Introduction: Colorectal cancer the second most lethal malignancy widely considered a disease tha... more Introduction: Colorectal cancer the second most lethal malignancy widely considered a disease that affects people after the 4th decade of life but an interesting change in trend is observed and it was found that colorectal cancer rate has been increasing in young patients living under their 4th decade. These patients even present with more advanced diseases and generally have a poor overall prognosis compared to the older patients. Material and Methods: Colorectal cancer patients presented in Sindh Institute of urology and transplantation from January 2011 till December 2020 were reviewed retrospectively. For data analysis, all patients were divided into two groups, Group A young age population (age between 18 to 50 years) Group B old age population (above 50 years). Subgroup analysis of study period (from January 2011 to December 2015 first period while from January 2016 to December 2020 second period) was performed to check the progressive change in the trend of stage and clinical...
Gastrointestinal Stromal Tumors account for 1%-2% of all gastrointestinal (GI) tract tumors. Amon... more Gastrointestinal Stromal Tumors account for 1%-2% of all gastrointestinal (GI) tract tumors. Among GISTs, duodenal localization occurs in less than 5% and usually presents with upper GI bleeding. A 45-year-old man presented in the outpatient department with complaints of epigastric discomfort, intermittent melena and undocumented weight loss for the preceding 3 months. Initial upper GI endoscopy showed mild duodenitis and no other upper GI pathology. For unexplained symptoms, a CT Scan was performed which demonstrated a well-defined solid lesion along the second part of the duodenum. An endoscopic ultrasound (EUS)-guided biopsy of a subepithelial lesion at D2 was performed. Immunohistochemistry findings were suggestive of GIST. Wedge resection of the duodenal mass was done. Duodenal GIST should be considered as a differential in cases of GI bleeding when other differentials have been ruled out. Limited resection of duodenal GIST should be considered over pancreaticoduodenectomy, in case of small size tumors.
The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) wi... more The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) with a possible infectious etiology. Infants diagnosed to have EHBA were tested by blood PCR for cytomegalovirus (CMV), Ebstein-Barr virus, HBsAg, anti-HCV and IgM antibodies for CMV, toxoplasma, rubella, and herpes infections. Thirty-three infants of EHBA were included in the study, male 22, median age when diagnosed 2.5 months (range 1.0-5.0 months). On examination pallor, oedema and hepatosplenomegaly were seen in all and ascites and microcephaly in 19 (57.6%). Centile height and weight were 50th in 23 and 25th in 10. Persistent CMV infection documented by PCR was present in 14 (42%) patients. Eleven of these also had positive CMV IgM antibodies. No other above mentioned infections could be detected in our patients of EHBA. Our data suggests that CMV infection may play a role in the pathogenesis and progression of EHBA.
Background Celiac trunk agenesis is the recent and the rarest vascular variation reported. Report... more Background Celiac trunk agenesis is the recent and the rarest vascular variation reported. Reported cases in literature were identified either incidentally on imaging or while cadaveric dissections. This is a unique experience of hepatectomy in a patient without celiac artery ever reported. Case presentation This is a case of a patient who was scheduled to undergo donor hepatectomy. He was found to have a rare anatomical variation of agenesis of the celiac trunk during preoperative imaging done as a routine transplant surgery workup. He underwent live donor hepatectomy with no intra-operative or post-operative complications. This is the first case to be reported in the literature of a donor hepatectomy for liver transplantation in a patient with this rarest vascular variation of the celiac axis. Conclusion Pre-operative imaging to determine hepatic vascular anatomy improves the understanding of the surgeon intraoperatively while dissection and decreases the chance of any iatrogenic ...
We report a case of 40 years old female who was diagnosed to have gallbladder mass on radiologica... more We report a case of 40 years old female who was diagnosed to have gallbladder mass on radiological imaging and underwent radical cholecystectomy. Microscopic analysis of surgical specimen confirmed the diagnosis of multifocal intracholecystic papillary-tubular neoplasms (ICPNs) of the gallbladder with negative resection margin.
