Qualification: 
MS
sudhi@aims.amrita.edu

Dr. Sudhindhran N. S. currently serves as Professor at the Department of Gastrointestinal Surgery, School of Medicine, Kochi.

Dr. Sudhindran S. is the Clinical Professor and Chief Transplant Surgeon, Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi. He is the first liver transplant surgeon in Kerala and a well-known expert in liver transplants. He has completed 820 liver transplants, mostly live donor transplants. He also has expertise in pancreas transplant as well as small bowel transplants. He completed his MBBS and MS from Trivandrum Medical College. Later, he trained in vascular surgery and solid organ transplantation from the UK. He has worked as a Clinical Fellow in Transplantation in Addenbrooke's Hospital, Cambridge. He has more than a hundred publications to his credit. Recently, he has been awarded “The Distinguished Alumnus Award” by Trivandrum Medical College. This award was presented on February 15, 2020, by Hon. Governor of Kerala, Sri. Arif Mohammad Khan, in grateful appreciation for the leadership and outstanding service to the alma mater, Trivandrum Medical College and for the contributions to the society at large.

Qualification: MS (General Surgery), FRCS (Glasgow), FRCS (Eng.), FRCS (General Surgery)

Previous Appointments

  • April 2000 - September 2002: Clinical Fellowship in Transplantation
    Addenbrooke’s Hospital, Cambridge
  • October 1999 - April 2000: Specialist Registrar in Transplantation
    Royal Liverpool University Hospital
  • October 1998 - September 1999: Specialist Registrar in Vascular Surgery
    Royal Liverpool University Hospital.
  • October 1997 - September 1998: Specialist Registrar in Gen. & Vascular Surgery
    Countess of Chester Hospital, Chester
  • October 1996 - September 1997: Specialist Registrar in Gen & Vascular Surgery
    Aintree Hospitals NHS Trust
  • October 1995 - September 1996: Specialist Registrar in Surgery
    Leighton Hospital, Crewe, Cheshire
  • April 1995 - September 1995: Specialist Registrar in Surgery
    Macclesfield District General Hospital
  • August 1994 - March 1995: SHO Surgery
    Memorial Hospital, Darlington
  • February 1994 - August 1994: SHO A&E and Orthopaedics
    Memorial Hospital, Darlington
  • August 1993 - January 1994: PRHO Surgery
    Memorial Hospital, Darlington
  • August 1991 - March 1993: Registrar General Surgery and Gastroenterology
    Devamatha Hospital, Kerala,
  • May 1988 - May 1991: SHO Rotation Surgery and Allied Specialties
    Trivandrum Medical College, Kerala,
  • April 1987 - April 1988: PRHO (Surgery, Medicine, O&G, Paediatrics and Community Medicine)
    Trivandrum Medical College, Kerala

Publications

Publication Type: Journal Article

Year of Publication Title

2013

P. H.S., K.H., I. Siyad, R.Nair, H., V.A., N., and Dr. Sudhindran S., “Correlation between postoperative liver function tests and short term ([Abstract]


Background: Immediately following liver transplantation, standard Liver Function Tests (LFT's) are used routinely to diagnose early problems such as graft preservation injury, rejection, graft dysfunction, technical complications or sepsis. However usefulness of the immediate postoperative LFT's in predicting later graft outcome is not clearly known.

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2013

P. Murthy, Nair, H. R., Kumar, L., Dr. Sudhindran S., and Narayanan, V. A., “Predictors of ICU-outcome and 3-month mortality in living donor liver transplant recipients”, Journal of Clinical and Experimental Hepatology, vol. 3, p. S117, 2013.

2013

R. N. Menon, Balakrishnan, D., Unnikrishnan, G., Saraf, V., Sudheer, O. V., Dhar, P., and Dr. Sudhindran S., “Hepatic Steatosis: Clinico-Pathological and Radiological Correlation Study as an Aid To Selecting Living Donor Grafts”, Liver transplantation, vol. 18, pp. S157-S158, 2013.

2013

Z. Shemin, Eapen, M., Jojo, A., and Dr. Sudhindran S., “Differing Aetiology of Acute Liver Failure in India, Compared to Other Countries.”, Liver transplantation , vol. 19, pp. S123-S123, 2013.

2012

Dr. Sudhindran S., Aboobacker, S., Menon, R. N., Unnikrishnan, G., Sudheer, O. V., and Dhar, P., “Cost and efficacy of immunosuppression using generic products following living donor liver transplantation in India”, Indian Journal of Gastroenterology, vol. 31, pp. 20-23, 2012.[Abstract]


Background: Cost of post liver transplant immunosuppression is a major financial burden to patients in developing countries. In India, generic varieties of various immunosuppressants are often used without any definite evidence to their efficacy. This study was aimed at studying the dosage, side effect profile and cost of post-liver transplant immunosuppression using generic products in Indian population following living donor liver transplantation (LDLT). Methods: Data on dose, cost, and toxicity of immunosuppression were retrieved retrospectively from case records of 59 patients who had undergone LDLT at our center. Results: Adequate immunosuppression was obtained by tacrolimus (Pangraf ®-Panacea) of 0. 04 to 0. 05 mg/Kg, and mycophenolate (Mycept ®-Panacea) of 500 to 1,000 mg; the acute rejection rate was 15% during the first month. Serum tacrolimus levels were 5. 4 to 7. 3 ng/mL. The cost of immunosuppression varied from Rs. 28,705 in the first month to Rs. 8,820 per month at the end of first year, amounting to an average monthly cost of Rs. 17,250. Approximately 23% and 51% of cost was for mycophenolate and for drug level measurement of tacrolimus, respectively. Conclusion: Average cost of immunosuppression after LDLT in India is much lower than that reported elsewhere in the world, since lower drug doses are needed and cheaper generic drugs are available. This can be reduced further by decreasing the frequency of tacrolimus drug level measurement. © 2011 Indian Society of Gastroenterology.

