Saturday, December 31, 2011

case : multiple jejunal intussecptions - lap assistdd resection^-www.drkeyurbhatt.in*

Young female with Known case of pseustes jeghers syndrome
presented with severe abdominal pain and nausea/vomiting..

Investigation s/o multiple intussecptions and one loop of intestine gangrenous...

surgery: lap assisted reduction and polypectomy with enterotomy and resection anastomosis..








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CASE: Malrotation with DJ obstruction - release of Ladd band and Duodeno jejunostomy

middle aged male with persistat vomiting

CECT : S/o malrotation with D3/4 obstruction





SURGERY: release of Ladd band and Duodeno jejunostomy




Pt discharged with normal diet on POD 7.

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Wednesday, November 30, 2011

CASE: CDC (Choledochal cyst type one) - Excision of CDC and RYHJ^-www.drkeyurbhatt.in*

Middle aged female with choledochal cyst type one.

CECT:

SURGERY: CDC Excision and Roux En Y hepatico Jejunostomy




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CASE: LIVER CELL TUMOR SEG 6 - SEGMENTAL RESECTION^-www.drkeyurbhatt.in*

Middle aged male with liver tumor, AFP & CEA : NEGATIVE, NO CLD,

CECT:

 

SURGERY: Rt segmental resection of segment 5 and 6 with tumor..with more than 2 cm of margin.
No transfusion required, post op pt shifted to Ward, without ICU Care, and discharged on POD 5.






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Thursday, November 17, 2011

Are There Better Guidelines for Allocation in Liver Transplantation?: A Novel Score Targeting Justice and Utility in the Model for End-Stage Liver Disease Era^-www.drkeyurbhatt.in*


Annals of Surgery:
November 2011 - Volume 254 - Issue 5 - p 745–754
doi: 10.1097/SLA.0b013e3182365081
Original Article From the ESA Proceedings

Dutkowski, Philipp MD*; Oberkofler, Christian E. MD*; Slankamenac, Ksenija MC*; Puhan, Milo A. MD‡; Schadde, Erik MD*; Müllhaupt, Beat MD†; Geier, Andreas MD†; Clavien, Pierre A. MD, PhD*

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Abstract

Objectives: To design a new score on risk assessment for orthotopic liver transplantation (OLT) based on both donor and recipient parameters.
Background: The balance of waiting list mortality and posttransplant outcome remains a difficult task in the era of the model for end-stage liver disease (MELD).
Methods: Using the United Network for Organ Sharing database, a risk analysis was performed in adult recipients of OLT in the United States of America between 2002 and 2010 (n = 37,255). Living donor-, partial-, or combined-, and donation after cardiac death liver transplants were excluded. Next, a risk score was calculated (balance of risk score, BAR score) on the basis of logistic regression factors, and validated using our own OLT database (n = 233). Finally, the new score was compared with other prediction systems including donor risk index, survival outcome following liver transplantation, donor-age combined with MELD, and MELD score alone.
Results: Six strongest predictors of posttransplant survival were identified: recipient MELD score, cold ischemia time, recipient age, donor age, previous OLT, and life support dependence prior to transplant. The new balance of risk score stratified recipients best in terms of patient survival in the United Network for Organ Sharing data, as in our European population.
Conclusions: The BAR system provides a new, simple and reliable tool to detect unfavorable combinations of donor and recipient factors, and is readily available before decision making of accepting or not an organ for a specific recipient. This score may offer great potential for better justice and utility, as it revealed to be superior to recent developed other prediction scores.

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