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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols.

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniform

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

Single-Centre Descriptive Epidemiological Study of Emergency Haemodialysis Patients in the Haemodialysis Unit of the CHU Point G (Mali)

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Open Journal of Nephrology 2023年第3期13卷 246-255页

作者： Hamadoun Yattara Nouhoum Coulibaly Abdoul Karim Traoré Seydou Sy Atabieme Kodio Karamoko Djiguiba Mahamadoun Kougoulba Moctar Coulibaly Sah Dit Baba Coulibaly Modi Sidibé Abdou Messoum Dolo Yohana Koné Moustapha Tangara Alkaya Touré Aboubacar Sididki Fofana Magara Samaké Sahare Fongoro Point G University hospital Bamako Mali Regional hospital of Segou Segou Mali Hopital Mère-Enfant le Luxembourg Bamako Mali Mali Gavardo hospital Bamako Mali infirmary Garnison de Kati Kati Mali Sikasso Regional hospital Sikasso Mali Kayes Regional hospital Sikasso Mali Faculty of Medicine and Ondotostomatology of bamako Bamako Mali

Introduction: Haemodialysis is an exchange of solutes and water between the patient’s blood and a dialysis solution with a composition close to that of normal extracellular fluid, through a semi-permeable membrane. It is used in the treatment of acute or chronic renal failure. The aim was to study the clinical and paraclinical aspects and the outcome of patients starting dialysis treatment for renal failure in an emergency setting. Method: This was a prospective study from 1 January to 31 July 2020, with a sample of 62 patients receiving haemodialysis in an emergency setting in the nephrology department of the Point G University hospital. Results: The study showed that the sex ratio was 1.38 in favour of men and that the mean age of patients was 36.82 years. The group of patients with a low socio-economic standard of living dominated, accounting for 71% of cases. Hypertension and anaemia were the predominant risk factors in 77.4% and 87.3% respectively. Hyperphosphaemia, hypocalcaemia and secondary hyperparathyroidism accounted for 94.7%, 98.2% and 97.7% respectively. Left ventricular hypertrophy was 29.27% on electrocardiogram and 22% on cardiac ultrasound. Isolated cardiomegaly was found in 30.76% of patients. The main indications for dialysis were uraemic syndrome (69.2%), pericardial friction (27.4), anuria for 48 hours (20.1%), hyperkalaemia (17.7%) and acute lung oedema (16.1%). The mean duration of haemodialysis was less than one month in one out of two cases. There was no significant association between age and time on dialysis (p = 0.178). The death rate was 20.97%. Case fatality was higher in patients whose duration of dialysis was less than one month than in the others (p = 0.0006). Conclusion: CKD is a public health problem in Mali. It affects young people, especially males. Low economic income is an obstacle to the management of this disease.

关键词： Haemodialysis Emergency CHU Point G

Epidemio-Clinical and Uretrocystographic Profile of Pathologies of the Lower Urinary Tract at the Chu Pr Bss of Kati

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Open Journal of Medical Imaging 2023年第1期13卷 40-48页

作者： Ilias Guindo Souleymane Sanogo Alassane Kouma Dramane Bagayoko Issa Diarra Mamadou N’diaye Ouncoumba Diarra Amadou Kassogue Salia Coulibaly Adama Diaman Keita Medical Imaging Department Kati University Hospital Kati Mali Department of Radiology Luxembourg Mother-Child Hospital Bamako Mali Radiology Department Bamako Infirmary Bamako Mali Medical Imaging Service CS Ref of Commune III Bamako Mali Department of Urology University Hospital of Kati Kati Mali Department of Radiology and Nuclear Medicine Point “G” University Hospital Bamako Mali