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2012

Dr. Sudhindran S., Menon, R. N., and Balakrishnan, D., “Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants”, Journal of Clinical and Experimental Hepatology, vol. 2, pp. 181-187, 2012.[Abstract]


Adult-to-adult living donor liver transplant (LDLT) frequently depend on using the right-lobes of the donor for obtaining adequate graft-to-recipient weight ratio (GRWR) of over 0.8% in the recipient. However, left-lobes remain an important option in adults, since the morbidity in the donor is considerably less with left donor hepatectomy when compared with right side liver resection. Further benefits of left-lobes in LDLT include more predictable anatomy of the left hepatic duct and left portal vein, which are usually long and single resulting in easier anastomosis in the recipient. Likewise, left-lobe grafts are easier to implant with an excellent venous outflow through the combined orifice of left and middle hepatic vein, as opposed to the complex hepatic vein reconstruction required in right-lobe grafts. However, left hepatic artery is often multiple unlike the right hepatic artery. The holy grail of left-lobe transplants is avoidance of small for size syndrome (SFSS) in the recipients. The strategies for overcoming SFSS currently depend on circumventing portal hyperperfusion in the graft. Measurement of portal pressure and modulating it if high, by splenic artery ligation, splenectomy, or hemiportocaval shunts are proving successful in avoiding SFSS. The future aim in adult LDLT should be to use the left-lobe as much as possible for the benefit of the donor at the same time avoiding SFSS even at very low GRWR for the benefit of the recipient. © 2012 INASL.

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2012

M. Anil, Appu, T., George, K., Georgy, M., Ginil, K., Indu, K. N., Lakshminarayana, G., Nair, B., Rajesh, R., Dr. Sudhindran S., Unni, V. N., and Sanjeevan, K. V., “Is early removal of prophylactic ureteric stents beneficial in live donor renal transplantation”, Indian Journal of Nephrology, vol. 22, pp. 275-279, 2012.[Abstract]


{Prophylactic ureteric stenting has been shown to reduce ureteric leaks and collecting system obstruction following renal transplantation and is in widespread use. However, the optimal time for removal of ureteric stents after renal transplantation remains unclear. Aim of this study was to compare the result of early versus late removal of ureteric stents after kidney transplantation of the laparoscopically retrieved live related donor grafts. Eligible patients were live donor kidney transplant recipients with normal urinary tracts. All recipients underwent extravesical Lich-Gregoire ureteroneocystostomy over 4F/160 cm polyurethane double J stents by a uniform technique. They were randomized on seventh postoperative day for early removal of stents on postoperative day 7 (Group I), or for late removal on postoperative day 28 (Group II). The incidence of urinary tract infections, asymptomatic bacteriuria, and urological complications were compared. Between 2007 and 2009, 130 kidney transplants were performed at one centre of which 100 were enrolled for the study, and 50 each were randomized into the two groups. Donor and recipient age, sex, native renal disease, immunosupression, number of rejection episodes, and antirejection therapy were similar in the two groups. The occurrence of symptomatic urinary tract infection during the follow-up period of 6 months was significantly less in the early stent removal group [5 out of 50 (10%) in Group I, vs 50 out of 15 (30%) in Group II

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2012

Aa Kumar, Dr. Sudhindran S., Dinesh, K. Ra, Vinod, Va, and Karim, Sa, “Chromobacterium violaceum-A rare cause of infected pancreatic pseudocyst”, Infectious Diseases in Clinical Practice, vol. 20, pp. 282-284, 2012.[Abstract]


Of the 2 species of Chromobacterium, Chromobacterium violaceum has been rarely implicated in human disease. It is a bacterium of low virulence causing occasional localized infection and sepsis. We report a case of C. violaceum infection of pancreatic pseudocyst. The patient was treated by cystojejunostomy with Roux-en-Y jejunal loop and antimicrobial therapy with ciprofloxacin and amikacin. As sepsis due to this organism is associated with high mortality, empiric therapy with fluoroquinolones and aminoglycosides is recommended, along with proper surgical management. © 2012 by Lippincott Williams & Wilkins.

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2011

S. Kalghatgi, Vivek, S., Dattaram, U., Binoj, S., Nitin, P., Ramachandran, M., Unnikrishnan, G., Dinesh, B., Sudheer, O., Puneet, D., Subhalal, N., and Dr. Sudhindran S., “Bilirubin as a predictor of early mortality after liver transplantation.”, J Clin Exp Hepatol, vol. 1, no. 2, pp. 144-5, 2011.[Abstract]


The CT angiogram showed evidence of arterioportal
shunting in segment VII of the liver likely secondary to
arterioportal fistula with high-density layering contents
suggestive of hemorrhage within the gallbladder and CBD.
A digital subtraction angiography (DSA) was done in the
view of embolization, super-selective catheterization beyond the fistula done, 018 fiber coils assisted with methyl
glue used to embolize the fistula.
A repeat CT angiogram showed resolution of the fistula.
Four weeks later the same patient underwent donor hepatectomy and the right lobe with MHV was transplanted
to the recipient who had cryptogenic chronic liver disease
(CLD) with decompensation, the patient and the recipient
did well in the postoperative period with no complications
and the patient was discharged home on day 7. The stent
was removed 4 weeks after surgery.
Conclusion: Hepatic arterioportal fistula is a rare complication of liver biopsy; an early diagnosis and aggressive
management using a multidisciplinary approach are needed
to have a good outcome and liver biopsy should be done
with extreme caution in centers where there is expertise

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2011

K. Pavithran and Dr. Sudhindran S., “Hanging liver tumor.”, Journal of gastrointestinal and liver diseases : JGLD, vol. 20, p. 8, 2011.

2011

A. Kumar, Augustine, D., Dr. Sudhindran S., Kurian, A. M., Dinesh, K. R., Karim, S., and Philip, R., “Weissella confusa: A rare cause of vancomycinresistant Gram-positive bacteraemia”, Journal of Medical Microbiology, vol. 60, pp. 1539-1541, 2011.[Abstract]


We describe a case of bacteraemia caused by Weissella confusa in a 48-year-old male who was operated on for adenocarcinoma of the gastro-oesophageal junction and maintained on total parenteral nutrition. Blood cultures were positive for a vancomycin-resistant streptococcus-like organism which was identified as W. confusa by 16S rRNA gene sequencing. © 2011 SGM.

