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Biliary leaks after laparoscopic cholecystectomy:time to stent or time to drain

Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 628-632页

作者： Haim Pinkas Patrick G.Brady Division of digestive Diseases and Nutrition University of South Florida

BACKGROUND:Endoscopic retrograde cholangiopan- creatography(ERCP)with placement of a biliary stent or nasobiliary(NB)drain is the procedure of choice for treatment of post-cholecystectomy bile duct *** aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal,length of hospital stay and number of required endoscopic procedures. METHODS:Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct *** patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was *** patients were treated with internal biliary *** sphincterotomies were performed for stone extraction or a presumed papillary *** bilomas were drained percutaneously prior to stenting. RESULTS:In all 20 patients,a cholangiogram and successful placement of a NB drain or internal stent was *** patients(20%)were found to have bile duct stones,which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary *** cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to *** of the leak was documented within 2 to 11 days(mean 4.7±0.9 days)in patients receiving a NB *** drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days(mean 29.1±4.4 days).The stent was then removed endoscopically after documentation of leak *** leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain,resulting in fewer ERCPs required for treatment of biliary *** biliary stents were in place longer owing to the nature of this intermittent endos

关键词： biliary leak cholecystectomy,laparoscopic endoscopic retrograde cholangiopancreatography nasobiliary drain biliary stent

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The future of minimally invasive liver resection for hepatocellular carcinoma BCLC stage 0-A

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 601-603页

作者： Trenton Lippert Allyson Lim-Dy Iswanto Sucandy University of South florida Morsani College of Medicine TampaFLUSA Advent health Tampa Digestive Health InstituteTampaFLUSA

Minimally invasive liver resection is moving toward the gold standard treatment for liver cancer due to its short-term clinical advantages when compared to the traditional open *** advent of robotic surgical system which enables surgeons to undertake liver resections that were technically difficult/impossible laparoscopically further advances forward the minimally invasive field.

关键词： Hepatocellular carcinoma minimally invasive surgery robotic surgery hepatobiliary surgery

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From hepatitis A to E:A critical review of viral hepatitis

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World Journal of Gastroenterology 2021年第16期27卷 1691-1715页

作者： Daniel Castaneda Adalberto Jose Gonzalez Mohammad Alomari Kanwarpreet Tandon Xaralambos Bobby Zervos digestive Disease Institute Cleveland Clinic FloridaWestonFL 33331United States Transplant Department Cleveland Clinic FloridaWestonFL 33331United States

Viral infections affecting the liver have had an important impact on humanity,as they have led to significant morbidity and mortality in patients with acute and chronic *** an unknown etiology,the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected *** the rapid scientific and technological advances in the last centuries,controlling and even curing the infections became a possibility,with a large focus on preventive medicine through ***,a comprehensive understanding of hepatitis A,B,C,D and E is required by primary care physicians and gastroenterologists to provide care to these *** review article describes the epidemiology,pathogenesis,clinical presentation,diagnostic tools and current medication regimens,with a focus on upcoming treatment options and the role of liver transplantation.

关键词： Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Treatment

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CDX2 protein expression compared to alcian blue staining in the evaluation of esophageal intestinal metaplasia

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World Journal of Gastroenterology 2015年第9期21卷 2770-2776页

作者： Dennis R Johnson Maisoun Abdelbaqui Maryam Tahmasbi Zoltan Mayer Hung-Wei Lee Mokenge P Malafa Domenico Coppola Department of Anatomic Pathology Moffitt Cancer Center and Research InstituteTampaFL 33612United States florida digestive health specialists Lakewood RanchFL 34202United States Department of Oncological Sciences University of South FloridaTampaFL 33612United States GI Tumor Program Moffitt Cancer Center and Research InstituteTampaFL 33612United States Tumor Biology Program Moffitt Cancer Center and Research InstituteTampaFL 33612United States

AIM:To compare the sensitivity and specificity of CDX2 and alcian blue(AB) p H 2.5 staining in identifying esophageal intestinal ***:One hundred and ninty-nine biopsies from 186 patients were retrospectively reviewed and categorized as Barrett's esophagus(BE)(n =108); non-Barrett's esophagus(NBE)(n =48); columnar blue cells(CB) and esophageal glands(EG)(n =43).The biopsies were stained with AB and immunostained for CDX2 using a mouse monoclonal antibody from Biogenex(clone CDX2-88) and the Ventana Discovery X automated *** positive and negative predictive value of each group was used to determine the predictive power of CDX2 and AB in diagnosing intestinal ***:All of the 108 BE biopsies(100%) were positive for AB and 102 of them(94.4%) were positive for *** six BE patients(5.6%) who failed to stain with CDX2 were found to have lost the focus of intestinal metaplasia upon deeper sectioning for *** AB and CDX2 were negative in 43 out of 48(89.6%) NBE *** NBE patients(10.4%) were falsely positive for AB due to the presence of EG and CB in these *** cases were all CDX2 *** addition,5 AB negative NBE were found to be CDX2 *** on these results the CDX2 immunostain had similar sensitivity but higher specificity(100% vs about 91%) than AB in detecting intestinal type metaplasia in these *** data shows that CDX2 has a better PPV in detecting intestinal metaplasia as compared to AB(95.6% vs 71.5%,respectively).CONCLUSION:CDX2 has a better positive predictive value than AB in detecting intestinal ***2may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE.