Gallbladder cancer in the background of polypoid lesions is rarely reported in children. We repor... more Gallbladder cancer in the background of polypoid lesions is rarely reported in children. We report a case of a gallbladder polyp and sludge in a 10-year-old girl who was presented with recurrent right upper quadrant abdominal pain and vomiting. Initial blood work up confirmed acute pancreatitis. Ultrasound examination of the abdomen revealed a polypoidal mass in gall bladder and later it was confirmed on Computerized Tomographic (CT) Scan to be 2.2 × 1.5 cm lesion arising from wall of gall bladder. Laparoscopic cholecystectomy was performed. Histopathological examination of the gallbladder revealed poorly differentiated adenocarcinoma arising in the background of adenomatous polyps. Tumor was reaching up to muscular layer with negative resection margins. Surveillance CT scan at 3 months showed bony metastasis. In conclusion, though gallbladder carcinoma is rare in children, it can be highly aggressive.
Although the kidney transplant program at this center has been active for the past 18 yr, five ou... more Although the kidney transplant program at this center has been active for the past 18 yr, five out of the seven cases of post-transplant lymphoma in kidney transplant patients were observed over the past 2 yr. During this period, we have shifted from cyclosporine to tacrolimus (FK506 or prograf) for maintenance immunosuppression and for rescue therapy. We have also introduced mycophenolate (RS-61443) and have continued an antibody induction regimen in the immediate postoperative period. FK506 is 50-100 times more potent than cyclosporine. We have reported a decreased incidence of rejection, improved graft survival, and a general optimalization of patient survival with these newer regimens. Nonetheless, five cases of post-transplant lymphoma out of 233 kidney transplants (2.1%) performed during this time period (December 1993 to December 1995) occurred between 3 months to 1 yr after the transplant. Four of the five patients are still alive between 12 and 24 months after the diagnosis...
JPMA. The Journal of the Pakistan Medical Association, 2011
The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) wi... more The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) with a possible infectious etiology. Infants diagnosed to have EHBA were tested by blood PCR for cytomegalovirus (CMV), Ebstein-Barr virus, HBsAg, anti-HCV and IgM antibodies for CMV, toxoplasma, rubella, and herpes infections. Thirty-three infants of EHBA were included in the study, male 22, median age when diagnosed 2.5 months (range 1.0-5.0 months). On examination pallor, oedema and hepatosplenomegaly were seen in all and ascites and microcephaly in 19 (57.6%). Centile height and weight were 50th in 23 and 25th in 10. Persistent CMV infection documented by PCR was present in 14 (42%) patients. Eleven of these also had positive CMV IgM antibodies. No other above mentioned infections could be detected in our patients of EHBA. Our data suggests that CMV infection may play a role in the pathogenesis and progression of EHBA.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2005
This is the first reported case of lymphoproliferative disease presenting with adrenal insufficie... more This is the first reported case of lymphoproliferative disease presenting with adrenal insufficiency after liver transplantation. A 38-year-old white man was admitted 8 months after transplantation for cryptogenic cirrhosis with fever (38-39 degrees C), chills, cough, and dyspnea. His blood pressure was 100/70 mm Hg, there was pallor of the conjunctiva, and a lymph node was palpable in the left groin. Laboratory analyses revealed the following values: serum sodium concentration (112 mmol/L), potassium (5.4 mmol/L), hemoglobin (7.8 g/L), white blood cell count (7.7 x 10(9)/L), glucose 3.9 (mmol/L), and mildly elevated liver functions. Abdominal ultrasound showed multiple hypoechoic solid-appearing lesions throughout the liver and spleen. Results of a biopsy specimen of the groin node confirmed polymorphic B-cell lymphoma. A negative Epstein- Barr virus screen before transplant became positive. The patient's fever increased to 40 degrees C. He subsequently developed sepsis and lat...