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2010

A. Kumar, Dr. Sudhindran S., Vivek, V., K. Dinesh, and Karim, S., “Mycotic aneurysm due to Salmonella”, International Journal of Infectious Diseases, vol. 14, p. S28, 2010.

2008

K. Vasilev, Reshedko, G., Orasan, R., Sanchez, M., Teras, J., Babinchak, T., Dukart, G., Cooper, A., Dartois, N., Gandjini, H., Orrico, R., and Ellis-Grosse, E., “A Phase 3, open-label, non-comparative study of tigecycline in the treatment of patients with selected serious infections due to resistant Gram-negative organisms including Enterobacter species, Acinetobacter baumannii and Klebsiella pneumoniae.”, J Antimicrob Chemother, vol. 62 Suppl 1, pp. i29-40, 2008.[Abstract]


OBJECTIVES: To evaluate the efficacy and safety of tigecycline in patients with selected serious infections caused by resistant Gram-negative bacteria, or failures who had received prior antimicrobial therapy or were unable to tolerate other appropriate antimicrobials. Secondary objectives included an evaluation of the microbiological efficacy of tigecycline and in vitro activity of tigecycline for resistant Gram-negative bacteria.

METHODS: This open-label, Phase 3, non-comparative, multicentre study assessed the efficacy and safety of intravenous tigecycline (100 mg initially, then 50 mg 12 hourly for 7-28 days) in hospitalized patients with serious infections including complicated intra-abdominal infection; complicated skin and skin structure infection (cSSSI); community-acquired pneumonia (CAP); hospital-acquired pneumonia, including ventilator-associated pneumonia; or bacteraemia, including catheter-related bacteraemia. All patients had infections due to resistant Gram-negative organisms, including extended-spectrum beta-lactamase-producing strains, or had failed on prior therapy or could not receive (allergy or intolerance) one or more agents from three classes of commonly used antibiotics. The primary efficacy endpoint was clinical response in the microbiologically evaluable (ME) population at test of cure (TOC). Safety data included vital signs, laboratory tests and adverse events (AEs).

RESULTS: In the ME population at TOC, the clinical cure rate was 72.2% [95% confidence interval (CI): 54.8-85.8], and the microbiological eradication rate was 66.7% (95% CI: 13.7-78.8). The most commonly isolated resistant Gram-negative pathogens were Acinetobacter baumannii (47%), Escherichia coli (25%), Klebsiella pneumoniae (16.7%) and Enterobacter spp. (11.0%); the most commonly diagnosed serious infection was cSSSI (67%). The most common treatment-emergent AEs were nausea (29.5%), diarrhoea (16%) and vomiting (16%), which were mild or moderate in severity.

CONCLUSIONS: In this non-comparative study, tigecycline appeared safe and efficacious in patients with difficult-to-treat serious infections caused by resistant Gram-negative organisms.

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2008

Pab Krishnan, Vayoth, SaOthiyil, Dhar, Pa, Dr. Sudhindran S., and Ponnambathayil, Sa, “Laparoscopy in suspected abdominal tuberculosis is useful as an early diagnostic method”, ANZ Journal of Surgery, vol. 78, pp. 987-989, 2008.[Abstract]


Background: Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis. Methods: A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6-year period, analysing its usefulness in establishing a histological diagnosis. Results: From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra-abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen-section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients. Conclusion: In patients suspected to have abdominal tuberculosis without evidence of extra-abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work-up may hence be averted by a timely laparoscopy and early treatment can be instituted. © 2008 The Authors.

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2008

Va Balakrishnan, Unnikrishnan, A. Ga, Thomas, Vb, Choudhuri, Gc, Veeraraju, Pd, Singh, S. Pe, Garg, Pf, Pai, C. Gg, Devi, R. N. Sh, Bhasin, Di, Jayanthi, Vj, Premalatha, Nk, Chacko, Al, Kar, Pm, Rai, R. Rn, Rajan, Ro, Subhalal, No, Mehta, Rp, Mishra, S. Pq, Dwivedi, Mq, Vinayakumar, K. R. Nr, Jain, A. Ks, Biswas, Kt, Mathai, Su, Varghese, Jv, Ramesh, Hw, Alexander, Tx, Philip, Jy, Raj, V. Vz, Vinodkumar, Aaa, Mukevar, Sab, Sawant, Pac, Nair, Pa, Kumar, Ha, Dr. Sudhindran S., Dhar, Pa, Sudheer, O. Va, Sundaram, K. Ra, Tantri, B. Vad, Singh, Dae, and Nath, T. Raf, “Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India”, Journal of the Pancreas, vol. 9, pp. 593-600, 2008.[Abstract]


Context: Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India. Objective: To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis. Setting: Thirty-two major centers from different regions of India contributed data on 1,086 patients to a common online website (www.ipans.org). Main outcome measures: Risk factors, clinical features complications and treatment of chronic pancreatitis. Results: Of the 1,086 subjects, complete data on risk factors were available for 1,033 subjects. Idiopathic pancreatitis was the most common form of pancreatitis (n=622; 60.2%) and alcoholic chronic pancreatitis accounted for about a third of the cases (n=400; 38.7%); the rest (n=11; 1.1%) had rare risk factors. Smoking and cassava intake were documented in 292 (28.3%) and 189 (18.3%) subjects, respectively. Using well-defined criteria, only 39 (3.8%)cases could be labeled as 'tropical pancreatitis'. Pain occurred in 971 patients (94.0%). Four hundred and eighteen (40.5%) subjects had diabetes mellitus. Of alcohol consumers, alcoholism and female gender were independent risk factors for diabetes in subjects with chronic pancreatitis (OR=1.48

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2007

B. T. Nair, Bhat, S. H., Narayan, U. V., Sukumar, S., Saheed, M., Kurien, G., and Dr. Sudhindran S., “Donate Organs Not Malignancies: Postoperative Small Cell Lung Carcinoma in a Marginal Living Kidney Donor”, Transplantation Proceedings, vol. 39, pp. 3477 - 3480, 2007.[Abstract]


A widening gap between supply and demand for transplantable kidneys has led to increasing use of marginal living donors from an elderly population in kidney transplantation programs. Although the graft survivals of these marginal organs are comparable with those of standard donors, the attendant risk of transmission of malignancy from older donors is high, given that aging is a risk factor for malignancy. Herein we have highlighted a case of small cell carcinoma developing in a marginal elderly donor at 10 months after kidney donation. The recipient remains free of malignancy at 36 months after transplantation. The exhaustiveness of tests for screening of elderly living donors for malignancy as well as the surveillance of recipients at high risk of developing donor-derived malignancy remain uncertain.