关键词： Barrett’s esophagus Alcian blue pH 2.5 CDX2 Intest

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Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature

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World Journal of Gastroenterology 2014年第26期20卷 8416-8423页

作者： Adnan Muhammad Gitanjali Vidyarthi Patrick Brady Division of digestive Diseases and Nutrition University of South FloridaMorsani College of Medicine Division of Gastroenterology James A Haley VA Hospital

Iron deficiency anemia(IDA)is common and often under recognized problem in the *** may be the result of multiple factors including a bleeding lesion in the gastrointestinal *** percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible *** is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in *** is one of the commonest lesions seen on the CE in elderly with *** diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of *** assisted enteroscopy is used to treat the lesions seen on *** has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive *** CE is a very safe and effective procedure for the evaluation of IDA in elderly.

关键词： Small bowel Capsule endoscopy Iron deficiency anemia Elderly Diagnostic yield

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A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

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Journal of Cancer Therapy 2014年第1期5卷 91-100页

作者： Paul G. Toomey Sharona Ross Shalin Shah Alexander S. Rosemurgy florida Cancer specialists Tampa USA The Southeastern Center for digestive Disorders & Pancreatic Cancer Advanced Minimally Invasive & Robotic Surgery Florida Hospital Tampa Tampa USA

Background: Survival for patients with pancreatic adenocarcinoma continues to be poor. Patients with pancreatic adenocarcinoma that is deemed borderline resectable have imaging that shows disease involvement of the portal vein and/or superior mesenteric vein that is amenable to reconstruction or abutment (≤180 degrees) of the superior mesenteric artery. The best initial treatment for patients with borderline resectable pancreatic adenocarcinoma has yet to be determined. Proponents of neoadjuvant therapy purport its utility for patients with borderline resectable pancreatic adenocarcinoma with the intention of increasing the likelihood of a microscopically negative (R0) margin, but the consequences of this approach are not established. This study was undertaken to systematically review the outcomes for patients with borderline resectable pancreatic adenocarcinoma to compare neoadjuvant therapy to a “resection first” approach. Methods: A MEDLINE/PubMed search was undertaken to find all studies regarding patients who underwent neoadjuvant therapy for patients with borderline resectable pancreatic adenocarcinoma. Results: A total of 112 studies were found regarding borderline resectable pancreatic cancer. Fourteen studies contained cohorts of patients with borderline resectable pancreatic adenocarcinoma who received neoadjuvant therapy (n = 471 patients) or a resection-first approach (n = 76 patients). Resection after neoadjuvant therapy was undertaken for 233 (49%) patients. Neoadjuvant therapy followed by an R0 resection occurred for 42% of patients. For patients who underwent resection first, 71% (54/76) had an R0 margin. Conclusion: Patients with borderline resectable pancreatic adenocarcinoma were more often found to undergo neoadjuvant therapy than a “resection first” approach in the available literature. Although neoadjuvant therapy portends a high rate of R0 resections, less than half of the patients who undergo neoadjuvant therapy for borderline resectable panc

关键词： Adenocarcinoma Borderline Cancer Chemotherapy Chemoradiation Neoadjuvant Pancreatic Resectable

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Altered vasoactive intestinal peptides expression in irritable bowel syndrome patients and rats with trinitrobenzene sulfonic acid-induced colitis

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World Journal of Gastroenterology 2015年第1期21卷 155-163页

作者： Arseima Y Del Valle-Pinero LeeAnne B Sherwin Ethan M Anderson Robert M Caudle Wendy A Henderson digestive Disorders Unit Biobehavioral BranchDivision of Intramural ResearchNational Institute of Nursing ResearchNational Institutes of HealthDepartment of Health and Human ServicesBethesdaMD 20892United States Department of Neuroscience University of Florida College of MedicineGainesvilleFL 32610United States Department of Oral and Maxillofacial Surgery University of Florida College of DentistryGainesvilleFL 32610United States

