Browsing by Author "Chitra Gupta"

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Iatrogenic extrahepatic bile duct injury: Prevention is better than repair
(2002) Kundan Kumar; Chitra Gupta; Priya Hazrah; Mallika Tewari; Vinita Srivastava; Vinod K. Dixit; Narendra K. Keswani; Hari S. Shukla
In the 6 year period, between 1994-1999, 40 patients with extrahepatic bile duct injury caused during open cholecystectomy (OC) (35 patients) and laparoscopic cholecystectomy (LC) (5 patients), were referred to one surgical unit from either the University Hospital, Banaras Hindu University (3 patients) or nursing homes (37 patients). These patients were studied with the aim to assess the cause, evaluate the treatment and suggest measures of prevention. Injury to the common bile duct (CBD) was present in 24 patients, common hepatic duct (CHD) in 16 patients and in one patient the accessory cystic duct was injured. In 14 patients the injury was detected during operation. No attempt to repair was made in 4 and an unsuccessful attempt of primary repair was made in 10 patients by the operating surgeon. The skin incision was inadequate, measuring less than 8 cms in 10 patients. Patients presented with bile fistula in 24, obstructive jaundice in 13 patients, peritonitis in 2 and ascites in 1 patient. Further ascites with fistula and obstructive jaundice was present in 3 and 1 patient respectively. Two patients with biliary peritonitis with fistula died and one more patient died after Roux-en-Y choledocho-duodenostomy. In one patient bile fistula closed spontaneously. A variety of bypass procedures were used in the remaining pateints including choledocho-duodenostomy in 6, hepatico-duodenostomy in 3 and Roux-en-Y choledocho-jejunostomy in 20 patients. Six to eighty (median 15) months follow-up has shown stricture formation in one patient who underwent choledocho-duodenostomy and one with repair of CBD on a T-tube. Eight (20%) patients continue to complain of dyspeptic symptoms. In conclusion 1. Extrahepatic bile duct injury occurs in a proportion of patients undergoing cholecystectomy. 2. On detection of the injury during operation the inexperienced surgeon should not make any attempt at primary repair. 3. Roux-en-Y choledocho/hepaticoenteric anastomosis is an adequate method of repair. Further research on the overall prevalence and the causes of iatrogenic injury to the extrahepatic biliary tree is indicated with the participation of all surgeons carrying out the procedure of cholecystectomy.
Neonatal hypoglycaemic brain injury, a common cause of early-childhood epilepsy in India: A prospective longitudinal study on aetiologies and outcomes
(John Wiley and Sons Inc, 2025) Chitra Gupta; Bhuvandeep Narang; S. G. Thenral; Rakhi Sharma; Sagnik Chatterjee; Vedam Laxmi Ramprasad; Sakthivel M. Murugan; Pradeep Goyal; Rajiv Kumar Bansal; Vivek Jain
Aim: To evaluate the aetiologies and long-term seizure outcomes in early childhood epilepsy in a low- to middle-income country (India). Method: This prospective descriptive study enrolled 231 children with epilepsy onset before age 5 years, over a 12-month period. A comprehensive neuroradiological and genetic evaluation was performed. Differences in epilepsy and neurodevelopmental profiles of the two most common acquired causes – neonatal hypoglycaemic brain injury (NHBI) and neonatal asphyxial brain injury (NABI) – were analysed. Seizure control at 24-month follow-up could be confirmed for 209 patients. Results: In 172 (74%) patients, an aetiology could be identified. The structural group was the most common (126, 55%), followed by unknown (48, 21%), genetic (41, 18%), and metabolic (5, 2%). At 24-month follow-up, 57 (27%) patients had poor seizure control. NHBI was the most common single cause (50, 22%) of epilepsy. NHBI was associated with focal seizures (p < 0.001), autistic features (p = 0.05), and hypotonia (p = 0.03), while NABI more often led to epileptic spasms (p = 0.05) and hypertonia (p < 0.001). Interpretation: NHBI was the leading cause of epilepsy in our cohort. These findings highlight the need to revise newborn feeding practices to reduce the long-term burden of epilepsy among Indian children. © 2025 Mac Keith Press.