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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 *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** 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 *** 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 *** 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 *** 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 *** involvement of a specialist diabetes team is essential to ensure a holistic *** 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 *** 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 *** need for perioperative support of diabetic

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

Use of ketamine sedation for the management of displaced paediatric forearm fractures

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World Journal of Orthopedics 2018年第3期9卷 50-57页

作者： Anatole Vilhelm Wiik Poonam Patel Joanna Bovis Adele Cowper Philip Socrates Pastides Alison Hulme Stuart Evans Charles Stewart Department of Surgery and Cancer Charing Cross Hospital Department of Paediatric Emergency Chelsea and Westminster Hospital Department of Trauma and Orthopaedics Chelsea Westminster Hospital

AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also *** During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthes

关键词： Paediatrics Forearm fractures Displaced fractures Ketamine Salter Harris Procedural sedation

hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic:A single-centre study

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World Journal of Clinical Cases 2022年第25期10卷 8837-8843页

作者： Wai Kin Mak Davide Di Mauro Eleanor Pearce Laura Karran Aye Myintmo Jessica Duckworth Amira Orabi Rebekah Lane Sophie Holloway Antonio Manzelli Somayyeh Mossadegh Upper GI Surgery Royal Devon and Exeter HospitalExeter EX25DWUnited Kingdom General Surgery Torbay HospitalTorquay TQ27AAUnited Kingdom General Surgery Chelsea and Westminster HospitalLondon SW109NHUnited Kingdom General Surgery Royal Cornwall Hospital TreliskeTruro TR13LJUnited Kingdom

BACKGROUND The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019(COVID-19)*** were partially lifted on 15 June and further eased on 4 *** in social behaviour,including increased alcohol consumption were described at the ***,there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions,specifically alcoholrelated acute pancreatitis(AP).This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 *** To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United *** All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this *** demographics,their initial presentation with AP,any recurrent admissions,disease severity and length of stay,were evaluated using ANOVA andχ^(2)and Kruskal–Wallis *** One hundred and thirty-six patients were included in the *** highest total number of AP admissions was seen in March–September 2019 and the highest single-month period was in March–May *** for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years,for example,2016(Phospital stay did not differ between patients from each of the year *** An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced;a fall in figur

关键词： Alcohol abuse Alcohol-related acute pancreatitis COVID-19 pandemic

Surgical chylothorax in neonates:management and outcomes

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World Journal of Pediatrics 2018年第2期14卷 110-115页

作者： Karina Miura Costa Amulya Kumar Saxena Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster Hospital NHS Foundation TrustImperial College LondonLondonUK Ribeirao Preto Medical School University of Sao PauloRibeirao PretoBrazil

Background Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic *** study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in *** PubMed database was searched for articles in English,Portuguese and Spanish from 2000 to *** were collected for surgery,chylothorax management,complications,mortality and length of hospital stay(LOS).Results Twenty studies offered 107 neonates:congenital diaphragmatic hernia(CDH)(n=76,71%),cardiac malforma-tions(n=25,23.4%),esophageal atresia(n=5,4.7%)and CDH+extralobar sequestration(n=1,0.9%).Medium-chain tri-glycerides(MCT)was the initial treatment in 52 neonates(48.6%),prednisolone+MCT in one(0.9%),total parenteral nutri-tion in 51 patients(47.7%),and three patients(2.8%)did not require any *** and somatostatin were used as second or third line treatment in 25 neonates(23.4%),and 15 neonates(14%)underwent 17 surgeries,including thoracic duct ligation(TDL)(n=9);pleurodesis(n=3)(2 patients required TDL);TDL+pleurodesis(n=2),and TDL+placement of hemostat(n=1).Complications due to the chylothorax were reported in 27 neonates(25.2%):hypoalbuminemia+hypona-tremia(n=18),hypoalbuminemia(n=4),hypoalbuminemia with cutaneous flushing as colateral effect of somatostatin(n=1),loose stool after somatostatin use(n=1),pneumonia(n=1),congestive heart failure+hypernatremia(n=1),and hyponatremia(n=1).There were 21 deaths(19.6%)and median LOS was 53.4 days(30-93.1 days).Conclusions Conservative management is appropriate as initial treatment for neonatal postsurgical *** and somatostatin are safe in neonates and surgical approach should be considered in prolonged leaks.