Introduction: Pathologies of the lower urinary tract are common in urology composed of various conditions, responsible for urinary disorders. Despite the new methods, exploration in Africa is mainly based on retrograde urethrocystography (UCR). The main objective was to determine the importance of UCR in the diagnosis of pathologies of the lower urinary tract. Materials and Methods: This was a retrospective and descriptive study covering a period of 5 years (July 2016-June 2021). It involved all patients admitted to the ward for retrograde urethrocystography during the period. A remote-controlled table of the GE PRESTILIX 1600× type was used for the examinations. Results: At the end of our study we collected 100 cases of pathologies of the lower urinary tract out of a total of 112 RCUs performed or 89.28%. Pathologies of the lower urinary tract accounted for 78% of the UCRs in the department. The age group of (61 - 70) was the most affected with extremes from 1 year to 101 years. Non-specific urination disorders were the most common indications (43%), followed by acute urine retention (18%). Acquired urethral pathology was the most common (89%), followed by bladder neck disease 5% and posterior urethral valve with 4%, Bladder struggle was the most common associated sign (54%) with post-urination residue in 97% of patients. Conclusion: Pathologies of the lower urinary tract are relatively common in our region, dominated by urethral narrowings. Retrograde urethrocystography remains the reference examination in our control for the diagnosis of obstructive pathologies of the lower urinary tract while specifying the seat of the obstacle.

关键词： Pathologies of the Lower Urinary Tract UCR CHU Kati

The Epidemiological, Clinical and Radiological (Echography, Mammography) Characteristics of Breast Pathologies at the Diagnostic Imaging Center (C.I.D) “Teriya” in bamako

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Open Journal of Medical Imaging 2023年第1期13卷 30-39页

作者： Ilias Guindo Souleymane Sanogo Mamadou N’diaye Mody Abdoulaye Camara Adama Dao Youssouf Goita Amadou Sow Mohamed Malinke Salia Coulibaly Mahamadou Diallo Medical Imaging Department CHU Pr BSS of Kati Kati Mali Medical Imaging Department CHU Gabriel Touré Bamako Mali Medical Imaging Department Luxembourg Mother-Child Hospital Bamako Mali Imaging Service Bamako Infirmary Central Directorate of Armed Forces Health Services (DCSSA) Bamako Mali Medical Imaging Department Mali Hospital Bamako Mali TERIYA Diagnostic Imaging Center Bamako Mali

Breast pathology is varied, bringing together tumor and non-tumor lesions. Objective: To study the contribution of the ultrasound-mammography pair in the diagnosis of breast pathologies. Materials and Method: This was a retrospective descriptive study, carried out over a period of 3 years (from January 2018 to December 2020) at the Diagnostic Imaging Center (C.I.D) “TERIYA” in bamako. It concerned all patients who came for a mammogram/ultrasound examination of the breast. All women admitted for mammogram or breast ultrasound who were diagnosed with a breast injury during the study period were included. Incomplete records and radiological checks were not included. The variables analyzed were age, sex, clinical data, and ultrasound and mammography aspects. The devices used are: a Voluson 730 PRO ultrasound machine and a G 600T type mammography machine. Results: At the end of our study, we collected 254 breast pathologies on a number of 382 women, i.e. a frequency of 66.49%. The average age of our patients was 41 years old. The dominant clinical data were mastodynia (41.88%) and mammary nodule (21.70%). On imaging (mammo-ultrasound) the lesions predominated on the left in 36% of cases, bilateral in 28% of cases and in the upper-outer quadrants in 31.5% of cases. Tumor pathologies represented 66.54% of which 45.27% were benign mainly composed of fibro-adenoma (20.88%) and cyst (18.50%), 11.8% of suspected cases and 9.45% of cancers. Non-tumor pathologies represented 33.46%, mainly mastitis (16.14%), galactophoric dilations (11.02%) and abscesses (5.51%). These pathologies were classified in 50.3% in ACR2, 17.75% in ACR3 and 4, and in 14.20% in ACR5. Lymphadenopathy was present in 73.21% of cases.

