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| 1 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 2 | Endoscopic management of acute cholangitis in elderly patients显示文摘AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage. | Naresh Agarwal Barjesh Chander Sharma Shiv K Sarin | 2006 | World Journal of Gastroenterology2006，12，40： | 14 |
| 3 | Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India显示文摘AIM To study the diagnostic accuracy of transient elastography(TE) for detecting clinically significant portal hypertension(CSPH) in Indian patients with cirrhotic portal hypertension.METHODS This retrospective study was conducted at the Institute of Liver, Gastroenterology, and Panceatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient(HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman's correlation test. Receiver operating characteristic ( ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE forthe diagnosis of CSPH was obtained using the Youden index.RESULTS The study included 326 patients [median age 52(range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic(45%) followed by alcohol(34%). The median HVPG was 16.0(range 1.5 to 30.5) mm Hg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG(rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740(95%CI: 0.662-0.818)(P < 0.01). A cut-off value of TE of 21.6 k Pa best predicted CSPH with a positive predictive value(PPV) of 93%.CONCLUSION TE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 k Pa identifies CSPH with a PPV of 93%. | Ashish Kumar Noor Muhammad Khan Shrihari Anil Anikhindi Praveen Sharma Naresh Bansal Vikas Singla Anil Arora | 2017 | World Journal of Gastroenterology2017，23，4： | 8 |
| 4 | 在稍尖的巨大的肺的栓塞的机械故障和 thrombolysis : 未来的试用显示文摘 AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to reestablish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). RESULTS: Eight patients, mean age 47.77±12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5±15.2/min, 0.995±0.156, 23.87±3.76 and 37.62±6.67 mmHg which reduced to 91.5±12.2/min (P=0.0325), 0.789±0.139 (P=0.0019), 5.87±1.73 (P=0.0000004) and 27.75±8.66 mmHg (P=0.0003) post procedurally. Mean BP improved from 80.00±3.09 mmHg to 90.58±9.13 mmHg (P=0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1. CONCLUSION: Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism. | Bishav Mohan Shibba Takkar Chhabra Naved Aslam Gurpreet Singh Wander Naresh Kumar Sood Sumati Verma Anil Kumar Mehra Sarit Sharma | 2013 | World Journal of Cardiology2013，5，5： | 5 |
| 5 | All ileo-cecal ulcers are not Crohn's:Changing perspectives of symptomatic ileocecal ulcers显示文摘AIM To investigated clinical,endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy.METHODS Consecutive symptomatic patients undergoing colonoscopy,and diagnosed to have ulcerations in the ileocecal(I/C) region,were enrolled.Biopsy was obtained and theirclinical presentation and outcome were recorded.RESULTS Out of 1632 colonoscopies,104 patients had ulcerations in the I/C region and were included in the study.Their median age was 44.5 years and 59% were males.The predominant presentation was lower GI bleed(55,53%),pain abdomen ± diarrhea(36,35%),fever(32,31%),and diarrhea alone(9,9%).On colonoscopy,terminal ileum was entered in 96(92%) cases.The distribution of ulcers was as follows:Ileum alone 40%(38/96),cecum alone 33%(32/96),and both ileum plus cecum 27%(26/96).The ulcers were multiple in 98% and in 34% there were additional ulcers elsewhere in colon.Based on clinical presentation and investigations,the etiology