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2006

Dr. Sudhindran S., Bhat, S., Sanjeevan, K. V., and Sayeed, C. S., “Laparoscopic right donor nephrectomy: is there a right way?”, Journal of endourology, vol. 20, p. 309—311, 2006.[Abstract]


There is a continuing reluctance among transplant surgeons to procure a right-kidney allograft laparoscopically. We describe our experience with right laparoscopic donor nephrectomy (RLDN) by three techniques.We retrospectively analyzed all seven RLDNs performed at our center from January 2002 to June 2005. The technique used in a particular case depended on the anatomy of the renal vasculature and included transperitoneal (N = 1), retroperitoneoscopic (N = 4), and retroperitoneoscopy-assisted approaches without the use of hand port or other assist devices (N = 2). No stapling or manual-assist devices were used in the last four cases for division of the renal vessels.The mean blood loss, operating time, hospital stay, and serum creatinine concentration on day 7 were 94.3 +/- 46.9 mL (SD), 212.8 +/- 66 minutes, 4.9 +/- 1.9 days, and 1.1 +/- 0.2 mg/dL, respectively. The overall warm ischemia time was 217 +/- 116 seconds. Our preferred technique currently is to go for a total retroperitoneoscopic approach to the right kidney initially. If the renal vein appears short, we make a small subcostal incision to retrieve the kidney openly at this stage (retroperitoneoscopy-assisted approach) with minimal risks to the donor and recipient.Retroperitoneoscopic RLDN performed without hand-assist or stapling devices is safe and cost-effective and yields kidneys with excellent function. Rather than have a fixed approach to RLDN, we suggest a choice depending on the length of the renal vessels observed during surgery.

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2006

Dr. Sudhindran S., Sunil, S., and Sinha, S., “Platelet counts are persistently increased following simultaneous pancreas and kidney transplantation.”, Transplant Proc, vol. 38, no. 5, pp. 1549-51, 2006.[Abstract]


BACKGROUND: Increased platelet counts has been reported to be a sequela of pancreas transplantation and even incriminated in the increased rate of thrombosis of pancreas grafts. The aim of the study was to measure the platelet counts after simultaneous kidney-pancreas transplantations compared to kidney transplants alone in diabetic patients.

METHODS: This retrospective case-control study included 57 patients who received simultaneous pancreas and kidney transplants (SPK), from 1985 to 2000 and had functioning grafts for more than 1 month. The control patients were 38 type I diabetic recipients of kidney transplants alone (KTA), matched for sex, era, and immunosuppression. The platelet counts, white cell counts, and hemoglobin were analyzed on the preoperative day, weeks 1 to 6, 3 months, 6 months and 1 year.

RESULTS: The mean age of the SPK group was significantly lower than that of the KTA group (39.8+/-8.3 versus 48.2+/-11.7, P<.01). Significantly higher platelet counts were demonstrated during weeks 2 to 6, which persisted at 3 months and at 1 year among the SPK compared to the KTA group. Although significantly higher white cell counts and lower hemoglobin levels were seen among the SPK versus KTA group during weeks 3 to 6, it did not persist after 3 months.

CONCLUSION: The mean platelet counts of patients with simultaneous pancreas and kidney transplantation was significantly higher than that of diabetic patients with kidney transplants alone. This thrombocytosis persisted up to the first year and cannot be explained by an increased amount of blood loss or higher infectious complications in the SPK group. Routine antiplatelet prophylaxis is recommended in this group of patients.

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2006

S. MC, Dr. Sudhindran S., and SH, B., “Laparoscopic live donor nephrectomy.”, BJU International, vol. 98, no. 5, pp. 1121-2, 2006.

2005

R. M. Mehta, Sudheer, V. O., John, A. K., Nandakumar, R. R., Dhar, P. S., Dr. Sudhindran S., and Balakrishnan, V., “Spontaneous rupture of giant gastric stromal tumor into gastric lumen.”, World Journal of Surgical Oncology, vol. 3, no. 1, p. 11, 2005.[Abstract]


BACKGROUND: Gastrointestinal stromal tumors (GIST) constitute a large majority of mesenchymal tumors of the gastrointestinal (GI) tract, which express the c-kit proto-oncogene protein, a cell membrane receptor with tyrosine kinase activity. GI stromal tumors of the stomach are usually associated with bleeding, abdominal pain or a palpable mass. CASE PRESENTATION: A 75-year-old male presented with upper abdominal pain and palpable mass. Computed tomographic (CT) scan of the abdomen showed a large mass arising in the posterior aspect of fundus, body, and greater curvature of the stomach. Second day after the admission, there was significant reduction in the size of the tumor, clinically as well as radiologically. Endoscopic biopsy showed large bulge in fundus and corpus of the stomach posteriorly with an opening in the posterior part of the corpus, and biopsy from the edge of the opening reveled GIST. Patient underwent curative resection. CONCLUSION: Spontaneous ruptured of giant gastric stromal tumor is very rare presentation of stomach GIST. Thorough clinical examination and timely investigation can diagnose rare complication.

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2005

U. G, P, D., and Dr. Sudhindran S., “Chemoradiotherapy for rectal cancer”, The New England Journal of Medicine, vol. 352, pp. 509-11, 2005.

