Preoperative factors predicting Postoperative Morbidity in patients with Periampullary Carcinoma undergoing Pancreaticoduodenectomy

Periampullary carcinoma is a carcinoma that forms near the ampulla of vater, an enlargement of the ducts from the liver and pancreas where they join and enter the small intestine. It consists of: 1. ampullary (Ampulla of vater), 2. Biliary (Intrapancreatic distal bile duct), 3. Pancreatic (Head –Uncinate process), 4. Duodenal (mainly from the second portion). AIM OF THE STUDY: 1. To evaluate the incidence of Periampullary carcinoma in Stanley Medical College from Feb 2016 to Sep 2016. 2. To know the clinical manifestation. 3. To know the investigations to aid the diagnosis and assess the respectability of these tumors. 4 To know about the preoperative factors which determine the postoperative morbidity in patients undergoing whipples procedure. 5. To study the treatment instituted and the management of complications. 6. To review the literature on the subject. MATERIALS AND METHODS: The study is to be carried out in Govt. Stanley Medical College Hospital, Chennai. This is a facility based prospective descriptive study involving all patients diagnosed as periampullary carcinoma clinically, radiologically, and pathologically. The relevant data shall be collected by using. • Detailed history. • Hematological investigations: complete hemogram, liver function test, serum proteins and albumin. • Coagulation profile – PT, aPTT, INR. • Blood culture & sensitivity Stool for occult blood. • Imaging studies : X-ray chest, X ray abdomen erect. • USG abdomen & pelvis – to find liver, gallbladder, common bile duct, pancreas and duodenum lesions, • CT (Plain and contrast) abdomen & pelvis /MRCP– to find exact location, size, extent of tumour. • Patients undergoing pancreaticoduodenectomy – pathologically proven carcinomatous. • lesions. • Postoperative factors like ventillatory support, abdominal distention, coagulation profile, peritonitis, fever, sepsis, no of days of ICU stay, ionotropic support, biochemical derangements are taken into study. Preoperative factors included in study: Age, Tumour localization, CA 19-9 levels, Preoperative bilirubin levels, Preoperative albumin levels, ERCP and stenting, cholangitis. Postoperative factors included in study: Ventillatory support, Sepsis, No of days of ICU stay, Ionotropic support, Biochemical derangements, Relaporotomy. Inclusion Criteria: All patients with periampullary carcinoma undergoing pancreaticoduodenectomy (whipple procedure) in Govt. Stanley Hospital. EXCLUSION CRITERIA: Uncertain diagnosis and death. SUMMARY: Among the study group of 25 patients underwent pancreaticoduodenectomy commonest neoplasm is ampullary growth. • Male female ratio 2.8: 1. • Age – commonest in our study is 6th decade. • In our study age group ranges from 3rd to 7th decade. • Ampullary growth is common in males, where as in females head of pancreas growth is common. • Among study group females had higher incidence of ampullary growth when they enter 6th decade. • Most common presenting symptom is abdominal pain, followed by jaundice. • Hyperbilirubinemia is seen in 74% of patients. • Cholangitis is seen in 48% of patients Hypoalbuminemia seen in 76% of patients. • Hypoalbuminemia is common in ampullary neoplasms, followed by head of pancreas Neoplasm. • 60% of patients with obstructive jaundice underwent ERCP and 35% of patients underwent. • ERCP guided stenting. • 12% (3 out of 25) patients had h/o previous surgery. • Patients having preoperative cholangitis had - post operative septicaemia, - requires ionotropic supports, - prolonged ventillatory support. • Among the patients who had preoperative cholangitis ERCP stented patients had uneventful. • postoperative course. • CA19- 9 levels elevated in 88% 0f cases. • 4% (1 patient) received preoperative chemotherapy. • 12% of patient underwent relaporotomy, commonest indication being pancreatic anastomotic leak (PJ > PG) followed by haemorrhage. • 4% of patient underwent angioembolisation for haemorrhage. CONCLUSION: Periampullary neoplasms are common in males. • Majority of patient underwent pancreaticoduodenecomy, commonest neoplasm is ampullary growth. • Maximum age of incidence is between 60 to 70 years. • Male female ratio 2.8: 1. • Commonest presentation is abdominal pain and jaundice. • CA 19 – 9 levels elevated in 88% of cases. • Hyperbilirubinemia and hypoalbuminemia causes severe postoperative morbidity. • Patients with obstructive jaundice requires ERCP and stenting reduces postoperative. • Morbidity. • Patients with obsructive jaundice requires prolonged ventillatory support, ionotropic support. • Patients with preoperative cholangitis had postoperative sepsis commonly. • Commonest indication for relaporotomy is pancreatic leak. • (PJ > PG). • Preoperative preparation of patient is influences the outcome of surgery

