Does Increasing Experience Improve Outcomes of Surgical ‘Step-Up Approach’ in Acute Necrotizing Pancreatitis? Lessons Learnt from a Tertiary Referral Center

( Rajesh Gupta ),( Aditya Atul Kulkarni ),( Rahul Gupta ),( Sunil Shenvi ),( Tanvi Jain ),( Raghavendra Babu ),( Mandeep Kang ),( Surinder Rana ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Step-up approach is becoming a standard of care for management of acute necrotizing pancreatitis. We aimed to investigate the learning curve effect and increasing experience on management and outcomes of surgical step-up approach at our high-volume tertiary referral center. Methods: In a retrospective analysis of database of patients with acute necrotizing pancreatitis referred to our unit, we divided patients into three distinct time periods: Group-1 (2008-2012), Group-2 (2013-2016) and Group-3 (2017-2019). Outcomes between different time periods were compared. Results: Total of 335 patients were included, with 92 patients in Group-1, 117 in Group-2 and 126 in Group-3. Patients treated on surgical side in later time period had higher incidence of multiorgan failure (26.1% vs. 49.6% vs. 45.2%, P<0.001), APACHE II scores at presentation (8 vs. 10 vs. 9, P=0.006) and at first intervention (9 vs. 11 vs. 10, P=0.037), as well higher mCTSI score (8 vs. 10 vs. 10, P<0.001). Over time, median percutaneous drain size (10Fr vs. 12Fr vs. 14 Fr, P<0.001) as well as sepsis reversal after drainage (40.2% vs. 59% vs. 49.2%, P=0.026) increased, whereas median number of drains (P=0.001) and interventions (4 vs. 3 vs. 3, P=0.005) decreased significantly. Necrosectomy requirement, length of stay and mortality remained similar over time despite more severe cases referred to surgical side. Conclusions: With increasing experience of step-up approach, sicker patients with higher severity of pancreatitis could be managed successfully with fewer drains and procedures leading to significantly higher sepsis reversal with drainage, with no increase in surgery requirement or mortality.

Fibrolamellar variant of hepatocellular carcinoma presenting during pregnancy

Nagalapuram Vishnu,Aditya V Kulkarni,Sreenivasan Vidhyalakshmi,Swaminathan Sambandam,Prerna Garg,Venkatakrishnan LeelaKrishnan,Krishnaveni Janarthan,Gursharan Singh,Maninder Kaur,TV Chitra,Biku Joseph 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.1

The Fibrolamellar variant of Hepatocellular Carcinoma (FLHCC) is a rare form of liver cancer that presents in the 3<SUP>rd</SUP> decade of life, is rarely associated with cirrhosis or chronic Hepatitis B/C virus infection, and usually presents with normal serum alpha-fetoprotein (AFP) levels. FLHCC presenting during pregnancy is extremely rare, with only 4 cases reported. We present a case of FLHCC in pregnancy and discuss the dilemmas in management. A 26 year-old primigravida, 26 weeks of gestation presented with a month’s history of obstructive jaundice secondary. Investigations revealed a mass in the left lateral segment of the liver with extension down the left hepatic duct into the common bile duct. Following an emergency caesarean section at 31 weeks, she underwent a left hepatectomy with extrahepatic bile duct excision. The postoperative course was uneventful. Histopathology showed FLHCC. In conclusion, liver tumors presenting during pregnancy should be managed in a multidisciplinary setup with facilities for neonatal intensive care. Management depends on the presumed pathology, period of gestation and family preferences.

High-Flexion Posterior-Stabilized Total Knee Prosthesis: Is It Worth the Hype?

( Sanjeev Jain ),( Aditya Chandrashekhar Pathak ),( Kalaivanan Kanniyan ),( Sourabh Kulkarni ),( Sandeep Tawar ),( Prashant Mane ) 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.3

High-flexion knee prosthesis was introduced with the aim of obtaining higher degree of flexion and good survivorship in patients with high functional demands or those requiring squatting, kneeling, etc., which is more common in Asians. Based on all the research and experience with this prosthesis, it was concluded that high flexion designs meet the need of deeper degrees of flexion in selected sets of patients only. Results were equal and comparable to the traditional standard posterior-stabilized total knee arthroplasty design and superior to it in terms of gaining more flexion and fulfilling activities, such as squatting, kneeling, and sitting cross-legged.

Genetic analysis of the postsynaptic transmembrane X-linked neuroligin 3 gene in autism

Hegde, Rajat,Hegde, Smita,Kulkarni, Suyamindra S.,Pandurangi, Aditya,Gai, Pramod B.,Das, Kusal K. Korea Genome Organization 2021 Genomics & informatics Vol.19 No.4

Autism is a complex neurodevelopmental disorder, the prevalence of which has increased drastically in India in recent years. Neuroligin is a type I transmembrane protein that plays a crucial role in synaptogenesis. Alterations in synaptic genes are most commonly implicated in autism and other cognitive disorders. The present study investigated the neuroligin 3 gene in the Indian autistic population by sequencing and in silico pathogenicity prediction of molecular changes. In total, 108 clinically described individuals with autism were included from the North Karnataka region of India, along with 150 age-, sex-, and ethnicity-matched healthy controls. Genomic DNA was extracted from peripheral blood, and exonic regions were sequenced. The functional and structural effects of variants of the neuroligin 3 protein were predicted. One coding sequence variant (a missense variant) and four non-coding variants (two 5'-untranslated region [UTR] variants and two 3'-UTR variants) were recorded. The novel missense variant was found in 25% of the autistic population. The C/C genotype of c.551T>C was significantly more common in autistic children than in controls (p = 0.001), and a significantly increased risk of autism (24.7-fold) was associated with this genotype (p = 0.001). The missense variant showed pathogenic effects and high evolutionary conservation over the functions of the neuroligin 3 protein. In the present study, we reported a novel missense variant, V184A, which causes abnormal neuroligin 3 and was found with high frequency in the Indian autistic population. Therefore, neuroligin is a candidate gene for future molecular investigations and functional analysis in the Indian autistic population.

Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy

Kunal Bikram Deo,Aditya Atul Kulkarni,Praveen Kumar-M,Gautham Krishnamurthy,Sunil Shenvi,Surinder Singh Rana,Rakesh Kapoor,Rajesh Gupta 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2

Backgrounds/Aims: Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear. Methods: This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM. Results: DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and non-diabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years. Conclusions: Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.