关键词： Chylothorax Neonate Thoracic surgery Treatment outcome

Studies on the allostimulatory function of dendritic cells from HCV-HIV-1 co-infected patients

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Cell Research 2004年第3期14卷 251-256页

作者： Justin STEBBING,Steve PATTERSON,Simon PORTSMOUTH,Claire THOMAS,Robert GLASSMAN,Adrian WILDFIRE,Frances GOTCH,Mark BOWER,Mark NELSON,Brian GAZZARD The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine The chelsea and westminster hospital 369 Fulham Ro

There is increasing recognition of the potential morbidity and mortality associated with HIV-1 and hepatitis C (HCV) co-infection. HIV appears to adversely affect HCV disease while the reciprocal effect of HCV on HIV remains controversial. We therefore studied the effect of co-infection on dendritic cell function versus HIV infection alone, as previous work has shown that HCV impairs dendritic cell (DC) function. HIV-1 positive individuals with HCV were matched for CD4 count, HIV-1 RNA viral load and therapy, to HIV-1 positive patients without HCV. Monocyte-derived DC were generated and mixed leukocyte reactions were performed. We assessed allostimulatory capacity with and without administration of exogenous Thl cytokines, using thymidine uptake and cell division analyses with the vital dye CFSE. We found that monocyte-derived DC from co-infected individuals showed no significant differences in allostimulatory capacity to ex vivo generated DC from HIV-1 infected individuals without HCV. Unlike the situat

关键词： hepatitis C HIV co-infection dendritic cells.

Ventilation strategies in burn intensive care:A retrospective observational study

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Burns & Trauma 2014年第1期2卷 29-35页

作者： Stefano Palazzo Emma James-Veldsman Caroline Wall Michelle Hayes Marcela Vizcaychipi Magill Department of Anaesthesia Intensive Care Medicine and Pain ManagementChelsea and Westminster HospitalLondonUK

Consensus regarding optimal burns intensive care(BICU)patient management is *** study aimed to assess whether ventilation strategies,cardiovascular support and sedation in BICU patients have changed over time,and whether this affects outcome.A retrospective observational study comparing two 12-patient BICU cohorts(2005/06 and 2010/11)was *** and admission characteristics,ventilation parameters,sedation,fluid resuscitation,cardiovascular support and outcome(length of stay,mortality)data were collected from patient *** was analysed using T-tests,Fisher’s exact and Mann-Whitney U *** our study cohort groups were equivalent in demographic and admission *** were equal ventilator-free days in the two cohorts 10±12.7 vs.13.3±12.2 ventilator free days;(P=0.447).The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort(568 ventilator days/1000 patient BICU days vs.206 ventilator days/1000 patient BICU days;P=0.001).The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous(17.8%vs.26%;P=0.001)and volumecontrolled modes(34.4%vs.40.8%;P=0.001).Patients in 2010/11 cohort were more heavily sedated(P=0.001)with more long-acting sedative drug use(P=0.001)than the 2005/06 cohort,fluid administration was *** outcome did not *** injury patients were ventilated in volume-controlled(44.5%vs.28.1%;P=0.001)and pressure-controlled modes(18.2%vs.9.5%;P=0.001)more frequently than those *** did not *** study showed there has been shift away from mechanical ventilation,with increased use of tracheostomy/tracheal tube airway spontaneous *** injury patients require more ventilatory support though patient outcomes do not *** trials are required to establish which strategies confer benefit.

关键词： Burns intensive care ventilation inhalation injury

Asynchronus bilateral ovarian torsions in girls-systematic review

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World Journal of Pediatrics 2017年第5期13卷 416-420页

作者： Maja Raicevic Amulya Kumar Saxena Clinic for Pediatric Surgery and Orthopedic Nis Clinical Center NisSerbia Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster NHS Fdn TrustImperial College LondonUnited Kingdom

Background:Bilateral ovarian torsions with complete loss of ovaries is *** study analyzed the literature on bilateral ovarian torsions in girls to evaluate surgical options and ***:Literature was searched on Pubmed(R)(1987-2014) using terms 'bilateral','adnexal','ovary','torsion' and 'children'.Data were collected on age,surgical preference,pathology and ***:Thirteen articles were identified,and 9 met the inclusion criteria (5 case reports,4 original articles);and analyzed 17 girls (mean age:8.75 years,range:1-16).Bilateral oophorectomies (n=4),ipsilateral oophorectomy of severely affected ovary and contralateral oophoropexy (n=10),and detorsion of bilateral ovaries and bilateral oophoropexy (n=3) were *** torsion recurrence occurred after two *** and open surgery was done in 2 and 15 girls,*** etiology,there were simple tubo-ovarian torsions (n=8),polycystic ovary (n=1),polycystic ovary associated with Down syndrome (n=1) and corpus luteum cyst (n=1).No tumors were *** ultrasound follow-ups of ipsilateral oophorectomy and contralateral oophoropexy (n=5) confirmed follicular function (n=4) and viability and position of the ovary (n=l).Conclusions:Though extremely rare,school age girls present bilateral ovarian torsion,Ipsilateral oophorectomy and contralateral detorsion with oophoropexy has been the preferred approach.

