Spontaneous rupture of giant gastric stromal tumor into gastric lumen

BACKGROUND: Gastrointestinal stromal tumors (GIST) constitute a large majority of mesenchymal tumors of the gastrointestinal (GI) tract, which express the c-kit proto-oncogene protein, a cell membrane receptor with tyrosine kinase activity. GI stromal tumors of the stomach are usually associated with bleeding, abdominal pain or a palpable mass. CASE PRESENTATION: A 75-year-old male presented with upper abdominal pain and palpable mass. Computed tomographic (CT) scan of the abdomen showed a large mass arising in the posterior aspect of fundus, body, and greater curvature of the stomach. Second day after the admission, there was significant reduction in the size of the tumor, clinically as well as radiologically. Endoscopic biopsy showed large bulge in fundus and corpus of the stomach posteriorly with an opening in the posterior part of the corpus, and biopsy from the edge of the opening reveled GIST. Patient underwent curative resection. CONCLUSION: Spontaneous ruptured of giant gastric stromal tumor is very rare presentation of stomach GIST. Thorough clinical examination and timely investigation can diagnose rare complication

Simultaneous pancreas–kidney transplant for type I diabetes with renal failure: Anaesthetic considerations

Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation

A focused survey of immediate postoperative practices in liver transplantation in India

Aim: Over the last decade, the number of liver transplantations and centers that provide this service in India have grown exponentially. However, not all practices relevant to liver transplantation are uniform across the country. We decided to get the opinion from living donor liver transplant (LDLT) centers across the country on four specific aspects relating to LDLT. Methods: We formulated four specific questions that were carefully worded to incorporate aspects of “routine practice” and also answerable in the negative or affirmative, so as to make comparison possible. We collected the data of LDLT centers in India from popular resources such as MOHAN Foundation, from our institutional memory, and also by inquiring with respondents. The following questions were asked: (1) Do you routinely use N-acetyl cysteine for LDLT donors? (2) Do you use routinely use prostaglandin E1 (alprostadil) to facilitate hepatic artery flow in recipients? (3) Do you routinely use antiplatelets to prevent hepatic artery thrombosis in adult LDLT recipients? (4) Do you routinely use low molecular weight heparin for deep vein thrombosis prophylaxis after donor hepatectomy? Results: We received a total of 38 responses, of which 34 were complete. Conclusions: There is no consensus among practitioners regarding the studied aspects of the practice pertinent to immediate postoperative care in liver transplantation. This is primarily because there is neither evidence nor clear guidance from learned societies regarding these issues