关键词： Breast Pathologies Ultrasound-Mammography Pair Diagnostic Imaging Center bamako

Lemon Myrtle(Backhousia citriodora): An Alternative and Effective Treatment for Molluscum Contagiosum in Children with Atopic Dermatitis

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Chinese Journal of Integrative Medicine 2023年第11期29卷 1018-1020页

作者： Konstantinos Kakleas Shilpee Sinha Deborah Wilson Gary Stiefel Paediatric Allergy Clinic Agia Sofia Children's HospitalAthens(11527)Greece Paediatric Allergy Clinic Leicester Royal Infirmary HospitalLeicester(LE15WW)United Kingdom

Atopic dermatitis is a common skin disorder that affects approximately 10%-20%of the children in the United Kingdom.^((1)) Children with atopic dermatitis are more prone to developing molluscum contagiosum(MC).^((2,3)) MC,a common viral cutaneous infection in childhood,is caused by poxvirus of the molluscipox genus and presents as one or more umbilicated,smooth,flesh-colored,dome-shaped lesions.The virus is transmitted through close physical contact.

关键词： dermatitis colored shaped

Is early patent ductus arteriosus ligation helpful in premature neonates? A 10-year retrospective study

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World Journal of Pediatrics 2022年第5期18卷 350-357页

作者： Anip Garg Naveen Athiraman Elizabeth Jenkins David Crossland Prakash Kannan Loganathan Neonatal Unit Royal Victoria InfirmaryNewcastleUK Paediatric Cardiology Freeman HospitalNewcastleUK Neonatal Unit James Cook University HospitalMarton RoadMiddlesbrough TS43BWUK

Background To compare short and long outcomes between early(≤28 days)(EL)and late ligation(LL)groups.To explore factors predicting early extubation(≤7 days)after patent ductus arteriosus(PDA)ligation.Methods We conducted a single center,retrospective cohort study of preterm infantshospital stay in the EL group[113(105-121)days vs.115(107-123)days;log rank P=0.026].Conclusion EL can be delivered safely with a clinically important lower incidenee of severe BPD and shorter duration of hospital stay compared to LL.

关键词： Bronchopulmonary dysplasia Extubation Patent ductus arteriosus ligation

Congenital diaphragmatic hernia survival in an English regional ECMO center

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World Journal of Pediatric Surgery 2023年第2期6卷 77-84页

作者： Elizabeth O'connor Ryo Tamura Therese Hannon Sundeep Harigopal Bruce Jaffray Paediatric surgery The Great North Children's HospitalNewcastle upon TyneTyne&WearUK Fetal medicine and obstetrics Royal Victoria InfirmaryNewcastle upon TyneTyne&WearUK Neonatal medicine Royal Victoria InfirmaryNewcastle upon TyneTyne&WearUK

Introduction Congenital diaphragmatic hernia(CDH)remains a cause of neonatal death.Our aims are to describe contemporary rates of survival and the variables associated with this outcome,contrasting these with our study of two decades earlier and recent reports.Materials and methods A retrospective review of all infants diagnosed in a regional center between January 2000 and December 2020 was performed.The outcome of interest was survival.Possible explanatory variables included side of defect,use of complex ventilatory or hemodynamic strategies(inhaled nitric oxide(iNO),high-frequency oscillatory ventilation(HFOV),extracorporeal membrane oxygenation(ECMO),and Prostin),presence of antenatal diagnosis,associated anomalies,birth weight,and gestation.Temporal changes were studied by measuring outcomes in each of four consecutive 63-month periods.Results A total of 225 cases were diagnosed.Survival was 60%(134 of 225).Postnatal survival was 68%(134 of 198 liveborn),and postrepair survival was 84%(134 of 159 who survived to repair).Diagnosis was made antenatally in 66%of cases.Variables associated with mortality were the need for complex ventilatory strategies(iNO,HFOV,Prostin,and ECMO),antenatal diagnosis,right-sided defects,use of patch repair,associated anomalies,birth weight,and gestation.Survival has improved from our report of a prior decade and did not vary during the study period.Postnatal survival has improved despite fewer terminations.On multivariate analysis,the need for complex ventilation was the strongest predictor of death(OR=50,95%CI 13 to 224,p<0.0001),and associated anomalies ceased to be predictive.Conclusions Survival has improved from our earlier report,despite reduced numbers of terminations.This may be related to increased use of complex ventilatory strategies.

关键词： Survival termination sided