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Acharya N.K.,Dwaraka Institute of Spine Care | Mahajan C.V.,Amrita Institute of Medical science | Kumar R.J.,Amrita Institute of Medical science | Varma H.K.,Sree Chitra Tirunal Institute for Medical Science and Technology | Menon V.K.,Lakeshore Hospital and Research Center
Journal of Spinal Disorders and Techniques | Year: 2010

Study Design: Prospective study. Objective: To prospectively validate the hypothesis that iliac crest donor site morbidity may be a structural issue and by reconstructing the crest its incidence might be reduced. The study also evaluates the efficacy of Chitra hydroxyapatite-bioactive glass ceramic composite (Chitra-HABG) as a material for reconstructing the iliac crest. Summary of Background Data: Tricortical iliac crest bone graft harvesting is associated with significant donor site morbidity, varying from 3% to 61%. Reconstruction of the defect has been shown to reduce this morbidity, but the only materials which have been shown to be useful and readily available are bioactive apatite-wollastonite glass ceramic and morcellized β-tricalcium phosphate. Methods: Twenty-six patients in whom tricortical graft was harvested from the iliac crest and defect reconstructed with an indigenously developed and tested graft substitute-Chitra HABG-were followed up to duration of 1 year. Outcome measures were donor site morbidity as assessed clinically and radiologic assessment for ceramic incorporation, dissolution, fragmentation, and migration. Results: At the end of 1 year from surgery, 25 of the 26 patients (96.15%) had no pain at the donor site, which had been reconstructed. Radiologic evaluation showed that in 21 cases the ceramic incorporation was complete, partial in 3, and absent in 2. Partial dissolution of ceramic was noticed in 3 patients and migration in 1. Conclusions: This study validates our hypothesis that the donor site morbidity after tricortical iliac crest graft harvesting is probably a structural issue and it can be reduced by reconstruction of the defect. It also highlights the fact that the Chitra-HABG block is an excellent material for reconstruction of the iliac crest defect, as it gets incorporated into the surrounding bone without adverse effects. © 2010 by Lippincott Williams & Wilkins.

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.

Abraham G.P.,Lakeshore Hospital and Research Center | Siddaiah A.T.,Lakeshore Hospital and Research Center | Ramaswami K.,Lakeshore Hospital and Research Center | George D.,Lakeshore Hospital and Research Center | Das K.,Lakeshore Hospital and Research Center
Journal of the Canadian Urological Association | Year: 2014

Introduction: We studied the feasibility of ex-vivo nephron-sparing surgery and autotransplantation for complex renal tumours. We also studied the role of laparoscopy in these situations.Methods: All patients who underwent renal autotransplantation for renal tumour at our centre were included in this retrospective study. Patient profiles were recorded in detail. Operative and postoperative details were also recorded.Results: Our series includes 3 patients. Two patients had complex renal cell carcinoma and 1 patient had bilateral large angiomyolipoma. In first 2 patients, laparoscopic approach was used for nephrectomy. Operative time for case 1, 2 and 3 was 5.5, 4.5, 8 (right side) and 6 (left side) hours, respectively. Cold ischemia time was 110, 90, 150 and 125 minutes, respectively. One patient required temporary postoperative hemodialysis.Conclusion: Ex-vivo nephron-sparing surgery and autotransplantation still remain a viable option for complex renal tumours. It offers satisfactory renal functional outcome with acceptable morbidity. The laparoscopic approach should be used whenever possible to reduce morbidity. © 2014 Canadian Urological Association.

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.

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.

Abraham G.P.,Lakeshore Hospital and Research Center | Siddaiah A.T.,Lakeshore Hospital and Research Center | Ramaswami K.,Lakeshore Hospital and Research Center | George D.,Lakeshore Hospital and Research Center | Das K.,Lakeshore Hospital and Research Center
Urology Annals | Year: 2015

Objective: The aim was to analyze the operative, postoperative and functional outcome of laparoscopic management of previously failed pyeloplasty and to compare operative and postoperative outcome with laparoscopic pyeloplasty for primary ureteropelvic junction obstruction (UPJO). Materials and Methods: All patients who underwent laparoscopic management for previously failed dismembered pyeloplasty were analyzed in this study. Detailed clinical and imaging evaluation was performed. Transperitoneal approach was followed to repair the recurrent UPJO. Operative, postoperative, and follow-up functional details were recorded. Operative and postoperative outcomes of laparoscopic redo pyeloplasty were compared with that of laparoscopic primary pyeloplasty. Results: A total of 16 patients were managed with laparoscopic approach for previously failed pyeloplasty. Primary surgical approach for dismembered pyeloplasty was open in 11, laparoscopy in four patients and robotic assisted in one patient. Fifteen were treated with redo pyeloplasty and one with ureterocalicostomy. Mean operative time was 191.25 ± 24.99 min, mean duration of hospital stay was 3.2 ± 0.45 days and mean follow-up duration was 29.9 ± 18.5 months with success rate of 93.3%. Operative time was significantly prolonged with redo pyeloplasty group compared with primary pyeloplasty group (191.25 ± 24.99 vs. 145 ± 22.89, P = 0.0001). Conclusion: Laparoscopic redo pyeloplasty is a viable option with a satisfactory outcome and less morbidity.

PubMed | Lakeshore Hospital and Research Center
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax.

PubMed | Lakeshore Hospital and Research Center
Type: Journal Article | Journal: Journal of surgical case reports | Year: 2016

Primary cardiac tumour is a rare entity as secondaries in the heart are more common. A 2-year-old child was having repeated respiratory tract infection with poor oral intake and poor activity for 3 months. His symptoms progressed from New York Heart Association (NYHA) Class II to IV. On evaluation he had an intracardiac mass with extracardiac extension. Emergency tumour excision under deep hypothermic circulatory arrest was performed with provisional diagnosis of sarcoma. But Serum markers, histopathological examination and immunohistochemistry confirmed diagnosis of yolk sac tumour. Postoperative recovery was uneventful and the child was receiving adjuvant chemotherapy. Extensive literature review revealed only four cases of primary intracardiac yolk sac tumour published till date. Our case report is unique, in that intracardiac tumour had extracardiac extension by infiltration through right atrial wall. Previous four reports mention purely intracardiac mass.

Lai Q.,University of Rome La Sapienza | Lai Q.,Catholic University of Leuven | Avolio A.W.,University Cattolica | Lerut J.,Catholic University of Leuven | 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.

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