Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing ... more Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.Materials and MethodsThe CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.ResultsOf the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.DiscussionThe occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns....
ABSTRACT A comparative study of interferon (IFN) production (type- and ) was carried out using Fi... more ABSTRACT A comparative study of interferon (IFN) production (type- and ) was carried out using Ficoll-hypaque purified fresh and cryopreserved mononuclear cells from eight normal healthy individuals. Newcastle disease virus-NDV (R2B strain) was used as an inducer for type- and Staphylococcal enterotoxin-A-(SEA) for type-IFN production. There was no significant difference between the titres of type- and -IFN and lymphocyte subpopulations of fresh and cryopreserved mononuclear cells studied under identical conditions.
The Journal of the Association of Physicians of India, 2013
Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and... more Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. To describe and correlate clinical and radiographic features of Influenza A(H1N1) infection in patients hospitalised in Intensive care unit. Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A(H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine clinical and radiographic features. Mean age of the patients was 33.43 years (+/- 12.152) with maximum patients between 18-40 years, with 53% males and 43% females. Cough (96%), Fever (95%), breathlessness (83%), throat pain (34%), crepitations (69%), Tachypnoea (59%)were the prominent symptoms and signs. 61% (n = 63) had comorbid condition like pregnancy (n = 13,20.63%), Diabetes Mellitus (DM) (n = 12,19.05%), HT (n = 11,17.60%), Obesity (n = 10, 15.87%) and Rheumatic Valvular Heart Disease (RVHD) (n = 6,09.52%). Chest X ray was abnormal in 91% patien...
The Journal of the Association of Physicians of India, 2013
Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and... more Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. Simple demographic, clinical and radiological variables are described in this article in mechanically ventilated and nonventilated patients. To describe and correlate demographic, clinical, radiographic characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of Influenza A(H1N1) infection. Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A (H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine demographic, clinical and radiographic features, comorbidities, mechanical ventilator required or not. 35 Patients required mechanical ventilation. 27 required IMV, 4 required NIMV while 4 patients initially were put on NIMV required IMV subsequently. 19 (40.42%) female patients required mechanical ventilator. Mean age of mec...
Journal of minimally invasive gynecology, Jan 23, 2015
To demonstrate the feasibility of laparoscopic anterior exenteration with intracorporeal ureteros... more To demonstrate the feasibility of laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy. IRB approval was taken. Patients who had undergone laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy were analyzed. 57 patients with advanced cervical carcinoma, stage IV A were retrospectively analyzed since year 2005. Pre-operative work-up was done by CECT abdomen…
Background: HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectio... more Background: HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectious morbidity and mortality. Hospitalization is an important metric for morbidity and is associated with high mortality, yet, little is known about rates and causes of hospitalization among these infants in the first 12 months of life. Methods: Using data from a prevention of mother-to-child transmission (PMTCT) trial (India SWEN), where HIVexposed breastfed infants were given extended nevirapine, we measured 12-month infant all-cause and causespecific hospitalization rates and hospitalization risk factors. Results: Among 737 HIV-exposed Indian infants, 93 (13%) were HIV-infected, 15 (16%) were on HAART, and 260 (35%) were hospitalized 381 times by 12 months of life. Fifty-six percent of the hospitalizations were attributed to infections; gastroenteritis was most common accounting for 31% of infectious hospitalizations. Gastrointestinalrelated hospitalizations steadily increased over time, peaking around 9 months. The 12-month all-cause hospitalization, gastroenteritis-related hospitalization, and in-hospital mortality rates were 906/1000 PY, 229/1000 PY, and 35/1000 PY respectively among HIV-infected infants and 497/1000 PY, 107/1000 PY, and 3/1000 PY respectively among HIV-exposed, uninfected infants. Advanced maternal age, infant HIV infection, gestational age, and male sex were associated with higher all-cause hospitalization risk while shorter duration of breastfeeding and abrupt weaning were associated with gastroenteritis-related hospitalization. Conclusions: HIV-exposed Indian infants experience high rates of all-cause and infectious hospitalization (particularly gastroenteritis) and in-hospital mortality. HIV-infected infants are nearly 2-fold more likely to experience hospitalization and 10-fold more likely to die compared to HIV-exposed, uninfected infants. The combination of scaling up HIV PMTCT programs and implementing proven health measures against infections could significantly reduce hospitalization morbidity and mortality among HIV-exposed Indian infants.
The Journal of the Association of Physicians of India, 2011
India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported... more India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had e...
Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding,... more Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established. Methods. The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT. Results. Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30%) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12%; odds ratio [...
