Javid Iqbal

CA 19-9 as a serum marker in urothelial carcinoma.

Introduction: CA 19-9 is a carbohydrate antigen related to Lewis A blood group antigen. It is well-known marker for pancreatic carcinoma and is being investigated for other malignancies including carcinoma bladder. We evaluated the role of serum CA 19-9 as a tumor marker and correlated its level with tumor stage and grade. Materials and Methods: Seventy-five patients with histologically proven urothelial carcinoma were included in this study as case and 25 healthy volunteers as control. Preoperative 5 ml blood sample was collected. Serum level of CA 19-9 was measured using solid-phase enzyme-linked immunosorbent assay kit. The value of CA19-9 was expressed in U/ml and 37 U/ml was taken as cut-off upper value of normal. Results: The range of CA19-9 in patients of urothelial carcinoma was 2 to 122 U/ml with a mean of 26.33±29.28, while in control, it was 8.48±5.01 U/ml (P<0.001). The sensitivity of CA19-9 was 29%. Serum CA19-9 was significantly elevated in invasive disease in comparison with superficial disease (47.17±34.43 vs 16.53±20.13) (P<0.001). Significantly high proportion of patients with invasive disease had value ≥37 U/ml (14/24 [58.3%] vs 8/51 [15.7%]) with P value <0.001. High proportion of high-grade tumor had raised value, 14/34 (41.25%); all patients with metastatic disease had value more than 37 U/ml. Conclusions: Serum CA19-9 is a marker of aggressiveness of urothelial carcinoma and is almost invariably raised in patients with metastatic disease. Thus, it may be used as a prognostic marker but not as a screening tool due to its low sensitivity.

Sclerosing Encapsulating Peritonitis: Complication of Laparoscopic Cholecystectomy

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction. It is difficult to make a definite preoperative diagnosis, and most cases are diagnosed at the time of laparotomy. It is usually of unknown origin, although, at times, it may be seen secondary to a variety of conditions. Spillage of bile and gallstones at laparoscopic cholecystectomy is an unusual cause of SEP and has not been reported in literature, to date. Contrast-enhanced computed tomography of the abdomen revealed small-bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle with loculated fluid in the interloop bowel location. Excision of the sac and adhesiolysis was done in our patient for recurrent episodes of intestinal obstruction, who recovered well in the postoperative period.

Day Care Laparoscopic Cholecystectomy: Next Standard of Care for Gall Stone Disease

Background To access the feasibility, safety and success of day care laparoscopic cholecystectomy in a tertiary center in India. Methods This is a retrospective analysis of prospectively collected data between 2004 and 2009 from a tertiary center in north India. All patients of symptomatic gallstone diseases having age less than 70 years, American Society of Anesthesiologists (ASA) grade I and grade II, living within 20 Kilometers of the hospital, availability of a responsible adult care taker at home, access to a telephone and a means of transportation to hospital if needed, underwent laparoscopic cholecystectomy under the care of the two participating surgeons, were considered for day care laparoscopic cholecystectomy. Clinical and operative data were recorded prospectively. All patients were discharged 6 to 8 hours after surgery with the advice to contact the surgical team over phone whenever necessary or on the day after discharge. Results A total of 602 laparoscopic cholecystectomies were performed over a period of 6years, among them 309 (51.32%) were operated on day care basis. Nine patients in day care procedure group had conversion to open procedure (5 due to distorted anatomy of calot’s triangle, 2 due to common bile duct stones, 1 due to bile duct injury and 1 due to bleeding from cystic artery stump). One patient had myocardial infarction and 3 had nausea and vomiting which failed to resolve by intravenous ondensteron and all these (13) patients (4.20%) needed unplanned admission to the hospital. Two hundred and ninety-six patients (95.79%) were discharged on same day. Conclusions In conclusion day care laparoscopic cholecystectomy is feasible, safe and equally effective in selected patients in Indian setup.