2005

V. Gandhi, Shyam, V., Unnikrishnan, G., Balakrishnan, D., and Dr. Sudhindran S., “Ruptured Mycotic Aneurysm of Peroneal Artery”, EJVES Extra, vol. 10, pp. 21 - 23, 2005.[Abstract]


A 61-year-old lady, with history of aortic and mitral valve regurgitation developed infective endocarditis due to acinetobacter following tooth extraction. While on antibiotic treatment, she developed pain and swelling of left calf. Duplex scan was done with a suspicion of deep vein thrombosis. It showed a leaking pseudo aneurysm of the peroneal artery, which was confirmed on angiography. Surgical repair of the defect on the peroneal artery with excision of pseudo aneurysm was done. She recovered on continued antibiotic therapy. Isolated pseudo aneurysm of peroneal artery following infective endocarditis is rare and mimics calf vein thrombosis. Surgical repair may give good results.

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2005

K. P, K, C., OV, S., P, D., and Dr. Sudhindran S., “Is sentinel node mapping useful in colorectal carcinoma?”, Indian Journal Gastroenterol, vol. 24, no. 3, pp. 129-30, 2005.

2004

A. L. Taylor, Gibbs, P., Dr. Sudhindran S., Key, T., Goodman, R. S., C Morgan, H., Watson, C. J. E., Delriviere, L., Alexander, G. J., Jamieson, N. V., J Bradley, A., and Taylor, C. J., “Monitoring systemic donor lymphocyte macrochimerism to aid the diagnosis of graft-versus-host disease after liver transplantation.”, Transplantation, vol. 77, no. 3, pp. 441-6, 2004.[Abstract]


BACKGROUND: The diagnosis of graft-versus-host disease (GvHD) after liver transplantation can be difficult because early symptoms are often nonspecific. In this study, the presence of donor lymphocyte macrochimerism in recipient peripheral blood was examined as a diagnostic aid for GvHD after cadaveric donor liver transplantation.

METHODS: Between 1996 and 2002, 33 liver transplant recipients with a clinical suspicion of GvHD (skin rash, diarrhea, pyrexia, pancytopenia, or anemia, without an obvious alternative cause) were investigated for peripheral blood donor lymphocyte macrochimerism. Donor macrochimerism was determined at the time of first clinical presentation by a low-sensitivity polymerase chain reaction (PCR) to detect donor human leukocyte antigen (HLA) alleles using genomic DNA extracted from recipient peripheral blood. Where donor HLA alleles were detected, the percentage of donor T cells was quantified by two-color flow cytometric analysis using antibodies specific for mismatched donor and recipient HLA alleles. The relationship between the presence or absence of donor lymphocyte macrochimerism and final diagnoses based on clinical and histological criteria was examined.

RESULTS: Seven of the 33 patients were PCR positive for donor HLA alleles. All had macrochimerism, with donor T lymphocyte levels ranging from 4% to 50% of circulating lymphocytes. All seven patients had normal liver function tests, skin rash, and diagnosis of GvHD histologically confirmed by skin or gut biopsies. Twenty-six patients were PCR negative, and, in 23, an alternative diagnosis was eventually established. The remaining three patients made a rapid and spontaneous recovery with no further symptoms suggestive of GvHD.

CONCLUSIONS: Donor lymphocyte macrochimerism was present in all patients in whom the diagnosis of GvHD was confirmed. In patients with symptoms consistent with GvHD and a negative PCR for donor HLA, an alternative diagnosis was eventually established or the patients recovered spontaneously. Detection of donor HLA alleles in recipient peripheral blood by PCR is a useful diagnostic tool for GvHD after liver transplantation.

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2004

H. S. Bhat, Sanjeevan, K. V., and Dr. Sudhindran S., “Terminal hand-assist for laparoscopic donor nephrectomy”, Transplantation Proceedings, vol. 36, pp. 1905 - 1906, 2004.[Abstract]


Background Laparoscopic donor nephrectomy (LDN) has become widely popular in developed countries but not so in developing countries. One explanation for this maybe the difficulty in getting access devices due to the prohibitive cost. We report our method of terminal hand-assisted LDN in which successful donor nephrectomy is feasible without expensive access devices. Method The patient is placed in the corresponding classic renal surgery position. Three ports are placed for left-sided and four for right-sided LDN. After complete mobilization of the kidney laparoscopically, the assistant's right hand is introduced for left-sided LDN through a 7-cm left lower quadrant transverse muscle-splitting incision. For right-sided LDN, the surgeon's right hand is inserted through a corresponding ipsilateral incision (for right-handed surgeons). A simple method to prevent the leakage of pneumoperitoneum is described. The hand inside the abdomen aids in the final steps and completes the extraction of the kidney swiftly. Manual mopping, lavage, and hemostasis are also possible. Results Five cases of LDN at our centre were done in this fashion, four on the left side and one on the right. The mean kidney retrieval time after clamping the renal artery was 3:18 ± 0:46 minutes (range 2:30 to 4:30). Postoperative stay was 4 to 5 days. Recipient serum creatinine normalized within 3 to 4 days. Conclusions Short duration terminal hand-assist for LDN without any special access device is possible without the fear of excessive gas leakage. It is helpful to reduce prolonged warm ischemia and to relieve the surgeon's apprehension, at least in the initial learning phase of LDN.

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2004

K. V. Sanjeevan, Bhat, H. S., and Dr. Sudhindran S., “Right-sided laparaoscopic donor nephrectomy is feasible: Experience with three cases”, Transplantation Proceedings, vol. 36, pp. 1907 - 1908, 2004.[Abstract]


Background Laparoscopic donor nephrectomy (LDN) is more difficult on the right than the left and is typically not recommended for the right kidney. Materials and methods Between November 2002 and May 2003, three patients underwent right-sided donor nephrectomy: one transperitoneally and two retroperitoneoscopically. All procedures were performed in the right kidney position. Three ports were placed for retroperitoneoscopic approach and four for transperitoneal, including one to retract the liver. Renal arteries were clipped thrice and divided, and renal veins divided using an endo-GIA30 stapler. Kidneys were retrieved in all cases by extending the lower port incision by 7 to 8 cm. The records of donors and recipients, including early graft outcomes were reviewed. Results Kidney retrieval time and total warm ischemic time were 3:30 minutes and 5 minutes, respectively, for transperitoneal LDN and 3:40 to 4:10 minutes and 5 to 7 minutes, respectively, for retroperitoneal LDN. The operating times were 176, 224, and 160 minutes, respectively. The first donor (transperitoneal) was discharged on the fourth postoperative day, and the other two (retroperitoneal) on the third day. The serum creatinine of all recipients normalized within 72 hours, with normal isotope renal scans on the fifth postoperative day. Conclusions Right-sided LDN is feasible and safe without adversely affecting graft quality. The retroperitoneal approach is technically easier, gives a longer length of renal artery, and has a quicker convalescence.