关键词： asynchronous bilateral outcomes ovarian torsion surgery

On COVID-19 and Membrane Lipids and Public Health

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粮油食品科技 2022年第3期30卷 55-58页

作者： Yi-qun WANG Mark JOHNSON Walter F.SCHMIDT Hong-wei REN Michael A CRAWFORD Department of Metabolism Digestion and ReproductionChelsea and Westminster Hospital CampusImperial CollegeLondon SW109NHUK United States Department of Agriculture Agricultural Research Service BeltsvilleMD 20705USA Division of Virology Department of PathologyUniversity of CambridgeCambridge CB21QPUK

Coronavirus has a lipid *** replication requires hijacking the RNA tools of the host to synthesize virion protein,that then has to be wrapped in a lipid membrane to enable the budding off which extends the *** studies implicate certain essential fatty acids with replication suppression *** lipid membrane is commonly thought of as a fatty barrier to water *** is however highly ordered and compositionally specific to cellular and sub cellular *** will likely also be an optimum specificity for the viral *** DNA,RNA and protein compositions are not affected by diet,the lipid membrane ***,the greater sensitivity of males over females to inadequacy of these essential fatty acids and membrane integrity has been known since the 1960 *** evidence that arachidonic and docosahexaenoic acids exhibiting anti-viral,immune,anti-inflammatory,blood pressure control and resolvin activity,their status needs to be urgently examined in relation to the prevention and therapy for *** would also be advisable to re-assess food *** lipid requirements for the membrane rich systems as in the brain,nervous,vascular and immune systems have not been *** is little doubt these were significant in shaping the human genome over several million *** from such conditions would be predicted to put populations at risk to disorder and infection,with males being more at risk than females.

关键词： coronavirus Covid-19 arachidonic docosahexaenoic membrane lipid male-female risk public health

Complications in children with percutaneous endoscopic gastrostomy (PEG) placement

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World Journal of Pediatrics 2019年第1期15卷 12-16页

作者： Brigitta Balogh Tamás Kovács Amulya Kumar Saxena Division of Pediatric Surgery Department of PediatricsUniversity of SzegedKorányi fasor 14-15Szeged 6725Hungary Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster NHS Fdn TrustImperial College LondonLondonUK

Introduction The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG),age,underlying diseases and other risk ***,analysis of the indications of PEG insertion and the underlying comorbidities was also *** This study performs a literature analysis of PEG-related complications in *** was searched on PubMed(R) (1994-2017) using terms 'percutaneous endoscopic gastrostomy','complications','mortality' and 'children'.Results Eighteen articles with 4631 patients were *** mean age was 3 years (0-26 years).Operative techniques were:pull technique in 3507 (75.7%),1 stage PEG insertion in 449 (9.7%),introducer technique in 435 (9.4%),image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%).Most frequent indications for PEG insertion were dysphagia (n =859,32.6%),failure to thrive (n =723,27.5%) and feeding difficulties (n =459,17.4%).Minor complications developed in n 1518 patients (33%),including granulation (n =478,10.3%),local infection (n =384,8.3%) and leakage (n =279,6%).In 464 (10%) patients,major complications occurred;the most common were systemic infection (n =163,3.5%)and cellulitis (n =47,1%).Severe complication like perforation occurred in less than 0.3%.Patients with lethal outcomes (n =7,0.15%) had severe comorbidities;and the cause of mortality was sepsis in all *** or young age did not affect complication *** with ventriculoperitoneal (VP) shunt had higher risk of major *** high-risk patients,laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull *** PEG is a safe operative technique;although minor complications are relatively common and occur in up to 1/3 of patients,there is a fairly low rate of severe ***-thirds of PEG patients have at least one ***

关键词： Children Complications Percutaneous endoscopic gastrostomy