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Indian J Surg ; 80(1): 87-89, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29581692


Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobiliary and pancreatic system. Cystic artery psuedoaneurysm is usually asymptomatic but may also present as vague abdominal pain, intra-abdominal mass, and hemobilia. In the event of rupture, it may present as a catastrophic intra-peritoneal bleeding with hemorrhagic shock. Doppler ultrasound and contrast-enhanced CT scan are useful tools for the diagnosis of this condition. However, selective visceral angiography is confirmatory and offers the opportunity for therapeutic embolization. We report a case which presented with upper right quadrant abdominal pain, vomiting, and hypotension. Abdominal ultrasonography revealed subhepatic hematoma and pericholecystic fluid collection along with acute calculus cholecystitis and sludge in the bile duct. Subsequent contrast-enhanced CT and CT angiography confirmed the presence of ruptured cystic artery psuedoaneurysm with subhepatic hematoma. The patient after resuscitation underwent selective visceral angiography and successful coil embolization of the cystic artery pseudoaneurysm. During the same admission, ERCP and biliary stenting were also performed followed by laparoscopic cholecystectomy. This case reports a rare entity which was successfully treated using a multimodality strategy.

Trop Gastroenterol ; 34(2): 95-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24377157


BACKGROUND: Preclinical studies have found ilaprazole to be significantly effective in preventing the development of reflux oesophagitis and gastric secretion in a dose-dependent manner; the drug also has a broad dose range and safety feature. Till date only one clinical study on patients with gastro-oesophageal reflux disease has shown its potency in suppressing gastric acid secretion. OBJECTIVES: To review the published randomized controlled trials (RCTs) assessing the efficacy of ilaprazole in duodenal ulcer (DU) compared to other available proton pump inhibitors (PPI). METHODS: RCTs comparing ilaprazole with other PPIs in DU were searched in the PubMed and Cochrane Library database using the term 'ilaprazole and duodenal ulcer'. All clinical studies showing effectiveness of ilaprazole in patients with DU, either full texts or scientific abstracts and found to be potentially eligible for the systematic review, were included and evaluated. RESULTS: Four RCTs having follow-up data were included. A total of 1077 patients with DU were assessed. All the trials had included omeprazole as a comparator PPI. The majority of patients (80%) became asymptomatic after treatment in both the groups. None of the trials data predict ilaprazole to be superior to omeprazole in terms of efficacy in patients with DU. CONCLUSION: The trials conducted were limited in numbers and all the trial data indicated the efficacy of ilaprazole to be similar to that of omeprazole. None of the trials indicated superiority of ilaprazole over the existing PPIs.

2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
Indian J Gastroenterol ; 27(1): 22-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18541934


AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.

Síndrome do Intestino Irritável/epidemiologia , Adulto , Feminino , Gastroenterologia , Humanos , Índia/epidemiologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Estudos Prospectivos , Sociedades Médicas
Pancreatology ; 3(1): 9-13, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12649559


BACKGROUND/AIM: Fever, as a significant event, has not been studied systematically in patients with acute pancreatitis. We studied prospectively incidence, etiology, and impact of fever on the management and outcome in patients with acute pancreatitis. METHODS: All consecutive patients with acute pancreatitis were studied for the development of fever, its etiology, and its influence on the management and outcome of acute pancreatitis. Fever was considered to be significant, if the temperature was >38 degrees C and persisted for >2 days. RESULTS: A total of 75 patients (51 males; mean age 41 years) with acute pancreatitis were included between January 1997 and June 1998. The causes of pancreatitis were gallstones in 48%, alcohol in 28%, and others in 24% of the patients. 20 patients had pancreatic necrosis, and 45 (60%) developed fever during the course of pancreatitis. The etiology of fever was infected pancreatic necrosis in 8 (18%), pancreatitis per se in 10 (22%), cholangitis in 4 (9%), nonpancreatic infections in 17 (38%), and an undetermined one in 6 (13%) patients. Of the 45 patients with fever, 17 had pancreatic necrosis as compared with only 3 of 30 patients who did not develop fever (p < 0.05). Patients with fever had a higher pancreatitis-related mortality than those without fever (p = 0.03). CONCLUSIONS: 60% of the patients with acute pancreatitis developed fever. Infected pancreatic necrosis was the cause of fever in 18% of the patients and not in the majority, i.e., 82% of the patients. The mortality rate was higher in patients who developed fever than in those who did not.

Febre/epidemiologia , Febre/etiologia , Pancreatite/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangite/complicações , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Febre/diagnóstico por imagem , Febre/mortalidade , Febre/fisiopatologia , Humanos , Infecções/complicações , Masculino , Pessoa de Meia-Idade , Necrose , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreatite/diagnóstico por imagem , Pancreatite/microbiologia , Pancreatite/mortalidade , Estudos Prospectivos , Tomografia Computadorizada por Raios X
J Gastroenterol Hepatol ; 16(9): 1055-9, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11595073


BACKGROUND AND AIM: Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis. METHODS: All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded. RESULTS: A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin. CONCLUSION: Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.

Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Pancreatite Necrosante Aguda/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Cefotaxima/uso terapêutico , Ceftazidima/uso terapêutico , Ciprofloxacina/uso terapêutico , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico