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Woo Hyun Paik Nerenthran Loganathan Jin-Hyeok Hwang 《World journal of gastrointestinal endoscopy》2014,(3)
Hilar cholangiocarcinoma is a tumor of the extrahepatic bile duct involving the left main hepatic duct, the right main hepatic duct, or their confluence. Biliary drainage in hilar cholangiocarcinoma is sometimes clinically challenging because of complexities associated with the level of biliary obstruction. This may result in some adverse events, especially acute cholangitis. Hence the decision on the indication and methods of biliary drainage in patients with hilar cholangiocarcinoma should be carefully evaluated. This review focuses on the optimal method and duration of preoperative biliary drainage(PBD) in resectable hilar cholangiocarcinoma. Under certain special indications such as right lobectomy for Bismuth type ⅢA or Ⅳ hilar cholangiocarcinoma, or preoperative portal vein embolization with chemoradiation therapy, PBD should be strongly recommended. Generally, selective biliary drainage is enough before surgery, however, in the cases of development of cholangitis after unilateral drainage or slow resolving hyperbilirubinemia, total biliary drainage may be considered. Although the optimal preoperative bilirubin level is still a matter of debate, the shortest possible duration of PBD is recommended. Endoscopic nasobiliary drainage seems to be the most appropriate method of PBD in terms of minimizing the risks of tract seeding and inflammatory reactions. 相似文献
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E. Agabiti A. Loganathan M. Rimmel R. A. Eames P. T. Cullen 《Acta chirurgica Belgica》2013,113(1):99-101
Cancer arising at an ileostomy site represents a rare late complication of total colectomy performed for ulcerative colitis. There are no more than 36 published cases in the literature. We describe a case of adenocarcinoma of the mucocutaneous junction at the ileostomy site, occurring 31 years after total colectomy for ulcerative colitis. Wide excision of the moderately differentiated adenocarcinoma was performed with refashioning of the ileostomy. Polypoid adenomas or adenocarcinomas of the ileostomy after colectomy performed for non-neoplastic conditions are extremely uncommon. Biopsies of polypoid lesions at the stoma site are recommended. 相似文献
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Widjaja D Yarlagadda S Singu BS Loganathan RS Blum S Bloom A Remy P 《Journal of the National Medical Association》2007,99(4):384-388
BACKGROUND: In the United States, among patients with hepatocellular carcinoma (HCC) and portal hypertension from chronic hepatitis-B virus infection, 44% were Hispanic and 28% were African American. Because our institution (Bronx Lebanon Hospital Center, Bronx, NY) predominantly serves these populations, we studied retrospectively the characteristics of patients with chronic hepatitis-B virus infection. METHODS: We reviewed the medical records of all patients aged > 18 years with chronic hepatitis-B virus infection who had been evaluated at our institution between January 1, 2002 and May 31, 2005. RESULTS: We identified 167 patients with chronic hepatitis-B virus infection. Only 12 (7%) patients underwent chronic hepatitis-B virus treatment. One-hundred-forty-six (87%) patients without decompensated liver cirrhosis were not treated owing to the following reasons: normal alanine aminotransferase level (86%), active injection drug or heavy alcohol use (9%), lack of health insurance coverage (3%) and noncompliance with visits during the evaluation period (2%). HCC screening was performed in 78 patients (47%). Lack of insurance coverage and compliance issues were predictors for HCC screening (p = 0.04 and p < 0.001, respectively). CONCLUSIONS: In the South Bronx, 87% patients were not considered candidates for hepatitis-B virus treatment because of normal alanine aminotransferase levels and the interference of potentially modifiable social factors. Only 47% of our patients with chronic hepatitis-B virus infection underwent HCC screening because of lack of insurance coverage and compliance issues. 相似文献
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Sevil Korkmaz‐Icz Kunsheng Li Sivakkanan Loganathan Qingwei Ding Mihly Ruppert Tams Radovits Paige Brlecic Alex A. Sayour Matthias Karck Gbor Szab 《American journal of transplantation》2020,20(10):2847-2856
Hearts are usually procured from brain‐dead (BD) donors. However, brain death may induce hemodynamic instability, which may contribute to posttransplant graft dysfunction. We hypothesized that BD‐donor heart preservation with a conditioned medium (CM) from mesenchymal stem cells (MSCs) would improve graft function after transplantation. Additionally, we explored the PI3K pathway's potential role. Rat MSCs‐derived CM was used for conservation purposes. Donor rats were either exposed to sham operation or brain death by inflation of a subdural balloon‐catheter for 5.5 hours. Then, the hearts were explanted, stored in cardioplegic solution‐supplemented with either a medium vehicle (BD and sham), CM (BD + CM), or LY294002, an inhibitor of PI3K (BD + CM + LY), and finally transplanted. Systolic performance and relaxation parameters were significantly reduced in BD‐donors compared to sham. After transplantation, systolic and diastolic functions were significantly decreased, terminal deoxynucleotidyl transferase‐mediated dUTP nick end‐labeling (TUNEL)‐positive cells and endonuclease G positive cells were increased in the BD‐group compared to sham. Preservation of BD‐donor hearts with CM resulted in a recovery of systolic graft function (dP/dtmax: BD + CM: 3148 ± 178 vs BD: 2192 ± 94 mm Hg/s at 110 µL, P < .05) and reduced apoptosis. LY294002 partially lowered graft protection afforded by CM in the BD group. Our data suggest that PI3K/Akt pathway is not the primary mechanism of action of CM in improving posttransplant cardiac contractility and preventing caspase‐independent apoptosis. 相似文献
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PurposeRepair of complex hernias with synthetic mesh is associated with a significant complication rate, which may necessitate mesh removal. Recent studies have reported good results with the use of collagen-based prosthesis for complicated or infected abdominal hernias. The aim of our study was to evaluate an initial experience using Permacol? for the repair of complex incisional and parastomal hernias.MethodsA retrospective study of patients with massive, recurrent, complex, or infected incisional and hernias who underwent repair with Permacol? at a tertiary referral centre was performed.ResultsBetween 2003 and 2007, 15 patients underwent repair of complex massive or recurrent hernias with Permacol?. Patients were followed up for a median of 377 days (range 85–1905). 16 postoperative complications developed in 11 patients. Two patients developed a recurrence and two patients developed fistulae. No patient has an active infection or required removal of the Permacol?. There have been no deaths.ConclusionsThere is increasing evidence that Permacol mesh can be safely used for complex and contaminated hernia repairs with acceptable overall results. 相似文献