Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter

( Abhijit Chandra ),( Uday C Ghoshal ),( Vishal Gupta ),( Ramendra Jauhari ),( Rajendra N Srivastava ),( Asha Misra ),( Ashok Kumar ) 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.3

Background/Aims Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. Methods Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. Results The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. Conclusions The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity. (J Neurogastroenterol Motil 2012;18:269-277)

Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction

Abhijit Chandra,Ashok Kumar,M Noushif,Nitish Gupta,Vijay Kumar,Navneet Kumar Chauhan,Vishal Gupta 대한대장항문학회 2013 Annals of Coloproctolgy Vol.29 No.1

Purpose: Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers. Methods: The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis. Results: The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o’clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied. Conclusion: An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.

Five new species of the genus Sphaeromias Curtis (Diptera: Ceratopogonidae) from India

Narayan Chandra Saha Abhijit Mazumdar,Prasanta Kumar Chaudhuri 한국응용곤충학회 2009 Journal of Asia-Pacific Entomology Vol.12 No.4

Five new Indian species, Sphaeromias lineus, S.ornatipes, S.prominens, S. similineus and S.verbosus are described. There are 7 recorded in India before this investigation. With these, the number of world species of the genus is raised from 27 to 32 including 12 from India. Five new Indian species, Sphaeromias lineus, S.ornatipes, S.prominens, S. similineus and S.verbosus are described. There are 7 recorded in India before this investigation. With these, the number of world species of the genus is raised from 27 to 32 including 12 from India.

Descriptive Epidemiology of Common Female Cancers in the North East India - a Hospital Based Study

Krishnatreya, Manigreeva,Kataki, Aamal Chandra,Sharma, Jagannath Dev,Nandy, Pintu,Talukdar, Abhijit,Gogoi, Gayatri,Hoque, Nazmul Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.24

Background: Cancers of the breast, uterine cervix and ovary are common cancers amongst females of North East India. Not much is known about the descriptive epidemiology of these cancers in our population. The present retrospective analysis was therefore performed. Materials and Methods: The data set available at the hospital based cancer registry of a regional cancer center of North-East India, containing information on patients registered during the period of January 2010 to December 2012, was applied. A total of 2,925 cases of breast, uterine cervix and ovarian cancer were identified. Results: Of the total, 1,295 (44.3%) were breast cancers, 1,214 (41.5%) were uterine cervix and 416 (14.2%) ovarian cancer, median age (range) for breast, uterine cervix and ovary were 45 (17-85), 48 (20-91) and 45 years (7-80), respectively. Some 43.5% of cases with uterine cervix patients were illiterate, 5.4% and 5.7% stage I in breast and cervix respectively and 96.4% of ovarian cancers in advanced stage. Conclusions: Improvement of female education can contribute to increase the proportion of early stage diagnosis of breast and uterine cervix in our population. Any population-based intervention for the detection of cancers of breast, uterine cervix and ovarian cancer should be started early in our population.

Elevated Expression of Maspin mRNA as a Predictor of Survival in Stage II and III Gallbladder Cancer Cases

Baghel, Kavita,Kazmi, Hasan Raza,Raj, Saloni,Chandra, Abhijit,Srivastava, Rajeshwar Nath Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.1

Background: Maspin expression is a potential prognostic factor for various malignancies but its relation with gallbladder cancer is unknown and needs to be investigated needs to be investigated. We therefore here focused on maspin mRNA expression in normal, gall stone disease and gallbladder cancer subjects, with particular attention to prognostic importance in individuals with malignancies. Materials and Methods: This study was carried out at the Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India. Gallbladder samples from normal (n=25), gall stone disease (n=25) and cancer patients (n=38) were analysed for maspin mRNA expression by semi-quantitative reverse transcriptase PCR and quantitative real time PCR. Statistical analysis was carried out using the Students t test or ANOVA. Survival analysis was conducted according to the Kaplan-Meier method and correlations were assessed using the Pearson correlation method. p<0.05 was considered statistically significant. Results: Significant increase (p=0.028) in expression of maspin mRNA was observed in gallbladder cancer as compared to gall stone disease, whereas no expression was found in normal tissues. Significant correlation (Pearson's coefficient(r)=-0.798, p<0.0001) was observed between relative quantification of maspin mRNA and survival of cancer patients after surgery, with significantly shorter (p=0.002) survival in patients having relative quantification >1.5 as compared to those having relative quantification <1.5. Similarly, significant differences in patient survival for maspin mRNA expression was observed for stage II (p=0.025) and III (p=0.011) cancer. Conclusions: Higher expression of maspin mRNA in gallbladder cancer has prognostic significance for stage II and III cancer, which needs to be investigated further.

Complex Obstetric Perineal Injury Reconstruction Using Antropyloric Valve Transposition

Saket Kumar,Noushif Medappil,Sunil Kumar Singh,Abhijit Chandra 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.1

Despite significant advancements in the field of medicine, management of complex obstetric perineal injuries remains a challenge. Although several surgical techniques have been described, no techniques have provided satisfactory long-term results. Recently, a perineal transposed antropyloric valve has been used for anorectal reconstruction in patients with damaged or excised anal sphincters. We describe this technique in the case of complex obstetric perineal trauma with extensive tissue loss, presenting with end stage fecal incontinence. The functional outcome after this procedure was evaluated. The patient tolerated the surgery well, and there were no procedure-related upper gastrointestinal disturbances. Short-term functional outcomes were encouraging. At the 36-month follow-up, the patient’s neoanal resting and squeeze pressures were 50 and 70 mmHg, respectively. The postoperative St. Mark’s incontinence score was 7. Perineal antropyloric valve transposition is feasible and can be successfully applied in the management of end-stage fecal incontinence associated with complex obstetric perineal injury.

Non-exhaust particulate pollution in Asian countries: A comprehensive review of sources, composition, and health effects

Anamika Roy,Mamun Mandal,Sujit Das,Manoj Kumar,Robert Popek,Amit Awasthi,Balendu Shekher Giri,Kartick Chandra Mondal,Abhijit Sarkar 대한환경공학회 2023 Environmental Engineering Research Vol.29 No.3

Recent regulations on exhaust emissions have led to an increase in non-exhaust emissions, which now surpasses exhaust emissions. Non-exhaust emissions are mainly generated from brake and tire particle abrasion, road wear, and re-suspended road dust. In Asia, non-exhaust emissions have increased significantly over the past 50 years, resulting in almost 92% of the population breathing polluted air, which accounts for 70% of air pollution related-deaths. Most Asian countries with poor air quality are developing or underdeveloped. Taking this into consideration, the current study aims to shed light on particulate pollution from non-exhaust emissions in the Asian context to assess the current status and its health consequences and provides technological solutions. The study is based on an in-depth analysis of existing reviews and research concerning non-exhaust emissions and their health impacts in Asia to pinpoint knowledge gaps. The study found that particulate pollutants had exceeded WHOs standards in many Asian countries, bringing deleterious health consequences among children and the elderly. The findings underscore the significance of future researchers efforts to devise solutions that curtail non-exhaust emissions, ultimately reducing air pollution, augmenting air quality, fostering better health outcomes, and paving way for a more sustainable future before it is too late.