CASE: Corrosive esophagial stricture - esophago colo plasty^-www.drkeyurbhatt.in*

14 yrs girl with accidental ingestion of corrosive poison before 3 yrs..was kept on dilatation for initial years and feeding gastrostomy... grade 4-5 dysphagial with undilatable esophagus and long stricture for last one year..

SURGERY: Esophago colo plasty (retrosternal condute, based on LCA)

dye study on POD 5 demonstrated no leak.

was started on oral liquids to semisolids..and discharged on POD 7. After one month feeding gastrostomy was removed as patient gained 2 kg wt with taking normal diet orally..and back to school on day 20.

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CASE: Infactive bowel gangrene- RA^-www.drkeyurbhatt.in*

Middle aged male with severe pain in abdomen for 2 days with nausea and vomiting

and abdominal distension.

Known DM case for last 5 yrs on OHA.

NO H/O HTN.

or surgery in past...or other medical disease.

presented with shock and hypotension not responding to fluid challenge..and started with inotrops..and low urine output

CECT: S/O intestinal obstruction...with terminal ileal ishcemia?

SURGERY: Exploratory laparotomy and resection of Gangrenous bowel. and jejuno ileal anastomosis..was done and discharged in time..without any undue complications.

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Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

                                   Dr Keyur Bhatt- Best GI Surgeon     

 

CASE: Chronic pancreatitis - LPJ^-www.drkeyurbhatt.in*

Young male with severe pain in central abdomen for 6 months
recently detected DM
wt loss of more than 25 kg..with anorexia  and postprandial severe pain

Diagnosis of chronic pancreatitis was made after CECT & MRCP.

SURGERY: LPJ With Head coring.

pt discharged pain free after 5 days with normal diet.

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Fibrolamellar carcinoma: a review with focus on genetics and comparison to other malignant primary liver tumors^-www.drkeyurbhatt.in*

Ward SC, Waxman S.

Source

The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, USA. Stephen.Ward@mssm.edu

Abstract

Fibrolamellar carcinoma is a rare primary malignant liver neoplasm that usually affects adolescents and young adults with no underlying liver disease. Morphologically, the tumor cells resemble oncocytic hepatocytes arranged in cords with a stroma of lamellated collagen fibers. Immunohistochemical studies have found that fibrolamellar carcinomas express markers associated with both biliary (CK7 and epithelial membrane antigen) and hepatocytic (heppar-1and glypican-3) differentiation, as well as markers associated with hepatic progenitor cells (CK19 and EpCAM) and stem cells (CD133 and CD44). Genetic studies show fewer alterations compared with classic hepatocellular carcinoma. Pooled data from comparative genomic hybridization studies show that fibrolamellar carcinomas have fewer and less frequent genomic alterations when compared with classic hepatocellular carcinoma, cholangiocarcinoma, and hepatoblastoma. Of the alterations seen in fibrolamellar carcinoma, the most frequent are gains in 1q and 8q (also frequently seen in other hepatic tumors) and loss of 18q. Fibrolamellar carcinoma also has less frequent methylation of tumor suppressor promoters compared with hepatocellular carcinoma and minimal alterations in mitochondrial DNA. Fibrolamellar carcinoma is associated with better survival than hepatocellular carcinoma and cholangiocarcinoma, presumably due to the young age of the patients and the lack of cirrhosis. These features make more aggressive surgical therapy possible. There is currently very little information on the effectiveness of chemotherapy for fibrolamellar carcinoma.

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Survival analysis for patients with hepatocellular carcinoma according to stage, liver function and treatment modalities^-www.drkeyurbhatt.in*

[Article in Korean]

Park KW, Park JW, Cho SH, Kim YI, Kim SH, Park HS, Lee WJ, Park SJ, Kim DY, Hong EK, Kim CM.

Source

Center for Liver Cancer, National Cancer Center, Goyang, Korea.

Abstract

BACKGROUND/AIMS:

Hepatocellular carcinoma (HCC) is 3rd leading cause of cancer in Korea and the prognosis for HCC patients is poor. For assessing the present treatment outcome, this study analyzed the three-year survival rate (3-YSR) and the prognostic factors for patients with HCC in Korea.

METHODS:

Between November 2000 and December 2003, 905 patients with HCC who were diagnosed and treated at the National Cancer Center Korea were enrolled in this study. The clinical variables, tumor characteristics and survival periods were analyzed.

RESULTS:

The mean age of all patients was 56.2+/-10.3 years and 732 (80.9%) patients were male (M:F=4.2:1). 508 (56.1%) patients died and the median survival period was 15.3 months. The overall 3-YSR of the patients with modified UICC stage I, II, III, IVa and IVb were 67.4%, 65.2%, 30.7%, 9.0% and 5.0%, respectively. The modified UICC stage could not differentiate stage I from II, and stage IVa from IVb, on the 3-YSR. The 3-YSR of the Child-Pugh class A patients with modified UICC stage I or II was 85.4% by surgical resection and it was 69.6% by transcatheter chemoembolization (TACE), respectively (P= .461), and those values for patients with stage III were 49.2% and 36.8%, respectively (P=.081). As compared with systemic chemotherapy or conservative therapy, TACE increased the survival rate more for the Child-Pugh class A patients with stage IV. The independent prognostic factors were serum AFP, portal vein thrombosis, the Child-Pugh classification and the stage of HCC.

CONCLUSIONS:

This follow-up study will be helpful in assessing the results of treatments for HCC and it will provide data for the establishment of a more effective treatment strategy.

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