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| 1 | Pathological abnormalities in splenic vasculature in non-cirrhotic portal hypertension:Its relevance in the management of portal hypertension显示文摘BACKGROUND Portal hypertension(PH)is associated with changes in vascular structure and function of the portosplenomesenteric system(PSMS).This is referred to as portal hypertensive vasculopathy.Pathological abnormalities of PSMS has been described in the literature for cirrhotic patients.Raised portal pressure and hyperdynamic circulation are thought to be the underlying cause of this vasculopathy.In view of this,it is expected that pathological changes in splenic and portal vein similar to those reported in cirrhotic patients with PH may also be present in patients with non-cirrhotic PH(NCPH).AIM To investigate pathological abnormalities of splenic vein in patients with NCPH,and suggest its possible implications in the management of PH.METHODS A prospective observational study was performed on 116 patients with NCPH[Extrahepatic portal vein obstruction(EHPVO):53 and non-cirrhotic portal fibrosis(NCPF):63]who underwent proximal splenorenal shunt(PSRS),interposition shunt or splenectomy with devascularization in JIPMER,Pondicherry,India,a tertiary level referral center,between 2011-2016.All patients were evaluated by Doppler study of PSMS,computed tomography portovenogram and upper gastrointestinal endoscopy.An acoustic resonance forced impulse(ARFI)scan and abdomen ultrasound were done for all cases to exclude cirrhosis.Intraoperative and histopathological assessment of the harvested splenic vein was performed in all.The study group was divided into delayed and early presentation based on the median duration of symptoms(i.e.108 mo).RESULTS The study group comprising of 116 patients[77(66%)females and 39(34%)males]with NCPH had a median age of 22 years.Median duration of symptoms was 108 mo.The most common presentation in both EHPVO and NCPF patients was upper gastrointestinal bleeding(hematemesis and melena).The ARFI scan revealed a median score of 1.2(1.0-1.8)m/s for EHPVO and 1.5(0.9-2.8)m/s for NCPF.PSRS was performed in 84 patients(two of whom underwent interposition PSRS using a 10 mm Dacron graft);splenoadrenal shunt in 9;interposition mesocaval shunt in 5;interposition 1st jejunal to caval shunt in 1 patient and devascularization with splenectomy in 17 patients.Median presplenectomy portal pressure was 25(range:15-51)mm Hg.In 77%cases,the splenic vein was abnormal upon intraoperative assessment.Under macroscopic examination,wall thickening was observed in 108(93%),venous thrombosis in 32(28%)and vein wall calcification in 27(23%)cases.Upon examination under a surgical magnification loupe,21(18%)patients had intimal defects in the splenic vein.Histopathological examination of veins was abnormal in all cases.Medial hypertrophy was noted in nearly all patients(107/116),while intimal fibrosis was seen in 30%.Ninety one percent of patients with intimal fibrosis also had venous thrombosis.Vein wall calcification was found in 22%,all of whom had intimal fibrosis and venous thrombosis.The proportion of patients with pathological abnormalities in the splenic vein were significantly greater in the delayed presentation group as compared to the early presentation group.CONCLUSION Pathological changes in the splenic vein similar to those in cirrhotic patients with PH are noted in NCPH.We recommend that PH in NCPH be treated as systemic and pulmonary hypertension equivalent in the gastrointestinal tract,and that early aggressive therapy be initiated to reduce portal pressure and hemodynamic stress to avoid potential lethal effects. | Shahana Gupta Biju Pottakkat Surendra Kumar Verma Raja Kalayarasan Sandip Chandrasekar A Ajith Ananthakrishna Pillai | 2020 | World Journal of Gastrointestinal Surgery2020，12，1： | 3 |
