 2014, Indian Rheumatology Association. All rights reserved.


Vaishya R.,Indraprastha Apollo Hospitals
BMJ case reports | Year: 2013

The use of bisphosphonates (BPs) is universally accepted in the management of osteoporosis. However, a small percentage of patients have been recognised to develop atypical subtrochanteric fractures of the femur with the prolonged use of BPs. We report a rare case of bilateral insufficiency lesions in the proximal femora, where a major subtrochanteric fracture developed with a minor fall. This was successfully treated with internal fixation using proximal femoral nail.


Chowdhary S.K.,Indraprastha Apollo Hospitals | Kandpal D.,Indraprastha Apollo Hospitals
Indian Pediatrics | Year: 2012

Over a period of 5 years, we analyzed our data on outcome, feasibility, and safety of Minimal Access Surgery (MAS) in 211 children. The outcome was compared objectively with age matched controls with similar diagnosis undergoing open surgery over the same period. There was no significant difference between mortality, morbidity, re-exploration rates and analgesic requirement between MAS and open surgery. There was a significant difference in the length of stay in hospital, in favour of laparoscopic cholecystectomy, appendectomy, nephrectomy, splenectomy, surgery for intra-abdominal testis compared to open surgery but not for children undergoing surgery for appendicular perforation and intestinal pathology. All parents preferred the cosmetic outcome of minimal access surgery. © 2012 Indian Academy of Pediatrics.


Uberoi R.S.,Indraprastha Apollo Hospitals
World hospitals and health services : the official journal of the International Hospital Federation | Year: 2013

Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.


Handa R.,Indraprastha Apollo Hospitals
Nature Reviews Rheumatology | Year: 2015

Rheumatology has been a neglected subspecialty in India. A staggering patient load, a severely inadequate number of trained rheumatology specialists, therapeutic nihilism and limited advocacy are some of the critical challenges that confront rheumatology care, and possibly explain the high rates of reliance on complementary and alternative medicines in India. Disease spectrum and treatment patterns are not remarkably different from those in other countries, but biologic agents have limited use and are administered for short periods only. Consequently, outcomes in India do not yet match those reported in developed countries. Furthermore, the high prevalence of infectious diseases continues to be a major contributor to mortality in patients with rheumatic disorders such as systemic lupus erythematosus. Several tropical diseases with rheumatic manifestations are relevant in India, including chikungunya, brucellosis, leptospirosis, dengue and melioidosis. To address the many problems with rheumatology care in India, curricular reforms, capacity building, patient education and political support are sorely needed. © 2015 Macmillan Publishers Limited.


Srivastava R.N.,Indraprastha Apollo Hospitals
Indian Pediatrics | Year: 2015

India is a signatory to UN Convention on Child Rights but the allocation of funds and interventions to address health problems have been insufficient. A rights-based rather than a welfare approach is needed to realize child rights, of which health and education are crucial. The health needs of the newborn (survival), infant (vaccinations, nutrition) and preschool child (infections, development) require particular attention. Health care delivery systems should be made fully functional, programs properly implemented, and accountability ensured at all levels. Basic curative services must be provided free for all children. Functional health literacy should be provided to the underprivileged. © 2015, Indian Academy of Pediatrics.


Taneja S.,Indraprastha Apollo Hospitals
Clinical Nuclear Medicine | Year: 2016

ABSTRACT: Ga-PSMA based integrated PET/MRI is emerging as a novel imaging technique for the staging of prostate carcinoma. We report a case of a 77-year-old man with raised prostate-specific antigen who presented to us for Glu-NH-CO-NH-Lys-(Ahx)-[Ga-(HBED-CC)] (Ga-PSMA) simultaneous PET/MRI scan for prostate cancer evaluation. A PSMA avid hepatic lesion on the background of cirrhotic liver was noted apart from PSMA avid lesion in the peripheral gland of the prostate. On histopathological examination, the hepatic lesion turned out to be hepatocellular carcinoma. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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