Effective doctor-patient communication is the heart of clinical medicine. Many callit to be an ar... more Effective doctor-patient communication is the heart of clinical medicine. Many callit to be an art. Recent findings have provided a neuro behavioral perspective in understanding the mechanism of this complex but vital component of the doctor-patient relationship. Empirical research has demonstrated that contingent interpersonal responses are accompanied by contingent neurobiological responses. Neuroscientists have now discovered a mirror neuronal system that contributes to this attuned responsiveness, with special relevance to empathy. Understanding the underlying mechanisms can also help optimize and make doctor-patient communication more effective.
In the early 1990's, Italian researchers discovered that the monkey brain contains a special ... more In the early 1990's, Italian researchers discovered that the monkey brain contains a special class of cells that fire when it sees or hears an action and when it carries out the same action on its own. These cells were termed as the ‘Mirror Neurons’. Subsequent research in humans revealed that the human brain has multiple mirror neuron systems that specialize in carrying out and understanding the actions, intentions, emotions and behavior. The available scientific literature provides substantial evidence that Mirror neurons offer the basis to grasp the actions and intentions of others through direct imitation without the need for any conceptual reasoning. The discovery of Mirror neurons has added a new light to the understanding of culture, empathy, philosophy, language, imitation and autism. The present paper gives a brief overview of the myriad applications of the concept and mechanism of mirror neurons. Here, we present an innovative concept of harnessing the functional mec...
The role of minimal invasive surgery is well established. As regards rectal cancers particularly ... more The role of minimal invasive surgery is well established. As regards rectal cancers particularly low lying rectal cancer studies are still going on for safety, feasibility and duplicability. A large prospective single-institutional study aims to assess the effectiveness of our technique of laparoscopic resection of rectal cancer in terms of oncological safety, complications and long-term prognosis. Between July 2006 and June 2016, 582 patients underwent laparoscopic LAR for rectal adenocarcinoma at our centre. Routine preoperative workup was done. Patients were evaluated for complications, graded and managed as per Clavien-Dindo classification. Survival probability analysis rate calculated using Kaplan Meier method. Total number of patients included in the study were 582 (375 men and 207 women) with the average age of 65 years. Tumours located in upper, middle and lower rectum were 132, 258 and 192 patients, respectively. A total of 33 patients received chemoradiation preoperatively and 450 received chemo+/-radiation postoperatively. Laparoscopic TME was done in 381 patients. Six out of 381patients underwent low anterior resection with hand-sewn coloanal anastomosis (CAA). Average operating time, blood loss and hospital stay were 124 min, 70 ml and 5 days, respectively. Average number of lymph nodes removed was 25.4 Overall complication rate was 20.8%, i.e. 121 out of 582 patients had complications. No conversion to conventional surgery was required. The most common postoperative complication was the anastomotic leak (grade II, IIIB and IV acc. to Clavien-Dindo classification); we had 71 leaks (13.4%).After a mean follow-up of 46 months (1–128 months), tumour recurrence occurred in 39 patients of 582. Overall recurrence rate was 6.7%. Overall cancer-related survival rate was 99.3, 96.7, 90.7, 90.7 and 87.7% at 1st, 2nd, 3rd, 4th and5th year, respectively. Five-year survival rate was 100% for stage I, 94.4% for stage II, 66.6% for stage III and 44.6% for stage IV. Laparoscopic TME technique is feasible and safe. With the development of improved technique, devices and expertise, laparoscopic resection for rectal cancer should be a standard method. Our results when compared with the other similar studies on laparoscopic low anterior resection clearly demonstrate that laparoscopic rectal resection with our technique is not associated with higher morbidity or mortality. Oncological and surgical principles were respected, and long-term outcomes compared with the previous literature and open surgery were comparable.
To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected... more To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients. A retrospective cohort study. Galaxy Care Laparoscopy Institute, Pune, India. Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients. The same surgeon and team performed all the operations for uniformity in 10 operative steps. The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%. Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival.
In 2010, the Medical Council of India published the Vision 2015 document, which sought to create ... more In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The impor...
14 patients of advanced carcinoma maxilla who presented to the Medical College Hospital, Aurangab... more 14 patients of advanced carcinoma maxilla who presented to the Medical College Hospital, Aurangabad, were treated by intra-arterial cyclophosphamide chemotherapy. Two dosage regime of 200 mg. per day and 500 mg. per day were used either continuously or intermittently. Regression of tumour was obtained in only two cases and regression in size of lymph nodes in another two cases. Subjective
Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing ... more Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.Materials and MethodsThe CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.ResultsOf the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.DiscussionThe occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns....
ABSTRACT A comparative study of interferon (IFN) production (type- and ) was carried out using Fi... more ABSTRACT A comparative study of interferon (IFN) production (type- and ) was carried out using Ficoll-hypaque purified fresh and cryopreserved mononuclear cells from eight normal healthy individuals. Newcastle disease virus-NDV (R2B strain) was used as an inducer for type- and Staphylococcal enterotoxin-A-(SEA) for type-IFN production. There was no significant difference between the titres of type- and -IFN and lymphocyte subpopulations of fresh and cryopreserved mononuclear cells studied under identical conditions.
