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| 1 | Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review显示文摘BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date. | Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 8 |
| 2 | Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula:Experience from 2404 scans显示文摘Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken.Incidentally,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period.In this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field. | Pankaj Garg Baljit Kaur Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastroenterology2021，27，33： | 6 |
| 3 | In-vitro scolicidal activity of Mallotus philippinensis (Lam.) Muell Arg. fruit glandular hair extract against hydatid cyst Echinococcus granulosus显示文摘Objective: To investigate new scolicidal agent from natural resources to cope with the side effects associated with synthetic drugs in Echinococcosis. Methods: The scolicidal potential of methanolic fruit powder extract (10 and 20 mg/mL) of Mallotus philippinensis ( M. philippinensis ) was investigated. Viability of protoscoleces was confirmed by trypan blue exclusion method, where mortality was observed at concentration of 10 and 20 mg/mL in 60 min treatment against Echinococcus granulosus ( E. granulosus ), under in-vitro conditions with reference to the known standard drug Praziquantel . Results: At concentration 10 and 20 mg/mL, the mortality rate was observed 97% and 99% respectively for 60 min treatment; while up to 93% mortality was observed with 20 mg/mL for only 10 min treatment. The concentration above 20 mg/mL for above 2 h showed 100% mortality, irrespective of further incubation. Conclusions: As compared with the standard anti-parasitic drug Praziquantel our extract has significant scolicidal activity with almost no associated side effects. | Mayank Gangwar Vijay C Verma Tryambak D Singh Sushil K Singh RK Goel Gopal Nath | 2013 | Asian Pacific Journal of Tropical Medicine2013，6，8： | 3 |
| 4 | Diagnosis of anorectal tuberculosis by polymerase chain reaction,GeneXpert and histopathology in 1336 samples in 776 anal fistula patients显示文摘BACKGROUND The association of tuberculosis(TB)with anal fistulas can make its treatment quite difficult.The main challenge is timely detection of TB in anal fistulas and its proper management.There is little data available on diagnosis and management of TB in anal fistulas.AIM To detect TB in fistula-in-ano patients were analyzed in different methods utilized.METHODS A retrospective analysis of different methods,polymerase chain-reaction(PCR),GeneXpert and histopathology(HPE),utilized to detect tuberculosis in fistula-inano patients,treated between 2014-2020,was performed.The sampling was done for tissue(fistula tract lining)and pus(when available).The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were studied.RESULTS In 1336 samples(776 patients)tested,TB was detected in 133 samples(122 patients).TB was detected in 52/703(7.4%)samples tested by PCR-tissue,in 77/331(23.2%)samples tested by PCR-pus,3/197(1.5%)samples tested with HPE-tissue and 1/105(0.9%)samples tested by GeneXpert.To detect TB,PCRtissue was significantly better than HPE-tissue(52/703 vs 3/197 respectively)(P=0.0012,significant,Fisher’s exact test)and PCR-pus was significantly better than PCR-tissue(77/331 vs 52/703 respectively)(P<0.00001,significant,Fisher’s exact test).TB fistulas were more complex than non-tuberculous fistulas[78/113(69%)vs 278/727(44.3%)respectively](P<0.00001,significant,Fisher’s exact test)but the overall healing rate was similar in tuberculous and non-tuberculous fistula groups[90/102(88.2%)vs 518/556(93.2%)respectively](P=0.10,not significant,Fisher’s exact test).CONCLUSION This is the largest study of anorectal TB to be published.The detection of TB by polymerase chain-reaction was significantly higher than by histopathology and GeneXpert.Amongst polymerase chain-reaction,pus had a higher detection rate than tissue.TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups. | Pankaj Garg Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 3 |
| 5 | Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas显示文摘Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper. | Pankaj Garg Vipul D Yagnik Sushil Dawka Baljit Kaur Geetha R Menon | 2022 | World Journal of Gastroenterology2022，28，16： | 2 |
| 6 | Correlation of surface sediment diatom with the present lake water pH in 28 Algoma Lakes,Ontario,Canada显示文摘 | SUSHIL S D MIKE D D | 1986 | Hydrobiologia1986，131，： | 1 |
| 7 | Effect of nucleation site spacing on the pool boiling characteristics of a structured surface 显示文摘 | NITESH D N SUSHIL H B RICHARD C J | 2006 | International Journal of Heat and Mass Transfer2006，49，1718： | 1 |
| 8 | The effect of spot blotch and heat stress on variation of canopy temperature de- pression,chlorophyll fluorescence and chlorophyll content of hexaploid wheat genotypes 显示文摘 | Umesh R R Sushil S Etienne D | 2010 | Euphytica2010，174，： | 1 |
| 9 | Successful management ofpresumed Candida endogenous endophthalm it is with oralvoriconazole显示文摘 | BUU R SUSHIL D GEORGY N K | 2009 | Indian J Ophthalmol2009，57，4： | 1 |
| 10 | A Theory of Fads,Fashion,Custom,and Cultural Change as Informational Cas-cades显示文摘 | Bikhchandani Sushil Hirshleifer D | 1992 | The Journal of Political Economy1992，5，100： | 1 |
| 11 | Preparation and Characterization of Gelatinized Granular Starch from Aqueous Ethanol Treatments 显示文摘 | Zhang B S Sushil D Enamul H | 2012 | Carbohydrate Polymers2012，90，： | 1 |
| 12 | Hydrogen production from glycerin by steam reforming over nickel catalysts显示文摘 | Adhikari Sushil Fernando Sandun D Haryanto Agus | 2008 | Renewable Energy2008，33，： | 1 |
| 13 | Effect of cryo-milling on starches: functionality and digestibility 显示文摘 | Sushil D Ashok K S Michael J G | 2010 | Food Hydrocolloids2010，24，1： | 1 |
| 14 | Characterization of the Origin and Distribution of the Minerals and Phases in Metallurgical Cokes显示文摘 | Sushil G Maria D | 2007 | Energy & Fuels2007，21，30： | 1 |
| 15 | Mammalian mucosal alpha - glucosidases coordinate with alpha - amylase in the initial starch hydrolysis stage to have a role in starch digestion beyond glucogenesis 显示文摘 | Sushil D Amy HM Lin Bruce RH | 2013 | Plos One2013，8，4： | 1 |
| 16 | Characterization of the Origin and Distribution of the Minerals and Phases in Metallurgical Cokes显示文摘 | Sushil G Maria D | | 0，，01： | 1 |
| 17 | Cardinality- based inference control in sum - only data cubes 显示文摘 | L Wang D Wijesekera J Sushil | 2002 | In Proceedings of the 7th European Symposium on Research in Computer Security2002，，： | 1 |
| 18 | Effect of cryo-milling on starches:functionality and digestibility显示文摘 | Sushil D Ashok K S Michael J G | 2010 | Food Hydrocolloids2010，24，1： | 1 |
| 19 | Effect of cryo- milling on starches : functionality and digestibility 显示文摘 | Sushil D Ashok K S Michael J G | 2010 | Food Hydrocolloids2010，24，1： | 1 |
| 20 | Cryo-milling of starch granules leads to different effects on molecular size and conformation显示文摘 | SUSHIL D ASHOK K S BERNADINE M F | 2011 | Carbohyd Polym2011，，84： | 1 |
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