In the era of 21st century, rapid urbanisation, climate change, increased population, scarcity of water and increased dry land are the factors responsible for the worldwide agricultural and nutritional challenges. As a widely cultivated popular grain in arid and semiarid regions across the globe, Millets can act as a multifaceted solution to the above global challenges because of their rich vitamins, minerals, phytochemicals and anti-oxidant content. In addition to vitamins, Millets are the rich source of flavanoids such as apigenin, catechin, daisein, orientin, isoorientin, lutolin, quercetin, vitexin, isovitexin, myricetin sponarin, violanthin, lucenin-1, and tricin. Further, the presence of essential amino acids enriches the nutritive potential of Millets. The rich anti-oxidant content in Millets reduces oxidative stress in human and animal models by significantly minimizing Reactive Oxygen Species (ROS) generation. Several bioactive principles in Millets are known to decrease cardiovascular risk, diabetes, ageing and even cancer. However, nutritive and therapeutic potentials of bioactive compounds found in Millets are underexplored and a systematic review encompassing available data in literature is grossly missing. The aim of this review is to compile the recent advances that have been carried out covering nutritional properties, processing technologies and their effects in reducing anti-nutritional factors enhancing nutrient bioavailability along with the potential health benefits of millets. Consumption of various traditional and modern millet based food and studies conducted in examining the bioavailability of minerals after consuming millet based food is also discussed in this review.
Biliary fistula and bile leak are known complications following hepatobiliary surgery, trauma, and percutaneous biliary interventions. In the case of an isolated biliary system with a prolonged indwelling percutaneous transhepatic biliary drainage (PTBD) catheter, a biliary-cutaneous fistula (BCF) may develop after catheter blockage or its accidental slippage. Due to the absence of internal drainage, secreted bile flows through the matured PTBD tract to form a fistula. If left untreated, chronic BCF will result in malabsorption, infection, and delayed wound healing. Here, we report a case of left-sided BCF following prolonged PTBD for Bismuth type II cholangiocarcinoma (metastatic disease), which was initially managed by bile duct ablation using N-butyl cyanoacrylate. The patient further needed fistulous tract embolization to obliterate the BCF.
Laparoscopic management of hemosuccus pancreaticus from the left gastric artery pseudoaneurysm secondary to traumatic pancreatitis and open splenectomyA 55-year-old male presented with complaints of mild epigastric pain radiating to the back for 2 years, with a history of melaena for the last 1 month that was associated with worsening of pain. He received 2 U of blood transfusions for this. This pain started 2 months after open splenectomy for blunt trauma abdomen. Oesophago-gastro-duodenoscopy demonstrated a globular bulge with normal overlying mucosa, along the posterior wall of the stomach, near the gastro-oesophageal junction (Fig. 1). A contrastenhanced computed tomography scan with angiography showed a 4.0 Â 3.2 Â 3.0 cm well-defined cystic lesion with hyperdense contents in the lesser sac, communicating with the pancreatic duct A pseudoaneurysm arising from the left gastric artery (LGA) was found within this cystic lesion (Fig. 2). Based on these findings, a diagnosis of hemosuccus pancreaticus (HP) was established.Catheter angiography of the celiac axis confirmed the presence of the LGA pseudoaneurysm. However, due to very acute take-off from the celiac trunk, super-selective cannulation of the LGA was not feasible after repeated attempts, and surgical intervention was planned. A 3D laparoscopic system (Olympus, Japan) was used for the procedure. Dense omental adhesions to the parietal wall due to prior splenectomy were gently taken down with a Harmonic scalpel (Johnsons, USA). The gastrohepatic ligament was frozen due to repeated attacks of pancreatitis. After careful dissection, the common hepatic artery was identified at the superior border of the pancreas, and was secured with a silicon vessel loop. The dissection was then gradually progressed towards the celiac trunk and the LGA take-off was identified, and the artery was isolated. The LGA was then secured with Hem-o-Lok clips (Teleflex, USA) at its origin and was divided (Fig. 3). The postoperative course was uneventful, and he was asymptomatic at the last (8 months) follow-up.Sandbloom first coined the term hemosuccus pancreaticus to describe bleeding into the pancreatic duct and subsequently to the gut, through the ampulla. 1 Bleeding into the pancreatic duct can occur from rupture of arterial aneurysms, rupture of pseudoaneurysms into pseudocysts and by iatrogenic means. Pseudoaneurysm occurs due to erosion of the vessel walls from the amylase-rich pancreatic fluid. It mainly arises from the splenic (60-65%), gastroduodenal (20-25%), pancreaticoduodenal arcade (10-15%) and the hepatic artery (5-10%). 2 Pseudoaneurysm arising from the LGA causing HP is rarely reported. We could find only one case report on this after a thorough search of the literature. 3 The clinical presentation is mostly with crescendo-decrescendo pain followed by haemorrhage, as in the index case. Our patient had a history of open splenectomy for blunt
Identification of factors predicting the outcome of surgery for chronic pancreatitis and preparation of a scoring system to predict the outcome following surgery. A total number of 76 patients who had undergone surgery for chronic pancreatitis were prospectively followed at Department of General Surgery, S.C.B. Medical College, Cuttack during the period from 2010-2013. Data on demographic details, pain score, opioid addiction, exocrine and endocrine insufficiency, insulin requirement and morphology of pancreas on imaging were recorded. On follow up, improvement in pain score and exocrine and endocrine insufficiency were recorded. Factors affecting surgical outcome were determined and a scoring system was done. The mean age of patients was 39.7±7.9 years (range 18-58 years). Chronic alcohol intake was the predominant cause accounting for 56% (n=34) cases. Mean pain score at admission on Visual Analogue Scale (VAS) was 5.98. Twenty-six patients (43.3%) were found to have endocrine insufficiency and 22 (36.6%) patients had exocrine insufficiency. Forty-two patients underwent Partington-Rochelle procedure, and 18 patients underwent Frey’s procedure. Eighty percent of patients (n=48) had significant pain relief. On logistic regression, preoperative VAS score, number of previous admissions, opioid dependence, main pancreatic duct (MPD) diameter, number and site of calcifications were found to be significant in predicting pain relief. Cohort of patients with chronic pancreatitis likely to get benefit from surgery can be predicted preoperatively.
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