Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes

( Ashok Kumar Saxena ),( Geetanjali T Chilkoti ),( Anand K Chopra ),( Basu Dev Banerjee ),( Tusha Sharma ) 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.4

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to “Bonferroni adjustments”. In patients with CPPP, the Δct values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP. (Korean J Pain 2016; 29: 239-48)

Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes

Saxena, Ashok Kumar,Chilkoti, Geetanjali T,Chopra, Anand K,Banerjee, Basu Dev,Sharma, Tusha The Korean Pain Society 2016 The Korean Journal of Pain Vol.29 No.4

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the ${\Delta}ct$ values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.

연구논문 - Fatigue and Crack Propagation - : Ct - 매개변수를 이용한 탄송 - 소성 - 크리프 변형 재료의 크리프 - 피로 균열성장모델

윤기봉(Kee Bong Yoon),Ashok Saxena(Ashok Saxena),이해무(Hae Moo Lee),방건웅(Gun Woong Bahng) 대한금속재료학회(구 대한금속학회) 1991 재료강도 심포지엄 Vol.- No.-

Mirizzi’s syndrome

Ashok Kumar,Ganesan Senthil,Anand Prakash,Anu Behari,Rajneesh Kumar Singh,Vinay Kumar Kapoor,Rajan Saxena 한국간담췌외과학회 2016 한국간담췌외과학회지 Vol.20 No.1

Backgrounds/Aims: Mirizzi’s syndrome (MS) poses great diagnostic and management challenge to the treating physician. We presented our experience of MS cases with respect to clinical presentation, diagnostic difficulties, surgical procedures and outcome. Methods: Prospectively maintained data of all surgically treated MS patients were analyzed. Results: A total of 169 MS patients were surgically managed between 1989 and 2011. Presenting symptoms were jaundice (84%), pain (75%) and cholangitis (56%). Median symptom duration s was 8 months (range, <1 to 240 months). Preoperative diagnosis was possible only in 32% (54/169) of patients based on imaging study. Csendes Type II was the most common diagnosis (57%). Fistulization to the surrounding organs (bilio-enteric fistulization) were found in 14% of patients (24/169) during surgery. Gall bladder histopathology revealed xanthogranulomatous cholecystitis in 33% of patients (55/169). No significant difference in perioperative morbidity was found between choledochoplasty (use of gallbladder patch) (15/89, 17%) and bilio-enteric anastomosis (4/28, 14%) (p=0.748). Bile leak was more common with choledochoplasty (5/89, 5.6%) than bilio-enteric anastomosis (1/28, 3.5%), without statistical significance (p=0.669). Conclusions: Preoperative diagnosis of MS was possible in only one-third of patients in our series. Significant number of patients had associated fistulae to the surrounding organs, making the surgical procedure more complicated. Awareness of this entity is important for intraoperative diagnosis and consequently, for optimal surgical strategy and good outcome.

Protective Effect of Panax ginseng extract on Renal Functions Altered by Mercuric Chloride in Albino Rats

Saxena, Prabhu-N.,Mahour, K.,Kumar, Ashok The Korean Society of Ginseng 2006 Journal of Ginseng Research Vol.30 No.3

Liver and kidney are specific organs which play an active role in biotransformation and detoxification mechanisms. Ant adverse effect of chemicals or heavy metal can cause the delay or fade in these mechanisms. Present study was designed to find out the protective effect of Panax ginseng extract on renal functions altered by mercuric chloride (heavy metal) in albino rat. Fifty albino rats were divided into 10 groups. Five groups for acute study and five groups for sud-acute study viz. control group (Tween 20 and distilled water), mercuric chloride treated group (0.926 mg/kg body wt. for acute and 0.044 mg/kg body wt. for sub-acute group after calculated $LD_{50}$ (9.26 mg/kg body wt.) by probit analysis (Finney, 1971), Panax ginseng extract treated group (10 mg/kg body wt. for acute and sub-acute sets), mercuric chloride treated followed by Panax ginseng extract and Panax ginseng extract followed by mercuric chloride group. All doses were given orally by gavage tube. The result revealed that the serum urea and creatinine significantly increased in mercuric chloride treated group, while significantly decreased (p<0.01) in Panax ginseng extract group after acute and sub-acute treatment. The biochemical estimation is also confirmed by nephropathological aspect. However, the Panax ginseng extract treated followed by mercuric chloride group is more prominent than the mercuric chloride treated followed by Panax ginseng extract group. It can be concluded that Panax ginseng extract had a protective nature on renal functions against mercuric chloride toxicity in albino rats.