The Journal of the Association of Physicians of India, 2013
Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and... more Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. To describe and correlate clinical and radiographic features of Influenza A(H1N1) infection in patients hospitalised in Intensive care unit. Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A(H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine clinical and radiographic features. Mean age of the patients was 33.43 years (+/- 12.152) with maximum patients between 18-40 years, with 53% males and 43% females. Cough (96%), Fever (95%), breathlessness (83%), throat pain (34%), crepitations (69%), Tachypnoea (59%)were the prominent symptoms and signs. 61% (n = 63) had comorbid condition like pregnancy (n = 13,20.63%), Diabetes Mellitus (DM) (n = 12,19.05%), HT (n = 11,17.60%), Obesity (n = 10, 15.87%) and Rheumatic Valvular Heart Disease (RVHD) (n = 6,09.52%). Chest X ray was abnormal in 91% patien...
The Journal of the Association of Physicians of India, 2013
Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and... more Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. Simple demographic, clinical and radiological variables are described in this article in mechanically ventilated and nonventilated patients. To describe and correlate demographic, clinical, radiographic characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of Influenza A(H1N1) infection. Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A (H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine demographic, clinical and radiographic features, comorbidities, mechanical ventilator required or not. 35 Patients required mechanical ventilation. 27 required IMV, 4 required NIMV while 4 patients initially were put on NIMV required IMV subsequently. 19 (40.42%) female patients required mechanical ventilator. Mean age of mec...
Journal of minimally invasive gynecology, Jan 23, 2015
To demonstrate the feasibility of laparoscopic anterior exenteration with intracorporeal ureteros... more To demonstrate the feasibility of laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy. IRB approval was taken. Patients who had undergone laparoscopic anterior exenteration with intracorporeal ureterosigmoidostomy were analyzed. 57 patients with advanced cervical carcinoma, stage IV A were retrospectively analyzed since year 2005. Pre-operative work-up was done by CECT abdomen…
Background: HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectio... more Background: HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectious morbidity and mortality. Hospitalization is an important metric for morbidity and is associated with high mortality, yet, little is known about rates and causes of hospitalization among these infants in the first 12 months of life. Methods: Using data from a prevention of mother-to-child transmission (PMTCT) trial (India SWEN), where HIVexposed breastfed infants were given extended nevirapine, we measured 12-month infant all-cause and causespecific hospitalization rates and hospitalization risk factors. Results: Among 737 HIV-exposed Indian infants, 93 (13%) were HIV-infected, 15 (16%) were on HAART, and 260 (35%) were hospitalized 381 times by 12 months of life. Fifty-six percent of the hospitalizations were attributed to infections; gastroenteritis was most common accounting for 31% of infectious hospitalizations. Gastrointestinalrelated hospitalizations steadily increased over time, peaking around 9 months. The 12-month all-cause hospitalization, gastroenteritis-related hospitalization, and in-hospital mortality rates were 906/1000 PY, 229/1000 PY, and 35/1000 PY respectively among HIV-infected infants and 497/1000 PY, 107/1000 PY, and 3/1000 PY respectively among HIV-exposed, uninfected infants. Advanced maternal age, infant HIV infection, gestational age, and male sex were associated with higher all-cause hospitalization risk while shorter duration of breastfeeding and abrupt weaning were associated with gastroenteritis-related hospitalization. Conclusions: HIV-exposed Indian infants experience high rates of all-cause and infectious hospitalization (particularly gastroenteritis) and in-hospital mortality. HIV-infected infants are nearly 2-fold more likely to experience hospitalization and 10-fold more likely to die compared to HIV-exposed, uninfected infants. The combination of scaling up HIV PMTCT programs and implementing proven health measures against infections could significantly reduce hospitalization morbidity and mortality among HIV-exposed Indian infants.
The Journal of the Association of Physicians of India, 2011
India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported... more India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had e...
Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding,... more Background. Maternal human immunodeficiency virus (HIV) RNA load, CD4 cell count, breast-feeding, antiretroviral use, and malaria are well-established factors associated with mother-to-child transmission (MTCT) of HIV; the role of maternal tuberculosis (TB), however, has not been well established. Methods. The study population was 783 HIV-infected Indian mother-infant pair participants in randomized and ancillary HIV-infected cohorts of the Six Week Extended-Dose Nevirapine (SWEN) Study, a study comparing extended nevirapine versus single-dose nevirapine, to reduce MTCT of HIV among breast-fed infants. Using multivariable logistic regression, we assessed the impact of maternal TB occurring during pregnancy and through 12 months after delivery on risk of MTCT. Results. Of 783 mothers, 3 had prevalent TB and 30 had incident TB at 12 months after delivery. Of 33 mothers with TB, 10 (30%) transmitted HIV to their infants in comparison with 87 of 750 mothers without TB (12%; odds ratio [...
