Browsing by Author "Ajay K Khanna"

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Assessment and grading of pigmentation in chronic venous insufficiency
(SAGE Publications Ltd, 2020) Satyendra K Tiwary; Praveen KG Kumar; Neeraj Dhameeja; Puneet Kumar; Ajay K Khanna; Soumya Khanna
Introduction: Chronic venous insufficiency causes skin pigmentation of the leg ranging from small patches of mild dyschromia to extensive areas of severe skin pigmentation. It is thought that the pigmentation is mainly due to haemosiderin or melanin deposition. Erythrodiapedesis which occurs as a result of venular hypertension causes erythrocytes to migrate across the microvascular network into the dermis. Methods: We categorized the grading of pigmentation into four grades: +, few spots; ++, pigmentation over gaiter area; +++, pigmentation involving leg and ankle; ++++, heavily pigmented (dark). Skin biopsies were taken from the patient while undergoing surgery; two biopsies were taken from each patient, one from apparently normal skin and other from the site of pigmentation. A total of 45 patients diagnosed as chronic venous insufficiency with pigmentation were included in the study and five patients included in control. The biopsy specimens were sent to pathology department for H&E, Perls stain and IHC for S100. Results: Majority of cases, i.e. 62% of limbs fall under (++) grade of pigmentation, followed by (+) grade of pigmentation in 20%, while (+++) and (++++) constitute 9% of the cases each. Increased melanin deposition was seen in 40 pigmented skin biopsies and 3 normal skin biopsies from the case group, and normal melanin deposition was seen in all the non-varicose controls. Conclusion: We have tried to categorize pigmentation in chronic venous insufficiency into four grades. As the grade of pigmentation increases the per cent of cases with ulceration is increasing. It was observed that presence of melanin deposition irrespective of the grade of pigmentation was distributed more towards the advanced clinical classification (C5 and C6). © The Author(s) 2019.
Colonic lipoma presenting with intussusception
(SAGE Publications Inc., 2021) Puneet Kumar; Mahesh Tiwari; Ajay K Khanna; Satyendra K Tiwary
Colonic lipomas are rare benign tumours, although they constitute the most common non-epithelial neoplasm of the gastrointestinal tract. They mostly remain asymptomatic and rarely present with intussusception. A 62-year-old male presented with acute intestinal obstruction. On laparotomy, intussusception of the descending colon was detected, with a single sessile polyp measuring 3 cm×3 cm as the lead point. A left hemicolectomy was performed, and histopathological examination revealed a lipoma of the colon. © The Author(s) 2020.
Giant Adrenal Myelolipoma: Review of Indian Literature and a Case Report
(Springer, 2024) Nyima Bole; Soumya Khanna; Rohit Kumar Singh; Satyendra Tiwary; Puneet; Ajay K Khanna
Adrenal myelolipoma is a rare benign tumor which consists of mature adipose tissues and hematopoietic tissues in variable proportion. These tumors are mostly detected incidentally on imaging done for other reasons but due to advancement in non-invasive imaging modalities they are found more frequently now. The incidence of adrenal myelolipoma is found to be 0.08 to 0.4%, whereas they constitute 15% of all adrenal incidentalomas. Usually, these tumors are small, unilateral, and hormonally inactive, arising from adrenal gland, but there are articles that have reported about giant, bilateral, extra-adrenal, or hormonally active myelolipomas. Here, we present a unique case of right adrenal myelolipoma with an unusual presentation as the patient was in the 2nd decade of life (24 years old) and the tumor weighed 5 kg which was successfully managed by right adrenalectomy. Further, we have reviewed the articles published in Indian literature. © Association of Surgeons of India 2023.
Reply of letter to the editor: Assessment and grading of pigmentation in chronic venous insufficiency in Phlebology 2020
(SAGE Publications Ltd, 2023) Satyendra K Tiwary; Praveen KG Kumar; Neeraj Dhameeja; Puneet Kumar; Ajay K Khanna; Soumya Khanna
[No abstract available]
SELSI Consensus Statement for Safe Cholecystectomy — Prevention and Management of Bile Duct Injury — Part A
(Springer, 2021) Virinder Kumar Bansal; Mahesh C. Misra; Anil K Agarwal; Jb Agrawal; Pn Agarwal; Sandeep Aggarwal; Mohammad Aslam; Asuri Krishna; Aditya Baksi; Anu Behari; Hemanga K Bhattacharjee; Rajesh Bhojwani; Jagdish Chander; Tk Chattopadhyay; Chintamani; Pradeep Chowbey; Abhay Dalvi; Nr Dash; Ik Dhawan; Shivanand Gamangatti; Pk Garg; Nm Gupta; Rajesh Gupta; Sk Gupta; Vikas Gupta; L. Kaman; Bml Kapur; Kamal Kataria; Muneer Khan; Ajay K Khanna; Rajesh Khullar; Anand Kumar; Atin Kumar; Sandeep Kumar; Subodh Kumar; Pawanindra Lal; Sd Maurya; Gs Moirangthem; Sujoy Pal; Rajesh Panwar; Rajinder Parshad; Biju Pottakkat; Om Prakash Prajapati; Shailesh Puntambekar; Piyush Ranjan; Yashwant Singh Rathore; Peush Sahni; Rathindra Sarangi; Vuthaluru Seenu; Rajeev Sharma; Vk Shukla; Dp Singh; Jaspal Singh; Rajdeep Singh; Rajeev Sinha; Sadiq S Sikora; Amit Srivastava; Anurag Srivastava; Kn Srivastava; Shaji Thomas; Gr Verma; Jd Wig; Vk Kapoor
Cholecystectomy is one of the most common general surgical operations performed worldwide. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality; it also increases the cost of treatment and can be a common reason for medico-legal suits against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects, especially in small peripheral centers, was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group. © 2019, Association of Surgeons of India.
SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B
(Springer, 2021) Virinder Kumar Bansal; Mahesh C. Misra; Anil K Agarwal; Jb Agrawal; Pn Agarwal; Sandeep Aggarwal; Mohammad Aslam; Asuri Krishna; Aditya Baksi; Anu Behari; Hemanga K Bhattacharjee; Rajesh Bhojwani; Jagdish Chander; Tk Chattopadhyay; Chintamani; Pradeep Chowbey; Abhay Dalvi; Nr Dash; Ik Dhawan; Shivanand Gamangatti; Pk Garg; Nm Gupta; Rajesh Gupta; Sk Gupta; Vikas Gupta; L. Kaman; Bml Kapur; Kamal Kataria; Muneer Khan; Ajay K Khanna; Rajesh Khullar; Anand Kumar; Atin Kumar; Sandeep Kumar; Subodh Kumar; Pawanindra Lal; Sd Maurya; Gs Moirangthem; Sujoy Pal; Rajesh Panwar; Rajinder Parshad; Biju Pottakkat; Om Prakash Prajapati; Shailesh Puntambekar; Piyush Ranjan; Yashwant Singh Rathore; Peush Sahni; Rathindra Sarangi; Vuthaluru Seenu; Rajeev Sharma; Vk Shukla; Dp Singh; Jaspal Singh; Rajdeep Singh; Rajeev Sinha; Sadiq S Sikora; Amit Srivastava; Anurag Srivastava; Kn Srivastava; Shaji Thomas; Gr Verma; Jd Wig; Vk Kapoor
Cholecystectomy is one of the commonest general surgical procedures performed all over India. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality. BDI increases the cost of treatment and is a common reason for a medicolegal suit against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects especially in small peripheral centers was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group. © 2019, Association of Surgeons of India.
Simplified Laparoscopic Suture Rectopexy for Idiopathic Rectal Prolapse In Children: Technique and Results
(W.B. Saunders, 2020) Vaibhav Pandey; Ajay K Khanna; Vivek Srivastava; Rakesh Kumar; Pranay panigrahi; Shiv P Sharma; Arj D Upadhayay
Background: Laparoscopic suture rectopexy is safe and effective treatment option for pediatric rectal prolapse. We performed this study to compare the outcome of modified laparoscopic suture rectopexy (MLSR) versus Classical Laparoscopic suture rectopexy (CLSR). Material and methods: The study was conducted between June 2015 to May 2019 including all the patients with persistent rectal prolapse who underwent surgery managed by either MLSR (Group A) or CLSR (Group B). The groups were compared for constipation, operative time, blood loss, length of stay, postoperative complications. Results: 19 patients from MLSR and 22 patients from CLSR were evaluated. The mean operative time in MLSR group was 41.5 ± 6.2 min which was significantly lesser than CLSR group with a mean operative time of 78.6 ± 14.2 (p = 0.001). The blood loss was also less in MLSR group compared to CLSR group (p = 0.013). At three months of follow up, the constipation was less in MLSR group compared to CLSR group (p = 0.041). Conclusion: The modification makes the procedure technically easy, minimizes the chances of complications and retaining all the advantages of suture rectopexy. Level OF Evidence: Level II. © 2019 Elsevier Inc.
Squamous cell carcinoma arising from pilonidal sinus
(Blackwell Publishing Ltd, 2014) Mithilesh K Pandey; Puneet Gupta; Ajay K Khanna
Pilonidal sinus is usually present in the sacrococcygeal region. The common presentations are cellulitis, abscess or sinus. Rarely malignant change may be seen in chronic pilonidal sinus. We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma. © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Study of association of varicose veins and inflammation by inflammatory markers
(SAGE Publications Ltd, 2020) Satyendra K Tiwary; Anoop Kumar; Shiv Prakash Mishra; Puneet Kumar; Ajay K Khanna
Objective: In varicose veins, increased levels of inflammatory markers are indicators of endothelial damage and increased procoagulant activity. These findings support the assumption that the constitution of blood in varicose veins differs from that of systemic blood. The purpose of the study was a correlative study of blood constituents in varicose veins and peripheral veins (normal vein) in same individual with varicose vein which was done by comparing the level of concentration of interleukin-6, fibrinogen, haemoglobin from blood of varicose veins and normal peripheral vein (antecubital vein). Method: Using citrated plasma samples withdrawn from arms and legs of same patient and plasma obtained by centrifugation of citrated venous blood at 5000 r/min for 10 min was used for correlation. Serum concentration of interleukin-6 and fibrinogen were determined by human enzyme-linked immunosorbent assay Kit for both interleukin-6 and fibrinogen, which is based on the standard sandwich enzyme-linked immunosorbent assay technology. This assay employs a monoclonal antibody specific for human interleukin-6 coated on a 96-well plate. Result: Expressed as median (interquartile range) in pg/mL, leg samples from patient having varicose vein has significantly increased interleukin-6 in cases as compared to controls (p value of '0.001). Leg samples from patient having varicose vein has significantly increased fibrinogen concentration than their arm samples (p value of '0.001). Concentration of haemoglobin significantly increased in leg samples as compared to blood withdrawn from arms (p value of 0.012). Conclusion: Blood withdrawn from the site of varicose vein appears to have significantly increased concentration of interleukin-6, fibrinogen and haemoglobin when compared to same patient’s antecubital blood sample supporting the hypothesis that inflammation is increased in tissues drained by varicose vein. © The Author(s) 2020.