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2004

K. V. Sanjeevan, Bhat, H. S., and Dr. Sudhindran S., “Laparoscopic simultaneous bilateral pretransplant nephrectomy for uncontrolled hypertension”, Transplantation Proceedings, vol. 36, pp. 2011 - 2012, 2004.[Abstract]


Severe hypertension resistant to multiple antihypertensive drugs represents an indication for bilateral pretransplant renal ablation by surgery or angioembolization. Besides causing severe pain and renal postinfarction syndrome, angioembolization may be ineffective. We present our experience with simultaneous bilateral laparoscopic pretransplant nephrectomies in patients with end-stage renal disease and severe uncontrollable hypertension. Among the three patients considered for bilateral pretransplant laparoscopic nephrectomy between September 2002 and August 2003, the procedure was successfully performed in two patients. Left nephrectomy was performed transperitoneally and right nephrectomy retroperitoneoscopically. In one of the three patients, a prior attempt at angioembolization had produced a dense perirenal reaction, rendering laparoscopic surgery impossible. Total operating time for bilateral laparoscopic nephrectomies was 260 and 280 minutes. Within 1 month following the nephrectomies, all patients became normotensive with minimal or no antihypertensive medications. We conclude that simultaneous bilateral laparoscopic nephrectomy is feasible and less morbid in end-stage renal disease patients. Prior angioembolisation can make laparoscopic surgery difficult or impossible.

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2004

Dr. Sudhindran S., Sanjeevan, K. V., Saheed, C. S. M., and Bhat, H. S., “Initial experience with laparoscopic donor nephrectomies”, Transplantation Proceedings, vol. 36, pp. 1901 - 1902, 2004.[Abstract]


Background Laparoscopic donor nephrectomy (LDN) is being adopted rapidly by transplant centres around the world as it offers less postoperative pain, quicker convalescence, and better cosmetic result when compared with the open approach. There may, however, be a steep learning curve with this technique. Method A retrospective review was performed to evaluate the donor morbidity and graft outcome of 21 consecutive LDN performed at one centre between May 2002 and August 2003. Results Eighteen LDN were performed on the left and three on the right side. All left and one right LDN were done transperitoneally while the remaining two right side kidneys were removed by a retroperitoneal approach. The mean (±SD) operating time and warm ischemic time were, respectively, 236 minutes (± 46) and 4 minutes (± 1). The mean time for resuming oral intake was 23 hours (SD ± 22.7). The median length of hospital stay was 5 days (range 3 to 18). One patient was reoperated for bleeding and required four units of packed cell transfusion. One recipient displayed delayed graft function requiring dialysis for 14 days. There were no graft losses. The mean creatinine of the recipients at the time of discharge was 1.15 mg/dL (± 0.21). Conclusions There is undoubtedly a learning curve with LDN. Nevertheless, with prior skills in similar procedures such as laparoscopic radical nephrectomies, it is feasible to diminish the learning curve and morbidity of LDN to yield results consistent with those in the published literature.

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2004

R. Mehta, Unnikrishnan, G., Sudheer, O. V., John, A., Dhar, P., Dr. Sudhindran S., and Balakrishnan, V., “Incidental detection of tubular esophageal duplication in gastric cardia malignancy.”, Indian Journal of Gastroenterology, vol. 23, no. 5, p. 192, 2004.[Abstract]


Congenital esophageal duplications represent about 15% of digestive tract duplications. We report a 38-year-old man who presented with longstanding heartburn and recent dysphagia. Endoscopy showed communicating tubular duplication of lower esophagus with ulceroproliferative growth at the gastric cardia extending into the lower esophagus. Histology of radical esophagogastrectomy specimen showed poorly differentiated adenocarcinoma of gastric cardia without evidence of Barrett's esophagus.

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2003

M. Shrotri, Fernando, B. S., Dr. Sudhindran S., Delriviere, L., Watson, C. J., Gibbs, P., Alexander, G. J., Jamieson, N. V., and AE, G., “Long-term outcome of liver transplantation for familial hypercholesterolemia”, Transplantation Proceedings, vol. 35, 1 vol., pp. 81-2, 2003.

2003

S. M, Dr. Sudhindran S., BS, F., G, P., CJ, W., NV, J., and JA, B., “Revascularisation in transplant renal artery stenosis using the internal iliac artery”, Transplantation Proceedings, vol. 35, no. 1, pp. 332-3, 2003.

2003

M. Shrotri, Dr. Sudhindran S., Gibbs, P., Watson, C. J., Alexander, G. J., Gimson, A. E., Jamieson, N. V., and Delriviere, L., “Case report of cavoportal hemitransposition for diffuse portal vein thrombosis in liver transplantation.”, Transplant Proc, vol. 35, no. 1, pp. 397-8, 2003.

