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101.
Asit Arora H. H. Nag Abhishek Yadav Shaleen Agarwal Amit Javed Anil K. Agarwal 《The Indian journal of surgery》2015,77(2):99-103
Postcholecystectomy bile duct injuries are a cause of significant morbidity and occasional mortality. Intraoperative recognition and repair of complete biliary transection with hepaticojejunostomy is the recommended treatment; however, it is possible only in few patients as either the injury is not recognized intraoperatively or the center is not geared up to perform an urgent hepaticojejunostomy in these patients with a nondilated duct. Retrospective analysis of data from a tertiary care referral center over a period of 10 years from January 2000 to December 2009 to report the feasibility and outcomes of prompt repair was done (defined as repair within 72 h of index operation) of postcholecystectomy bile duct injury. Ten patients of postcholecystectomy bile duct injury detected intraoperatively and referred early underwent prompt repair. All patients had a complete transection of the bile duct (type of injuries as per Strasberg classification: Type E V: 1, Type E III: 5, Type E II: 3 and Type E I: 1). The mean duration between injury and bile duct repair in the form of Roux-en-Y hepaticojejunostomy (RYHJ) was 22.7 (range 5–42) hours. The mean diameter of the anastomosis was 1.63 (range1–2.1) cm, and the anastomosis was stented in 7 patients. The mean duration of surgery was 4.6 +1.7 h. One patient developed bile leak on the first postoperative day, which settled by day 5. The mean duration of hospital stay was 5.1 (range 4–8) days. With a mean follow-up of 42 (range 24–110) months, all patients had excellent (70 %) or good outcome (30 %). Prompt RYHJ (within first 72 h) for postcholecystectomy biliary transection is an effective treatment and potentially limits the morbidity to the patient. 相似文献
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Ng Deborah Chieh Yih Lee Hwee Chyen Yang Cunli Punamiya Sundeep Jaywantraj Azucena Benedict Cesar Isip Sule Ashish Anil 《The International journal of angiology》2014,23(1):71-76
The nutcracker syndrome is a rare clinical manifestation of symptoms caused by the compression of the left renal vein by an overriding superior mesenteric artery, an anatomical variant otherwise known as the nutcracker phenomenon. Usually present in women and children, when symptomatic, it commonly presents with hematuria, proteinuria, and chronic pelvic pain. Effective modalities of treatment apart from conservative management, include both invasive surgical procedures such as renal vein transposition and autotransplantation of the kidney and more popular recently, the less invasive endovascular stenting. Both options, however, are not without complications, such as, retroperitoneal hematomas or stent migration, thrombosis and restenosis. We now present a case of spontaneous renosplenic shunting in a 68-year-old lady of Chinese descent with the nutcracker syndrome—the first of such cases to be ever reported in a patient with no preexisting predilection for chronic liver disease and portosystemic shunting. Despite having significant pelvic venous congestion as evident on computed tomography scans, she remained asymptomatic. This may present a novel paradigm shift for the treatment of the nutcracker syndrome —surgical creation of a renosplenic bypass instead of current modalities, an alternative solution which can be performed laparoscopically and is without problems related to stent use. The creation of laparoscopic splenorenal bypass has been reported once thus far in Cleveland Ohio by Chung and Gill with good symptomatic improvement but no further studies since to validate its long-term effectiveness. 相似文献
106.
Andreas Jaehne Thomas Unbehaun Bernd Feige Ulrich C. Lutz Anil Batra Dieter Riemann 《Sleep medicine》2012,13(10):1286-1292
ObjectiveSubjective quality of sleep is impaired in smokers compared with non-smokers, but there is only limited evidence from methodologically sound studies about differences in polysomnography (PSG) sleep characteristics. Therefore, this study used PSG to evaluate sleep in smokers and non-smokers while controlling for other parameters that affect sleep.MethodsAfter an adaptation night, PSG sleep laboratory data were obtained from 44 smokers (29 men and 15 women, median age 29.6 years) and compared with PSG data from 44 healthy, sex- and age-matched never smokers. Exclusion criteria were alcohol or other substance abuse, psychiatric or endocrine diseases, and treatment with any kind of psychotropic medication. Nicotine and cotinine plasma levels were measured (in the smoking group) and subjective sleep quality assessed in both groups.ResultsThe smokers had a Fagerström tolerance score of 6.4, consumed an average of 21.2 cigarettes per day and had been smoking for 13.1 years (median). Smokers had a shorter sleep period time, longer sleep latency, higher rapid eye movement sleep density, more sleep apneas and leg movements in sleep than non-smokers. There were no differences regarding parameters of spectral analysis of the sleep electroencephalogram as well as in the sleep efficiency measured by PSG. Nevertheless smokers rated their sleep efficiency lower on the Pittsburgh Sleep Quality Index compared with non-smoking individuals, but no differences were detected on the SF-A. Plasma cotinine level correlated negatively with slow wave sleep in the smoking group.ConclusionsSmokers showed a number of insomnia-like sleep impairments. The findings suggest that it is important for sleep researchers to control smoking status in their analyses. Further research should focus on the causes and consequences of impaired sleep during tobacco cessation, as sleep disturbances are a known risk factor for early relapse after initial tobacco abstinence. 相似文献
107.
Rehan Ul Haq Prashant Modi IK Dhammi Anil K Jain Puneet Mishra 《Indian Journal of Orthopaedics》2013,47(3):302-306
Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed. 相似文献
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Sunita Managutti Anil Managutti Michael Pragasm 《Journal of maxillofacial and oral surgery》2012,11(1):109-114
Osteopetrosis (OP) is a rare congenital disorder (present at birth) in which the bones become over dense. This results from
an imbalance between the formation of bone and the resorption of the bone. Thickening of the bones which become abnormally
dense due to an inherited defect in bone resorption, the process in which old bone is broken down and removed so that new
bone can be added to the skeleton. Osteoclasts are the cells responsible for bone resorption. In osteopetrosis the osteoclasts
do not perform normally. This flaw in bone resorption results in bones that are abnormally dense, yet are fragile and easily
broken. Osteopetrosis is also known as Albers–Schonberg disease, generalized congenital osteosclerosis, ivory bones, marble
bones, osteosclerosis fragilis generalisata. In this article, we have described about the diagnosis and medical and surgical
management of osteopetrosis reported case to our hospital. 相似文献
110.
The innate immune response represents the first line of defense against hepatitis C virus (HCV) infection. The response is
an early, coordinated effort orchestrated by host interferon (IFN) production, natural killer cell activation, and dendritic
cell maturation, which, when effective, primes a successful adaptive immune response, leading to resolution of infection.
Numerous mechanisms allow subversion of innate immunity, often establishing chronicity and resistance to conventional antiviral
therapy. Recent groundbreaking studies examining viral evasion of host defenses and genetic host determinants of response
to IFN have advanced our understanding of the innate immune response to HCV. This has provided the framework for individualized
treatment approaches and the development of novel therapeutics aimed at restoring innate immune signaling during chronic infection.
The objective of this report is to review advances in our understanding of HCV and host innate immune defenses, and to highlight
their clinical translation. 相似文献