A Study on Clinical features, success rate and complications of endotherapy in choledocholithiasis

INTRODUCTION: Choledocholithiasis is defined as the occurrence of stones in the bile ducts. It is a common clinical problem worldwide. It has been estimated that 10–15% of patients undergoing cholecystectomy for symptomatic gallstones harbor concomitant stones in their CBD. Primary ductal stones formed de novo also add a further small percentage to the overall prevalence. OBJECTIVES: 1. To study the various clinical presentations of choledocholithiasis. 2. To study the success rate of endotherapy in choledocholithiasis. 3. To study the complications of endotherapy in choledocholithiasis. 4. To study the epidemiology of choledocholithiasis. 5. To study the associated conditions with choledocholithiasis. MATERIALS AND METHODS: This is a prospective study conducted in DDHD, Government peripheral Hospital, Anna Nagar, Chennai – 102 from April 2008 to December 2009. INCLUSION & EXCLUSION CRITERIA: 1. All patients with CBD stones who underwent ERCP were included in this study. 2. Patients with CBD stones not willing for ERCP were excluded from this study. 3. Patients with CBD stones who were all not fit for ERCP excluded. 4. Patients with obstructive jaundice other than CBD stones were excluded. All patients were explained about the procedure and its complications. We got informed consent from all the patients. ERCP was performed by the Professor and the Associate Professor of our department. All patients received premedications Inj. pentazocine 30mg (1cc), Inj.promethazine 50mg (2cc), Inj. hyoscine butylbromide 20mg (1cc), and Inj.midazolam 2mg I.V. RESULTS: In this study, the patients were divided into three groups; Group 1- Patients with CBD stones with GB stones, Group 2- Patients with CBD stones with no stones in GB, Group 3- Patients with CBD stones in postcholecystectomy state. Total number of patients underwent ERCP in our study were 115. Out of which 51 were males and 64 were females. Overall success rate was 91.3%. Failure rate was 8.69%. The procedure was successful in 95 patients in first attempt, 12 patients in second attempt, and 8 patients in third attempt. Abdominal pain was the presenting symptom in 70 [60.86%] patients, Jaundice in 44 [38.26%], Fever in 42 [36.52%], Charcots triad in 38 [33.04%], Biliary pancreatitis in 6 [5.21%], Asymptomatic in 4 [3.47%] patients. 38 patients developed post procedural abdominal discomfort, 13 patients developed pancreatitis [Mild-9, Moderate -4, and Severe - 0], and 2 patients had retroduodenal perforation. No post sphincterotomy bleeding noted. No procedure related mortality was noted in this study. CONCLUSION 1. Most common presentation of CBD stones in this study was abdominal pain 60.86%, followed by jaundice 38.26%, and fever 36.52%.Charcots triad was seen in 33.04%. 2. In the study, overall success rate was 91.3% and failure rate was 8.69%. 3. Overall complication rate was 13.04%. No post sphincterotomy bleeding was noted. No procedure related mortality was noted. Hence endotherapy are very effective with fewer complications in the treatment of choledocholithiasis. 4. CBD Stones were more common in females (F- 64 pts, M- 51 pts). Mean age of presentation was 49.91 years (range 9 – 76 yrs). 5. Biliary ascariasis was seen in one patient, choledochal cyst type 1 was seen in 2 patients, periampullary diverticulum was seen in 15 patients, distal CBD stricture was seen in 19 patients and intra hepatic stones were seen in 3 patients. 6. There was no statistically significant difference in clinical presentations, associated features, success rate and complications of endotherapy in all the three groups of choledocholithiasis

Cluster Radioactivity in 127I

Using the preformation cluster model of Gupta and collaborators we have studied all the possible cluster decay modes of 127 I. The calculated half-lives are compared with recently measured lower limits of cluster decay half-lives (for the clusters like 24Ne, 28Mg, 30Mg, 32Si, 34Si, 48Ca and 49Sc) of 127I. Our calculated half-life values lies well above the experimentally measured lower limits and the trend of the values also matches with experimental ones

Patient choice significantly affects mastectomy rates in the treatment of breast cancer

Mastectomy rates may be affected by patient choice. 203 patients who had a Total Mastectomy for breast cancer were invited to complete questionnaires at routine follow up clinics to ascertain if they had been offered a choice of Breast Conserving Surgery (BCS), and to establish the reasons for their preference. Questionnaires were checked against medical and nursing records to confirm the reasons for the patients' choice of mastectomy. 130 patients (64%) chose to have a mastectomy, reporting that they felt safer (n = 119); wanted to decrease the risk of further surgery (n = 87) and/or wished to avoid radiotherapy (n = 34). Some were advised not to have BCS if they had a large tumour size, central or multifocal tumours and/or associated extensive microcalcification on mammography (n = 29). 24 patients had BCS as first operation but had repeat surgery for involved or narrow excision margins. Despite being advised that there is no difference between survival rates of this and breast conserving surgery, many patients still feel safer with mastectomy

