Frey procedure for chronic pancreatitis in children: A single center experience.

BACKGROUND: There is paucity of literature regarding the Frey procedure for children with chronic pancreatitis. The purpose of this study is to present our experience with the Frey procedure in children. METHODS: This is an observational retrospective review study. All children, who underwent a Frey procedure between August 2007 and May 2014 in the Department of Surgical Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were included in this study. RESULTS: Twenty four children were included in our study. There were 13 girls and 11 boys. Mean age at operation was 13.95years (range, 4 to 18years). Mean duration between the diagnosis of chronic pancreatitis and surgery was 4.41years (range, 1 to 14years). Frey procedure was performed after failure of medical or endoscopic therapy. Mean duration of operation and blood loss were 215minutes (range, 150-300minutes) and 177ml (range, 50 to 500ml) respectively. Average postoperative hospital stay was 8days (range, 5 to 16days). Five patients (21%) developed postoperative complications. There was no in hospital mortality and no patient required reoperation for postoperative complications. More than a median follow-up of 29months (range, 3-78months), 91% of the patients remained pain free. CONCLUSION: Frey procedure is safe and feasible in children with acceptable perioperative complications and good short-term pain control.

Surgical Management of Gastric Outlet Obstruction Due to Corrosive Injury.

Corrosive gastric injury is common in India due to easily available acids which are ingested mostly for suicide attempt. Resulting gastric outlet strictures need operation in majority of the patients. We review our experience of surgical management of these cases. Thirty-seven consecutive patients over the last 4 years with corrosive gastric strictures were reviewed. Extent of gastric cicatrisation was assessed by endoscopy and barium study. Nutrition was maintained, if necessary by feeding jejunostomy. Early definitive operation was preferred. Outcome of surgery was assessed. Patients presented with vomiting, weight loss, and dysphagia. Twenty patients (54 %) had predominant gastric corrosive injury. The oesophageal stricture in other 17 patients (46 %) could be managed easily by endoscopic dilatation. Prepyloric short gastric stricture was found in 19 patients (51 %). Surgical procedures included stricturoplasty for short strictures and gastrojejunostomy for more extensive distal gastric cicatrisation. Complications included wound infection in six (16 %) patients and pneumonitis in four (11 %) patients. All patients gained weight within 6 to 8 weeks. Management of corrosive gastric injury depends on the extent of gastric involvement, associated oesophageal stricture, and general condition of the patient. Early definitive operation and avoiding gastric resection can give satisfactory outcome.

On-chip lectin microarray for glycoprofiling of different gastritis types and gastric cancer.

An on-chip lectin microarray based glycomic approach is employed to identify glyco markers for different gastritis and gastric cancer. Changes in protein glycosylation have impact on biological function and carcinogenesis. These altered glycosylation patterns in serum proteins and membrane proteins of tumor cells can be unique markers of cancer progression and hence have been exploited to diagnose various stages of cancer through lectin microarray technology. In the present work, we aimed to study the alteration of glycan structure itself in different stages of gastritis and gastric cancer thoroughly. In order to perform the study from both serum and tissue glycoproteins in an efficient and high-throughput manner, we indigenously developed and employed lectin microarray integrated on a microfluidic lab-on-a-chip platform. We analyzed serum and gastric biopsy samples from 8 normal, 15 chronic Type-B gastritis, 10 chronic Type-C gastritis, and 6 gastric adenocarcinoma patients and found that the glycoprofile obtained from tissue samples was more distinctive than that of the sera samples. We were able to establish signature glycoprofile for the three disease groups, that were absent in healthy normal individuals. In addition, our findings elucidated certain novel signature glycan expression in chronic gastritis and gastric cancer. In silico analysis showed that glycoprofile of chronic gastritis and gastric adenocarcinoma formed close clusters, confirming the previously hypothesized linkage between them. This signature can be explored further as gastric cancer marker to develop novel analytical tools and obtain in-depth understanding of the disease prognosis.

Malrotation of Intestine with Carcinoma Colon in Adult.

Malrotation of gut is a congenital anomaly and patients usually present in childhood. Occasionally it may present in adulthood. Patients are usually asymptomatic when malrotation of gut is detected during investigations or operation. Also, it can cause longstanding abdominal symptoms and volvulus of gut. Rarely malrotation of gut may present with gastrointestinal neoplasm. We present a 60 year old female with carcinoma caecum along with intestinal malrotation.

Concomitant tuberculosis and carcinoma colon: coincidence or causal nexus?

Two rare cases of adenocarcinoma of the caecum and ascending colon concomitant with tuberculosis at the same site are reported. The plausibility of an aetiological relationship between the two pathological conditions has been discussed along with a review of the relevant literature. Tuberculosis complicating malignant disease is a diagnostic and therapeutic challenge; and the likelihood of the two occurring together should be kept in mind especially in tuberculosis endemic areas and in patients with equivocal symptoms.

Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis.

BACKGROUND: Radiation induced haemorrhagic proctitis is a well recognized complication of pelvic radiotherapy and its treatment is quite challenging. AIM: To evaluate the efficacy of local instillation of 4% formalin in the management of uncontrolled radiation induced haemorrhagic proctitis. METHODS: This prospective study included twenty-three patients who underwent formalin instillation. We documented the control of the symptoms, assessed the outcome of the treatment, presence of complications & long term results. RESULTS: All patients were followed for a median of 13 months. In 15 patients, the bleeding stopped after a single treatment and in 6 after a second session. Only two patients required formalin instillation for the third time. During the follow-up period all patients were reviewed systemically with reference to the pretreatment complaints. No recurrent rectal bleeding occurred, bowel frequency was decreased and no further blood transfusion was required. CONCLUSION: Local instillation of 4% formalin is an effective treatment for uncontrolled radiation induced haemorrhagic proctitis.

Comparative assessment of three in vitro exposure methods for combustion toxicity.

A comparative assessment of three approaches for the use of human cells in vitro to investigate combustion toxicity was conducted. These included one indirect and two direct (passive and dynamic) exposure methods. The indirect method used an impinger system in which culture medium was used to trap the toxicants, whilst the direct exposure involved the use of a Horizontal Harvard Navicyte Chamber at the air/liquid interface. The cytotoxic effects of thermal decomposition products were assessed using the MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay (Promega) on a selection of human cells including: HepG2, A549 and skin fibroblasts. A small scale laboratory fire test using a vertical tube furnace was designed for the generation of combustion products. Polymethyl methacrylate (PMMA) was selected as a model polymer to study the cytotoxic effects of combustion products. NOAEC (no observable adverse effect concentration), IC10 (10% inhibitory concentration), IC50 (50% inhibitory concentration) and TLC (total lethal concentration) values were determined from dose response curves. Assessment using the NRU (neutral red uptake) and ATP (adenosine triphosphate) assays on human lung derived cells (A549) was also undertaken. Comparison between in vitro cytotoxicity results against published toxicity data for PMMA combustion and predicted LC50 (50% lethal concentration) values calculated from identified compounds using GCMS (gas chromatography mass spectrometry) was determined. The results suggested that the indirect exposure method did not appear to simulate closely exposure via inhalation, whilst exposure at the air/liquid interface by using the dynamic method proved to be a more representative method of human inhalation. This exposure method may be a potential system for in vitro cytotoxicity testing in combustion toxicity.

Household dust metal levels in the Sydney metropolitan area.

Household dust was collected from 82 residential homes within the Sydney metropolitan area. The geometric mean concentrations of metals in the household dust were Cd, 1.9 microg/g; Cr, 64.3 microg/g; Cu, 103 microg/g; Fe, 2740 microg/g; Mn, 54 microg/g; Ni, 15.6 microg/g; Pb, 85.2 microg/g; and Zn, 437 microg/g. Differences in household income level, dwelling type, or the number of occupants were not statistically significant for the majority of metals. The exceptions were higher amounts of Zn (P=0.033) and Fe (P=0.047) found in households with only 1-2 residents compared to those with 3-4 or >4 residents, and slightly higher Mn levels (P=0.033) were found in low-income households (AUD 0-30,000 dollars/year). Region was highly significant for Pb levels in Sydney but not significant for other metals. Large variations in Pb levels were found in household dust (16-16,600 microg/g), with the inner-west region associated with significantly higher Pb levels (P<0.001). Comparisons with a study from a decade earlier have revealed that the household dust Pb levels have remained constant despite substantial improvements in air quality in the inner-west area of Sydney. New epidemiological studies are required to determine whether Pb blood levels have also remained unchanged and whether accumulated Pb in household dust represents a significant health risk to children in this region.

Photo-Fenton degradation of dichloromethane for gas phase treatment.

A continuous photo-Fenton process has been used for the degradation of gaseous dichloromethane (DCM). By absorbing gaseous DCM into a reactive Fenton mixture, the scrubbing and degradation processes could be completed in the one reactor. Operating with a Dark Fenton solution did not result in removal of DCM any better than simply using MilliQ water. This was because the Fe(II) quickly converted to Fe(III) but was unable to regenerate. After a short time, the Fenton process was no longer operating and the DCM quickly accumulated in the reaction solution, preventing further accumulation due to a decreasing concentration gradient in the reactive solution. However, by using UV light and increasing the retention time from 20 to 50 s, there was sufficient time for the reactive solution to regenerate and continuous operation could achieve at least 65% removal of DCM from the gaseous phase at ambient temperature.