Bobby V.M. Dasari

Primary hepatocellular carcinoma of the pancreas: a case report and review of the heterogeneous group of pancreatic hepatoid carcinomas

Paul J Kelly, Robert Spence, Bobby V Dasari, Alastair D Burt, Mark Taylor, Maurice B Loughrey

Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: Systematic review

BACKGROUND Obese patients with general surgical emergencies provide unique challenges to the emergency surgical teams. Acute appendicitis is the most common adult acute surgical emergency encountered in practice. This systematic review evaluates the role of laparoscopic appendicectomy in obese by comparing the outcomes of laparoscopic appendicectomy in obese versus non-obese and the laparoscopic versus open appendicectomy in obese patients. METHODS Relevant comparative studies were identified from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PubMed (1990-2013). Primary outcomes evaluated were mortality, overall morbidity and duration of surgery. Secondary outcomes evaluated were superficial (superficial wound infection) and deep surgical site infection (intra-abdominal abscesses), conversion to open surgery, and cost of the procedure. RESULTS Seven retrospective cohort studies and one prospective randomized controlled trial met the inclusion criteria. There was no statistically significant difference in the primary and secondary outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy. Laparoscopic appendicectomy in obese patients is associated with reduced mortality (risk ratio [RR]: 0.19 (95% CI 0.12-0.30), reduced overall morbidity (RR: 0.49 (95% CI: 0.47-0.51)), reduced superficial wound infections (RR: 0.27 (95% CI 0.21-0.35)), shorter operating times and post-operative length of hospital stay, compared to open appendicectomy. Methodological quality of the included studies is low. CONCLUSION Laparoscopic appendicectomy appears to be a safer alternative approach to open surgery in obese adult patents. There is no significant difference in the outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy.

Immunosuppression in patients with Crohn's disease and neoplasia: an ongoing clinical dilemma.

DISEASES OF THE COLON & RECTUM VOLUME 55: 9 (2012) Thiopurines have been shown to induce remission in approximately 50% of patients and maintain remission in about 70% of patients with IBD. In a recent Cochrane Review, a response rate of 54% was reported with the use of azathioprine (AZT) or 6-mercaptopurine (6-MP) in patients with Crohn’s disease (CD). The pooled odds ratio for response to AZT or 6-MP was 2.43 (95% CI 1.62–3.64). The odds ratio for maintenance of remission with AZT was 2.32 (95% CI 1.55–3.49). However, thiopurines have been implicated in the development of malignancy while patients are on these immunosuppressants. This often leads to a dilemma as to the role of thiopurines in patients who have a past history of malignancy or who develop malignancy while on treatment. There are no specific guidelines as to whether or not immunosuppressants should be stopped in these patient groups and, if so, for how long.

Overview of pancreatic resections: postoperative management

British Journal of Hospital Medicine, April 2015, Vol 76, No 4