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Variant anatomy of the buccal nerve
Mayank Patel,Joe Iwanaga,Shogo Kikuta,Rod J. Oskouian,R. Shane Tubbs 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.1
Knowledge of the anatomy and variations of the nerves of the oral cavity is important to surgeons who operate this region. Herein, we report a rare case of a buccal nerve with two distinct roots. The anatomy of this case and its clinical applications is discussed.
Mayank Patel,Abhishek Jha,Tatjana Antic,Sarah M. Nielsen,Jane E. Churpek,Alexander Ling,Karel Pacak 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.5
Although rare, a metastatic renal cell carcinoma could present with 68Ga-DOTATATE avidity. A 66-year-old man with von Hippel-Lindau syndrome (VHL) presented with 68Ga-DOTATATE uptake in the pancreatic head, splenic hilar region, and multiple osseous sites, including the right lateral portion of the T9 vertebrae. Biopsy of the T9 lesion confirmed metastatic renal cell carcinoma. Various VHL-associated cancers may display 68Ga-DOTATATE avidity, which can change and guide clinical decisions for the patient.
Mayank Patel,Akash Aggarwal,Arvind Kumar 대한금속·재료학회 2023 METALS AND MATERIALS International Vol.29 No.8
The processing of high-strength Al7075 alloy through the laser powder bed fusion process is challenging because of crackingsusceptibility. In this work, an experimental study has been carried out to understand the defects formation and to predict theoptimum conditions for defect-free parts by varying process parameters such as laser power, scanning speed, base-plate heatingtemperature, remelting speed, and powder composition. A detailed mechanical and microstructural characterization hasbeen carried out to investigate porosities, cracks, microstructure, grain structure, and mechanical properties. It was observedthat the single-melting-based fabrication of Al7075 samples results in excessive porosities and solidification cracks alongthe build direction. The cracks are due to the insufficient liquid back-filling of the long columnar-dendritic grains during thesolidification. The ramped-down high-speed remelting eliminates the balling defect, decreases the porosity percentage, andreduces surface roughness. The base plate heating of 473 K and 573 K reduces the extent of porosity and crack formation. Adding 4 wt% nano-TiC reinforcement to the Al7075 matrix eliminates the porosity and solidification cracks due to the veryfine equiaxed grain because of heterogeneous nucleation.
Swapnil Patel,Sriniket Raghavan,Amar Prem,Mayank Tripathi,Saumya Chopra,Durgatosh Pandey 대한종양외과학회 2021 대한임상종양학회 학술대회지 Vol.2021 No.6
Background/Aims Laparoscopic approach for total colectomy is acceptable ontologically if executed with a complete mesocolic excision and central vascular ligation to ensure radical D3 lymphadenectomy. Methods This is an illustrative video vignette showing a step by step approach to total colectomy with complete mesocolic excision with central vascular ligation. Our patient was a 45yr gentleman with adenocarcinoma of the transverse colon extending to splenic flexure and descending colon with synchronous polyps in right colon on colonoscopy. Staging computed tomography scan did not show any distant metastases. Results Total colectomy was done using laparoscopic approach with a complete mesocolic excision. Stapled ileo-rectal anastomosis was performed. Blood loss was 200mL and intra-operative period was uneventful. Post-operative period was uneventful and patient was discharged on day 6. Final histopathology revealed a moderately differentiated adenocarcinoma of transverse colon and left colon (pT3N1, 0/56 nodes) with dysplastic polyps in right colon. Patient was referred to Medical Oncology for adjuvant chemotherapy. Conclusions This video vignette highlights step by step conduct of a technically challenging procedure using laparoscopy while ensuring oncological adequacy.