Panax ginseng Extract as Protectant in Mercuric Chloride Induced Alterations in Protein Biochemistry in the Serum of Albino Rats

Mahour, K.,Saxena, Prabhu-N.,Kumar, Ashok The Korean Society of Ginseng 2006 Journal of Ginseng Research Vol.30 No.3

Adverse changes in individual's biochemistry under heavy metal stress are directly linked with its metabolic activity and health status. The present investigation highlights the differences in protecting role of Panax ginseng extract against mercuric chloride induced alterations in serum proteins. The assessment was based on dividing fifty albino rats into two sets, one for acute and the other for sub-acute study. All the sets had five groups with five albino rats in each i.e. control group, mercuric chloride treated group, Panax ginseng extract treated group, mercuric chloride followed by Panax ginseng extract treated group and Panax ginseng extract followed by mercuric chloride treated group. Mercuric chloride was given orally 0.926 mg/kg body weight for acute set and 0.044 mg/kg body weight for sub-acute set after LD50 (9.26 mg/kg body weight) determination by probitt analysis. 10 mg/kg body weight Panax ginseng extract was given in both acute and sub-acute sets after incorporating safety trials. The control group received tween-20 and distilled water only. The result exhibited significantly reduction (P<0.01) in serum protein, albumin and globulin following mercuric chloride intoxication whereas significant (P<0.01) enhancement in other groups with Panax ginseng extract as an ingredient confirming its protective role. All serum samples were also electrophoresed in 10% SDS with standard marker using discontinuous buffering system. Gradual disappearance of alpha-2 and beta-1 globulin bands from electrophoretic pattern was observed, while a single sharp band was observed between beta-2 and gamma globulin in serum protein pattern of acutely mercuric chloride treated rats. However, this band could not be visualized in sub-acute studies. Panax ginseng extract exhibits a better protection after acute intoxication.

Tuberculosis of the Spleen as a Cause of Fever of Unknown Origin and Splenomegaly

( Biju Pottakkat ),( Ashok Kumar ),( Archana Rastogi ),( Narendra Krishnani ),( Vinay K. Kapoor ),( Rajan Saxena ) 대한소화기기능성질환·운동학회 2010 Gut and Liver Vol.4 No.1

Background/Aims: Splenic involvement of tuberculosis, which is rare, warrants better definition in the current era of resurgence of tuberculosis. Methods: Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients. Results: All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV, and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes, cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period. Conclusions: In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement, and even in immunocompetent individuals. (Gut Liver 2010;4:94-97)

Protective Effect of Panax ginseng extract on Renal Functions Altered by Mercuric Chloride in Albino Rats

Prabhu N. Saxena,K. Mahour,Ashok Kumar 고려인삼학회 2006 Journal of Ginseng Research Vol.30 No.3

Liver and kidney are specific organs which play an active role in biotransformation and detoxification mechanisms. Ant adverse effect of chemicals or heavy metal can cause the delay or fade in these mechanisms. Present study was designed to find out the protective effect of Panax ginseng extract on renal functions altered by mercuric chloride (heavy metal) in albino rat. Fifty albino rats were divided into 10 groups. Five groups for acute study and five groups for sud-acute study viz. control group (Tween 20 and distilled water), mercuric chloride treated group (0.926 ㎎/㎏ body wt. for acute and 0.044 ㎎/㎏ body wt. for sub-acute group after calculated LD?? (9.26 ㎎/㎏ body wt.) by probit analysis (Finney, 1971)¹, Panax ginseng extract treated group (10 ㎎/㎏ body wt. for acute and sub-acute sets), mercuric chloride treated followed by Panax ginseng extract and Panax ginseng extract followed by mercuric chloride group. All doses were given orally by gavage tube. The result revealed that the serum urea and creatinine significantly increased in mercuric chloride treated group, while significantly decreased (p<0.01) in Panax ginseng extract group after acute and sub-acute treatment. The biochemical estimation is also confirmed by nephropathological aspect. However, the Panax ginseng extract treated followed by mercuric chloride group is more prominent than the mercuric chloride treated followed by Panax ginseng extract group. It can be concluded that Panax ginseng extract had a protective nature on renal functions against mercuric chloride toxicity in albino rats.