Oral dosing for antenatal corticosteroids in the Rhesus macaque.

Antenatal corticosteroids (ACS) are standard of care for women at risk of preterm delivery, although choice of drug, dose or route have not been systematically evaluated. Further, ACS are infrequently used in low resource environments where most of the mortality from prematurity occurs. We report proof of principle experiments to test betamethasone-phosphate (Beta-P) or dexamethasone-phosphate (Dex-P) given orally in comparison to the clinical treatment with the intramuscular combination drug beta-phosphate plus beta-acetate in a Rhesus Macaque model. First, we performed pharmacokinetic studies in non-pregnant monkeys to compare blood levels of the steroids using oral dosing with Beta-P, Dex-P and an effective maternal intramuscular dose of the beta-acetate component of the clinical treatment. We then evaluated maternal and fetal blood steroid levels with limited fetal sampling under ultrasound guidance in pregnant macaques. We found that oral Beta is more slowly cleared from plasma than oral Dex. The blood levels of both drugs were lower in maternal plasma of pregnant than in non-pregnant macaques. Using the pharmacokinetic data, we treated groups of 6-8 pregnant monkeys with oral Beta-P, oral Dex-P, or the maternal intramuscular clinical treatment and saline controls and measured pressure-volume curves to assess corticosteroid effects on lung maturation at 5d. Oral Beta-P improved the pressure-volume curves similarly to the clinical treatment. Oral Dex-P gave more variable and nonsignificant responses. We then compared gene expression in the fetal lung, liver and hippocampus between oral Beta-P and the clinical treatment by RNA-sequencing. The transcriptomes were largely similar with small gene expression differences in the lung and liver, and no differences in the hippocampus between the groups. As proof of principle, ACS therapy can be effective using inexpensive and widely available oral drugs. Clinical dosing strategies must carefully consider the pharmacokinetics of oral Beta-P or Dex-P to minimize fetal exposure while achieving the desired treatment responses

Building a prototype VANET testbed to explore communication dynamics in highly mobile environments

Applications for VANETs will require seamless communication between vehicle-to-infrastructure and vehicle-to-vehicle. However, this is challenging because this is a highly mobile environment. Therefore, traditional handover techniques are inadequate due to the high velocity of the vehicle and the small coverage radius of Road-side Units. Hence in order to have seamless communication for these applications, a proactive approach needs to be carefully investigated. This requires measurements from a real testbed in order to enhance our understanding of the communication dynamics. This paper is about building and evaluating a prototype VANET network on the Middlesex University Hendon Campus, London to explore these issues. The testbed is being used to investigate better propagation models, road-critical safety applications as well as algorithms for traffic management. In addition, the Network Dwell Time of vehicles travelling in the coverage of the RSUs is measured to explore proactive handover and resource allocation mechanisms

A unique measles B3 cluster in the United Kingdom and the Netherlands linked to air travel and transit at a large international airport, February to April 2014

