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Rahul,Kulbhushan Haldeniya,Ashish Singh,Neha Bhatt,Prabhakar Mishra,Rajneesh Kumar Singh,Rajan Saxena 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4
Backgrounds/Aims: Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus. Methods: A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC. Results: Twenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05). Conclusions: Asymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.
A Universal Craniometric Index for Establishing the Diagnosis of Basilar Invagination
Jayesh Sardhara,Sanjay Behari,Suyash Singh,Arun K. Srivastava,Gaurav Chauhan,Hira Lal,Kuntal K. Das,Kamlesh Singh Bhaisora,Anant Mehrotra,Prabhakar Mishra,Awadhesh K. Jaiswal 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: The conventional criteria for defining the basilar invagination (BI) focus on the relationship of odontoid tip to basion and opisthion, landmarks that are intrinsically variable especially in presence of occipitalised atlas. A universal single reference line is proposed that helps in unequivocally establishing the diagnosis of BI, may be relevant in establishing both Goel types A and B BI, as well as in differentiating a ‘very high’ from ‘regular’ BI. Methods: Study design – case-control study. In 268 patients (group I with BI [n=89] including Goel type A BI [n=66], Goel type B BI [n=23], and group II controls [n=179]), the perpendicular distance between odontoid tip and line subtended between posterior tip of hard palate-internal occipital protuberance (P-IOP line) was measured. Logistic regression analysis determined factors influencing the proposed parameter (p<0.05). Results: In patients with a ‘very high’ BI (n=5), the odontoid tip intersected/or was above the P-IOP line. In patients with a ‘regular’ BI (n=84), the odontoid tip was 6.56±3.9mm below the P-IOP line; while in controls, this distance was 12.53±4.28 mm (p<0.01). In Goel type A BI, the distance was 7.01±3.78 mm and in type B BI, it was 5.07±4.19 mm (p=0.004). Receiver-operating characteristic curve analysis identified 9.0 mm (8.92–9.15 mm) as the cut-point for diagnosing BI using the odontoid tip-P-IOP line distance as reference. Conclusion: The odontoid tip either intersecting the P-IOP line (very high BI) or being <9 mm below the P-IOP line (Goel types A and B BI) is recommended as highly applicable criteria to establish the diagnosis of BI. This parameter may be useful in establishing the diagnosis in all varieties of BI.