2003

Dr. Sudhindran S., Pettigrew, G. J., Drain, A., Shrotri, M., Watson, C. J. E., Jamieson, N. V., and Bradley, J. A., “Outcome of transplantation using kidneys from controlled (Maastricht category 3) non-heart-beating donors”, Clinical Transplantation, vol. 17, pp. 93-100, 2003.[Abstract]


Abstract: Background:  Many renal transplant centres are reluctant to use kidneys from non-heart-beating (NHB) donors because of the high incidence of primary non-function and delayed graft function reported in the literature. Here, we report our favourable experience of using kidneys from Maastricht category 3 donors (controlled NHB donors). Materials and methods:  From January 1996 to June 2002, 42 renal transplants using kidneys from 25 controlled NHB donors were undertaken at our centre. The rates of primary non-function, delayed graft function (DGF), rejection and long-term graft and patient survival were compared with those of 84 recipients of grafts from heart-beating (HB donors) transplanted contemporaneously. Results:  Primary non-function did not occur in recipients of grafts from NHB donors but was seen in two grafts from HB donors. DGF occurred in 21 of 42 (50%) kidneys from NHB donors and 14 of 84 (17%) kidneys from HBD donars (p < 0.001). The acute rejection rates in the two groups were similar (33% for grafts from NHB donors vs. 40% from HB donors). By 1 month after transplantation, there was no significant difference in serum creatinine concentration between the two groups. Over a median follow-up period of 32 months (range 2–75 months), the actuarial graft survival rates at 1, 3 and 5 yr after transplantation were 84, 80 and 74% for recipients of kidneys from NHB donors, compared with 89, 85 and 80% for kidneys from HB donors. Conclusion:  Controlled NHB donors are a valuable and under-used source of kidneys for renal transplantation. The outcome for recipients of kidney allografts from category 3 NHB donors is similar to that seen in recipients of grafts from conventional HB cadaveric donors.

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2003

Dr. Sudhindran S., Taylor, A., Delriviere, L., Collins, V. P., Liu, L., Taylor, C. J., Alexander, G. J., Gimson, A. E., Jamieson, N. V., Watson, C. J. E., and Gibbs, P., “Treatment of Graft-Versus-Host Disease After Liver Transplantation with Basiliximab Followed by Bowel Resection”, American Journal of Transplantation, vol. 3, pp. 1024-1029, 2003.[Abstract]


Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a serious complication with mortality rates over 80%. Two patients with established GVHD after OLT were treated with Basiliximab, a chimeric murine human monoclonal antibody which binds to the alpha-chain of interleukin-2 receptor (IL-2R). Two males, aged 45 and 56 years, presented after OLT with a clinical picture consistent with GVHD. Quantitative measurements of recipient peripheral blood donor lymphocyte chimerism were carried out by flow cytometric analysis, and showed peak chimerism levels of 5% and 8%, respectively. Treatment comprised 3 doses of 1 g methyl prednisolone followed by 2 doses of 20 mg of Basiliximab. In both, treatment resulted in complete disappearance of macro-chimerism in blood. There was resolution of skin rash by day 7; however, diarrhea persisted. White cell scan showed increased uptake in the terminal ileum and small-bowel resection was performed in both patients. One patient is alive and well 36 months after OLT. The other patient had resolution of GVHD, but died of recurrent hepatitis C 1 year after OLT. The combination of immunological and surgical treatment for GVHD following solid organ transplantation has not previously been described.

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2002

, AC, R., MS, M., and Dr. Sudhindran S., “A multicentre analysis of the results of kidney transplantation from non-heart beating donors in the UK”, British Journal of Surgery, vol. 89, 2002.

2002

Dr. Sudhindran S. and A, T., “Shipped and Locally Transplanted Renal Allografts”, New England Journal of Medicine, vol. 346, pp. 708-709, 2002.

2001

Dr. Sudhindran S. and PR, E., “Surgical training takes time”, Ann R Coll Surg Eng , vol. 83, pp. 196-197, 2001.

2001

Dr. Sudhindran S., Bromwich, E., and Edwards, P., “Prospective randomized double-blind placebo-controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopancreatography-induce pancreatitis”, The British journal of surgery, vol. 88, pp. 1178-82, 2001.[Abstract]


One possible aetiology of pancreatitis following endoscopic retrograde cholangio pancreatography (ERCP) is cannulation-induced spasm of the sphincter of Oddi and consequent pancreatic duct obstruction. Sublingual glyceryl trinitrate (GTN) has been shown to produce periampullary sphincter relaxation. The aim of this study was to determine whether prophylactic long-acting GTN could reduce the incidence of ERCP-induced pancreatitis. In a randomized double-blind study, prophylactic treatment with GTN (2 mg given sublingually 5 min before endoscopy) was compared with placebo in 186 patients who presented for elective ERCP. The primary endpoint was the occurrence of pancreatitis within 24 h, defined as a serum amylase concentration greater than 1000 units/ml in association with a visual analogue pain score of more than 5. The incidence of pancreatitis was lower in the GTN group compared with placebo (seven of 90 versus 17 of 96; P < 0.05). Mean serum amylase values were similar in the two groups. The protective effect of GTN appears to be highest in the diagnostic ERCP group (one of 54 versus ten of 66; P = 0.012) and in the group in which cholangiography alone was performed (one of 54 versus eight of 57; P = 0.032). Prophylactic treatment with GTN reduces the incidence of pancreatitis following ERCP but does not seem to reduce the extent of hyperamylasaemia or the severity of pancreatitis.

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2000

Dr. Sudhindran S. and Sinha, S., “Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon.”, Br J Surg, vol. 87, no. 3, pp. 376-7, 2000.

2000

Dr. Sudhindran S., Emms, N., Sinha, S., and Kumar, A., “Too many confounding variables”, Transplantation, vol. 70, no. 10, 2000.

2000

G. L. Gilling-Smith, Martin, J., Dr. Sudhindran S., Gould, D. A., McWilliams, R. G., Bakran, A., Brennan, J. A., and Harris, P. L., “Freedom From Endoleak After Endovascular Aneurysm Repair Does Not Equal Treatment Success”, European Journal of Vascular and Endovascular Surgery, vol. 19, pp. 421 - 425, 2000.[Abstract]


