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Small bowel transplants are performed all over the world with acceptable success rates. Although there are isolated reports of small bowel transplants from India, a robust intestinal transplant programme similar to western countries is lacking. Our aim is to share our experience to build up on the evolving field of small bowel transplants in India. Deceased donor small bowel transplant was performed for three patients with intestinal failure, two for short gut syndrome following surgery and one for visceral myopathy. All were on preoperative total parenteral nutrition for varying periods of time (6 to 13 months). There were multiple episodes of line sepsis in all patients. Post-transplant, all received induction immunosuppression with anti-thymocyte globulin (first two patients) or alemtuzumab (3rd patient). All had systemic venous drainage and stoma. Protocol weekly intestinal biopsies were done in all patients. All died in hospital at 24, 12 and 28 days following surgery. Biopsy-proven rejection was observed in only patient who had received ABO-compatible non-identical graft (O to A). This patient subsequently developed vascular thrombosis necessitating explant of the graft. Sepsis due to multidrug resistant bacteria was the reason for mortality in the remaining two patients. Despite the absence of technical complications, successful small bowel transplant seems to be an elusive entity for the Indian transplant community. [ABSTRACT FROM AUTHOR]

AIMS: To audit the information content of the pathology report on Low Anterior Resection (LAR) specimens and to provide recommendations in order to improve the existing standard of reporting. MATERIALS AND METHODS: All the reports of LAR specimens during 2004 – 2005 were collected from the Hospital Information System (HIS). Individual items of information were compared with the minimum data sets provided by the Royal College of Pathologists (RCP). RESULTS: Fifty–nine reports were audited. Nineteen percent of the reports were classified as satisfactory. Although many items were well reported, only 30.5% (18/59) of the reports contained a statement on the completeness of excision at the circumferential resected margin and only 25.4% of all reports mentioned the relation of tumors to the peritoneal reflection. CONCLUSION: The information content of the reports on colorectal cancer resection specimens is inadequate. The use of the standard proforma (template) for reporting rectal cancer is therefore recommended, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management. [ABSTRACT FROM AUTHOR]

Introduction- The incidence of Gastroesophageal junction (GEJ) adenocarcinoma is increasing rapidly. Data separately on GEJ tumors management is rare. Objectives- to evaluate the clinicopathological characteristics of GEJ tumors, to compare two modalities of treatment- Neoadjuvant treatment followed by surgery(group-N) and upfront surgery(group-S) in GEJ tumors in terms of recurrence and survival. Materials and methods- Records of all the patients diagnosed and treated with curative intent as GEJ tumors as per Siewert classification, between 2005-2013 were reviewed. Patients of age above 18yrs, ECOG PS 0, 1, 2, clinical, radiological, endoscopic and histologically proven GEJ tumor limited loco-regionally were included. Kaplan-Meire graph utilized to calculate survival and recurrence pattern. Chi-square(X2) test used to assess association between clinico-pathological parameters and outcome. The comparison of survival and recurrence rate was computed by log rank test. Results- Among 68 eligible patients group-S were 43(63.2%) and group-N 25(36.8%). Predominant histology was adenocarcinoma (85?ch). Group-N received either neoadjuvant chemotherapy-19(76%) or concurrent chemoradiation-6(24%). Surgery in both groups was Ivor- Lewis 52(76.4%) or Minimally invasive Mckeowns 16(23.6%). Median follow-up period was 21months. In group-S, high grade tumors had worse survival (OS-grade III 20 months Vs grade I, II 36 months. p-0.015). No clinico-pathological factors affected outcome in group-N. In group-N 5/25(20%) had grade 3 toxicity. Severe postoperative complications occurred 10(23%) in group-S and 4(16%) in group-N. Group-N has higher DFI (17.5months) and OS (30.5 months) compared to group-S (DFI 14months; OS 21.5months) but without statistical significance (p-0.56 and p-0.83 respectively.) Conclusion- In our single institute study, improved recurrence free period and survival with neoadjuvant treatment over primary surgery group in the management of GEJ carcinoma is not reflected statistically. Further prospective randomized studies are required to assess the effect of neoadjuvant therapy in GEJ tumors. [ABSTRACT FROM AUTHOR]

