Efficacy of Pancreatic Endotherapy In Pancreatic Ascites And Pleural Effusion.

Pancreatic ascites and effusion is a challenging complication to manage, hence our aim was to evaluate the efficacy of pancreatic endotherapy in pancreatic ascites and pleural effusion. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) with a pancreatogram and pancreatic stent placement across the leak in patients with pancreatic ascites/effusion. A total of 53 patients were included after successful cannulation. The male:female ratio was 7.8:1. The pancreatogram revealed a leak from the pancreatic duct in 20/53 (37.73%) patients. The most common leak site was the pancreatic body in 10/53 (18.9%) patients followed by the tail in 6/53 (11.32%) patients and the genu in 4/53 (7.5%) patients. In 29/53 (54.7%) patients, stent was placed beyond the leak site. Sphincterotomy was done in 7/53 (13.2%) patients, and in five patients with an obscure leak site, stent was placed empirically. A total of 39/53 (73.6%) patients benefited in terms of achieving the complete resolution of ascites and pleural effusion. The factors which were significant for the success of pancreatic endotherapy in the multivariate analysis were the site of the pancreatic ductal leak (p value = 0.008) and the ability of the stent to cross the leak site (p value = 0.004). To sum up, bridging the pancreatic ductal leak by stent offers a high rate of success. Pancreatic endotherapy is less invasive and highly effective in managing pancreatic ascites/pleural effusion.

Retrospective and prospective validation of model for end-stage liver disease (MELD) score in predicting mortality in patients of alcoholic liver disease.

BACKGROUND AND AIM: Patients with alcoholic hepatitis and alcoholic cirrhosis have significant morbidity and mortality. The model for end-stage liver disease (MELD) score is used to predict mortality in patients with liver disease. Our study aimed to validate the utility of MELD score versus Child Pugh Turcotte (CPT) and modified CPT (CPT+creatinine; CPTC) scores in predicting mortality among alcoholic liver disease (ALD) patients. METHODS: We examineda retrospective (n=110; mean age 44.5years; 109 men) and a prospective (n=96; mean age 45 years; 92 men) cohort of patients suffering from ALD, with varying disease severity, and compared the ability of MELD, CTP and CPTC scores to predict the 1-, 3- and 6-month mortality using concordance (c-) statistics. RESULTS: The median MELD, CPT and CPTC scores were 21, 10 and 11 in the retrospective group and 21, 10 and 10 in prospective groups, respectively. The 1-month, 3-month and 6-month mortality was 41 (37.3%), 59 (53.6%) and 81 (73.6%) in the retrospective group and 27 (28.1%), 41 (42.7%) and 65 (67.7%) in the prospective group. The predictive ability of MELD, CPT and CPTC was 0.72, 0.67, 0.68 for 1-month mortality, 0.73, 0.70, 0.68 for 3-month mortality and 0.83, 0.75, 0.73 for 6-month mortality in retrospective group and 0.86, 0.56, 0.63 for 1-month mortality, 0.80, 0.57, and 0.60 for 3-month mortality, and 0.88, 0.51, and 0.64 for 6-month mortality in the prospective cohort, respectively. The predictive accuracy of MELD was significantly better than CPT and CPTC scores in the prospective group. CONCLUSIONS: MELD is a valid prognostic score compared to CPT and CPTC scores for predicting short-term mortality in patients of alcoholic liver disease.

A rare case of primary pancreatic Burkitt lymphoma in a young Indian male. Case report and review of the literature.

CONTEXT: Lymphomas of the gastrointestinal system are usually of a non-Hodgkin's type. Primary lymphomas of the pancreas are uncommon and Burkitt lymphoma involving the pancreas is very rare. It is important to recognize this entity because it can mimic adenocarcinoma but its management is entirely different. CASE REPORT: We present the case of a young Indian male who presented with rapidly progressing obstructive jaundice, gastric outlet obstruction and severe weight loss. CONCLUSION: Early diagnosis of this aggressive tumor and prompt induction of chemotherapy dramatically improved the patient's condition and avoided unnecessary surgical intervention.

Neonatal presentation of a rare metabolic liver disease.

Tyrosinemia is a rare paediatric metabolic liver disorder. A 15-days-old neonate born of a third degree consanguineous marriage presented with jaundice due to tyrosinemia, which progressed to fatal hepatic encephalopathy. The diagnosis was based on very high alpha-fetoprotein level, with urine aminoacidogram revealing tyrosine spot and liver biopsy depicting cirrhosis. Very early neonatal presentation and rapid progression were the unusual features of this case.