Abhishek Jha,Mayank Patel,Eva Baker,Melissa K. Gonzales,Alexander Ling,Corina Millo,Marianne Knue,Ali Cahid Civelek,Karel Pacak 대한핵의학회 2020 핵의학 분자영상 Vol.54 No.1
We describe an unusual case of a 42-year-old female with an unresectable succinate dehydrogenase subunit B (SDHB)-related pterygopalatine fossa paraganglioma. She underwent somatostatin receptor imaging with 68Ga- DOTA(0)-Tyr(3)-octreotate (68Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT), which showed uptake in the above mentioned tumor. Hence, the patient was started on octreotide, a cold somatostatin analog, and responded with tumor stabilization and improvement of clinical symptoms for 36 months since initiation of octreotide therapy. This case demonstrates the role of 68Ga-DOTATATE PET/CT in diagnostic localization and its subsequent role in treatment using cold somatostatin analog as a potential choice of therapy in the management of paraganglioma in an unusual location with limited therapeutic options.
Pankaj Desai,Chintan Patel,Mayank Kabrawala,Subhash Nandwani,Rajiv Mehta,Ritesh Prajapati,Nisharg Patel,Krishna Parekh 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.3
The coexistence of an esophageal leiomyoma with an achalasia cardia is extremely rare and poses a diagnostic dilemma as the clinical presentation of an esophageal leiomyoma strongly resembles to an achalasia cardia. Moreover, at most of the time, an esophageal leiomyoma exist with absence of leiomyoma specific symptoms or findings. It could be the reason why the diagnosis of esophageal leiomyoma is missed while the patient has the coexistence of the both. Here, we present a case series of an unusual coexistence of an esophageal leiomyoma with achalasia in three patients who were presented with dysphagia and had an initial diagnosis of achalasia. Even endoscopic evaluation couldn’t reveal esophageal leiomyoma; it became apparent during the peroral endoscopic myotomy.
Pankaj Desai,Chintan Patel,Mayank Kabrawala,Subhash Nandwani,Rajiv Mehta,Ritesh Prajapati,Nisharg Patel,Krishna Parekh 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.3
The coexistence of an esophageal leiomyoma with an achalasia cardia is extremely rare and poses a diagnostic dilemma as the clinical presentation of an esophageal leiomyoma strongly resembles to an achalasia cardia. Moreover, at most of the time, an esophageal leiomyoma exist with absence of leiomyoma specific symptoms or findings. It could be the reason why the diagnosis of esophageal leiomyoma is missed while the patient has the coexistence of the both. Here, we present a case series of an unusual coexistence of an esophageal leiomyoma with achalasia in three patients who were presented with dysphagia and had an initial diagnosis of achalasia. Even endoscopic evaluation couldn’t reveal esophageal leiomyoma; it became apparent during the peroral endoscopic myotomy.
Pankaj N. Desai,Chintan N. Patel,Mayank V. Kabrawala,Subhash K. Nandwani,Rajiv M. Mehta,Parika Kalra,Ritesh Prajapati,Nisharg Patel,Krishna K. Parekh 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2
Foreign bodies in common bile duct (CBD) are rare. Obstructive jaundice in patients who have undergone cholecystectomy may be due to a variety of causes. Common causes of obstruction in these cases are residual stones, inflammatory or ischaemic strictures following CBD injury during cholecystectomy or malignant strictures. Foreign bodies in the bile duct in these post cholecystectomy patients are known but reported very rarely. Clinical features and biochemistry of these patients are no different than those due to other causes mentioned above. Imaging studies will show obstruction due to stones or sludge or narrowing but may not give conclusive diagnosis of a foreign body. Endoscopic ultrasound is helpful in these cases as it shows a hyperechoic foreign body within the stone if the substance is a metallic clip. In our current case series, we are presenting eight such cases with post cholecystectomy foreign bodies, in the form of materials used for ligating or clipping the cystic duct before transection during cholecystectomy, or a mistakenly left behind gauze piece, migrating into the bile duct and forming a nidus for stone formation and causing CBD obstruction. To conclude, if a patient presents with biliary obstruction with a history of cholecystectomy, the possibility of foreign body in the CBD must be considered as a possible differential diagnosis.
