Publications by authors named "R Jayachandra Babu"

546 Publications

Rare case of a duodenal de novo dedifferentiated gastrointestinal stromal tumour.

BMJ Case Rep 2021 May 7;14(5). Epub 2021 May 7.

Department of Medical Oncology, HealthCare Global Enterprises Ltd, Bangalore, Karnataka, India.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Dedifferentiation in these tumours occurs rarely, and when it does occurs most commonly after prolonged treatment with imatinib. We report the case of a 64-year-old man who presented with a mass of 8×7×3 cm dimensions involving the duodenum and head of the pancreas. On histopathology, areas of anaplastic tumour cells were negative for DOG-1, c-kit, CD-34, desmin and panCK along with a molecular level study showing wild-type KIT and PDGFRA (platelet-derived growth factor receptor alpha) gene. Based on focal GIST-like areas and CD117 positivity and absence of prior therapy, the diagnosis of a de novo dedifferentiated GIST was made. These tumours need to be reported as they pose a diagnostic challenge and their predicted response rated to targeted molecular therapies are unclear as compared with their c-kit positive counterparts.
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http://dx.doi.org/10.1136/bcr-2020-241442DOI Listing
May 2021

Inflammatory myofibroblastic tumours of the duodenopancreaticobiliary tract.

BMJ Case Rep 2021 May 6;14(5). Epub 2021 May 6.

Department of Hepato Pancreato Biliary(HPB) Surgery and Liver Transplant, HealthCare Global Enterprises Ltd, Bangalore, Karnataka, India.

Inflammatory myofibroblastic tumours (IMTs) are rare benign neoplasms of intermediate malignant potential that are found in the lungs and rarely at extrapulmonary sites common in children and young adults. IMTs tend to be locally invasive and have some amount of metastatic potential as well. We present two cases of IMTs involving the duodenum, pancreas and distal bile duct. The first case presented with extensive involvement of the first three parts of the duodenum and head of the pancreas, while the second presented with a pancreatic and biliary tree involvement. Upon examinations and investigations, these tumours mimicked malignant neoplasms. A Whipple procedure for surgical resection was undertaken in both cases. The histological findings showed fascicles of spindle cells with infiltration of lymphocytes and plasma cells. The inflammatory myofibroblastic tumour was diagnosed based on pathological grounds with immunohistochemistry. Preoperative diagnosis of IMTs is difficult and complete surgical resection is the primary treatment.
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http://dx.doi.org/10.1136/bcr-2020-240833DOI Listing
May 2021

Functional outcomes of pediatric laparoscopic pyeloplasty: post-operative functional recovery is superior in infants compared to older children.

Pediatr Surg Int 2021 May 4. Epub 2021 May 4.

Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India.

Aim: Laparoscopic pyeloplasty (LP) is less popular and considered less successful in infants compared to older children. There are few reports analyzing the functional results of LP in relation to age of surgery. The aim of this paper is to compare the functional results of LP in infants (group 1) with children over 1 year of age (group 2).

Material And Methods: The data of all children undergoing LP between August 2016 and July 2019 were retrospectively analyzed for patient details and follow-up. Only children (n = 135) with at least 1-year follow-up and completed post-operative ultrasound and diuretic renogram were included. All children underwent pre-operative and post-operative ultrasound and diuretic renogram; pre-operative, operative and post-operative parameters were compared between both groups. Statistical analysis was done using software; Mann-Whitney U test, Student t test, and Fisher's exact test were applied.

Results: There were 71 infants (group 1) and 64 children > 1 year (group 2). Pre-operatively, all kidneys had SFU grade 3 or 4 HDN and 131/135 kidneys had a renal pelvic APD > 20 mm; all kidneys had unequivocal obstruction on DR. At surgery, the preferred drainage method was intra-operative antegrade placement of a JJ stent in 68 (96%) group 1 and 63 (98%) group 2 children. The remaining 4 cases (3 group 1, 1 group 2) had a nephrostomy with trans-anastomotic external stent placement, because the JJ stent could not be negotiated into the bladder. The demographic data and comparison of pre- and post-operative parameters between both groups are summarized in Tables 1 and 2, respectively. Group 1 had significantly more children with antenatal diagnosis of HDN (87% vs 56%, p = 0.0005). The 36 children with antenatal diagnosis in group 2 were initially followed expectantly; the indication for pyeloplasty was deterioration of SRF on serial DR, urinary infection, and pain, in 13, 14, and 9 children, respectively. The operating time was significantly longer in group 2 (p = 0.0001). There was no difference in the success of LP or complication rate in both groups. Group 2 had significantly more children with extrinsic obstruction (1.4% vs 17%, p = 0.001). All children underwent post-operative US and DR; a significant reduction in hydronephrosis (APD) on follow-up was noted in both groups (p = 0.0001). The mean pre-operative SRF in both groups was comparable (p = 0.088). The mean SRF in both groups improved significantly after LP; however, the mean post-operative SRF was significantly higher in group 1 when compared to group 2 (p = 0.0001). Furthermore, group 1 had significantly more kidneys demonstrating > 10% increase in SRF after LP (53% vs 26%, p = 0.0003).

Conclusions: The safety profile and success of LP in infants was comparable to older children. Infant LP took shorter time to perform, while older children had increased incidence of extrinsic obstruction. Infant kidneys demonstrated better functional improvement than older children after LP. These findings should encourage more surgeons to utilize LP for pyeloplasty even in infants.
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http://dx.doi.org/10.1007/s00383-021-04914-1DOI Listing
May 2021

Anuric Acute Kidney Injury Requiring Dialysis Following Acetazolamide Use for Cataract Surgery.

Am J Case Rep 2021 Apr 23;22:e931319. Epub 2021 Apr 23.

Department of Nephrology, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates.

BACKGROUND Acetazolamide (ACTZ) is commonly used in the prevention and treatment of various clinical conditions, and anuric acute kidney injury (AKI) is one of its known life-threatening complications. CASE REPORT We hereby report the case of a middle-aged man known to have compensated heart failure and hypertension with previously normal kidney function, who received a total dose of 2250mg of ACTZ over 3 days after cataract surgery. One week after the operation, he presented with anuria and severe bilateral renal colic, as well as progressively worsening kidney function and metabolic profile, which eventually required hemodialysis prior to recovery. CONCLUSIONS The cause of the AKI was attributed to intra-tubular obstruction by ACTZ-induced crystalluria, which required discontinuing the offending agent and dialysis to correct the kidney functions.
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http://dx.doi.org/10.12659/AJCR.931319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077391PMC
April 2021

Nickel-Catalyzed Guerbet Type Reaction: C-Alkylation of Secondary Alcohols Double (de)Hydrogenation.

Org Lett 2021 May 21;23(9):3320-3325. Epub 2021 Apr 21.

Department of Chemistry, Indian Institute of Science Education and Research (IISER) Tirupati, Tirupati 517507, India.

Acceptorless double dehydrogenative cross-coupling of secondary and primary alcohols under nickel catalysis is reported. This Guerbet type reaction provides an atom- and a step-economical method for the C-alkylation of secondary alcohols under mild, benign conditions. A broad range of substrates including aromatic, cyclic, acyclic, and aliphatic alcohols was well tolerated. Interestingly, the C-alkylation of cholesterol derivatives and the double C-alkylation of cyclopentanol with various alcohols were also demonstrated.
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http://dx.doi.org/10.1021/acs.orglett.1c00782DOI Listing
May 2021