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Enzyme pattern of biliary colic: A counterintuitive picture

World Journal of Hepatology 2016年第36期8卷 1629-1636页

作者： Elad Resnick Shimon Shteingart Bernardo Melamud Tali Bdolah-Abram Todd Zalut Adrian Reuben Yoav Lurie Department of Interns Hadassah University Hospital Department of Pathology Share’e Zedek Medical Center Digestive Disease Institute Share’e Zedek Medical Center Department of Social Medicine Hebrew University Hadassah Hospital Department of Emergency Medicine Share’e Zedek Medical Center Division of Gastroenterology and Hepatology Medical University of South Carolina

AIM To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary *** Files were reviewed of 1039 patients who were admitted to the Share'e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria:(1) a diagnosis of biliary colic or symptomatic cholelithiasis;(2) at least two biochemical blood tests performed; and(3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological *** Three-quarters of the patients were women, whose average age of 37 years was younger than the averageof the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients' admissions. Alanine aminotransferase(ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase(AST), gamma-glutamyl transferase(GGT), bilirubin and alkaline phosphatase(ALKP)- all these increases were statistically significant(P biliary colic.

关键词： biliary colic Symptomatic cholelithiasis Gallstones Liver enzymes Aspartate aminotransferase Alanine aminotransferase Enzyme pattern Diagnostic tool Emergency department

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Analgesic effect of paracetamol combined with low- dose morphine versus morphine alone on patients with biliary colic： a double blind, randomized controlled trial

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World Journal of Emergency Medicine 2016年第1期7卷 25-29页

作者： Mohammad Reza Farnia Rasoul Babaei Farzaneh Shirani Mehdi Momeni Majid Hajimaghsoudi Elnaz Vahidi Morteza Saeedi Emergency Medicine Department Imam Reza Hospital Kermanshah University of Medical Sciences Kermanshah Iran Emergency Medicine Department Shariati Hospital Tehran University of Medical Sciences Tehran Iran Emergency Medicine Research Center Emergency Medicine Department Shariati Hospital Tehran University of Medical Sciences Tehran Iran Emergency Medicine Department Shahid Dr Rahnemoon Hospital Shahid Sadoughi University of Medical Sciences Yazd Iran

BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic,especially opioids,but still there is a tendency to use less narcotics because of their side effects and the unwillingness of some *** present study aimed to compare the analgesic effect of paracetamol combined with low-dose morphine versus morphine alone in patients with biliary ***:A randomized double-blind controlled trial was performed in 98 patients with biliary colic,recruited from two emergency departments from August 2012 to August *** patients were excluded and the remaining were randomized into two groups:group A received 0.05mg/kg morphine+1 000 mg paracetamol in 100 m L normal saline and group B received 0.1 mg/kg morphine+normal saline(100 m L)as *** scores were recorded using visual analogue scale(VAS)at baseline and 15 and 30 minutes after drug *** effects and the need for rescue medication(0.75 g/kg intravenous fentanyl)were also reported within 60 minutes of drug ***:Before the infusion,the mean±SD VAS scores were 8.73±1.57 in group A and8.53±1.99 in group *** 15 minutes after drug administration,the mean±SD VAS scores were2.16±1.90 in group A vs.2.51±1.86 in group B;mean difference was–0.35,and 95%CI–1.15 to 0.45(P=0.38).At 30 minutes the mean±SD VAS scores were 1.66±1.59 in group A vs.2.14±1.79 in group B;mean difference was–0.48,and 95%CI–1.20 to 0.24(P=0.19).The mean pain scores in the two groups at 15 and 30 minutes demonstrated no significant ***:Paracetamol combined with low-dose morphine may be effective for pain management in patients with biliary colic.

关键词： biliary colic Morphine Paracetamol Visual analogue scale

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Endoscopic management of biliary ascariasis: A case report

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World Journal of Clinical Cases 2021年第20期9卷 5695-5700页

作者： Xing Wang Yan-Lin Lv Sheng-Nan Cui Chang-Hao Zhu Ying Li Yao-Zhen Pan Department of Hepatobiliary Surgery The Affiliated Cancer Hospital of Guizhou Medical UniversityGuiyang 550001Guizhou ProvinceChina Graduate School Guizhou Medical UniversityGuiyang 550001Guizhou ProvinceChina

BACKGROUND biliary ascariasis is rare but remains the most common parasitic infection in remote areas and in people with poor medical ***,we reported a case of biliary ascariasis in order to raise awareness of possible parasitic *** SUMMARY A 68-year-old female was admitted to the emergency room of the Affiliated Hospital of Guizhou Medical University on 28 September 2017,with chief complaint of pain in the right upper *** of the abdomen showed that the upper segment of the common bile duct was slightly dilated with parallel tubular structures,indicative of biliary *** retrograde cholangiopancreatography was performed under general anesthesia on 29 September 2017,and an adult Ascaris lumbricoides worm was *** the worm was removed from the bile duct,the patient’s pain immediately *** patient was successfully cured,without any *** This report emphasizes the need for physicians to consider biliary ascariasis as a possible cause when treating cases of biliary colic.