Pankaj N. Desai,Chintan N. Patel,Mayank V. Kabrawala,Subhash K. Nandwani,Rajiv M. Mehta,Ritesh M. Prajapati,Nisharg B. Patel,Krishna K. Parekh,Neha D. Sheth 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.1
Background: To assess the usefulness of endoscopic pancreatography without contrast agents and efficacy of transpapillary intervention for pancreatic duct (PD) rupture in chronic pancreatitis. Methods: We retrospectively analyzed all cases of chronic pancreatitis with ductal rupture causing ascites, effusions and pseudocysts. We performed magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde pancreatography (ERP) without contrast. Results observed based on the possibility of wire crossing the leak or not and their resolutions were noted. Results: We performed ERP in 1,324 patients. Ductal disruptions in 321/1,324 (24.2%). We divided cases into two groups. Group 1 involves disruptions causing ascites in 60 cases (18.7%) and effusions in 34 cases (10.6%), and group 2 involves pseudocysts in 227 cases (70.7%). In group 1, 82 patients (87.2%) experienced successful cannulation of PD. Leak crossed in 70 (74.5%) with complete resolution in all. Leak did not cross in 12 cases of which 8 (8.5%) installed stents resolved while four (4.3%) did not resolve. In group 2, 219 (96.5%) PD cannulated. Leak did not cross but stents put in cyst (176, 77.5%). Complete resolution occurred without infection. Leaks were crossed in 43 (18.9%); complete resolution, 14 (32.6%). Complete regression was not achieved in 19 (8.3%). Eight cysts were not resolved (3.5%). Transmural drainage was done. Infection was noted in 2 cases (0.9%). Sites of leak in pseudocysts were jenu & body, 167 (73.6%); tail, 60 (26.4%). We recorded pancreas divisum in 24/321 (7.5%). ERP failed in 20 (6.2%). Three were managed medically (1.3%), 5 with distal pancreatectomy (2.2%), 4 with lateral pancreatico jejunostomy (1.8%), and 8 with transmural drainage (3.5%). Conclusion: PD rupture in chronic pancreatitis can be managed transpapillary, without any contrast during ERP. In majority, endosonography aspiration and transmural drainage are needed only when transpapillary fails. Leak from tail responded better than those from proximal duct with ERP.
Novel pre-peroral endoscopic myotomy preparation for esophageal clearance: Simple yet effective!
Pankaj N. Desai,Chintan N. Patel,Mayank V. Kabrawala,Rajiv M. Mehta,Subhash K. Nandwani,Ritesh M. Prajapati,Nisharg B. Patel,Krishna K. Parekh 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.1
Background: Having a clean esophagus is an integral part of the peroral endoscopic myotomy (POEM) procedure for ensuring safety and success. Conventional preparation is a tricky, because there is no defined definite timeline of fasting for the different types of achalasia. The present study introduces a simple yet effective preparation of esophageal clearance. Methods: All patients who underwent POEM were included. Patients were stratified in novel and conventional preparation groups by a random selection. In the novel preparation, the cases were maintained on lukewarm water and carbonated drink followed by nil per oral (NPO) prior to the procedure. In conventional preparation, the controls were maintained on clear liquid followed by NPO. Success rate of preparation and procedure related outcomes were compared using independent t tests and chi-squared tests. Results: A total of 150 patients (male 54.0%; mean age 41.2 ± 15.5 years) were included in the study. Known baseline and clinical factors which could affect esophageal clearance were evenly distributed between the two groups. Novel preparation had provided absolute esophageal clearance (97.3%) without the requirement of pre-POEM endoscopic cleaning. Moreover, Novel preparation demonstrates several advantages over the conventional preparation: decreased anesthesia aspiration risk (P < 0.0001), reduced preoperative hospitalization (P < 0.0001), and hospital stays (P < 0.005). Conclusion: Evidently, the novel preparation is very simple, efficient, safe and appropriate for all types of achalasia. Moreover, novel preparation provides absolute esophageal clearance without requiring prolonged period of liquid diet, fasting and pre-POEM endoscopic cleaning.