Groove pancreatitis (GP) is a rare type of segmental pancreatitis, and it remains largely an unfamiliar entity to most physicians. It is often misdiagnosed as pancreatic cancer and autoimmune pancreatitis. With better understanding of radiological findings, preoperative differentiation is often possible. If there is preoperative diagnosis of GP, one can employ non-surgical treatment. But most of the patients ultimately require surgery. Pancreaticoduodenectomy (PD) is the surgical treatment of choice. We report three cases of GP that were treated by Whipple's operation at our unit. All the three patients had a history of long-standing alcohol intake. In the first and third patients, we had a preoperative diagnosis of GP. But, in the second patient, our pre-operative and intra-operative diagnosis was a pancreatic head malignancy. Diagnosis of GP was made only after histopathological examination. All the three patients had uneventful postoperative recovery and were well at 55-, 45- and 24-month follow-up respectively. In addition to detail descriptions of our three cases, a detailed review of the current literature surrounding this clinical entity is also provided in this article.

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The Clostridia are unusual causes of primary pleuropulmonary infection in the absence of penetrating chest injury or surgery.' We describe here the first reported case of primary pleuropulmonary infection caused by Clostridium bifermentans, in this case associated with pulmonary thromboembolism.Case report A 41-year-old woman was admitted to the hospital with a one-week history of increasing fatigue, weakness, and breathlessness. She had a persistent cough, haemoptysis, and a sharp pleuritic chest pain on the right the evening before admission.Her temperature was 36-3'C (oral), the respiratory rate was 30/min, the pulse was 130/min with atrial fibrillation, and the blood pressure was 110/66 mmHg. Examination did not reveal conjunctival petechiae, mucous membrane lesions, ulcerations, splinter haemorrhages, or Janeway lesions. Murmurs consistent with mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation were present. There wras no calf tenderness, Homans' sign was absent, and neurological examination was within normal limits.The total leucocyte count was 15 800/mm' (neutrophils 70% and the SGOT and LDH were both raised. Chest radiograph demonstrated generalised cardiomegaly, prominent vasculature to the upper

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Background: Although rectal administration of nonsteroidal anti-inflammatory drugs is recommended as the standard pharmacologic modality to prevent postendoscopic retrograde cholangiopancreatography (ERCP) post-ERCP pancreatitis (PEP), vigorous periprocedural hydration (vHR) with lactated Ringer’s solution (LR) is emerging as an effective prophylaxis modality for PEP. There has been no head-to-head comparison between these 2. Study: This was a single-center, randomized, open-label, noninferiority, parallel-assigned, equal allocation, controlled clinical trial in a tertiary care hospital. Consecutive adults referred for ERCP, satisfying predefined inclusion criteria, underwent simple randomization and blinded allocation into 2 groups. Those allocated to vHR received intravenous LR at 3 mL/kg/h during procedure, 20 ml/kg bolus immediately afterward, and then at 3 mL/kg/h for another 8 hours. Those randomized to rectal Indomethacin received only per-rectal 100 mg suppository immediately post-ERCP. Assuming PEP of 9% in Indomethacin arm and noninferiority margin of 4%, we calculated sample size of 171 patients in each arm for 80% power and α-error 5%. Primary outcome was incidence of PEP, within 1 week, as defined by Cotton’s criteria. All analysis were done by intention-to-treat. Results: Between October, 2017 to February, 2018, 521 patients were assessed. In all, 352 were enrolled, 178 randomized to vHR, and 174 to per-rectal Indomethacin. Baseline details and ERCP outcomes were not different between 2 groups. PEP occurred in 6 (1.7%) overall, with 1 (0.6%) in hydration arm, and 5 (2.9%) in indomethacin arm; an absolute risk reduction of 2.3% (95% confidence interval: 0.9%-3.5%) and odds ratio of 0.19 (95% confidence interval: 0.02-1.65). Three patients developed severe PEP, all receiving indomethacin. Conclusions: vHR with LR is noninferior to postprocedure per-rectal Indomethacin for PEP prevention (ClinicalTrials.govID:NCT03629600).

Summary Introduction and objective Mortality data from high‐income group countries are frequently used in developing countries for healthcare planning. This study was planned to explore the mortality pattern of cirrhosis in India in terms of survival after diagnosis of cirrhosis, predictors of death and aetiology specific effect on mortality. Methods This observational study enrolled newly diagnosed patients with liver disease (n = 3193) attending a tertiary care hospital in Kolkata, India between April 2010 and October 2012 and were followed up to September 2015. Results Patients with cirrhosis having complete follow‐up data (n = 702) were analysed. Median follow‐up duration was 21 months (range: 1‐84 months). Mortality among them was 51% (n = 358 out of 702). Development of HCC (OR 2.8: 95%CI 1.8‐4.2, P < 0.0001), male gender (OR 1.4: 95% CI 1.0‐1.8, P = 0.009) and higher Child score at the time of diagnosis (OR 1.2: 95%CI 1.1‐1.3, P < 0.0001) were predictors of mortality. Survival after the diagnosis of cirrhosis was significantly shorter in alcohol (16.5 month; range 1‐51)‐ and HCV (16 month; range 1‐48)‐related cirrhosis in comparison to HBV (23 month; range 1‐48)‐related and cryptogenic cirrhosis (22 month; range 1‐84) (P = 0.014). Conclusion Majority of the patients with cirrhosis had decompensation at the time of diagnosis. Shorter survival was noticed in alcohol‐ and HCV‐related cirrhosis.

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