关键词： biliary ascariasis Ultrasonography Endoscopic retrograde cholangiopancreatography Lumbricoides biliary colic Case report

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Early vs late cholecystectomy in mild gall stone pancreatitis: Anupdated meta-analysis and review of literature

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World Journal of Clinical Cases 2021年第13期9卷 3038-3047页

作者： Saqib Walayat Muhammad Baig Srinivas R Puli Department of Internal Medicine OSF Saint Francis Medical CenterUniversity of Illinois Peoria CampusPeoriaIL 61637United States Department of Gastroenterology University of IllinoisPeoriaIL 61637United States Department of Medicine University of Illinois-PeoriaPeoriaIL 61604United States

BACKGROUND Gallstone pancreatitis is one of the most common causes of acute *** remains the definitive treatment of choice to prevent *** rate of early cholecystectomies during index admission remains low due toperceived increased risk of *** compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy *** Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy *** analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early *** patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital

关键词： Cholecystectomy Gallstone pancreatitis Acute pancreatitis Laparoscopic cholecystectomy biliary colic Open cholecystectomy

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Impact of COVID-19 on presentation,management,and outcomes of acute care surgery for gallbladder disease and acute appendicitis

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 859-870页

作者： Orly Nadell Farber Giselle I Gomez Ashley L Titan Andrea T Fisher Christopher J Puntasecca Veronica Toro Arana Arielle Kempinsky Clare E Wise Kovi E Bessoff Mary T Hawn James R Korndorffer Jr Joseph D Forrester Micaela M Esquivel Department of Surgery Stanford University School of MedicinePalo AltoCA 94305United States

BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical *** from the early months suggest that acute care patient populations deferred presenting to the emergency department(ED),portending more severe disease at the time of ***,care for this patient population trended towards initial non-operative *** To examine the presentation,management,and outcomes of patients who developed gallbladder disease or appendicitis during the *** A retrospective chart review of patients diagnosed with acute cholecystitis,symptomatic cholelithiasis,or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June,2020 and in the same months of *** were selected through a research repository using international classification of diseases(ICD)-9 and ICD-10 *** both years,313 patients were identified with either type of gallbladder disease,while 361 patients were identified with acute *** primary outcome was overall incidence of *** outcomes included presentation,management,complications,and 30-d re-presentation *** between different variables were explored using Pearson’s r correlation *** were compared using the Welch’s t-Test,Chi-squared tests,and Fisher’s exact test as *** Patients with gallbladder disease and appendicitis both had more severe presentations in *** respect to gallbladder disease,more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort[50%(80)vs 35%(53);P=0.01].Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores[mean(SD)1.39(0.56)vs 1.16(0.44);P=0.02].With respect to appendicitis,more patients were diagnosed with a perforated appendix at presentation in 2020[20%(36)vs 16%(29);P=0.0

关键词： COVID-19 Cholecystitis biliary colic Appendicitis Acute care surgery

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Liver Research 2018年第4期2卷 186-199页

作者： Helen H.Wang Piero Portincasa Min Liu Patrick Tso David Q.-H.Wang Department of Medicine Division of Gastroenterology and Liver DiseasesMarion Bessin Liver Research CenterAlbert Einstein College of MedicineBronxNYUSA Department of Biomedical Sciences and Human Oncology Clinica Medica“A.Murri”University of Bari“Aldo Moro”Medical SchoolBariItaly Department of Pathology and Laboratory Medicine University of Cincinnati College of MedicineCincinnatiOHUSA

The terms biliary sludge and cholesterol microlithiasis(hereafter referred to as microlithiasis)were originated from different diagnostic techniques and may represent different stages of cholesterol gall-stone *** the pathogenesis of biliary sludge and microlithiasis may be similar,micro-lithiasis could be preceded by biliary sludge,followed by persistent precipitation and aggregation of solid cholesterol crystals,and eventually,gallstone *** clinical conditions are clearly associated with the formation of biliary sludge and microlithiasis,including total parenteral nutrition,rapid weight loss,pregnancy,organ transplantation,administration of certain medications,and a variety of acute and chronic *** studies have demonstrated complete resolution of biliary sludge in approximately 40%of patients,a cyclic pattern of disappearing and reappearing in about 40%,and progression to gallstones in nearly 20%.Although only a minority of patients with ultrasonographic demonstration of biliary sludge develop gallstones,it is still a matter of controversy whether micro-lithiasis could eventually evolve to cholesterol *** sludge and microlithiasis are asymp-tomatic in the vast majority of patients;however,they can cause biliary colic,acute cholecystitis,and acute *** sludge and microlithiasis are most often diagnosed ultrasonographically and bile microscopy is considered the gold standard for their *** measures to prevent the development of biliary sludge are not practical or cost-effective in the general *** cholecystectomy offers the most definitive therapy on biliary *** sphincterotomy or surgical intervention is effective for microlithiasis-induced *** acid can effectively prevent the recurrence of solid cholesterol crystals and significantly reduce the risk of recurrent pancreatitis.

关键词： biliary sludge Cholesterol microlithiasis Acute cholecystitis Acute pancreatitis biliary colic Cholesterol monohydrate crystals Lithogenic bile

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