Panax ginseng Extract as Protectant in Mercuric Chloride Induced Alterations in Protein Biochemistry in the Serum of Albino Rats

K. Mahour,Prabhu N. Saxena,Ashok Kumar 고려인삼학회 2006 Journal of Ginseng Research Vol.30 No.3

Adverse changes in individual’s biochemistry under heavy metal stress are directly linked with its metabolic activity and health status. The present investigation highlights the differences in protecting role of Panax ginseng extract against mercuric chloride induced alterations in serum proteins. The assessment was based on dividing fifty albino rats into two sets, one for acute and the other for sub-acute study. All the sets had five groups with five albino rats in each i.e. control group, mercuric chloride treated group, Panax ginseng extract treated group, mercuric chloride followed by Panax ginseng extract treated group and Panax ginseng extract followed by mercuric chloride treated group. Mercuric chloride was given orally 0.926 ㎎/㎏ body weight for acute set and 0.044 ㎎/㎏ body weight for sub-acute set after LD50 (9.26 ㎎/㎏ body weight) determination by probitt analysis. 10 ㎎/㎏ body weight Panax ginseng extract was given in both acute and sub-acute sets after incorporating safety trials. The control group received tween-20 and distilled water only. The result exhibited significantly reduction (P<0.01) in serum protein, albumin and globulin following mercuric chloride intoxication whereas significant (P<0.01) enhancement in other groups with Panax ginseng extract as an ingredient confirming its protective role. All serum samples were also electrophoresed in 10% SDS with standard marker using discontinuous buffering system. Gradual disappearance of alpha-2 and beta-1 globulin bands from electrophoretic pattern was observed, while a single sharp band was observed between beta-2 and gamma globulin in serum protein pattern of acutely mercuric chloride treated rats. However, this band could not be visualized in sub-acute studies. Panax ginseng extract exhibits a better protection after acute intoxication.

Management of Chronic Pancreatitis- Step Up?

( Peeyush Varshney ),( Rk Singh ),( Anu Behari ),( Ashok Kumar ),( Vk Kapoor ),( Rajan Saxena ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Endoscopic treatment is used in several units prior to surgical treatment for pain in chronic pancreatitis. There is limited information on patients who undergo surgical ‘salvage’ after endoscopic failure. We conducted a comparative study between patients who had undergone surgery after prior non-surgical intervention and upfront surgery. Methods: Patients who underwent surgical drainage in our institution over the last 6 years were reviewed, in two groups- Group A (n=29) - surgery with prior non-surgical interventions (ESWL and/or endoscopy); Group B (n=79) - upfront surgery. Pain scores and QOL scores were measured prospectively. Results: The two groups were comparable for baseline characteristics except that group A patients had more strictures/ stones in body and tail region (P<0.05). Short term morbidity was more in Group A vs Group B (65% vs 26%, P<0.01) - wound infection (45% vs 10%, P<0.01; Gastroparesis (10% vs nil, P<0.01). On long term followup complete pain relief was worse in Group A patients (37% vs 68%, P=0.05). Quality of life scores (WHOQOL- BREF) in social domain was significantly better in Group B. Improvement in exocrine and endocrine insufficiency was similar in both groups. Conclusions: Patients with chronic pancreatitis who undergo ‘salvage’ surgery after non-surgical interventions are at increased risk of postoperative morbidity, lower quality of life and poor pain control as compared to those who undergo upfront surgery. Patients with pancreatic body/tail strictures/ stones have poor outcomes with non-surgical interventions and may be considered for upfront surgery.