Nimish Shah

Clinical profile and management of tuberculous bronchoesophageal fistula

Background and Objectives: Tracheoesophageal/bronchoesophageal fistula is a rare clinical condition, and occurs due to a variety of disease processes. This report describes the clinical profile, management, and outcome of bronchoesophageal fistulas due to tuberculosis in five patients. Patients and Methods: Patients diagnosed with esophageal tuberculosis over the last eight years were included. Details regarding the demographics, symptomatology, barium swallow, upper GI endoscopy, with biopsy and high resolution computed tomography of the chest were recorded for patients with tracheoesophageal fistula. The diagnosis was confirmed by acid fast bacilli (AFB) positive fluid aspirate/brush cytology from the fistula, lymph node biopsy showing caseous necrosis or AFB bacillus and tissue tuberculosis culture and polymerase chain reaction (PCR). Results: There were five patients (four males and one female) with a mean age of 43.8 ± 17 years (range, 17 to 59 years). The mean duration of symptoms was 38 ± 7 days. The most common symptom was coughing on swallowing followed by dysphagia. Two patients had concomitant pulmonary tuberculosis; two had human immunodeficiency virus (HIV) infection, and one was a post-renal transplant. The diagnosis of tuberculosis was established in all five patients with esophageal cytology, lymph node biopsy, and tissue tuberculosis PCR. All the patients were successfully treated with a combination of antituberculous drugs (five patients), glue application on fistula (one patient), Percutaneous endoscopic gastrostomy (PEG) tube insertion (three patients), and surgery (one patient). [TAG:2]Conclusions[/TAG:2] : Tuberculous bronchoesophageal fistula is a rare complication and can be successfully managed predominatly with a combination of antituberculous treatment, PEG tube placement, and rarely surgery.

Tu1048 Coagulopathy in Cirrhosis a Prospective Study to Correlate Conventional Tests of Coagulation and Bleeding Following Invasive Procedures in Cirrhotics

BACKGROUND Conventional tests of coagulation which only measure procoagulant factors do not correctly estimate the actual in vivo hemostatic balance in cirrhosis. This prospective multicenter study was conducted to evaluate safety of various invasive procedures in the presence of abnormal coagulation tests and to correlate conventional coagulation parameters with clinically significant bleeding in cirrhotics. METHODS Three hundred and eighty patients (median age 54 years, 287 males) enrolled in the study were divided into two groups (A and B), according to the presence or absence of abnormal coagulation parameters (defined as INR ≥1.5 and/or platelet count ≤50,000/cum). RESULTS One hundred and twenty-eight patients (33.68%) were qualified in group A. Alcohol was the predominant etiology of cirrhosis (40% and 32% in groups A and B, respectively). The two groups were similar in baseline characteristics other than tests of coagulation and severity of liver disease. Low risk procedures (abdominal paracentesis most common) were carried out in 47% and 53% patients in two groups, respectively. None of the patients in either group had clinically significant bleeding. Similarly, high risk procedures (central vein cannulation, liver biopsy, etc.) were carried out in 14% and 10%, respectively, in two groups. Three patients in group A developed clinically significant bleeding, however, the difference was statistically nonsignificant (p=0.061). None of our patients received periprocedural correction of abnormal coagulation parameters with plasma/platelet concentrate. CONCLUSIONS Deranged conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis. Whenever indicated, any invasive procedure could be safely carried out in patients with cirrhosis without prior correction of coagulation abnormalities.

Cutaneous metastasis in esophageal squamous cell carcinoma

Cutaneous metastasis from internal malignancies are common in breast cancer, pulmonary malignancies and melanomas. The primary site of metastases has been reported to the chest and abdomen. We are hereby reporting rare case of cutaneous metastasis in esophageal cancer.

Cystic lesion of pancreas - Intraductal papillary mucinous neoplasm

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an intraductal mucin-producing epithelial neoplasm that arises from the main and/or branched pancreatic duct. It usually presents as cystic lesion of pancreas. There are well known differential diagnosis of cystic pancreatic lesion. Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use of abdominal imaging. The diagnosis and treatment of intraductal papillary mucinous tumors (IPMN) of the pancreas has evolved over the past decade. IPMN represents a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. Definitive management is surgical resection for appropriate candidates, as benign lesions harbor malignant potential. IPMN has a prognosis, which is different from adenocarcinoma of the pancreas. We report a case of a 58-year-old male with intraductal papillary neoplasm involving main duct and side branches presenting to us with clinical symptoms of chronic pancreatitis with obstructive jaundice and cholangitis treated surgically.