Objective to determine whether freedom from endoleak after endovascular repair of abdominal aortic aneurysm (EVAR) is a reliable guide to freedom from persistent or recurrent pressurisation of the aneurysm sac (endotension) and therefore freedom from risk of rupture. Patients and methods the records of 55 patients followed for more than 3 months after EVAR were reviewed to correlate the presence or absence of endoleak on contrast-enhanced CT and/or angiography with changes in maximum aneurysm diameter (DMAX). Results in 22 (40%) patients there was no significant change in DMAX during follow-up. In 21 of these no endoleak was observed on CT or angiography. One patient developed a secondary side-branch endoleak which remains under observation. In 18 (33%) patients, DMAX decreased during follow-up. Thirteen of these remained free of endoleak. Four patients developed secondary endoleaks which were treated by secondary intervention. One patient with persistent primary endoleak suffered fatal aneurysm rupture three days before planned intervention. DMAX increased in 15 (27%) patients. In only five of these could an endoleak be identified on CT and/or angiography. One primary side-branch endoleak persists following failed embolisation. Four secondary endoleaks have been corrected by secondary intervention. Four of the remaining 10 patients died suddenly from unknown cause. All had DMAX greater than 65 mm at last follow-up. One patient underwent late conversion, which suggested continued pressurisation through thrombus at the site of a ««sealed»» primary proximal endoleak. Two patients are scheduled to undergo embolisation of patent side-branches revealed only by Levovist enhanced Duplex scanning and three patients remain under observation. Conclusion freedom from endoleak on conventional imaging incorrectly suggested freedom from endotension in 10 (18%) of our patients. Follow-up after endovascular repair must include regular measurement of DMAX and/or aneurysm sac volume to identify those patients who remain at risk of rupture.

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1999

Dr. Sudhindran S., GT, A., and PR, E., “Subclavian artery stenting for pseudoaneurysm”, The British Medical Journal, 340 (Minerva)., vol. 318, 1999.

1999

Dr. Sudhindran S., Edwards, P. R., and de Cossart, L. M., “Mortality after elective abdominal aortic aneurysm repair: not where .. but how many and by whom.”, Ann R Coll Surg Engl, vol. 81, no. 2, pp. 141-2, 1999.

1999

Dr. Sudhindran S., “Reducing the risk of major elective surgery. Paper should have given details on causes of death.”, BMJ, vol. 319, no. 7221, pp. 1369; author reply 1370-1, 1999.

1999

Dr. Sudhindran S., S, R., WJ, P., GRJ, S., and LM, deCossart, “The Impact Of Duplex Scanning For The Diagnosis Of Deep Vein Thrombosis On Workload In A District General Hospital.”, Phlebology , vol. 14, no. 4, pp. 143-145, 1999.

1998

Dr. Sudhindran S., “An audit of hospital mortality after urgent and emergency surgery in the elderly.”, Ann R Coll Surg Engl, vol. 80, no. 1, p. 76, 1998.

1998

Dr. Sudhindran S., “Magnetic resonance imaging in evaluation of common bile duct stones”, British Journal of Surgery, 873 (letter), vol. 85, 1998.

1998

Dr. Sudhindran S., E, B., and PR, E., “Double blind randomised controlled trial of buccal suscard versus placebo in the prevention of endoscopic retrograde cholangio pancreatography induced pancreatitis”, Br J Surg , vol. 85, 1998.

1997

Dr. Sudhindran S., “Preoperative indicators to predict common bile duct stones.”, Am J Surg, vol. 173, no. 2, p. 150, 1997.

1997

Dr. Sudhindran S., “Vascular complications of injecting drug misuse”, British Journal of Surgery (letter), vol. 84, pp. 582-3 , 1997.

1997

Dr. Sudhindran S., “Prospective randomized trial comparing sequential avulsion with stripping of the long saphenous vein.”, Br J Surg, vol. 84, no. 5, p. 727, 1997.

1997

Dr. Sudhindran S., “Perioperative blood transfusion: a plea for guidelines”, Annals of the Royal College of Surgeons of England, vol. 79, no. 4, pp. 299 - 302, 1997.[Abstract]


Red blood cells are still transfused inappropriately in spite of recent media attention and public awareness about the risks of blood products. A prospective audit was conducted to determine the avoidable blood transfusion rates in the elective perioperative setting utilising the guidelines issued by the American College of Physicians (ACP). Of 82 consecutive adult patients who were admitted for major elective surgery over a 3-month period, 28 were transfused a total of 94 units of homologous SAG-M blood, of which 50 (53%) were inappropriate as recommended by the ACP guidelines. Violations of the guidelines were perioperative transfusion in bleeding patients who were haemodynamically stable (31%) and transfusion in asymptomatic, stable patients solely to attain a haemoglobin level above 10 g% (22%). There is a need for objective, easily adaptable and widely disseminated consensus guidelines to the indications for red blood cell transfusion.

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1996

Dr. Sudhindran S., “Two layer closure of typhoid ileal perforations”, British Journal of Surgery, vol. 83: 282 (letter), 1996.

1996

Dr. Sudhindran S., “Routine preoperative infusion cholangiography at elective cholecystectomy”, British Journal of Surgery, vol. 83:1658 (letter), 1996.

1996

Dr. Sudhindran S. and KJ, R., “Better bridge for loop stomas”, British Journal of Surgery (letter), vol. 83, 1797, 1996.

1996

L. Muir and Dr. Sudhindran S., “Blood transfusion requirements in femoral neck fractures.”, Ann R Coll Surg Engl, vol. 77, no. 6, pp. 453-6, 1996.[Abstract]


Fractures of the femoral neck are common, and their incidence seems likely to increase. A prospective study in 1991 of 80 patients with such fractures suggested that not all need to be cross-matched preoperatively, a finding supported by the existing literature. At the same time, a survey of transfusion protocols in hospitals throughout the country suggested that much blood was being wasted daily in unnecessary cross-matching. This survey was repeated in 1995, and little appears to have changed. The implications of this are discussed.

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1994

Dr. Sudhindran S., Varghese, C., and Ramesh, H., “Pseudomyxoma peritonei: a report of eight cases.”, Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, vol. 13 4, pp. 137-8, 1994.

1992

, Dr. Sudhindran S., and Jabba, “Acute intestinal obstruction due to sigmoid malignancy”, Kerala Medical Journal , vol. 33, no. 2, pp. 48- 50., 1992.

1992

Dr. Sudhindran S., H, R., and CJ, V., “Mortality following pancreaticoduodenectomy”, Ind J Gastroenterology , vol. II (suppl): A50 M7, 1992.