Effective doctor-patient communication is the heart of clinical medicine. Many callit to be an ar... more Effective doctor-patient communication is the heart of clinical medicine. Many callit to be an art. Recent findings have provided a neuro behavioral perspective in understanding the mechanism of this complex but vital component of the doctor-patient relationship. Empirical research has demonstrated that contingent interpersonal responses are accompanied by contingent neurobiological responses. Neuroscientists have now discovered a mirror neuronal system that contributes to this attuned responsiveness, with special relevance to empathy. Understanding the underlying mechanisms can also help optimize and make doctor-patient communication more effective.
In the early 1990's, Italian researchers discovered that the monkey brain contains a special ... more In the early 1990's, Italian researchers discovered that the monkey brain contains a special class of cells that fire when it sees or hears an action and when it carries out the same action on its own. These cells were termed as the ‘Mirror Neurons’. Subsequent research in humans revealed that the human brain has multiple mirror neuron systems that specialize in carrying out and understanding the actions, intentions, emotions and behavior. The available scientific literature provides substantial evidence that Mirror neurons offer the basis to grasp the actions and intentions of others through direct imitation without the need for any conceptual reasoning. The discovery of Mirror neurons has added a new light to the understanding of culture, empathy, philosophy, language, imitation and autism. The present paper gives a brief overview of the myriad applications of the concept and mechanism of mirror neurons. Here, we present an innovative concept of harnessing the functional mec...
The role of minimal invasive surgery is well established. As regards rectal cancers particularly ... more The role of minimal invasive surgery is well established. As regards rectal cancers particularly low lying rectal cancer studies are still going on for safety, feasibility and duplicability. A large prospective single-institutional study aims to assess the effectiveness of our technique of laparoscopic resection of rectal cancer in terms of oncological safety, complications and long-term prognosis. Between July 2006 and June 2016, 582 patients underwent laparoscopic LAR for rectal adenocarcinoma at our centre. Routine preoperative workup was done. Patients were evaluated for complications, graded and managed as per Clavien-Dindo classification. Survival probability analysis rate calculated using Kaplan Meier method. Total number of patients included in the study were 582 (375 men and 207 women) with the average age of 65 years. Tumours located in upper, middle and lower rectum were 132, 258 and 192 patients, respectively. A total of 33 patients received chemoradiation preoperatively and 450 received chemo+/-radiation postoperatively. Laparoscopic TME was done in 381 patients. Six out of 381patients underwent low anterior resection with hand-sewn coloanal anastomosis (CAA). Average operating time, blood loss and hospital stay were 124 min, 70 ml and 5 days, respectively. Average number of lymph nodes removed was 25.4 Overall complication rate was 20.8%, i.e. 121 out of 582 patients had complications. No conversion to conventional surgery was required. The most common postoperative complication was the anastomotic leak (grade II, IIIB and IV acc. to Clavien-Dindo classification); we had 71 leaks (13.4%).After a mean follow-up of 46 months (1–128 months), tumour recurrence occurred in 39 patients of 582. Overall recurrence rate was 6.7%. Overall cancer-related survival rate was 99.3, 96.7, 90.7, 90.7 and 87.7% at 1st, 2nd, 3rd, 4th and5th year, respectively. Five-year survival rate was 100% for stage I, 94.4% for stage II, 66.6% for stage III and 44.6% for stage IV. Laparoscopic TME technique is feasible and safe. With the development of improved technique, devices and expertise, laparoscopic resection for rectal cancer should be a standard method. Our results when compared with the other similar studies on laparoscopic low anterior resection clearly demonstrate that laparoscopic rectal resection with our technique is not associated with higher morbidity or mortality. Oncological and surgical principles were respected, and long-term outcomes compared with the previous literature and open surgery were comparable.
To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected... more To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients. A retrospective cohort study. Galaxy Care Laparoscopy Institute, Pune, India. Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients. The same surgeon and team performed all the operations for uniformity in 10 operative steps. The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%. Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival.
In 2010, the Medical Council of India published the Vision 2015 document, which sought to create ... more In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The impor...
14 patients of advanced carcinoma maxilla who presented to the Medical College Hospital, Aurangab... more 14 patients of advanced carcinoma maxilla who presented to the Medical College Hospital, Aurangabad, were treated by intra-arterial cyclophosphamide chemotherapy. Two dosage regime of 200 mg. per day and 500 mg. per day were used either continuously or intermittently. Regression of tumour was obtained in only two cases and regression in size of lymph nodes in another two cases. Subjective
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Papers by Dr Arun Jamkar