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62.
Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines 总被引:2,自引:0,他引:2
Miura F Takada T Kawarada Y Nimura Y Wada K Hirota M Nagino M Tsuyuguchi T Mayumi T Yoshida M Strasberg SM Pitt HA Belghiti J de Santibanes E Gadacz TR Gouma DJ Fan ST Chen MF Padbury RT Bornman PC Kim SW Liau KH Belli G Dervenis C 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(1):27-34
Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis),
according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management
of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment
may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For
severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After
hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed.
For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic,
percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with
mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade
II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation,
elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy.
For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary
peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective
cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general
medical condition. 相似文献
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Purpose
The objective of this study was to assess the construct validity of the EQ-5D instrument among the Malaysian population. 相似文献66.
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A. Rosich-Medina S.S. Liau A. Jah E. Huguet T.C. See N. Jamieson R. Praseedom 《International journal of surgery case reports》2010,1(3):33-36
Percutaneous transhepatic biliary drainage (PTBD) is commonly used in the management of cholangiocarcioma. Major and minor complications of PTBD such as cholangitis, haemorrhage and catheter dislocation are well documented. A lesser reported complication are cutaneous metastases following PTBD for cholangiocarcinoma.We report a case of a 79 year old man who presented with right upper quadrant pain, jaundice and weight loss, with dilated intra-hepatic bile ducts on imaging. The cytology results from a sample taken during endoscopic retrograde cholangiopancreatography were highly suspicious of cholangiocarcioma. A PTBD was subsequently performed and bilateral metal biliary stents were placed without external drainage. Five months after the PTBD he was found to have a hard nodule under the PTBD puncture site. The nodule was excised and the histology confirmed a cholangiocarcinoma metastasis.A review of the literature identified twelve cases of cutaneous metastases from cholangiocarcinoma, following PTBD. In addition, tumour seeding along the catheter tract following PTBD, with metastatic deposits on the abdominal wall, peritoneoum, chest wall, pleural space, and liver parenchyma have also been reported.Health care professionals should be aware of this rare complication and offer appropriate management options to patients. 相似文献
68.
AB Rossi JJ Leyden AS Pappert A Ramaswamy A Nkengne R Ramaswamy M Nighland 《Journal of the European Academy of Dermatology and Venereology》2011,25(4):398-402
Background Post‐inflammatory hyperpigmentation (PIH) is a common occurrence in patients with acne vulgaris, particularly in those with skin of colour. Aims A previous study has demonstrated the benefit of tretinoin (retinoic acid) in the treatment of PIH; however, there is currently no standard protocol to evaluate change in PIH following treatment. Based on these findings, we performed a pilot, exploratory, blinded, intraindividual‐controlled methodology study that consisted of a photographic assessment protocol with facial mapping. Materials and methods The study was based on a secondary analysis of a phase 4, community‐based trial of 544 acne patients who were treated with tretinoin gel microsphere 0.04% or 0.1%. Only patients with Fitzpatrick types III–V (skin of colour) were included in the study; subjects with Fitzpatrick skin type VI were excluded because the photographic assessment did not allow for proper evaluation. Results Despite the small number of subjects evaluated (n = 25), the results revealed consistent assessment of improvement in PIH between two independent graders (weighted κ = 0.84). Conclusion Further study with a larger population is recommended to validate the accuracy of this method. 相似文献
69.
A Levy Bencheton JM Berenger P Del Giudice P Delaunay F Pages JJ Morand 《Journal of the European Academy of Dermatology and Venereology》2011,25(5):599-602
Background Bedbugs (Cimex lectularius) have been feeding on sleeping human beings since prehistory. In Europe, bed bugs were common and endemic until World War II when improved body and home hygiene, and widespread use of insecticides led to almost complete eradication. Current evidence indicates that bedbugs are making a comeback in Europe, USA, Canada and Australia. In our practice in Southern France, we observed several cases within a period of only 1 year. Objectives Based on this experience, we conducted an epidemiological study to evaluate the status of bedbugs in France. Methods During summer 2009, we mailed a short questionnaire to all hospital professors in the CEDEF (Collège des Enseignants de Dermatologie de France) asking four questions: number of suspected diagnosis of bedbugs in the year 2009, and number of certain positive diagnosis, difficulties in treatment, use of a pest control professional for treatment, and finally personal opinion on actual incidence of bedbugs, compared with past years. Results Of the 84 questionnaires sent, there were only 26 responses despite two reminders. The responses were predominantly southern France, probably as a result of intensive immigration and increased travel and trade. Difficulties encountered during diagnosis and treatment are also mentioned. Utilizing the services of entomological experts and pest control professionals is essential. Conclusions France has the same experience regarding the resurgence of bedbugs as several European countries, USA, Canada and Australia, especially the southern regions. This emerging health problem has to be known by dermatologists. A national programme has been launched in France to assess actual incidence and study C. lectularius‐ related diseases. 相似文献
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