of ulcers was classified into infective causes(43%) and noninfective causes(57%).Fourteen patients(13%) were diagnosed to have Crohn's disease(CD).CONCLUSION Non-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region.And if all infections are clubbed together then infection is the most common(> 40%) cause of ulcerations of the I/C region.Cecal involvement and fever are important clues to infective cause.On the contrary CD account for only 13% cases as a cause of ileo-cecalulcers.So all symptomatic patients with I/C ulcers on colonoscopy are not Crohn's. | Jay Toshniwal Romesh Chawlani Amit Thawrani Rajesh Sharma Anil Arora Hardik L Kotecha Mohan Goyal Vijendra Kirnake Pankaj Jain Pankaj Tyagi Naresh Bansal Munish Sachdeva Piyush Ranjan Mandhir Kumar Praveen Sharma Vikas Singla Rinkesh Bansal Vineet Shah Sunita Bhalla Ashish Kumar | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，7： | 5 |
| 6 | Carcinoma of the gallbladder显示文摘 | Sanjeev Misra Arun Chaturvedi Naresh C Misra Indra D Sharma | 2003 | Lancet Oncology2003，，3： | 2 |
| 7 | 坏死性筋膜炎1例显示文摘报告1例具有典型症状的坏死性筋膜炎。患者女,70岁。皮损位于左臀部和左大腿,为显著性红斑、硬结、片状坏死,皮损有恶臭,组织中有产气现象,自觉疼痛剧烈。经组织病理检查确诊为坏死性筋膜炎。对患者施行清创术和对症支持治疗,包括消炎、镇痛和补液,获得令人满意的疗效。 | Virendra N Sehgal Naresh Sehgal Ruchi Sehgal Sujay Khandpur Sonal Sharma | 2005 | 临床皮肤科杂志2005，34，2： | 2 |
| 8 | Hydro system scheduling using ANN approach 显示文摘 | Naresh R Sharma J | 2000 | IEEETrans on Power Systems2000，15，1： | 1 |
| 9 | An integrated neural fuzzy approach for fault diagnosis of transformers显示文摘 | Naresh R Sharma V Vashisth M | 2008 | IEEE Transactions on Power Delivery2008，23，4： | 1 |
| 10 | Optimization of fermentation parameters for production of ethanol from kinnow waste and banana peels by simultaneous sacchari? cation and fermentation 显示文摘 | Naresh Sharma Kalra K L Harinder Singh Oberoi | 2007 | Microbiol2007，47，： | 1 |
| 11 | An overview on pectins显示文摘 | Sharma B Naresh L Dhuldhoya N | | 0，，： | 1 |
| 12 | DaM Development of a Single-Reaction Multiplex PCR Toxin Typing Assay for Staphylococcus Strains显示文摘 | Naresh K Sharma Catherine E D Rees | 2000 | Applied and Environmental Micrabiology2000，66，4： | 1 |
| 13 | An integrated neu- ral fuzzy approach for fault diagnosis of transformers显示文摘 | Naresh R Sharma Veena Vashisth Manisha | 2008 | IEEE Transactions on Power Delivery2008，23，4： | 1 |
| 14 | A nonlinear AIDS epidemic model with screening and time delay 显示文摘 | NARESH R TRIPATHI A SHARMA D | 2011 | Appl Math Comput2011，217，9： | 1 |
| 15 | Two phase neural network based modeling framework of constrained economic load dispatch显示文摘 | Naresh R Dubey J Sharma J | 2004 | IEE Proc Gener Transm Distfib2004，151，3： | 1 |
| 16 | Two-phase Neural Network Based Solution Technique for Short-term Hydrothermal Scheduling显示文摘 | Naresh R Sharma J | | lEE Proceedings-Gener Transm and Distrib 1990，146，6： | 1 |
| 17 | Hydro system scheduling using ANN approach显示文摘 | Naresh R Sharma J | 2000 | IEEE Trans on Power Systems2000，15，1： | 1 |
| 18 | Two-phase neural network based modelling framework of constrained economic load dispatch显示文摘 | Naresh R Dubey J Sharma J | 2004 | IEE Proceedings-Generation Transmission and Distribution2004，151，3： | 1 |
| 19 | Short term hydro scheduling using two-phase neural network显示文摘 | Naresh R Sharma J | 2002 | International Journal of Electrical Power&Energy Systems2002，24，7： | 1 |
| 20 | An integrated neural fuzzy approach for fault diagnosis of transformers显示文摘 | Naresh R Sharma V Vashisth M | 2008 | IEEE Transaetions on Power Delivery2008，23，4： | 1 |
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