AIM: To investigate the vasoactive intestinal peptides(VIP) expression in irritable bowel syndrome(IBS) and trinitrobenzene sulfonic acid(TNBS) induced ***: The VIP gene expression and protein plasma levels were measured in adult participants(45.8% male) who met Rome Ⅲ criteria for IBS for longer than 6 mo and in a rat model of colitis as induced by *** and colons were collected from naive and inflamed *** assessing inflammation(i.e.,weight changes and myeloperoxidase levels) were assessed on days 2,7,14 and 28 and compared to *** hypersensitivity of the rats was assessed with colo-rectal distension and mechanical threshold testing on hind *** patients(n = 12) were age,gender,race,and BMI-matched with healthy controls(n = 12).Peripheral whole blood and plasma from fasting participants was collected and VIP plasma levels were assayed using a VIP peptide-enzyme *** gene expression of VIP was analyzed using a custom PCR ***: TNBS induced colitis in the rats was confirmed with weight loss(13.7 ± 3.2 g) and increased myeloperoxidase *** hypersensitivity tocolo-rectal distension was increased in TNBS treated rats up to 21 d and resolved by day *** hypersensitivity was also increased up to 14 d post TNBS induction of *** expression of an inflammatory marker myeloperoxidase was significantly elevated in the intracellular granules of neutrophils in rat models following TNBS treatment compared to naive *** confirmed the induction of inflammation in rats following TNBS *** plasma concentration was significantly increased in rats following TNBS treatment as compared to naive animals(P < 0.05).Likewise,the VIP gene expression from peripheral whole blood was significantly upregulated by 2.91-fold in IBS patients when compared to controls(P < 0.00001; 95%CI).VIP plasma protein was not significantly different when compared with controls(P = 0.193).CONCLUSION: Alterat

关键词： Irritable bowel syndrome Vasoactive intestinal pep

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An Update on Treatment of Drug-Induced Liver Injury

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Journal of Clinical and Translational Hepatology 2014年第2期2卷 74-79页

作者： Christin Giordano John Rivas Xaralambos Zervos Department of Faculty and Academic Affairs University of Central Florida College of Medicine Orlando FL USA digestive Disease Institute Cleveland Clinic Florida Weston FL USA

Drug-induced liver injury (DILI) has been linked to more than 1,000 medications and remains the most common cause of acute liver failure in the United States. Here, we review the most current literature regarding treatment and make recommendations for the management of this relatively common disease. Since treatment of DILI remains largely elusive, recent studies have attempted to define new management strategies for these difficult patients. Early diagnosis and withdrawal of the suspected medication is the mainstay of treatment of DILI. For acetaminophen and Amanita mushroom poisoning, there are specific therapies in use. Finally, there are other possible management mod-alities for DILI, including corticosteroids and ursodeoxycholic acid.

关键词： Drug-induced liver injury Hepatotoxicity Acetaminophen toxicity

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Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?

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Gastroenterology Report 2021年第3期9卷 234-240,I0002页

作者： Antonio Zanghi Andrea Cavallaro Emanuele Lo Menzo Serena Curella Botta Salvatore Lo Bianco Maria Di Vita Francesco Cardi Alessandro Cappellani General and Breast Surgery Unit Department of SurgeryUniversity of CataniaCataniaItaly Department of General Surgery Digestive Disease InstituteCleveland Clinic FloridaWestonFLUSA

Background:The prognosis of colorectal cancer depends on the number of positive lymph nodes(LNþ)and the total number of lymph nodes resected(rLN).This represents the lymph-node ratio(LNR).The aim of our study is to assess how the length of the resected specimen(RL)influences the prognostic values of the ***:We conducted a retrospective study of all the patients operated on for colorectal cancer from 2000 to 2015 at our *** details were *** total number of rLN,the number of LNþ,and the LNR were calculated and measured against the *** receiver-operating characteristic(ROC)curve of patients with LNþwas ***:Of the 670 patients included in our study,337 were men(50.3%)and the mean age was 69.2 *** correlation with prognosis of the LNR is greater than that of the LNR adjusted to RL(LNR/RL),both in subjects with positive nodes(n=312)and in all cases(n=670).The LNR presents a higher prognostic value than LNR/RL and RL in patients with LNþexcept for metastatic recurrence,for which the predictive value appears slightly higher for LNR/*** statistical significance of the maximal divergence in Kaplan–Meier survival plots was demonstrated for the LNR(P=0.043),not for LNR/RL(P=0.373)and RL alone(P=0.314).Conclusion:An increase in RL causes an increase in the number of harvested lymph nodes without affecting the number of LNþ,thus representing a confounding factor that could alter the prognostic value of the *** larger-scale studies are needed to confirm these findings.

关键词： colorectal cancer lymph-node ratio resection length prognostic value

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Soft tissue swelling incidence using demineralized bone matrix in the outpatient setting

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World Journal of Orthopedics 2017年第10期8卷 770-776页

作者： Kingsley R Chin Fabio JR Pencle Jason A Seale Juan M Valdivia Charles E. Schmidt College of Medicine at florida Atlantic University Less Ex-posure Surgery specialists Institute Herbert Wertheim College of Medicine at florida International University Less Exposure Surgery Society

AIM To assess use of demineralized bone matrix(DBM) use in anterior cervical discectomy and fusion(ACDF) in outpatient *** One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone(PEEK) cages. Two groups created, Group 1(75) outpatients and control Group 2(70) hospital patients. Prevertebral soft tissue swelling(PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years. RESULTS There was no intergroup significance between preoperative and postoperative visual analogue scales(VAS)and neck disability index(NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, P = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, P = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level *** ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores(P = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBMpacked PEEK cages can be safely done in an ASC with satisfactory outcomes.

关键词： Ambulatory surgery center Anterior cervical discectomy and fusion Demineralized bone matrix Less Exposure Surgery Packed polyetheretherketone cages

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