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Ramesh H.,Lakeshore Hospital and Research Center
Journal of Clinical and Experimental Hepatology | Year: 2014

Hepatocellular Carcinoma (HCC) continues to present major challenges in management, which is further complicated by the presence of associated chronic liver disease. Key issues in surgical resection of HCC include the site, size, and number of lesions, the severity of the chronic liver disease, and the size of the functional liver remnant. De novo HCC in the absence of chronic liver disease can be treated by major liver resection with little risk of postoperative liver failure. Liver resection can also be used a bridge to liver transplantation as it affords the possibility of determining the pathologic grade of the tumortumor and its invasiveness, and thereby the prognosis. This review summarizes the current treatment approaches to surgical resection for HCC. © 2014 INASL.

Ramesh H.,Lakeshore Hospital and Research Center
Indian Journal of Surgery | Year: 2010

Pancreatic ductal adenocarcinoma has a dismal prognosis, despite advances in surgery, and adjuvant therapy. Surgical resection with negative margins remains the mainstay of treatment, and results can be improved with neoadjuvant therapy when the lesion is of borderline respectability. Extended lymphadenectomy has no role in improving survival, but may worsen quality of life. Venous resection can be performed if it helps to achieve an R0 resection, but arterial resection is not justified. A host of newer agents, both cytotoxic and targeted, are being evaluated. The article summarizes the critical issues and looks ahead to the future. © Association of Surgeons of India 2010.

Lai Q.,University of Rome La Sapienza | Lai Q.,Catholic University of Louvain | Avolio A.W.,University Cattolica | Lerut J.,Catholic University of Louvain | And 10 more authors.
Journal of Hepatology | Year: 2012

Background & Aims: Greater tumor aggressiveness and different management modalities of hepatocellular cancer (HCC) before liver transplantation (LT) may explain the higher recurrence rates reported in Asia. This study investigates the prognostic factors for HCC recurrence in a Western and an Eastern HCC patient cohort in order to analyze the respective roles of tumor- and management-related factors on the incidence of post-LT HCC recurrence. Methods: Data of 273 HCC patients, transplanted during the period January 1999-March 2009, were obtained from the Rome Inter-University Liver Transplant Consortium (n = 157) and Hong Kong University (n = 116) databases. Median follow-up was 4.3 years (range: 0.2-12). Recurrence rate and multivariate logistic regression analysis was performed on the entire population and on Milan criteria-in (MC-in) patients. Results: Multivariate analysis on the entire population identified four independent risk factors for post-LT HCC recurrence: microvascular invasion (odds ratio, OR = 4.88; p = 0.001), poor tumor grading (OR = 6.86; p = 0.002), diameter of the largest tumor (OR = 4.72; p = 0.05), and previous liver resection (LR) (OR = 3.34; p = 0.04). After removal of LR, only tumor-related variables were independent risk factors for recurrence. When only MC-in patients were analyzed, no difference was observed between the two cohorts in terms of recurrence rate after LR patient removal. Conclusions: LR followed by salvage "for HCC recurrence" LT represents the main reason for a higher HCC recurrence rate in the Hong Kong patients, but not LR followed by salvage "for liver failure" LT in the Roman group. This approach towards HCC before LT may not be universally applicable. The precise patient background must be taken into account in order to identify the best pre-LT strategy. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Kannampilly J.J.,Lakeshore Hospital and Research Center
Diabetes Technology and Therapeutics | Year: 2010

Background: Some people with type 2 diabetes mellitus (T2DM) and cirrhosis tend to have fluctuating glucose values usually uncontrolled with conventional therapy. The aim of this case series was to retrospectively analyze the effect of continuous subcutaneous insulin infusion (CSII) on four patients with cirrhosis and poorly controlled T2DM. Methods: The four patients in this case series presented with chronic cirrhosis with no ascitis, preexisting T2DM, and inadequate blood glucose (BG) control with conventional insulin therapy. After initiation of CSII, patients' BG values were monitored at regular intervals, and basal and bolus doses were adjusted. Fasting BG, postprandial BG, and glycated hemoglobin A1c (HbA1c) values were monitored while the patient was in the hospital, upon discharge, and at one follow-up visit. Results: The daily dose of insulin was reduced in three patients. Fasting and postprandial BG values returned to normal ranges for all four patients. HbA1c was reduced in all four patients and reduced to normal ranges in two patients. There were no recorded incidents of severe hypoglycemia, diabetic ketoacidosis, or weight gain associated with the use of CSII. Conclusion: Initiation of CSII in patients with T2DM and cirrhosis was beneficial in controlling BG values in the four patients studied in this case series. © 2010, Mary Ann Liebert, Inc.

Kumar S.P.,Lakeshore Hospital and Research Center
World Journal of Laparoscopic Surgery | Year: 2013

Ectopic pregnancy is the most common life-threatening emergency in early pregnancy. This complication results in not only fetal loss, but also causes significant maternal morbidity and mortality. A literature search was carried out using various search engines and the selected articles were analyzed on the outcomes, such as success of the surgery, operating time, intraoperative and postoperative complications, hospital stay, future fertility, convalescence and cost effectiveness. After having analyzed the same it can be concluded that laparoscopic surgery is safe, effective and economical when compared to open laparotomy as the surgical treatment for ectopic pregnancy, and that it should be considered as the gold standard method in managing ectopic pregnancies.

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