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| 1 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 2 | Endoscopic management of acute cholangitis in elderly patients显示文摘AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage. | Naresh Agarwal Barjesh Chander Sharma Shiv K Sarin | 2006 | World Journal of Gastroenterology2006，12，40： | 14 |
| 3 | Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians显示文摘瞄准:与非含酒精的脂肝疾病(NAFLD ) 评估病人的临床、生物化学的侧面并且在表示估计他们的组织学的严厉。方法:介绍给所有印度的肝诊所的连续病人与提起的 transaminases 医学科学(AIIMS ) 开创到乘正常的上面的限制的至少 1.5,并且组织学地证实的非酒精的脂肝疾病被包括。或谁有重要白酒吸入或另外的肝疾病的积极标记的病人正在服知道生产脂肝的药被排除。这个组的临床、生物化学、组织学的侧面被学习。结果:有 NAFLD 的 51 个病人形成了学习人口。他们的中部的年龄和 BMI 是 34 (17-58 ) 年并且 26.7 (21.3-32.5 ) kg/m (2 ) 分别地并且(90.1%) 46 是男性。病人的多数有温和发炎,也分级 1 [32 (63%)] 或等级 2 [16 (31%)] 并且仅仅 3 (6%) 病人们有严重(等级 3 ) 发炎。23 (45%) , 19 (37%) , 8 (16%) 并且 1 (2%) 病人有 0, 1, 2 和 3 纤维变性分别地在索引活体检视和没有上有的舞台肝硬化。在 univariate 分析上,甘油三酸酯铺平超过 150 mg %( 或 = 7.1;95% CI:1.6-31.5, P = 0.002 ) 并且著名计算机生产厂商 / 中高音 ratio>1 (或 = 14.3;95% CI:1.4-678.5, P = 0.008 ) 与发炎的高等级被联系,任何一个都没与先进纤维变性被联系。在上多变量逻辑回归分析, hypertriglyceridemia >150 mg% 是独立地与发炎的高等级的存在联系的唯一的因素(或 = 1.6;95% CI:1.3-22.7, P = 0.02 ) ,当任何一个都没与先进纤维变性被联系时。甘油三酸酯层次与煽动性的等级断然相关(r = 0.412;P = 0.003 ) 。结论:在诺思印第安人病人的 NAFLD 是年轻超重男性,其中大多数是抵抗的胰岛素的疾病,他们趋于在表示有温和组织学的疾病。 | Kaushal Madan Yogesh Batra S Datta Gupta Bal Chander K D Anand Rajan M S Tewatia S K Panda S K Acharya | 2006 | World Journal of Gastroenterology2006，12，21： | 7 |
| 4 | Carvedilol, an antihypertensive drug with antioxidant properties, protects against glycerol-induced acute renal failure显示文摘 | Singh D Chander V Chopra K | 2003 | Am J Nephrol2003，23，： | 1 |
| 5 | Cyclin D1 (G870A) polymorphism and risk of cervix cancer:a ease control study in north Indian population显示文摘 | Satinder K Chander SR Pushpinder K | 2008 | Mol Cell Biochem2008，315，12： | 1 |
| 6 | Carvedilol attenuates ischemia- reperfusion-indueed oxidative renal injury in rats 显示文摘 | Singh D Chander V Chopra K | 2004 | Fundam Clin Pharmacol2004，18，： | 1 |
| 7 | Is the dehydrogenase assay invalid as a method to estimate microbial activity in copper-contaminated soils? 显示文摘 | Chander K Brookes P C | 1991 | Soil Biology & Biochemistry1991，23，： | 1 |
| 8 | Different sources of heavy metals and their long-term effects on soil microbial properties显示文摘 | CHANDER K DYCHMANS J JOERGENSEN R G MEYER B RAUBUCHE M | 2001 | Biology and Fertility of Soils2001，34，4： | 1 |
| 9 | E-PULRP: energy opti- mized path unaware layered routing protocol for underwater sensor net- works显示文摘 | GOPI S GOVINDAN K CHANDER D | 2010 | IEEE Trans on Wireless Communications2010，9，11： | 1 |
| 10 | Soil organic matter, microbial biomass and enzyme activities in a tropical agroforestry system显示文摘 | Chander K Goyal S Nandal D P | 1998 | Biology and Fertility of Soils1998，27，2： | 1 |
| 11 | An evolutionary game-theoretic approach to the strategies of community members under joint forest management regime 显示文摘 | Chander S Shashi K | 2007 | Forest Policy and Economics2007，9，7： | 1 |
| 12 | Role of nitric oxide in resveratrolinduced renal protective effects of ischemic preconditioning显示文摘 | Chander V Chopra K | | 0，，6： | 1 |
| 13 | Is the dehydrogenase assay invalid as a method to estimate microbial activity in copper-contaminated soils显示文摘 | Chander K Brookes P C | 1991 | Soil Biology & Biochemist1991，23，： | 1 |
| 14 | Is the dehydrogenase assay invalid as a method to estimate microbial activity in copper contaminated soils显示文摘 | Chander K Brookes P C | 1991 | Soil Biol Biochem1991，23，10： | 1 |
| 15 | Protcctivc effect of catechin on ischemia reperfusion-induced renal injury in rats显示文摘 | Singh D Chander V Chopra K | | 0，，1： | 1 |
| 16 | Is the dehydrogenase assay invalid as a method to estimate microbial activity in copper-contaminated soils显示文摘 | Chander K Brookes PC | 1991 | Soil Boil Biochem1991，23，： | 1 |
| 17 | Influence of inorganic fertilizers and organic amendments on soil organic matter and soll microbial properties under tropical conditions 显示文摘 | Sneh Goyal Chander K Mundra M C Kapoor K K Goyal S | 1999 | Biology and Fertility of Soils1999，29，： | 1 |
| 18 | Protective effect of naringin,a bioflavo noid on glycerol-induced acute renal failure in ralkidney显示文摘 | Singh D Chander V Chopra K | 2004 | Toxicology2004，201，： | 1 |
| 19 | Residual effects of zinc,copper,and nickel in sewage sludge on microbial biomass in a sandy loam显示文摘 | Chander K Brookes P C 1993 | 1993 | Soil Biol Biochem1993，25，： | 1 |
| 20 | Protective effect of catechin on ischemia-reperfusion-induced renal injury in rats显示文摘 | SINGH D CHANDER V CHOPRA K | 2005 | Pharmacol Rep2005，，57： | 1 |
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