Rita de Sousa (Bolseira EUPHEM) - Investigadora do Departamento de Doenças Infeciosas do Instituto Ricardo JorgeThis report describes a joint measles outbreak investigation between public health officials in the United Kingdom (UK) and the Netherlands following detection of a measles cluster with a unique measles virus strain. From 1 February to 30 April 2014, 33 measles cases with a unique measles virus strain of genotype B3 were detected in the UK and the Netherlands, of which nine secondary cases were epidemiologically linked to an infectious measles case travelling from the Philippines. Through a combination of epidemiological investigation and sequence analysis, we found that measles transmission occurred in flight, airport and household settings. The secondary measles cases included airport workers, passengers in transit at the same airport or travelling on the same flight as the infectious case and also household contacts. This investigation highlighted the particular importance of measles genotyping in identifying transmission networks and the need to improve vaccination, public health follow-up and management of travellers and airport staff exposed to measles.info:eu-repo/semantics/publishedVersio

Synthesis and Stoichiometry of MgB2

The system MgxB2 has been investigated to investigate possible nonstoichiometry in MgB2. When synthesized at 850oC, MgB2 is a line compound with a possible Mg vacancy content of about 1%. Small changes in lattice constants as a function of starting composition result from grain interaction stresses, whose character is different in the Mg-rich, near-stoichiometric, and Mg-deficient regimes. A small linear decrease of the superconducting transition temperature, Tc, in the Mg-rich regime results from accidental impurity doping.Comment: Accepted for publication in Physica C. 24 pages, 7 figure

Effect of PVA doping on flux pinning in Bulk MgB2

The synthesis and characterization of PVA (Poly Vinyl Acetate) doped bulk MgB2 superconductor is reported here. PVA is used as a Carbon source. PVA doping effects made two distinguishable contributions: first enhancement of Jc field performance and second an increase in Hc2 value, both because of carbon incorporation into MgB2 crystal lattice. The susceptibility measurement reveals that Tc decreased from 37 to 36 K. Lattice parameter a decreased from 3.085 A to 3.081 A due to the partial substitution of Carbon at Boron site. PVA doped sample exhibited the Jc values greater than 10^5 A/cm2 at 5 & 10 K at low fields; which is almost 3 times higher than the pure one, while at high fields the Jc is increased by an order of magnitude in comparison to pure MgB2. From R(T)H measurements we found higher Tc values under magnetic field for doped sample; indicating an increase in Hc2. Also the magnetization measurements exhibited a significant enhancement in Hirr value. The improved performance of PVA doped MgB2 can be attributed to the substitution of carbon at boron site in parent MgB2 and the resulting impact on the carrier density and impurity scattering. The improved flux pinning behavior could easily be seen from reduced flux pinning force plots.Comment: 14 Pages of Text + Figs. To appear in Physica

Differentiating Schizophrenia from Bipolar Illness on 18 F FDG PET CT Based on white Matter Metabolism; an under-Utilised Parameter

18F-FDG PET/CT positron emission tomography studies (FDG-PET) have shown similar cortico-limbic metabolic dysregulation in bipolar disorder and schizophrenia, with hypoactive prefrontal cortex coupled with hyperactive anterior limbic areas. However, it is not clear whether white matter metabolism connecting these regions is differently affected in the two disorders. Forty eight patients with schizophrenia mean age ± S.D] 31.6 ± 7.8 and 56 patients with bipolar disorder [mean age±S.D] 46.2 ± 8.9 underwent an 18F-FDG PET/CT scan. Normalized datasets the two groups of patients were compared on a voxel-by-voxel basis using a two-sample t statistic test as implemented in SPM8, and adding age as covariate. Group differences were assessed applying a threshold of p<0.0005. White matter metabolic rates significantly differed between schizophrenia and bipolar disorder, whereas no differences were shown for cortical activity. This is the first 18F-FDG PET/CT to our best knowledge, directly comparing subjects with schizophrenia to those with bipolar disorder. It reports decreased activity in the center of large fronto-temporal and cerebellar white matter tracts in patients with schizophrenia in respect to those with bipolar disorder. This feature may characterize and differentiate the regional brain metabolism of the two illnesses