ANALYSIS ON RETURN, RISK AND VOLATILITY OF SECTORAL INDICES AGAINST BSE

BSE has classified industrial grouping based on similar production processes, products or nature of business. Automobile, Banking, Energy, Fast moving Consumer Goods (FMCG), Healthcare, Industrials, IT, Oil & Gas, Power, Public Sector Undertakings (PSU) and Telecom are the classifications. This paper analyzes the return, risk and volatility of such sectoral indices against BSE for the period 2007:01 to 2016:12. The objectives of the study are “ To classify sectors based on Return (High, Medium and Low)”, “To classify sectors based on sensitivity (High, Medium and low), “To classify sectors based on risk (High, Medium and Low)”, “To classify sectors based on volatility”, “To find the sectors which moves with and against S&P BSE 500”. The study reviewed various relevant literatures available and various research works of past and present. The study gathered monthly closing index of S&P BSE 500 and sector wise monthly closing index for the period 2007:01 to 2016:12. The study adapted tools like Pearson correlation, Standard deviation, Beta and Linear Regression to ensure the validity. The study would contribute to investment decisions by investors in selecting sectors based on risk, return, volatility and sensitivity of market

Spectral fluctuation characterization of random matrix ensembles through wavelets

A recently developed wavelet based approach is employed to characterize the scaling behavior of spectral fluctuations of random matrix ensembles, as well as complex atomic systems. Our study clearly reveals anti-persistent behavior and supports the Fourier power spectral analysis. It also finds evidence for multi-fractal nature in the atomic spectra. The multi-resolution and localization nature of the discrete wavelets ideally characterizes the fluctuations in these time series, some of which are not stationary.Comment: 7 pages, 2 eps figure

Features in the Primordial Spectrum from WMAP: A Wavelet Analysis

Precise measurements of the anisotropies in the cosmic microwave background enable us to do an accurate study on the form of the primordial power spectrum for a given set of cosmological parameters. In a previous paper (Shafieloo and Souradeep 2004), we implemented an improved (error sensitive) Richardson-Lucy deconvolution algorithm on the measured angular power spectrum from the first year of WMAP data to determine the primordial power spectrum assuming a concordance cosmological model. This recovered spectrum has a likelihood far better than a scale invariant, or, `best fit' scale free spectra (\Delta ln L = 25 w.r.t. Harrison Zeldovich, and, \Delta ln L = 11 w.r.t. power law with n_s=0.95). In this paper we use Discrete Wavelet Transform (DWT) to decompose the local features of the recovered spectrum individually to study their effect and significance on the recovered angular power spectrum and hence the likelihood. We show that besides the infra-red cut off at the horizon scale, the associated features of the primordial power spectrum around the horizon have a significant effect on improving the likelihood. The strong features are localised at the horizon scale.Comment: 8 pages, 4 figures, uses Revtex4, matches version accepted to Phys. Rev. D, main results and conclusions unchanged, references adde

Spectroscopic (FT-IR, FT-Raman and NMR) and NBO analysis of 3, 4-dimethylanisole by density functional method

Combined experimental and theoretical studies have been conducted on the molecular structure and vibrational, spectra of 3, 4-dimethyl anisole (DMA). The FT-IR and FT-Raman spectra of DMA have been recorded in the solid phase. The molecular geometry and vibrational frequencies of DMA in the ground state have been calculated by using the ab-initio Hartree-Fock (HF) and density functional methods (B3LYP) invoking 6-31+G (d,p) basis set. The optimized geometric bond lengths and bond angles obtained by HF method shows best agreement with the experimental values. Comparison of the observed fundamental vibrational frequencies of DMA with calculated results by HF and density functional methods indicates that B3LYP is superior to the scaled HF approach for molecular vibrational problems. The difference between the observed and scaled wave number values of most of the fundamental is very small. The thermodynamic functions and atomic change of the title compound has also been performed at HF/B3LYP/6-31+G(d,p) level of theories. A detailed interpretation of the FT-IR, FT-Raman, NMR spectra of DMA has also been reported. The theoretical spectrograms for infrared and Raman spectra of the title molecule have been constructed. The thermodynamic function of the title compound has also been performed at HF/6-31+G (d,p) and B3LYP/6-31+G (d,p) level of theories. Natural bond orbital analysis has been carried out to explain the change transfer or delocalization of change due to the intra-molecular interactions. Energy of the highest occupied molecular (HOMO) orbital and lowest unoccupied (LUMO) molecular orbital have been predicted

Bis(μ-phenyl­tellurido-κ2 Te:Te)bis­[tetra­carbonyl­rhenium(I)]

The title compound, [Re2(C6H5Te)2(CO)8], crystallizes with two mol­ecules in the asymmetric unit, in which two Re atoms are coordinated in a slightly distorted octa­hedral environment and are bridged by two Te atoms, which show a distorted trigonal-pyramidal geometry. The torsion angles for the Te—Re—Te—Re sequence of atoms are 19.29 (18) and 16.54 (16)° in the two mol­ecules. Thus, the Re—Te four-membered rings in the two mol­ecules deviate significantly from planarity. Two intra­molecular C—H⋯O inter­actions occur in one of the mol­ecules. Te—Te [4.0551 (10) Å] inter­actions between the two mol­ecules and weak inter­molecular C—H⋯O inter­actions stabilize the crystal packing