| 2 | Non-operative management of pancreatic trauma in adults显示文摘To the Editor:Pancreatic trauma accounts for 0.4%-2.0%of all trauma-related injuries worldwide[1-3].The American Association for the Surgery of Trauma(AAST)categorizes pancreatic injury according to the severity[4].Pancreatic injury involving transection of the gland(grades III to V)typically requires surgical management[4].However,pancreatic trauma,especially in children and young adults,can be managed without surgery[5].This study reports the outcome of a policy of preferential non-operative management of pancreatic trauma in adults. | Nadia Matias a Santhalingam Jegatheeswaran a Vinotha Nadarajah Aali J.Sheen Saurabh Jamdar Ajith K.Siriwardena | 2020 | Hepatobiliary & Pancreatic Diseases International2020，19，6： | 3 |
| 3 | Co-supplementation of single and multi doses of vitamins C and E ameliorates cisplatin- induced acute renal failure in mice显示文摘 | AJITH T A ABHISHEK G ROSHNY D | 2009 | Experimental and Toxicologic Pathology2009，61，6： | 1 |
| 4 | Anurnutagenic effect of Phellinus rimosus (Berk) Pilat against chemical induced mutations of histidine dependent Salmonella typhimurium strains显示文摘 | Ajith T A Janardhanan K K | 2011 | Food and Chemical Toxicology2011，49，10： | 1 |
| 5 | A Strategic Framework to Eco-Regionalize Ontario显示文摘 | Ajith H P James A B Lawrence E B | 1996 | Environmental Monitoring and Assessment1996，39，： | 1 |
| 6 | Chaotic dynamic characteristics in swarm intelligence显示文摘 | Liu H B Ajith A Maurice C | 2007 | Applied Soft Computing2007，7，3： | 1 |
| 7 | Antipemxidative, anti-inflammatory, and antimutagenic activities of ethanol extract of the Mycelium of Ganoderma lucidum occurring in south india 显示文摘 | Lakshmi B Ajith T A Sheena N | 2003 | Teratogenesis Carcinogenesis and Mutagenesis Supplement2003，1，： | 1 |
| 8 | A hybrid genetic algorithm and bacterial foraging approach for global optimization显示文摘 | Dong H K Ajith A Jae H C | 2007 | Information Sciences2007，177，2： | 1 |
| 9 | A hybrid genetic aIgorithm and bacterial foraging approach for global optimization显示文摘 | Dong H K Ajith A Jae H C | 2007 | Information Sciences2007，，177： | 1 |
| 10 | Automatic clustering using an impoved differential evolutionary algorithm显示文摘 | Swagatam D Ajith A | 2008 | IEEE Trans on Systems Man and Cybemelics2008，38，1： | 1 |
| 11 | Hybrid differential arti- ficial bee colony algorithm 显示文摘 | Abraham Ajith Jatoth R K Rajasekhar A | 2012 | Computational and Theoretical Nanoscience2012，，9： | 1 |
| 12 | Antimutagenic effect of Phellinus rimosus (Berk) Pilat against chemical induced mutations of histidine dependent Salmonella typhimurium strains显示文摘 | Ajith T A Janardhanan K K | 2011 | Food Chem Toxicol2011，49，10： | 1 |
| 13 | Themedicinal cracked-cap polypore mushroom Phellinus rimosus (higher Basidiomycetes)attenuates alloxan-induced hyperglycemia and oxidative stress in rats显示文摘 | Kuttikkadan A Rony Thekkuttuparambil A Ajith John Mathew | 2013 | Internationaljournal of medicinal mushrooms2013，15，3： | 1 |
| 14 | Cytotoxic and antiumor activities of a polypore macrofungus,Phellinus rimosus (Berk ) Pilat 显示文摘 | Ajith T A Janardhanan K K | 2003 | Journal of Ethnopharmacology2003，84，2： | 1 |
| 15 | Discovering stock price prediction rules using rough sets 显示文摘 | Hameed A Q Aboul E H Ajith Abraham | 2008 | Neural Network World Journal2008，18，3： | 1 |
| 16 | Modeling intrusion detection system using hybrid intelligent systems显示文摘 | Sandhya P Ajith A Crina G | 2005 | Computers & Security2005，，30： | 1 |
| 17 | A hybrid genetic algorithm and bacterial foraging approach for global optimization显示文摘 | Dong H Ajith A Jae H | 2007 | Information Sciences2007，177，18： | 1 |
| 18 | Cytotoxic and antitumor activities of a polypore macrofungus,Phellinus rimosus(Berk) Pilat显示文摘 | Ajith A Janardhanan K K | 2003 | J Ethnopharmacol2003，84，2： | 1 |
| 19 | Antimutagenic activity of methanolic extract of Ganoderma lucidum and its effect on he- patic damage caused by benzo pyrene 显示文摘 | Lakshmi B Ajith T A Nayana J | 2006 | J Ethnopharma- co2006，107，2： | 1 |
| 20 | Antiperoxidative,anti-inflammatory and antimutagenic activities of ethanol extract of the Mycelium of Ganoderma lucidum occurring in south india显示文摘 | Lakshmi B Ajith T A Sheena N | | 0，，01： | 1 |
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