Background: Double barrelled uro-colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES)., Methods: This cohort study evaluated short- and long-term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database., Results: Mean age 59 years (range 27-76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7-17 h). Mean follow-up duration 29.1 months (range 2.6-90.1 months). Early DBUC-related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC-related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication., Conclusion: DBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion., (© 2024 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background. Since October 2021, there have been more than 500 cases of severe hepatitis of unknown origin in children reported worldwide, including 180 cases in the U.S. The most frequently detected potential pathogen to date has been adenovirus, typically serotype 41. Adenovirus is known to cause a self-limited infection in the immunocompetent host. However, in immunosuppressed individuals, severe or disseminated infections may occur. Method. We present the case of a two-year-old female who presented with cholestatic hepatitis and acute liver failure (ALF). Work up for etiologies of ALF was significant for adenovirus viremia, but liver biopsy was consistently negative for the virus. The risk for severe adenoviral infection in the setting of anticipated immunosuppression prompted us to initiate cidofovir to decrease viral load prior to undergoing liver transplantation. Result. Our patient received a successful liver transplant, cleared the viremia after 5 doses of cidofovir, and continues to maintain allograft function without signs of infection at the time of this report, 5 months posttransplant. Conclusion. Recent reports of pediatric hepatitis cases may be associated with adenoviral infection although the exact relationship is unclear. There is the possibility of the ongoing SARS-CoV-2 environment, or other immunologic modifying factors. All patients presenting with hepatitis or acute liver failure should be screened for adenovirus and reported to state health departments. Cidofovir may be used to decrease viral load prior to liver transplantation, to decrease risk of severe adenoviral infection. [ABSTRACT FROM AUTHOR]

Hepatorenal Syndrome (HRS) is a reversible functional renal impairment that occurs in patients with advanced liver cirrhosis or those with fulminant hepatic failure To evaluate the effect of terlipressin and albumin combination in various clinical outcomes in Hepatorenal Syndrome patients Methods and Material: It was a prospective study involving 50 patients with HRS. The effectiveness parameters of the treatments were: confirmed HRS reversal, Recurrence of HRS within 90 days of treatment and mortality rate up to 90 days. The safety assessment includes adverse events collected up to 14 days of post-treatment. The quality of life of HRS patients was assessed using SF-12 questionnaire. In the present study the mean age of patients was found to be 55.10 ± 9.35 years. Mean serum creatinine values were found to be reduced (1.22 ± 0.96) by 10th day in type 1 HRS which indicated improved renal function. Study patients showed a marked improvement in liver function throughout the observation period. 74% of patients did not have HRS recurrence and 79.48% of patients had completely relieved from HRS. Loose stool (14.2%) and hyponatremia (14.2%) were the prominent side effects of the therapy. The quality of life of patients also showed a statistically significant betterment in both physical and mental functioning. Our study concluded that terlipressin and albumin combination was safe and effective in successfully stabilising cirrhosis patients with Hepatorenal Syndrome and bridging eligible patients to liver transplantation by restoring the liver and renal function with minimal adverse effects. [ABSTRACT FROM AUTHOR]

It is well established that zinc phosphide (Zn3P2) toxicity occurs through its reduction to the phosphine gas. The study evaluates the effect of acute and hyper-acute Zn3P2 toxicity in rats on liver biochemical parameters, oxidative stress, cholinesterase and histological changes. Also, serum and urine concentrations of Zn & phosphorus (P) were estimated. A total of 24 male Sprague-Dawley rats were divided into 3 groups; a control group, an acute Zn3P2 intoxicated (35 mg/kg) and a hyper-acute Zn3P2 intoxicated (60 mg/kg) groups. We investigated ALT, AST, ALP, serum glucose, plasma cholinesterase, hepatic reduced glutathione (GSH), Malondialdehyde (MDA), serum & urine Zn & P concentrations, and histological hepatic changes. Zn3P2 significantly increased ALT, AST, ALP, MDA and indirect bilirubin, while it decreased GSH and serum glucose. Histopathological changes confirmed the hepatic damage. Serum Zn & P concentrations were increased in the acute and the hyper-acute toxicity, while their urinary concentrations were increased in the acute then decreased in the hyper-acute toxicity as compared to the acute intoxicated group. A significant liver damage occurred following an acute and a hyper-acute Zn3P2 toxicity with more deleterious effects in the hyper-acute toxicity, indicating a dose dependent hepatic damage. We can conclude that metabolic & histological disturbances induced by Zn3P2 were due to the oxidative stress & lipid peroxidation that diversely affects mitochondrial functions and tissue energy production. Zn and P concentrations could be markers of the liver damage and an indication of Zn3P2 ingestion for clinical and forensic purposes. [ABSTRACT FROM AUTHOR]