灿烂如SPA

一个男人的"出轨" 其实,这个世界上最需要呵护的是脸上长满胡子的男性,谁要是跟我说"见你的鬼去吧",那肯定是个心里一直自以为得意的女人。男人要安排除了经期、产假之外女人从来无法插手的事件,最后只能得到一句:"你知道做女人的辛苦吗?" 天地可鉴,壮劳力、长期饭票、女上司的骚扰、一家的负担、面对三十的困境,我     

牙光灿烂的日子

口腔健康是全身健康的重要部分,拥有健康美丽的牙齿已不仅仅是你自己的事,更是社会文明的一个重要标志,但今天的美牙新时尚你都了解吗?     

愈夜愈灿烂

2000年秋冬,女性面貌出现了多元化的变化,无论是穿着动物图纹的夏娃,40年代的优雅保守女性、80年代的女强人、朋克、拜金女郎,还是游走在时代边缘的自由女骑士,一致的走向始终是:优雅、雍容与华贵。     

春光灿烂 防敏有方

春日里阳光明媚，百花绽放，繁花似锦。然而春风乍起，柳絮飞扬，花粉纷飞，浮尘细菌也乘机漫天飞舞。这样的季节让人又爱又恨，一边享受春风拂面的温暖，一边担心气候引起的皮肤过敏问题。     

烤瓷牙的笑容灿烂如花

拥有一口洁白整齐的牙齿，才能给自己一个满意的微笑。如今．“贵族”烤瓷牙已悄然走进了我们的生活![编者按]     

为明天接风洗尘

世上无难事,只怕有心人。遇到任何事情,我都用这句话来鼓励自己。因为生活长长短短,是个风起云涌的寓言故事,有人会觉得无论生活给予你什么困难,那都是岁月优雅馈赠的,也有悲观的人会觉得那是一场令人心惊胆战的灾难。老屋子没下雨也会长出霉菌来;流星一落,有人许愿,也有人再见;钢筋水泥的城市也抵不过海啸地震     

Hepatobiliary nutrition: history and future

The liver is a master metabolic gland; consequently, liver disease commonly results in significant malnutrition. Complex metabolic derangements always accompany liver failure, often reflect the magnitude of hepatic insufficiency, and are characterized by accentuated catabolism. Nutritional assessment is problematic in these patients, because many of the usual indicators of nutritional status are altered directly by the hepatic pathophysiology rather than, or in addition to, preexisting or subsequent secondary malnutrition. The objective of nutritional support in patients with liver failure is to provide adequate nutrients to ensure the availability of specific substrates for energy and protein synthesis and for normal hepatocyte survival and function, without inducing or accentuating encephalopathy or otherwise compounding hepatic insufficiency. In the near future, guidelines must be developed for the specific nutritional support of patients with fulminant hepatic failure, cholestatic liver disease, steatosis, and cirrhosis. Currently, work is underway to develop an artificial liver for patients awaiting transplantation; to use genetic engineering technology to provide an alternative source of hepatic tissue; and to test the utility of various intermediary metabolites for hepatobiliary nutrition support. No ideal regimen for nutritional support of all forms of liver failure exists, and this also represents a significant challenge for future basic and clinical investigations. However, it is mandatory to attempt to maintain optimal nutrition in patients with severe liver failure if morbidity and mortality are to be reduced and survival is to be maximized. Received: February 19, 2002 / Accepted: March 8, 2002 Offprint requests to: S.J. Dudrick     

Diet and bowel diseases--past history and future prospects

Changes in diet from ancient times until the present are described. Previously relatively low in energy and animal products yet high in fibre-containing foods, diets are now high in energy and animal products (particularly fat), yet contain less fibre. The changing incidences of bowel disorders and diseases are described, with assessments of the role of diet. Clearly, diet is implicated as regards predisposition to constipation, appendicitis, colorectal cancer and diverticular disease; however, a meaningful dietary role in irritable bowel syndrome, ulcerative colitis and Crohn's disease is doubtful. In South Africa the rarity of bowel diseases in rural blacks compared with whites affords valuable aetiological information about some bowel diseases. The low occurrence thereof (except inflammatory bowel disease) in Indian and coloured populations is not readily explicable. While dietary changes in whites are being widely urged in order to combat degenerative diseases, the magnitude of changes made is unlikely to reduce the occurrence of bowel diseases. The progressive westernization of the diets and lifestyles of less-privileged populations is likely to be associated with increases in the incidences of these diseases.     

Laparoscopic pyeloplasty: history, evolution, and future

Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital; however, acquired conditions at the level of the UPJ may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy has allowed minimally invasive reconstructive surgery that mirrors open surgical techniques. In the hands of experienced surgeons, laparoscopic pyeloplasty offers a less invasive alternative to open surgery with decreased morbidity, shorter hospital stay, and faster convalescence. During the last decade, laparoscopic pyeloplasty for the treatment of congenital or acquired UPJ obstruction has garnered much interest, but, as this procedure is technically challenging, it is being performed only at selected medical centers by surgeons with advanced laparoscopic training. This review describes the early results, ongoing evaluation, and future role for this novel surgical procedure.     

Mirizzi syndrome: history, present and future development

BACKGROUND: Mirizzi syndrome was reported in 0.3-3% of patients undergoing cholecystectomy. The distortion of anatomy and the presence of cholecystocholedochal fistula increase the risk of bile duct injury during cholecystectomy. METHODS: A Medline search was undertaken to identify articles that were published from 1974 to 2004. Additional papers were identified by a manual search of the references from the key articles. RESULTS: A preoperative diagnosis was made in 8-62.5% of cases. Open surgical treatment gave good short-term and long-term results. There was a lack of good data in laparoscopic treatment. Conversion to open surgery rates was high, and bile duct injury rate varied from 0 to 22.2%. CONCLUSION: A high index of clinical suspicion is required to make a preoperative or intraoperative diagnosis, which leads to good surgical planning to treat the condition. Open surgery is the gold standard. Mirizzi syndrome should still be considered as a contraindication for laparoscopic surgery.     

The history of pancreas transplantation: past, present and future

The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966, followed by a series of whole pancreas transplantation. Due to the lack of potent immunosuppressive drugs, rejections and infections, it was concluded that pancreas was less antigenic than the kidney which was less antigenic than the duodenum. It opened the door to a period, between the mid 70's to mid 80's where only segmental pancreatic grafts were used in the recipient. Numerous techniques for diverting or dealing with the pancreas juice secretion were described, none of them being satisfactory. In the late 70's - early 80's, three major events happened and boosted the development of pancreas transplantation: firstly the introduction of Cyclosporine A in the clinical field, secondly the organization on March 1980, of the first international meeting on Pancreas Transplantation with the first report of the International Pancreas Transplantation Registry (IPTR) and finally in 1982, the organization of the first informal so-called Spitzingsee meetings where pancreas transplantation successes but mainly failures were discussed which precluded the onset of IPITA (International Pancreas and Islet Transplantation Association), EuroSPK (European Study Group for simultaneous Pancreas and Kidney Transplantation) and EPITA (European Pancreas and Islet Transplantation Association). During one of the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That was clinically achieved during the mid 80's and remained the mainstay technique during the next decade. In parallel, the Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas. During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion became the gold standard for simultaneous pancreas and kidney transplantation (SPK), with portal drainage of the venous effluent of the pancreas, even for pancreas after kidney (PAK) or pancreas transplantation alone (PTA). Today, there remains room for improvement: safety of using the duodeno-duodenal anastomosis technique must be confirmed by prospective analysis while preventing ischemic reperfusion injuries, using specific drugs; that must be assessed in new trials.