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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
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Background:
Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi''s external stabilization system (JESS) for its efficacy.Materials and Methods:
Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9%) patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS) Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months.Results:
Forty-two (93.4%) of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4%) complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8%) patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients.On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity.Conclusion:
We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures. 相似文献4.
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Reyad A. Abbadi MD FRCS Umar Sadat PhD FRCS Asif Jah FRCS Raaj K. Praseedom FRCS Neville V. Jamieson MD FRCS Heok K. Cheow MRCP FRCR Siobhan Whitley MRCP FRCR Hugo E. Ford MD FRCP Charles B. Wilson MD MRCP FRCR Simon J.F. Harper MD FRCS Emmanuel L. Huguet PhD FRCS 《Journal of surgical oncology》2014,110(3):313-319
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Seyyed Mohammad Jazayeri Ali Akbar Esmaili Jah Mohsen Karami 《Knee surgery, sports traumatology, arthroscopy》2009,17(3):244-247
The posterior cruciate ligament (PCL) plays a major role in knee stabilization, and clinical studies have shown an increase
in incidence of its injury. Due to the surrounding neurovascular elements in the popliteal space, open approaches to repair
such injury are difficult to perform. The “safe postero-medial approach” to PCL avulsion fracture is a simple approach, does
not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients. 相似文献
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Irum Amin Andrew J. Butler Gail Defries Neil K. Russell Simon J. F. Harper Asif Jah Kourosh Saeb‐Parsy Gavin J. Pettigrew Christopher J. E. Watson 《Transplant international》2017,30(4):410-419
Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno‐jejunostomy; the use of Roux‐en‐Y enteric drainage is uncommon. We report a retrospective analysis of a single‐centre experience of Roux‐en‐Y enteric drainage following pancreas transplantation. Over a 14‐year period (2001–2015), 204 consecutive adult pancreas transplants were performed (96.6% simultaneous pancreas and kidney transplants), of which 26.0% were from donors after circulatory death (DCD). During a median follow‐up of 67 months (range 13–183 months), 14 (6.9%) recipients experienced complications related to their enteric drainage. Complications during follow‐up included early enteric anastomotic haemorrhage (five patients), non‐anastomotic enteric bleeding (one patient), small bowel obstruction (four patients) and graft duodenal perforation (two within 6 weeks, five beyond 12 months). No recipient lost their graft as a direct result of complications related to enteric drainage. Patient and pancreas graft survival at 1 year was 99.0% and 94.0% and at 5 years 91.3% and 84.9%, respectively. We conclude that Roux‐en‐Y enteric drainage following pancreas transplantation is a safe and effective procedure and facilitates graft salvage in the event of graft duodenal perforation. 相似文献
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Jack Martin Angelica Petrillo Elizabeth C Smyth Nadeem Shaida Samir Khwaja HK Cheow Adam Duckworth Paula Heister Raaj Praseedom Asif Jah Anita Balakrishnan Simon Harper Siong Liau Vasilis Kosmoliaptsis Emmanuel Huguet 《World journal of clinical oncology》2020,11(10):761-808
The liver is the commonest site of metastatic disease for patients with colorectal cancer, with at least 25% developing colorectal liver metastases (CRLM) during the course of their illness. The management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing chemotherapy, optimisation of liver remnant by portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and combining resection with ablation, in the context of improvements in the functional assessment of the future remnant liver. Liver resection may safely be carried out laparoscopically or open, and synchronously with, or before, colorectal surgery in selected patients. For unresectable patients, treatment options including systemic chemotherapy, targeted biological agents, intra-arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic radiotherapy, and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to operability. Currently evolving areas include biomarker characterisation of tumours, the development of novel systemic agents targeting specific oncogenic pathways, and the potential re-emergence of radical surgical options such as liver transplantation. 相似文献
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Felicity Fitzgerald Asad Naveed Kevin Wing Musa Gbessay J.C.G. Ross Francesco Checchi Daniel Youkee Mohammed Boie Jalloh David Baion Ayeshatu Mustapha Hawanatu Jah Sandra Lako Shefali Oza Sabah Boufkhed Reynold Feury Julia A. Bielicki Diana M. Gibb Nigel Klein Foday Sahr Shunmay Yeung 《Emerging infectious diseases》2016,22(10):1769-1777
Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014–2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus–positive children 2 days–12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children. 相似文献