Introduction: Colorectal cancer the second most lethal malignancy widely considered a disease tha... more Introduction: Colorectal cancer the second most lethal malignancy widely considered a disease that affects people after the 4th decade of life but an interesting change in trend is observed and it was found that colorectal cancer rate has been increasing in young patients living under their 4th decade. These patients even present with more advanced diseases and generally have a poor overall prognosis compared to the older patients. Material and Methods: Colorectal cancer patients presented in Sindh Institute of urology and transplantation from January 2011 till December 2020 were reviewed retrospectively. For data analysis, all patients were divided into two groups, Group A young age population (age between 18 to 50 years) Group B old age population (above 50 years). Subgroup analysis of study period (from January 2011 to December 2015 first period while from January 2016 to December 2020 second period) was performed to check the progressive change in the trend of stage and clinical...
Gastrointestinal Stromal Tumors account for 1%-2% of all gastrointestinal (GI) tract tumors. Amon... more Gastrointestinal Stromal Tumors account for 1%-2% of all gastrointestinal (GI) tract tumors. Among GISTs, duodenal localization occurs in less than 5% and usually presents with upper GI bleeding. A 45-year-old man presented in the outpatient department with complaints of epigastric discomfort, intermittent melena and undocumented weight loss for the preceding 3 months. Initial upper GI endoscopy showed mild duodenitis and no other upper GI pathology. For unexplained symptoms, a CT Scan was performed which demonstrated a well-defined solid lesion along the second part of the duodenum. An endoscopic ultrasound (EUS)-guided biopsy of a subepithelial lesion at D2 was performed. Immunohistochemistry findings were suggestive of GIST. Wedge resection of the duodenal mass was done. Duodenal GIST should be considered as a differential in cases of GI bleeding when other differentials have been ruled out. Limited resection of duodenal GIST should be considered over pancreaticoduodenectomy, in case of small size tumors.
The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) wi... more The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) with a possible infectious etiology. Infants diagnosed to have EHBA were tested by blood PCR for cytomegalovirus (CMV), Ebstein-Barr virus, HBsAg, anti-HCV and IgM antibodies for CMV, toxoplasma, rubella, and herpes infections. Thirty-three infants of EHBA were included in the study, male 22, median age when diagnosed 2.5 months (range 1.0-5.0 months). On examination pallor, oedema and hepatosplenomegaly were seen in all and ascites and microcephaly in 19 (57.6%). Centile height and weight were 50th in 23 and 25th in 10. Persistent CMV infection documented by PCR was present in 14 (42%) patients. Eleven of these also had positive CMV IgM antibodies. No other above mentioned infections could be detected in our patients of EHBA. Our data suggests that CMV infection may play a role in the pathogenesis and progression of EHBA.
Background Celiac trunk agenesis is the recent and the rarest vascular variation reported. Report... more Background Celiac trunk agenesis is the recent and the rarest vascular variation reported. Reported cases in literature were identified either incidentally on imaging or while cadaveric dissections. This is a unique experience of hepatectomy in a patient without celiac artery ever reported. Case presentation This is a case of a patient who was scheduled to undergo donor hepatectomy. He was found to have a rare anatomical variation of agenesis of the celiac trunk during preoperative imaging done as a routine transplant surgery workup. He underwent live donor hepatectomy with no intra-operative or post-operative complications. This is the first case to be reported in the literature of a donor hepatectomy for liver transplantation in a patient with this rarest vascular variation of the celiac axis. Conclusion Pre-operative imaging to determine hepatic vascular anatomy improves the understanding of the surgeon intraoperatively while dissection and decreases the chance of any iatrogenic ...
We report a case of 40 years old female who was diagnosed to have gallbladder mass on radiologica... more We report a case of 40 years old female who was diagnosed to have gallbladder mass on radiological imaging and underwent radical cholecystectomy. Microscopic analysis of surgical specimen confirmed the diagnosis of multifocal intracholecystic papillary-tubular neoplasms (ICPNs) of the gallbladder with negative resection margin.
