Anjilivelil Joseph

Clinical profile and outcome of chronic pancreatitis in children.

ObjectiveTo evaluate the etiology, presentation, complications and management of chronic pancreatitis in children.DesignRetrospective chart review.SettingGastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010.Participants99 Children (<18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features.Main outcome measuresEtiology, clinical presentation, complications and management of chronic pancreatitis in children.ResultsOf 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27 %) had pain relief. There was no death.ConclusionsIdiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.

Aetiology of paediatric portal hypertension - experience of a tertiary care centre in South India.

The aetiological profile of paediatric portal hypertension in our hospital, a tertiary care centre in South India, showed that the commonest causes were extrahepatic portal venous obstruction (EHPVO) and cirrhosis. Wilsons disease was the most common cause of cirrhosis.

Endoscopic ultrasonography--a sensitive tool in the preoperative localization of insulinoma.

OBJECTIVE A number of imaging modalities have been used in the preoperative localization of insulinomas. Computed tomography (CT) is the most commonly employed modality. Endoscopic ultrasound (EUS) allows the transducer to be placed in close proximity to the pancreas, thereby yielding higher quality images, which facilitates accurate localization, minimally invasive surgery, and a lower occurrence of residual tumors, all of which contribute to a better clinical outcome. METHODS We analyzed the hospital records of all adult patients (age >18 years) diagnosed with insulinoma between October 2004 and September 2010. The diagnosis was based on the clinical practice guidelines of the American Endocrine Society. We compared the sensitivities of EUS and multidetector computed tomography (MDCT) in lesion. RESULTS Eighteen patients were seen over a period of 6 years, and all underwent EUS. MDCT scans were carried out in 17 patients. EUS had greater sensitivity (89%) in localizing insulinomas compared to CT (69%). In this series, the lesions that were missed on CT but picked up on EUS were smaller (<12 mm, P<.001). Lesions that were near mesenteric vessels and those located in the head of the pancreas were more likely to be missed on CT. CONCLUSIONS EUS has a greater sensitivity in identifying and localizing insulinomas. As availability increases, EUS should be part of a preoperative insulinoma workup.

Acute pancreatitis and hyperparathyroidism: A case series

Primary hyperparathyroidism is a rare cause of acute pancreatitis. Five consecutive patients with acute or recurrent acute pancreatitis and primary hyperparathyroidism were included. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Both ultrasonography and Sestamibi scan was used to localize parathyroid adenoma. Except for one, all patients underwent parathyroidectomy and postoperative histology was consistent with parathyroid adenoma. One patient died while on treatment. Metabolic causes of acute pancreatitits, though uncommon, are important as early recognition helps management and prevents recurrence.

Duodenal villous morphology assessed using magnification narrow band imaging correlates well with histology in patients with suspected malabsorption syndrome

Narrow band imaging with magnification enables detailed assessment of duodenal villi and may be useful in predicting the presence of villous atrophy or normal villi. We aimed to assess the morphology of duodenal villi using magnification narrow band imaging and correlate it with histology findings in patients with clinically suspected malabsorption syndrome.

Cyclosporine in steroid refractory acute severe colitis.

This is a pilot study to test the hypothesis that polymorphisms that may be linked to cyclooxygenase production may affect the likelihood and the nature of bleeding in patients with ulcer disease. Of the two polymorphism that have previously been studied for links we chose the A842G polymorphims. Of the 50 patients with ulcer bleeding who were studied, 8 had a heterozygous polymorphisms and 42 had the normal configuration. On comparing these two groups. there were no significant differences in clinical presentation except that there was a tendency to have less gastric ulcers among those with the A842G/C50T polymorphism. Based on these studies we need to undertake a larger studies comparing these groups with those with ulcers without GI bleeding and those without ulcers

Squamous papilloma of esophagus

Esophageal papillomas are rare benign epithelial lesions, occurring in 0.01 % to 0.45 % of people undergoing endoscopy [1]. These are more common in middle-aged men. Proposed possible etiologies are chronicmucosal irritation (due to gastroesophageal reflux, smoking, alcohol, chronic food impaction, caustic injury, and mechanical irritants like nasogastric tubes or post bougie assisted esophageal dilatation) and infection with human papilloma virus. Esophageal papillomas are generally single, but multiple lesions have been described [2]. Shown here is a lesion from a 36-year-old lady with dyspepsia without alarm symptoms. White light examination showed small, white-pink, warty exophytic projections in mid esophagus (Fig. 1). On narrow band imaging, the lesion appeared as papillary projections of mucosa without dilated microvessels (Fig. 2). Histopathology confirmed the diagnosis of squamous cell papilloma.

A gastric submucosal mass

A 42-year-old male was referred with epigastric pain of insidious onset, progressive over a duration of 3 months. Pain was non-radiating, continuous, with no specific aggravating or relieving factors. There was no loss of appetite or loss of weight. …

Plasma Citrulline, Glycans, and Hydrogen Sulfide in Patients With Acute Pancreatitis: Possible Markers of Intestinal Damage.

diagnosis of concurrent AIP and pancreatic cancer. The accuracy of endoscopic ultrasound FNA biopsy is far from perfect for cancer, often due to inadequate biopsy specimens with FNA as well as inflammation and fibrosis surrounding the cancer. In conclusion, we report not only a rare case of multifocal mass-forming AIP mimicking pancreatic cancer, but also the diagnosis being made from a strongly suggestive ampullary biopsy in conjunction with other features delineated by the ICDC.

Plasma hydrogen sulphide does not predict severity of acute pancreatitis in humans.

The primary aim of this study was to assess the usefulness of plasma hydrogen sulphide (H2S) level at admission as a predictor of severity of acute pancreatitis. The secondary aims were to examine whether the level of H2S after 48 h correlated with severity and whether level of H2S correlated with pulmonary, renal or infectious complications. Plasma hydrogen sulphide was measured within 24 h of admission and 48 h later, in patients with acute pancreatitis. Patients were classified as having mild or severe pancreatitis, and H2S levels in the two groups were compared. A total of 55 patients had H2S estimation carried out within 24 h of admission. H2S levels were similar in patients with mild (mean 31.8 ± 18.8, range 7.1 to 81.4 µmol/L) and severe pancreatitis (mean 28.2 ± 21.6, range 6.1 to 74.4 µmol/L; p = 0.339). There was no difference found between the groups after 48 h (mild n = 28, mean 26.8 ± 19.4 µmol/L, and severe n = 20, mean 34.6 ± 21.0 µmol/L; p = 0.127). There was also no difference in the levels between patients with or without lung injury, kidney injury or sepsis. Performing H2S estimation to predict severity in acute pancreatitis is not beneficial.