Gallbladder cancer in the background of polypoid lesions is rarely reported in children. We repor... more Gallbladder cancer in the background of polypoid lesions is rarely reported in children. We report a case of a gallbladder polyp and sludge in a 10-year-old girl who was presented with recurrent right upper quadrant abdominal pain and vomiting. Initial blood work up confirmed acute pancreatitis. Ultrasound examination of the abdomen revealed a polypoidal mass in gall bladder and later it was confirmed on Computerized Tomographic (CT) Scan to be 2.2 × 1.5 cm lesion arising from wall of gall bladder. Laparoscopic cholecystectomy was performed. Histopathological examination of the gallbladder revealed poorly differentiated adenocarcinoma arising in the background of adenomatous polyps. Tumor was reaching up to muscular layer with negative resection margins. Surveillance CT scan at 3 months showed bony metastasis. In conclusion, though gallbladder carcinoma is rare in children, it can be highly aggressive.
Although the kidney transplant program at this center has been active for the past 18 yr, five ou... more Although the kidney transplant program at this center has been active for the past 18 yr, five out of the seven cases of post-transplant lymphoma in kidney transplant patients were observed over the past 2 yr. During this period, we have shifted from cyclosporine to tacrolimus (FK506 or prograf) for maintenance immunosuppression and for rescue therapy. We have also introduced mycophenolate (RS-61443) and have continued an antibody induction regimen in the immediate postoperative period. FK506 is 50-100 times more potent than cyclosporine. We have reported a decreased incidence of rejection, improved graft survival, and a general optimalization of patient survival with these newer regimens. Nonetheless, five cases of post-transplant lymphoma out of 233 kidney transplants (2.1%) performed during this time period (December 1993 to December 1995) occurred between 3 months to 1 yr after the transplant. Four of the five patients are still alive between 12 and 24 months after the diagnosis...
JPMA. The Journal of the Pakistan Medical Association, 2011
The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) wi... more The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) with a possible infectious etiology. Infants diagnosed to have EHBA were tested by blood PCR for cytomegalovirus (CMV), Ebstein-Barr virus, HBsAg, anti-HCV and IgM antibodies for CMV, toxoplasma, rubella, and herpes infections. Thirty-three infants of EHBA were included in the study, male 22, median age when diagnosed 2.5 months (range 1.0-5.0 months). On examination pallor, oedema and hepatosplenomegaly were seen in all and ascites and microcephaly in 19 (57.6%). Centile height and weight were 50th in 23 and 25th in 10. Persistent CMV infection documented by PCR was present in 14 (42%) patients. Eleven of these also had positive CMV IgM antibodies. No other above mentioned infections could be detected in our patients of EHBA. Our data suggests that CMV infection may play a role in the pathogenesis and progression of EHBA.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2005
This is the first reported case of lymphoproliferative disease presenting with adrenal insufficie... more This is the first reported case of lymphoproliferative disease presenting with adrenal insufficiency after liver transplantation. A 38-year-old white man was admitted 8 months after transplantation for cryptogenic cirrhosis with fever (38-39 degrees C), chills, cough, and dyspnea. His blood pressure was 100/70 mm Hg, there was pallor of the conjunctiva, and a lymph node was palpable in the left groin. Laboratory analyses revealed the following values: serum sodium concentration (112 mmol/L), potassium (5.4 mmol/L), hemoglobin (7.8 g/L), white blood cell count (7.7 x 10(9)/L), glucose 3.9 (mmol/L), and mildly elevated liver functions. Abdominal ultrasound showed multiple hypoechoic solid-appearing lesions throughout the liver and spleen. Results of a biopsy specimen of the groin node confirmed polymorphic B-cell lymphoma. A negative Epstein- Barr virus screen before transplant became positive. The patient's fever increased to 40 degrees C. He subsequently developed sepsis and lat...
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